Cataract surgery is usually performed with topical anesthesia and sedation, which may be provided through a number of different care models with or without involvement of a physician anesthesiologist. We sought to describe anesthesiology care for cataract surgery in Ontario, Canada, and examine the association between the model of anesthesiology care and health service and perioperative outcomes after cataract surgery. We conducted a population-based study of patients who underwent cataract surgery in Ontario using linked health administrative data between 2012 and 2021. The primary outcome was a composite of death, acute hospital admission, or emergency department visit up to 7 days postoperatively. We also collected data on health system costs and operative complications (from physician billing codes). We used multilevel, multivariable regression to estimate adjusted associations between anesthesiology care - fee-for-service anesthesiology care (FFS), care from an anesthesiology care team (ACT), or no physician anesthesiologist care - and outcomes. Of 1 271 251 patients who underwent cataract surgery, 670 754 (52.8%) received FFS care, 256 760 (20.2%) received ACT care, and 343 737 (27.0%) had no physician anesthesiologist care. Adjusted analyses estimated slightly lower odds of the primary composite outcome for patients who received FFS care (n = 8682, 1.3%; adjusted odds ratio [OR] 0.93, 95% confidence interval [CI] 0.88 to 0.99) or ACT care (n = 3034, 1.2%; adjusted OR 0.83, 95% CI 0.76 to 0.89) compared with those with no physician anesthesiologist care (n = 5056, 1.5%). Odds of operative complications were lower and overall costs were higher with any type of physician-provided anesthesiology care. Primary results differed by whether care was provided in a teaching or nonteaching hospital. Care provided or overseen by a physician anesthesiologist was associated with significantly lower odds of an emergency department visit, hospital admission, or death; however, effect sizes were small and of limited clinical importance, and costs were higher. Given these findings, the use of physician anesthesiology care for routine cataract surgery should be reconsidered. Open Science Framework identifier https://osf.io/9y3mt/overview.
Craniosynostosis correction can be performed through minimally invasive endoscopic suturectomy or traditional open cranial vault remodeling. While both achieve morphologic correction, comparative data on perioperative morbidity and cranial remodeling outcomes remain limited in regional centers. This study evaluates operative, perioperative, and morphometric outcomes following endoscopic versus open craniosynostosis repair at a tertiary neurosurgical institution. A retrospective cohort analysis was conducted on patients who underwent surgical correction for craniosynostosis between January 2021 and May 2025. Demographic, operative, and postoperative data were extracted from a prospectively maintained registry. Primary outcomes included operative time, estimated blood loss (EBL), length of hospital and ICU stay, and helmet therapy. Morphometric outcomes were assessed using the cephalic index (CI) and the cranial vault asymmetry index (CVAI). Statistical analysis was performed using IBM SPSS Statistics v23, with P<0.05 considered significant. Twenty-seven patients were analyzed (endoscopic=16; open=11). The endoscopic cohort was younger (3.8±1.3 versus 17.5±8.9 mo; P<0.001) and demonstrated significantly reduced operative time (135 versus 240 min; P<0.001), EBL (90 versus 250 mL; P<0.001), hospital stay (3.4 versus 5.5 d; P<0.001), and ICU utilization (0% versus 100%; P<0.001). Both groups achieved significant cranial remodeling-CI improved from 0.75 to 0.78 (P=0.02) and CVAI from 4.8 to 1.5 (P<0.001). No major complications or reoperations occurred. Endoscopic suturectomy performed early in infancy achieves equivalent morphologic correction with markedly reduced perioperative morbidity compared with open cranial vault remodeling. These findings support minimally invasive endoscopic repair as a safe, effective, and resource-efficient approach for early single-suture craniosynostosis.
Academic anesthesiology department chairs face significant responsibilities, yet formal leadership pathways remain unclear. The purpose of this study was to characterize the educational backgrounds and career trajectories of current U.S. anesthesiology department chairs. Chair information was sought for all 192 Accreditation Council for Graduate Medical Education-accredited anesthesiology residency programs. During data collection, 40 were excluded due to absence of a designated chair or insufficient publicly available information, yielding a final sample of 152 chairs. The most common medical schools that the chairs attended were the University of Washington, the University of Chicago, and Johns Hopkins University (each, n = 4; 2.6%). Massachusetts General Hospital was the most frequent residency site (13/149; 8.7%) and fellowship site (9/84, 10.7%). Median time from residency to chair appointment was 21 yr (interquartile range [IQR], 15 to 27) and median tenure was 5 yr (IQR, 3 to 9). Most chairs had modest to moderate scholarship (Hirsch Index: 1 to 15 in 54.1%) with a median of 14 (IQR, 4 to 34). These findings suggest pathways to chair are frequently diverse, often non-research-intensive, and support the imperative for structured leadership development.
Penetrating carotid artery injuries are rare but life-threatening, particularly in resource-limited and conflict settings. We report a case of a 23-year-old male presenting with hypovolemic shock, respiratory arrest, and active neck hemorrhage secondary to a shrapnel injury. Emergency open exploration and primary repair of the carotid artery were performed in a field hospital without access to anesthesiology support, advanced imaging, or intensive care facilities. The patient survived without neurological deficit and was discharged on postoperative day 14. This case highlights the feasibility of life-saving vascular repair in austere environments using fundamental surgical principles.
To compare the environmental impact of ambulatory inguinal hernia repair performed using open surgery versus laparoscopy through a life cycle assessment (LCA). A descriptive, prospective, non-interventional study was conducted at Toulouse University Hospital between October 2024 and February 2025. Intraoperative consumption of materials, energy, and medical devices was prospectively recorded in real time. Environmental impacts were quantified using a comprehensive LCA covering the full life cycle of all products used. The two surgical approaches were compared across 16 environmental impact categories of which the 8 most contributive were analyzed in detail. Laparoscopic repair was associated with a 1.44-fold higher environmental impact than open surgery, with an overall score of 4.67 x 10⁻³ versus 3.23 x 10⁻³, respectively. This difference corresponded to an additional 15.5 kg CO₂-equivalent emissions per procedure. Single-use non-woven materials and cotton-based products were the main contributors, whereas operating room energy consumption and sterilization of reusable devices contributed minimally. In ambulatory inguinal hernia repair, the choice of surgical approach has a substantial influence on environmental impact, underscoring the importance of integrating environmental considerations into operative decision-making.
Situational awareness (SA) is a critical nontechnical skill for intensive care unit (ICU) physicians, underpinning safe decision-making and patient safety. Despite its importance, evidence regarding how SA is assessed and improved in ICU practice remains fragmented. To map the existing evidence on interventions and assessment methods for SA among physicians in adult ICUs, and to evaluate their reported effectiveness. Scoping review of randomised controlled trials, quasi-experimental studies, cross-sectional studies, and qualitative studies, conducted in accordance with PRISMA-Scr guidelines. MEDLINE, Web of Science, Scopus, and PsycINFO were searched from inception to July 2024. Reference lists and supplementary searches were performed. We included studies involving ICU physicians, residents and medical students working in adult ICUs that assessed or intervened on SA. Exclusions included studies limited to paediatric/neonatal ICUs, non-ICU staff, inter-unit handovers, reviews, opinion pieces and nonpeer-reviewed literature. From 991 records, 11 studies were included. Simulation-based training consistently improved SA and team co-ordination, while lecture-based training alone was largely ineffective. Crew resource management (CRM) courses increased self-reported awareness but had mixed effects on outcomes. Technological tools (e.g. dashboards, 3D visualisations) showed promise in enhancing early recognition of clinical deterioration and supporting decision-making. SA assessment was most frequently performed using the Situation Awareness Global Assessment Technique (SAGAT), though this remains impractical for real-time ICU use. Methodological quality was generally moderate, with small sample sizes and heterogeneity limiting quantitative synthesis. Simulation-based interventions and novel technological tools appear most effective in enhancing SA among ICU physicians, whereas CRM and didactic methods yield mixed results. The lack of validated, ICU-specific SA assessment tools represents a critical gap. Future research should focus on scalable, team-based training models, context-appropriate assessment instruments, and integration of technological decision-support to strengthen SA and improve patient safety.
Enhanced recovery strategies in cardiac surgery emphasize early liberation from mechanical ventilation. Operating room (OR) extubation is one approach to improve outcomes and reduce resource utilization. This study evaluated a quality-improvement intervention (QII) designed to establish OR extubation as the default recovery pathway in open aortic surgery. Retrospective, single-center cohort study with QII analyzed by pre- and post-implementation periods. Single academic medical center. Adults undergoing open aortic surgery between 2014 and 2025 (N = 658), analyzed by extubation pathway (OR v intensive care unit [ICU]) and intervention period. A multidisciplinary QII was implemented in 2020 using plan-do-study-act cycles, impact-confidence-ease prioritization, and the Kotter change-management framework to systematically adopt OR extubation as institutional standard practice. The primary endpoint was prolonged ICU length of stay (LOS), defined as ICU LOS exceeding the 75th percentile (>124 hours); a sensitivity analysis used ICU LOS >72 hours. Safety outcomes included major complications and mortality. Among 658 patients, 191 (29%) were extubated in the OR and 467 (71%) were extubated in the ICU. Prolonged ICU stay (>124 hours) occurred in 8% of OR-extubated patients versus 35% of ICU-extubated patients (p < 0.001). According to the >72-hour definition, prolonged ICU stay occurred in 35% of OR-extubated patients versus 71% of ICU-extubated patients (p < 0.001). Following QII implementation, OR extubation rates increased from <5% to >50% of cases, while rates of prolonged ICU stay declined from 33% to 19% (p < 0.001) and median ICU LOS decreased from 96 to 65 hours (p < 0.001). There were no differences in mortality or major complications. OR extubation was associated with reduced prolonged ICU utilization after open aortic surgery without compromising safety. When implemented through a structured quality-improvement framework, OR extubation achieves durable system-level adoption and offers a scalable strategy to improve recovery and ICU capacity.
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a critical intervention for patients in refractory cardiac arrest. Rapid and high-quality cannulation is essential for timely ECMO initiation and improved patient outcomes. Therefore, optimizing educational strategies for VA-ECMO training is crucial to ensure skill acquisition and effectiveness in clinical practice. This study aimed to compare the effectiveness of full-scale high-fidelity simulation versus a procedural simulation workshop for VA-ECMO cannulation training in anesthesiology and critical care residents. We conducted a prospective, randomized, two-arm, single-center, open-label trial at the Nantes university hospital simulation center. Thirty anesthesiology and critical care residents were randomly assigned to either a high-fidelity simulation group or a procedural simulation workshop group. Prior to the intervention, all participants completed an e-learning module on VA-ECMO cannulation. The procedural simulation workshop group underwent a 3-hour session focusing on technical skills, with guided hands-on practice. The high-fidelity simulation group participated in a full-day session incorporating immersive high-fidelity scenarios of refractory cardiac arrest, hands-on VA-ECMO cannulation, training on ECMO console management, and transesophageal echocardiography simulation. The primary outcome was total cannulation time (seconds) on a mannequin in a simulated refractory cardiac arrest scenario, measured from sterile preparation to circuit connection. Secondary outcomes included a procedural quality score, developed using a Delphi consensus method and assessed by blinded evaluators, as well as skill-specific sub-item analyses. Median cannulation times were similar between the procedural simulation workshop group (908 s; IQR 817-1015) and the high-fidelity simulation group (836 s; IQR 801-1029; p=0.71). Overall procedural quality scores did not significantly differ between groups. However, exploratory sub-item analyses suggested that specific procedural skills might be differentially influenced by each training modality. High-fidelity simulation and procedural workshops yielded similar performance for VA-ECMO cannulation. Although each may enhance specific skills, neither proved superior. Further research should determine the optimal integration of these training modalities.
Acute kidney injury (AKI) is a significant postoperative complication, particularly following abdominal surgery. Although acetaminophen is widely used for postoperative pain management, its impact on AKI risk in this context remains underexplored. This study investigates the association between postoperative acetaminophen use and AKI incidence in abdominal surgery patients. A retrospective cohort study was conducted using the MIMIC-IV database, including 8696 abdominal surgery patients. Multivariable logistic regression and Cox proportional hazards models were used to assess the relationship between acetaminophen administration within 48 h postsurgery and AKI occurrence within 7 days. Subgroup analyses were performed to evaluate effects based on anemia severity, sodium levels, surgery type, and gender. Acetaminophen use within 48 h postsurgery was associated with a 40% reduction in AKI risk (odds ratio = 0.60, 95% confidence interval: 0.54-0.67; hazard ratio [HR] = 0.57, 95% confidence interval: 0.53-0.62). Greater protective effects were observed in females (HR = 0.51 versus males = 0.62), patients with severe anemia (HR = 0.44), hyponatremia (HR = 0.47), and those undergoing open surgery (HR = 0.50). Time-dependent analysis revealed that delayed acetaminophen administration (18-48 h postsurgery) provided stronger protection, with odds ratio values declining from 0.8 to 0.4. Postoperative acetaminophen use is associated with a reduced risk of AKI in abdominal surgery patients, particularly in high-risk subgroups such as females, anemic patients, and those with hyponatremia or undergoing open surgery. These findings suggest that acetaminophen may serve as a safer alternative to nonsteroidal anti-inflammatory drugs for postoperative pain management. Further prospective studies are needed to optimize dosing and timing strategies.
Developmental dysplasia of the hip (DDH) is a common congenital pediatric orthopedic malformation that often requires open reduction combined with pelvic osteotomy, resulting in severe postoperative pain. Pediatric patients under 2 years old have immature anatomical and physiological characteristics, high sensitivity to opioid analgesics, and an inability to subjectively express pain, which makes perioperative analgesia and anesthesia management a major clinical challenge. Traditional opioid-based analgesic regimens carry a high risk of adverse reactions such as respiratory depression and restlessness, which hinder postoperative recovery. This case reports the optimized perioperative anesthesia and analgesia management strategy for a 19-month-old female infant (12 kg, ASA Ⅰ) with right DDH undergoing open hip reduction and pelvic osteotomy, and preliminarily explores the clinical application value, efficacy and safety of ultrasound-guided type Ⅱ QLB in infant DDH surgery. A composite anesthesia strategy of general anesthesia combined with ultrasound-guided type Ⅱ QLB (0.2% ropivacaine, 0.5 mL/kg, total 6 mL) was adopted, with optimized perioperative management including precise airway selection, targeted vital sign monitoring, and multimodal postoperative analgesia (PCIA+on-demand oral acetaminophen). Pain was evaluated using the FLACC behavioral scale, and vital signs and adverse reactions were closely monitored postoperatively. The infant's 24-hour postoperative FLACC scores were all ≤2 points without the need for rescue analgesics, with significantly reduced opioid consumption (intraoperative sufentanil 6 μg, 24-hour PCIA tramadol 70 mg) compared with traditional regimens. Vital signs remained stable postoperatively, with no adverse reactions such as restlessness, nausea/vomiting, urinary retention, or local hematoma. The infant achieved independent turning and sitting at 48 h postoperatively and was discharged uneventfully at 14 days with no long-term complications, and parental analgesia satisfaction was 9/10. Ultrasound-guided type Ⅱ QLB combined with general anesthesia is a safe and effective perioperative management strategy for infant DDH surgery, which addresses pediatric-specific perioperative analgesia challenges, reduces opioid-related adverse reactions, and improves postoperative comfort. Strict control of local anesthetic dosage, proficient ultrasound localization for immature pediatric anatomy, and multimodal analgesia are the key to successful perioperative management, which provides a valuable clinical reference for pediatric orthopedic anesthesia practice.
This study aims to compare the responses provided by commonly used artificial intelligence-based chatbots such as ChatGPT-3.5, ChatGPT-4o, Gemini 2.0 Flash, and DeepSeek-R1 about dental local anesthesia, sedation, and general anesthesia in terms of accuracy, reliability, and readability. Sixty questions were created from the American Dental Association (ADA) and American Society of Anesthesiologists (ASA) guidelines. Thirty were patient questions, thirty professional questions. Each group contained ten open-ended, ten multiple-choice, and ten true/false questions. The questions were submitted to ChatGPT-3.5, ChatGPT-4o, DeepSeek-R1, and Gemini 2.0 Flash. Four blinded pediatric dentists evaluated the answers with a modified global quality scale. Clinical safety and risk analysis were evaluated using a 3-point Likert scale. Readability was measured by Flesch Reading Ease Score (FRE) and Flesch-Kincaid Grade Level (FKGL). The intraclass correlation coefficient (ICC) tested inter-rater reliability. Significance was set at p < 0.05. DeepSeek-R1 demonstrated the highest overall accuracy and inter-rater agreement, providing the most accurate and reliability responses across all question types (p < 0.001). It was followed by Gemini 2.0 Flash, ChatGPT-4o, and ChatGPT-3.5. In terms of readability, Gemini 2.0 Flash consistently produced the most accessible responses, while DeepSeek-R1 was significantly less readable (p = 0.012). GPT-3.5 showed variability by question type, with MCQs being easier to read than open-ended ones (p = 0.027). No significant readability differences were observed across question types for ChatGPT-4o, Gemini 2.0 Flash, or DeepSeek-R1 (p > 0.05). Chatbot performance depends on both question type and evaluation criteria. DeepSeek-R1 excelled in accuracy and quality. Gemini 2.0 Flash produced the clearest, patient-friendly responses. AI chatbots can support communication in dental anesthesia. Choosing the right model may improve education, assist clinical training, and guide professional decisions.
Intracranial vertebral artery dissecting aneurysm is a rare type of intracranial aneurysm characterized by outward protrusion of the vessel wall due to damage to the intima and elastic membrane. Aplastic anemia is a relatively rare and severe syndrome involving bone marrow failure leading to pancytopenia. No previously reported cases exist of intracranial vertebral artery dissecting aneurysm complicated by aplastic anemia. Due to thrombocytopenia and coagulation dysfunction, managing concomitant vascular lesions during neurointerventional therapy poses significant challenges. We report the case of a 40-year-old man who with a history of aplastic anemia. Computed tomography angiography revealed a dissecting aneurysm in the right vertebral artery segment IV, with a distal branch to the posterior inferior cerebellar artery. The patient demonstrated favorable outcomes following individualized neurointerventional surgery with no complications. This case underscores the importance of developing personalized neurointerventional strategies for patients with intracranial aneurysms complicated by hematologic disorders. Priority should be given to controlling bleeding risks while maintaining posterior circulation patency, providing crucial guidance for clinicians managing such conditions.
Mental health problems among undergraduate medical students are a major global public health concern that emerge early during training and are shaped by demanding educational environments, emotional stressors and organisational pressures. Although research has expanded rapidly, the literature remains fragmented across themes, regions and methods. This scoping review aims to map the global quantitative literature on medical students' mental health and identify gaps in scope, geography, methodology and equity. This scoping review will be conducted in accordance with the Joanna Briggs Institute methodological guidance and reported in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We will include quantitative studies assessing mental health among undergraduate medical students. MEDLINE (Ovid), Web of Science (Clarivate), the Cochrane Library (Wiley) and PsycINFO (Ovid) will be searched without date or language restrictions using a keyword-based search strategy. Two reviewers will independently screen titles, abstracts and full texts and extract data using a standardised form. Data will include publication year, country, study design, sample size, mental health measures, thematic domains and patterns of collaboration. Mental health domains will be classified using an a priori thematic framework encompassing psychological symptoms and distress, psychological resources, academic environment, social support and physical health and lifestyle factors. Equity-related variables (sex, gender identity, sexual orientation, race/ethnicity, socioeconomic status) will be operationalised based on analytical use. Results will be synthesised descriptively using tables and visualisations. Ethical approval is not required. Findings will be disseminated through publication and presentations. The dataset and code will be openly available on publication. Protocol registration will be made available online via the Open Science Framework (doi:10.17605/OSF.IO/2EHNU).
BackgroundPerioperative neurocognitive disorders (PND) encompass delayed neurocognitive recovery (dNCR; ≤30 days) and postoperative neurocognitive disorder (NCD; >30 days). While the HMGB1-TLR4/NF-κB axis drives acute neuroinflammation, the temporal dynamics of this signaling beyond the acute phase and distinct contributions of HMGB1 versus TLR4 to dNCR-to-NCD transition remain elusive. This study investigated whether glycyrrhizin attenuates sevoflurane-surgery-induced recognition memory deficit via modulation of HMGB1-TLR4 signaling.MethodsEight-month-old male C57BL/6J mice underwent right common carotid artery dissection under prolonged sevoflurane anesthesia (3%, 2 h) with or without glycyrrhizin pretreatment (30 mg/kg, i.p., 1 h preoperatively; n = 15/group for Batch 1, n = 7/group for Batch 2). Cognitive function was assessed via open field, novel object recognition, Y-maze, and Morris water maze. Hippocampal neuroinflammation (cytokines, microglia/astrocyte activation), HMGB1-TLR4-NF-κB signaling, synaptic proteins (synaptophysin, PSD-95), and histological alterations (Nissl staining) were evaluated at postoperative day 7 and day 20.ResultsProlonged sevoflurane exposure combined with surgical trauma induced recognition memory impairment and reduced platform crossings in the Morris water maze, both attenuated by glycyrrhizin. While peripheral IL-6 normalized by day 7, hippocampal cytokines (IL-6, IL-1β, TNF-α) and glial activation persisted through day 20. At the molecular level, HMGB1 was elevated at day 7 but normalized by day 20, whereas TLR4/NF-κB remained elevated at both time points; glycyrrhizin suppressed this cascade. Synaptic proteins were reduced and CA3/dentate gyrus exhibited Nissl staining reductions at days 7 and 20, protected by glycyrrhizin, whereas CA1 Nissl staining showed no significant alterations at either time point.ConclusionsThese findings demonstrate a temporal dissociation between HMGB1 normalization and sustained TLR4/NF-κB activation following sevoflurane-surgery in middle-aged mice. Prophylactic glycyrrhizin attenuates recognition memory deficits and suppresses hippocampal neuroinflammation, though mechanistic inferences remain speculative and require rigorous validation.
. The widely used inhalational anesthetic sevoflurane increases susceptibility to postoperative cognitive dysfunction (POCD), especially among the elderly. Esculetin, a natural coumarin compound derived from Cortex Fraxini, possesses anti-inflammatory and neuroprotective activities. This study aimed to determine whether esculetin mitigates sevoflurane-induced POCD and to clarify its underlying mechanisms. . POCD was induced in aged male C57BL/6J mice by 3% sevoflurane inhalation. Esculetin was administered 1 h before each exposure. Learning, memory, and locomotion were evaluated by Morris water maze and open field tests. Hippocampal apoptosis was detected by TUNEL staining and western blotting (WB) of apoptosis-associated proteins. Neuroinflammation was assessed through Iba-1 immunofluorescence, ELISA, WB, and RT-qPCR. NF-κB and NLRP3 inflammasome pathways were analyzed by WB and immunofluorescence. In vitro, HT22 neurons were treated with sevoflurane and/or esculetin, and microglia-mediated neuroinflammation was examined using a BV2-HT22 co-culture system. . In aged mice, esculetin alleviated sevoflurane-induced spatial learning and memory impairments. Hippocampal neuronal apoptosis was reduced, as indicated by fewer TUNEL-positive cells and restored expression of Bcl-2, Bax, and cleaved caspase-3. Esculetin also inhibited microglial activation, along with the sevoflurane-induced elevation of proinflammatory cytokines (TNF-α, IL-1β, IL-6) and M1 microglial markers (iNOS, CD68). Mechanistically, esculetin inhibited sevoflurane-triggered phosphorylation of IκBα and p65, as well as NLRP3, apoptosis-associated speck-like protein containing a CARD (ASC), and caspase-1 upregulation. In vitro, esculetin dose-dependently protected HT22 cells against sevoflurane-induced apoptosis. In the co-culture system, esculetin attenuated microglia-driven neuroinflammation and NF-κB/NLRP3 inflammasome activation in HT22 cells. Esculetin ameliorates sevoflurane-induced cognitive deficits in aged mice by inhibiting hippocampal neuroinflammation and neuronal apoptosis through NF-κB/NLRP3 inflammasome inhibition.
Alzheimer's disease (AD) is a progressive disorder characterized by cognitive decline. Physical exercise and audiovisual stimulation have gained increasing concern for their potential to mitigate AD pathology. However, the therapeutic advantages of combining these interventions and the precise molecular mechanisms underlying these strategies need further demonstration. This study aimed to assess the protective effects and underlying mechanisms of physical exercise combined with audiovisual stimulation on cognitive and affective functions, as well as on pathological alterations in AD mice. Both AD model mice established by injecting Aβ₄₂ oligomers into hippocampus and APP/PS1 AD transgenic mice were used. Mice were subjected to treadmill training, 40 Hz audio-visual stimulation, or a combination of these interventions, respectively. After the interventions, the cognitive and anxiety/depression-like behaviors were evaluated by novel object recognition, morris water maze, open field, tail suspension, or forced swimming, respectively. Quantitative proteomics combined with molecular analyses and transmission electron microscopy were used to systematically evaluate the underlying mechanism of multimodal interventions in AD model mice. The multimodal intervention significantly prevented cognitive impairment and ameliorated anxiety/depression-like behaviors of APP/PS1 AD transgenic mice and AD model mice induced by injecting Aβ₄₂ oligomers, outperforming single-modality treatments. It markedly diminished hippocampal accumulation of β-amyloid (Aβ) and tau phosphorylation in AD mice. Multiple interventions also reversed synapse loss of AD mice. Proteomic analyses revealed that multimodal intervention exerted a more comprehensive restoration of dysregulated proteins in AD mice compared to single-modality interventions. The interventions have synergetic effects in decreasing inflammation reactions and restoring the autophagy-lysosomal function. Multimodal intervention upregulated the expression TFEB, and concurrently increased HSPA1L expression to restore lysosomal membrane integrity. The degradation function of lysosomes was also improved by multimodal intervention as revealed by the decreased LC3II/I ratio, reduced p62 level, as well as alleviated lysosome enlargement in AD mice. Upregulation of HSPA1L reversed the disruption of lysosome membrane integrity of AD transegenic mice, thereby reversed the increased accumulation of Aβ and cognitive defects of AD. Physical exercise and audiovisual stimulation exert synergistic effects in decreasing the inflammation reaction and maintaining autophagy-lysosomal homeostasis by increasing the biogenesis of lysosomes and restoring the integrity of lysosome membrane, thereby reducing Aβ deposition and cognitive defect of AD mice. This study highlights the significant therapeutic potential of multimodal, non-pharmacological strategies for Alzheimer's disease.
To assess the current levels of knowledge, attitudes, practices (KAP), and institutional support regarding Chemical, Biological, Radiological, and Nuclear (CBRN) disaster preparedness among anesthesia professionals in India, and to identify predictors and barriers to effective readiness. A cross-sectional, web-based survey was conducted among 294 anesthesia professionals across India. The validated questionnaire assessed 4 domains: knowledge (11 items), attitude (6 items), practice (8 items), and institutional support (9 items). Descriptive statistics, multivariable linear regression, and non-parametric group comparisons were performed. Thematic analysis was applied to open-ended responses. Only 10.9% of respondents reported prior CBRN training, and 8.2% had participated in drills. Trained participants demonstrated significantly higher knowledge scores (9.66 ± 1.32 vs. 7.51 ± 1.31; P < 0.001). CBRN training and trauma network affiliation independently predicted knowledge. Attitude, practice, and institutional scores showed no significant association with training status, designation, or institution type. Barriers included lack of formal training (n = 224), inadequate PPE (n = 183), and absence of SOPs (n = 177). Thematic analysis revealed five key themes, emphasizing the need for structured training and role clarity. CBRN preparedness among Indian anesthesiologists remains suboptimal. Cognitive gains from training are evident, but broader institutional and behavioral readiness requires systemic reforms, stakeholder engagement, and simulation-integrated curricula.
Depression is a clinically important comorbidity of trigeminal pain disorders, including trigeminal neuralgia, yet the neural circuits linking persistent trigeminal nerve injury to negative affect remain incompletely understood. The present study aimed to investigate the involvement of the ventrolateral periaqueductal gray (vlPAG)-lateral habenula (LHb) pathway in depression-like behavioral measures in a young adult male mouse model of trigeminal neuropathic pain. A mouse model of trigeminal neuropathic pain was established in young adult male mice using infraorbital nerve chronic constriction injury (IoN-CCI). Spontaneous facial pain-related behavior and depression-like behavioral measures were assessed using facial grooming analysis, the sucrose preference test, the open field test, and the tail suspension test. c-Fos mapping, cell-type analysis, viral tracing, and chemogenetic manipulation of vlPAG glutamatergic neurons and the vlPAG-LHb pathway were performed to examine neuronal recruitment, anatomical connectivity, and behavioral relevance. In young adult male mice, IoN-CCI induced persistent facial grooming behavior as an index of spontaneous facial pain-related behavior and, by 4 weeks after surgery, was associated with depression-like behavioral changes without detectable alterations in body weight, general locomotor activity, or hindpaw mechanical and thermal sensitivity. c-Fos mapping and cell-type analyses showed a progressive increase in c-Fos expression in vlPAG neurons following IoN-CCI, with most labeled neurons identified as glutamatergic, suggesting recruitment of vlPAG glutamatergic neurons in this model. Chemogenetic inhibition of vlPAG glutamatergic neurons decreased depression-like behavioral measures, whereas chemogenetic activation increased these measures, without significantly altering facial grooming behavior used as an index of spontaneous facial pain-related behavior. Viral tracing provided anatomical evidence for a projection from the vlPAG to the LHb, and c-Fos expression in LHb neurons increased following IoN-CCI. Chemogenetic inhibition of the vlPAG-LHb pathway decreased depression-like behavioral measures, whereas chemogenetic activation increased these measures in IoN-CCI mice and was associated with similar behavioral changes in naive mice. These findings suggest that the vlPAG-LHb pathway is functionally associated with behavioral measures related to negative affect in a young adult male mouse model of trigeminal neuropathic pain, providing a circuit-level framework for understanding pain-associated affective disturbances. Not applicable.
Paravertebral block (PVB) is considered the gold-standard regional technique for thoracotomy analgesia, whereas the erector spinae plane block (ESPB) has gained popularity. However, evidence comparing these 2 techniques in open thoracotomy remains inconsistent. The nociception level (NOL) index provides a more objective assessment of intraoperative nociception. This study aimed to compare the analgesic efficacy of preoperative PVB and ESPB during thoracotomy using NOL-guided opioid administration. Prospective randomized clinical trial. Single tertiary-care university hospital. Fifty-seven patients who underwent elective thoracotomy surgeries were included in this study. Patients were randomized to receive preoperative ultrasound-guided PVB or ESPB at the T5 level using 20 mL of 0.25% bupivacaine. Intraoperative opioid infusion rate was titrated with the NOL index. Intraoperative remifentanil and postoperative morphine consumptions, pain scores at rest and during coughing, rescue analgesic need, and adverse events were recorded. Intraoperative remifentanil consumption was significantly lower in the PVB group than in the ESPB group (431.4 ± 287.7 mcg vs 863.6 ± 385.5 mcg, p < 0.001). Total 24-hour postoperative morphine use was also lower in the PVB group (15.2 ± 6.6 mg vs 20.1 ± 6.6 mg, p = 0.002). Numeric rating scale (NRS) scores at rest were significantly lower in the PVB group at 9 and 12 hours, while NRS scores during coughing were significantly lower at all postoperative time points. In patients undergoing thoracotomy, PVB provided superior intraoperative and postoperative analgesia compared with ESPB, with significantly reduced opioid requirements and lower pain scores. Objective nociception monitoring with the NOL index demonstrated that ESPB may be insufficient for major thoracic surgery.
Pediatric heart disease (PHD), including congenital heart defects, is often incompletely captured in electronic health records, particularly when clinical significance must be inferred from unstructured echocardiogram reports. Automated methods capable of extracting clinically meaningful PHD from narrative reports could improve clinical decision support and research applications. The aim of the study is to evaluate the feasibility of using supervised fine-tuning of large language models (LLMs), with and without chain-of-thought (CoT) reasoning, to characterize patients with clinically significant or historical PHD from unstructured echocardiogram reports. We developed a PHD detection algorithm using fine-tuned open-source LLMs, including LLaMA (Meta) and Qwen (Alibaba), to analyze 9749 echocardiogram reports. A subset of 712 reports was adjudicated by 2 pediatric cardiac anesthesiologists, classifying 506 (71.1%) as clinically significant PHD and 206 (28.9%) as not significant. While DeepSeek R1 has shown improved performance with CoT reasoning, its application in medical contexts is underexplored. We incorporated R1-generated CoT into model prompts and fine-tuned backbone LLMs. The fine-tuned Qwen-7B-10k-overthink-CoT achieved the highest accuracy (92.4%), outperforming Qwen-7B-without-CoT (90%), LLaMA-3B-without-CoT (87.9%), Qwen-3B-without-CoT (85.6%), Qwen-3B-10k-overthink-CoT (68.5%), and LLaMA-3B-10k-overthink-CoT (46.2%). In a second dataset, an external validation was performed (n=113; 64 positive, 49 negative), Qwen-7B-10k-overthink-CoT sustained a strong, balanced performance (82.7%), followed by Qwen-7B-without-CoT (88.4%), LLaMA-3B-without-CoT (86.8%), Qwen-3B-without-CoT (84.5%), Qwen-3B-10k-overthink-CoT (58.9%), and LLaMA-3B-10k-overthink-CoT (46.2%). The fine-tuned Qwen-7B model with overthinking CoT (10,000 tokens) achieved the highest internal accuracy (92.4%), with balanced sensitivity and specificity. Across repeated runs, CoT-enhanced models demonstrated improved classification consistency compared to non-CoT models (Qwen-7B-without-CoT: 90%, LLaMA-3B-without-CoT: 87.9%, Qwen-3B-without-CoT: 85.6%). In external validation (n=113), non-CoT variants achieved higher accuracy (up to 88.4%), whereas the Qwen-7B CoT model demonstrated more balanced class performance (accuracy=82.7%). Supervised fine-tuning of LLMs with CoT offers an effective approach for automated PHD detection within unstructured data in the electronic medical record. While CoT-enhanced models demonstrated improved internal performance and more balanced classification, they did not consistently achieve higher accuracy in external validation, highlighting trade-offs between accuracy and class balance. These findings highlight the promise of LLM-based approaches for clinical text phenotyping while underscoring the need for larger, multicenter validation and careful calibration for real-world deployment. Continued validation and integration into the electronic medical record are essential for real-world, artificial intelligence-driven clinical decision support.