With continuous advancements in medical technology and the steady improvement of the healthcare system, the future of day surgery in China holds immense potential for growth. This review explores recent advances and challenges in day surgery in China, focusing on policy, technological innovation, and implementation gaps. While these advancements present exciting opportunities, challenges remain, necessitating collaborative efforts to ensure the sustainable expansion of day surgery in China.
Stroke can cause severe cognitive impairment in patients. Recently, neurogenesis has been proposed as a potential approach to improve cognitive abilities after stroke. However, no effective treatment strategy currently exists for stimulating hippocampal neurogenesis to promote cognitive recovery. Therefore, this study investigated the mechanisms underlying the increase in hippocampal neurogenesis induced by mitochondrial biogenesis.
To achieve the objective, mice subjected to the global cerebral ischaemia (GCI) model via bilateral common carotid artery occlusion were used to investigate mitochondrial biogenesis in vivo through western blotting, transmission electron microscopy, and immunofluorescence staining. Hippocampal neurogenesis was assessed using immunofluorescence staining. Cognitive functions were evaluated using the open field test, novel object recognition, fear conditioning, and Morris water maze. In addition, an in vitro oxygen–glucose deprivation model served as a stroke analogue. Neurite outgrowth in primary neurons was quantified using immunofluorescence staining, while mitochondrial function parameters, including adenosine triphosphate, mitochondrial membrane potential, and reactive oxygen species, were measured using specific assay kits. Lentiviruses were used to manipulate mitochondrial biogenesis both in vivo and in vitro.
We observed that the time course of mitochondrial biogenesis matched that of neurogenesis in the hippocampal dentate gyrus (DG) following GCI. Promoting mitochondrial biogenesis enhanced neurogenesis in the DG, lengthened neurites, and improved mitochondrial function, collectively alleviating cognitive deficits following stroke. Conversely, inhibition of mitochondrial biogenesis had the opposite effect. In addition, ubiquinol-cytochrome c reductase core protein 1 (UQCRC1) was identified as a crucial component of mitochondrial biogenesis. UQCRC1 knockdown impaired neurogenesis and cognitive abilities in mice.
This study highlights that mitochondrial biogenesis plays a pivotal role in neurogenesis within the hippocampal DG and may represent a promising strategy for treating cognitive impairment associated with ischaemic stroke.
Early prediction of the major perioperative adverse events is of great significance for reducing mortality, morbidity and medical costs. Machine learning (ML) leverages the capacity for predicting the probability of perioperative adverse events, revealing the promise to facilitate risk stratification, tailored prevention, and individualized perioperative management. However, significant heterogeneity has been demonstrated in the model’s performance of discrimination, calibration, interpretability, and transparency among studies, which raises concerns over their clinical efficacy and usability. A lack of guidance for non-expert medical professionals and stakeholders hinders rigorously conducting research with standard procedure, appropriate methodology, consistent measures, and complete reports. We established a multidisciplinary team consisting of clinicians, data scientists, computer scientists. Multiple libraries including Medline, PubMed, Web of Science, Embase, and CINAHL were searched. We comprehensively summarized critical issues within the entire workflow of ML-based model study, including scenarios and problems, task definition, data collecting and processing, feature representation, model development and validation, clinical implementation and evaluation, aiming to provide guidance and insights for this topic. This review provides a practical checklist of the ML workflow tailored for perioperative teams, bridging technical innovations with clinical translation.
Using Mendelian Randomization (MR) analysis, this study aimed to assess any causal effect of educational attainment on the risk of delirium and to determine whether smoking mediates this association.
We obtained genome-wide association study (GWAS) summary-level statistics for educational attainment (n = 765,283), age of smoking initiation (n = 341,427), cigarettes per day (n = 337,334) and delirium (4,381 cases, 469,981 controls) from GWAS repositories. The inverse variance weighted approach served as the main analytical strategy for causal estimation. Multiple sensitivity tests were used to assess the robustness of MR analyses. We evaluated the causal effect of educational attainment on delirium, the effect of educational attainment on smoking-related traits and the effect of smoking-related traits on delirium. We then performed mediation analysis to evaluate the mediating effect of smoking traits on the association between educational attainment and delirium. In addition, we performed linkage disequilibrium score regression (LDSC) to evaluate genetic correlations between traits.
Higher educational attainment was significantly associated with a lower delirium risk (OR = 0.767, 95% CI: 0.637–0.922, P = 0.005). Age of smoking initiation was positively associated with educational attainment (β = 0.289, P = 8.89 × 10-133) and inversely associated with delirium risk (OR = 0.553, P = 0.014), whereas cigarettes per day was inversely associated with educational attainment (β = –0.315, P = 1.70 × 10-32) and positively associated with delirium risk (OR = 1.238, P = 0.022). Sensitivity analyses indicated that the MR results were not affected by heterogeneity or horizontal pleiotropy. Mediation analysis indicated that the age of smoking initiation and cigarettes per day mediated 64.4% (P = 0.014) and 25.3% (P = 0.024) of the total effect, respectively. LDSC analysis revealed a significant negative genetic correlation between educational attainment and delirium, and between age of smoking initiation and delirium. Educational attainment also showed strong correlations with smoking traits, positively with age of initiation and negatively with cigarettes per day.
The findings of this MR study support the notion that higher educational attainment may reduce the risk of delirium by promoting a later age of smoking initiation and decreasing the number of cigarettes smoked per day.
Modern anesthesiology has expanded beyond intraoperative care. It now integrates pain management, critical care, and emergency resuscitation. However, it still faces challenges like biological variability in drug responses, unpredictable intraoperative crises, and complex perioperative complications. Artificial intelligence (AI) emerges as a transformative force, can effectively enhance clinical quality and operational efficiency by extracting critical insights from vast amounts of healthcare data including electronic health records, vital sign waveforms, and imaging databases. AI applications in clinical anesthesia span the entire perioperative period, encompassing preoperative risk assessment, intraoperative physiological monitoring with adverse event prediction and visualized procedural guidance, as well as postoperative outcome forecasting and dynamic adaptive individualized treatment to enhance recovery after surgery. Beyond direct patient care, AI enhances operating room efficiency and revolutionizes anesthesia education. Despite progress, challenges persist in algorithm generalizability, data interoperability, and clinical validation. This review synthesizes the transformative role of AI across anesthesiology subspecialties, analyzes the barriers to implementation, and proposes strategic directions to bridge technological innovation with clinical optimization.
Coagulopathy is a common perioperative complication in aortic surgery, increasing the risk of bleeding and transfusion requirements. This study aimed to evaluate the impact of autologous plateletpheresis on reducing perioperative red blood cell (RBC) transfusion rates in adult aortic surgery patients.
This prospective, single-center, single-blind randomized controlled trial enrolled 134 participants undergoing aortic surgery with cardiopulmonary bypass, randomized in a 1:1 ratio. The primary outcome was the perioperative RBC transfusion rate and covariates included patient preoperative characteristics and intraoperative factors. Multivariable logistic regression models of the relative risk were evaluated.
The intervention group demonstrated several clinical advantages, including significantly reduced perioperative blood transfusion requirements, lower Factor VII usage, and shorter surgical duration (all p < 0.05). Storage of autologous platelet in citrate-containing bags resulted in increased calcium administration (median 3.00g vs 2.00g; p < 0.05) and prolonged time between central venous catheter placement and heparinization in aortic root surgery (52.14 ± 7.75 vs 42.15 ± 6.13 min; p < 0.001).
The autologous plateletpheresis technique reduces transfusion requirements, shortens surgical duration, enhances clinical outcomes, and accelerates recovery. However, careful calcium ion monitoring and coordination of pre-CPB preparation times are essential to maintain surgical workflow.
Registered at the Chinese Clinical Trial Registry on November 16, 2022 (ID ChiCTR2200065834, https://www.chictr.org.cn/showproj.html?proj=185761).
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