Anesthesiology and Perioperative Science最新文献

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a form of extracorporeal circulation that provides cardiopulmonary support in cardiogenic shock unresponsive to conventional therapy. Historically, VA-ECMO was limited to the operating room and primarily used to manage postcardiotomy cardiogenic shock cases. However, with advances in ECMO technology and a better understanding of patient selection criteria, VA-ECMO has expanded its role as a temporary and adaptable intervention in cardiogenic shock of diverse etiologies. This review provides an updated overview of the indications for peripheral VA-ECMO, discussing how recent studies have enhanced our understanding of when VA-ECMO should be considered. In addition, we discuss the feasibility of surgery during VA-ECMO support to improve perioperative planning and tailored anesthetic strategies following ECMO-related physiologic and pharmacological changes.

The rapid development of artificial intelligence (AI) technology, in particular AlphaFold, has greatly improved protein structure prediction and design, reshaped protein biology and expanded research directions in anesthesiology and perioperative medicine. AI relies on deep learning to accurately model key proteins, such as G protein-coupled receptors, to aid drug development. In perioperative medicine, AI improves individualized treatment, patient safety and postoperative recovery through biomarker identification and anesthetic protocol optimization. In addition, AI accelerates anesthetic drug discovery, optimizes drug screening, toxicity prediction and clinical trials to improve the efficiency of research and development. Whilst data interpretation and diversity remain challenges, the continued advancement of AI in the fields of precision medicine and perioperative management will promote the development of individualized anesthesia and precision medicine.

Purpose

Electroencephalography (EEG) is commonly used to assess sedation levels in general anesthesia, but its ability to indicate perioperative trauma and inflammation activation levels remains unclear. This study examines the relationship between the nociception index (NOX), an EEG-derived metric, and related immune changes in surgical patients.

Methods

Patients aged 18 to 75 years scheduled for elective surgery under general anesthesia, without chronic pain, hepatic or renal dysfunction, pregnancy, intensive care unit stay, and a postoperative stay of less than 1 day. We investigated the relationship between the NOX and immune-inflammatory parameters in surgical patients. NOX and bispectral index (BIS) values were recorded upon post-anesthesia care unit admission and after awakening from anesthesia. We collected immune-related indicators, including immune cell counts in routine blood tests, C-reactive protein (CRP) levels, hemoglobin, and the length of postoperative hospital stay. The association of NOX with inflammatory response from surgical stimulation and postoperative prognosis was assessed.

Results

A total of 100 patients were included in the analysis. NOX value is positively associated with immune-inflammatory parameters, such as the postoperative CRP level (R = 0.3313, P = 0.0002), changes in monocyte counts (R = 0.3078, P = 0.0009), and changes in hemoglobin (R = 0.4036, P < 0.0001) before and one day after surgery, whereas the BISpro index is not associated with these parameters (All P > 0.05). In comparison to patients with NOX values lower than the BISpro values, patients with NOX values exceeding BISpro levels showed elevated levels of immune-related indicators, such as CRP level (P = 0.0182), monocyte count (P = 0.0357), and changes in hemoglobin before and one day after surgery (P = 0.0234). The variation of NOX (△NOX) negatively correlates with the CRP level (R = –0.2708, P = 0.0073), changes in monocyte numbers (R = –0.3606, P = 0.0002), changes in hemoglobin (R = –0.3083, P < 0.0001), and postoperative hospital stay (R = –0.1882, P = 0.0327).

Conclusions

Our study demonstrates that, as an EEG index, NOX and its dynamic variation may be associated with the inflammatory response induced by surgical trauma, potentially offering insights into postoperative immune status.

Trial registration

Registered at the Chinese Clinical Trial Registry (ChiCTR, https://www.chictr.org.cn/showproj.html?proj=199672) with No. ChiCTR2300074319.

Purpose

The present study aims to evaluate the effects of electroconvulsive therapy (ECT) on depressive behaviors. In addition, we explore mechanisms by which ECT alters the composition and functioning of gut microbiota through the microbiota-gut-brain axis.

Methods

A depression model in mice was established using chronic unpredictable mild stress. The mice were divided into three groups: control, depression, and ECT-treated. Depressive behaviors were assessed through a series of behavioral tests, including monitoring body weight, open field tests, sucrose preference and forced swim tests. Histological and microcirculatory assessments of brain and gut tissues were conducted using hematoxylin and eosin (H&E) staining, Nissl staining and immunofluorescence methodology along with laser speckle contrast imaging. In addition, the inflammatory cytokines Tumor Necrosis Factor-α (TNF-α), Interleukin-6 (IL-6) and Interleukin-1β (IL-1β) were quantified in gut tissues using enzyme-linked immunosorbent assay. Metagenomic sequencing was employed to evaluate the diversity and abundance of the gut microbiota.

Results

ECT significantly improved depressive behaviors in mice as evidenced by increased body weight and decreased immobility time in the forced swim tests. H&E staining indicated a substantial reduction in gut inflammation while Nissl staining revealed a restoration of neuronal morphology following ECT treatment. Furthermore, immunofluorescence analysis showed elevated c-Fos expression in the hippocampal region (P < 0.05). Assessments of inflammatory cytokines demonstrated significant reductions in TNF-α, IL-6, and IL-1β levels in the ECT group. In addition, metagenomic sequencing showed that ECT enhanced gut microbiota diversity, particularly restoring the abundance of Bacteroides and Verrucomicrobia (P < 0.05).

Conclusion

ECT exerts its antidepressant effects by modulating gut microbiota and enhancing the functionality of the gut-brain axis.

Peripheral nerve injury (PNI) can occur after various types of trauma; these are common clinical injuries. These injuries often result in chronic conditions such as neuropathic pain and permanent disabilities, severely affecting quality of life and work. Achieving optimal repair of injured peripheral nerves remains a focal point of clinical research. In recent years, platelet-rich plasma (PRP) has been increasingly applied in clinical settings due to associated high concentration of various growth factors that promote tissue repair. Here we review advances in PNI repair and the prospect of using autologous PRP as a treatment paradigm.