Anesthesiology and Perioperative Science最新文献

{"title":"2026 Chinese expert consensus on perioperative management for left ventricular assist device implantation in adults","authors":"Jingfei Guo, Wenying Kang, Jiange Han, Su Yuan","doi":"10.1007/s44254-026-00189-8","DOIUrl":"10.1007/s44254-026-00189-8","url":null,"abstract":"<div><h3>Purpose</h3><p>This consensus was developed to address the lack of standardized perioperative management protocols for left ventricular assist device (LVAD) implantation in China and to build on recently published national consensus documents addressing preoperative and postoperative care. Given the increasing clinical use of domestically developed LVADs, context-specific guidance is needed. This consensus aimed to standardize perioperative care, reduce procedure-related complications, and improve outcomes in adults with end-stage heart failure undergoing LVAD implantation.</p><h3>Methods</h3><p>This expert consensus was jointly developed by the Chinese Society of Cardiothoracic Anesthesiology, the National Center for Cardiovascular Diseases Expert Committee, and the Beijing Medical Association. The consensus panel comprised 83 specialists from 41 clinical centers. The project development was registered on the Practice guideline REgistration for transPAREncy (PREPARE) platform (registration no. PREPARE-2025CN1348). Using the Population, Intervention, Comparator, and Outcomes (PICO) framework and the Delphi method, the panel systematically reviewed relevant international guidelines and peer-reviewed literature published through April 2026. Following evidence synthesis, multiple rounds of expert discussion, and formal voting, the panel developed 11 core recommendations. The certainty of the evidence and strength of the recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><h3>Results</h3><p>The recommendations address three phases of perioperative care: preoperative assessment, intraoperative management, and postoperative recovery. Preoperative recommendations emphasize assessment of right ventricular function, prediction of postoperative right heart failure, and evaluation of indications for LVAD implantation to support appropriate patient selection. Intraoperative recommendations specify hemodynamic targets, strategies for optimizing right ventricular performance, and blood-conservation measures intended to minimize transfusion requirements. Postoperative recommendations address multimodal analgesia and enhanced recovery after surgery (ERAS) protocols adapted to individual patient characteristics and institutional resources. The consensus also summarizes clinically relevant differences in the design and management of durable LVADs developed domestically and internationally to support device-specific care.</p><h3>Conclusions</h3><p>This consensus provides a structured, evidence-informed pathway for the perioperative management of adults undergoing LVAD implantation in China. By integrating international evidence with Chinese clinical experience and evidence involving domestically developed LVADs, the recommendations may improve the consistency and quality of perioperative care. Further evaluation is needed to determine their effects on postoperative complications and","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00189-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesiology and Perioperative Sciences: first impact factor milestone achieved","authors":"Jin Liu, Daqing Ma, David G. Lambert, Yufei Wang","doi":"10.1007/s44254-026-00190-1","DOIUrl":"10.1007/s44254-026-00190-1","url":null,"abstract":"","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00190-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148837589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benchmark evaluation of OpenAI-o1 vs DeepSeek-R1 for junior anesthesiologists in Chinese hospitals: hazards of fast large language models use in high-stakes specialties","authors":"Zhuoxi Wu,&nbsp;Yuting Tan,&nbsp;Qin Chen,&nbsp;Xinming Ye,&nbsp;Qin Zhang,&nbsp;Jiefeng Bi,&nbsp;Hong Li","doi":"10.1007/s44254-026-00176-z","DOIUrl":"10.1007/s44254-026-00176-z","url":null,"abstract":"<div><h3>Purpose</h3><p>Junior physicians may experience critical competency gaps during the transition to unsupervised practice, particularly in high-risk specialties such as anesthesiology, where errors can compromise patient safety. Although large language models (LLMs) are being rapidly integrated into healthcare, their accuracy and safety in supporting junior physicians—who may lack sufficient experience to identify model errors—remain insufficiently quantified in high-stakes clinical settings. This study evaluated OpenAI-o1 (OA) and DeepSeek-R1 in English (DSE) and Chinese (DSC) to address this evidence gap.</p><h3>Methods</h3><p>In this dual-axis evaluation, 30 anesthesia crisis scenarios were developed through Delphi consensus. Responses generated by OA, DSE, and DSC were assessed by 20 experts for accuracy using a 5-point Likert scale and for clinical logicality using an 8-point Situation–Background–Assessment–Recommendation (SBAR) scoring system, with each component rated from 0 to 2 points. Practicality was assessed by 20 junior physicians using a 5-point Likert scale across three subdimensions: step clarity, guideline applicability, and learning assistance. Accuracy and practicality were the two primary evaluation domains, while clinical logicality, qualitative feedback, and readability were examined as complementary outcomes. Performance was compared across nine pre-specified, order-constrained hypotheses using Bayes Factor Design Analysis (<i>n</i> = 600 per group), with outcomes expressed as posterior probabilities (PPs) and Bayes Factors (BFs).</p><h3>Results</h3><p>OA demonstrated superior accuracy (OA &gt; DSE &gt; DSC; PP = 0.94; BF₄ᵤ = 4.70, strong evidence), whereas DSC showed greater practicality (OA &lt; DSE &lt; DSC; PP = 0.82; BF₇ᵤ = 3.67). This inverse relationship was also observed in the practicality subdimensions, with DSC performing better in step clarity (PP = 0.75) and guideline applicability (PP = 0.82). For high-complexity tasks, such as urgent decision-making, all models failed to establish an effective SBAR Situation-to-Assessment linkage despite showing equivalent overall clinical logicality (PP = 0.59; BF₁ᵤ = 161.05, decisive evidence). Notably, 95.2% of junior physicians reported that DSC alleviated decision-making anxiety, compared with 28.6% for OA, suggesting a preference for actionable guidance despite accuracy limitations.</p><h3>Conclusions</h3><p>LLMs exhibit divergent capabilities: OA provides greater accuracy but lacks operational specificity, whereas DeepSeek-R1, particularly the Chinese version, offers more practical scaffolding at the expense of accuracy. This trade-off highlights the urgent need to develop and validate robust, specialty-specific evaluation frameworks and safeguards before such models can be safely deployed to support clinical decision-making in high-stakes environments.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00176-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148750890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DMH glutamatergic and GABAergic neurons differentially regulate post-anesthesia sleep disturbance through CB1R signaling","authors":"Jiajia Wang,&nbsp;Fang Zhou,&nbsp;Xinxin Zhang,&nbsp;Sansan Jia,&nbsp;Huiqing Liu,&nbsp;Xiaofei Fei,&nbsp;Lu Yin,&nbsp;Zefei Zhang,&nbsp;Yang Liu,&nbsp;Yuan Fang,&nbsp;Hailong Dong,&nbsp;Zhihong Lu,&nbsp;Haixing Zhong","doi":"10.1007/s44254-026-00185-y","DOIUrl":"10.1007/s44254-026-00185-y","url":null,"abstract":"<div><h3>Purpose</h3><p>Post-operative sleep disturbance affects more than 60% of surgical patients and impedes recovery. Although general anesthesia itself may profoundly remodel brain function and contribute to this pathology, the underlying neural mechanisms remain unclear. We previously identified the dorsomedial hypothalamus (DMH) as a key modulator of emergence and arousal. Here, we investigated the distinct roles of DMH glutamatergic neurons (DMH^Glu) and GABAergic neurons (DMH^GABA) in the pathophysiology of post-anesthesia sleep disturbance (PSD).</p><h3>Methods</h3><p>Using a mouse model of PSD induced by 2 h of 1.4% isoflurane anesthesia, we used chemogenetics to selectively activate or inhibit DMH neurons. Sleep–wake architecture was assessed using wireless electroencephalography (EEG) and electromyography (EMG) biotelemetry, complemented by fiber photometry for neuronal activity monitoring and single-nucleus RNA sequencing for molecular profiling.</p><h3>Results</h3><p>Isoflurane anesthesia induced a delayed-onset sleep disturbance characterized by increased wakefulness and reduced, fragmented sleep during the subsequent rest phase. Notably, DMH^Glu neurons showed heightened activity specifically during rest-phase wakefulness, whereas DMH^GABA neurons were predominantly active during wakefulness and non-rapid eye movement sleep in the post-anesthesia active phase. Activation of DMH^Glu neurons reversed PSD in a circadian phase-dependent manner, while both activation and inhibition of DMH^GABA neurons improved PSD without significant phase variation. Single-nucleus RNA sequencing revealed the involvement of retrograde endocannabinoid signaling in both DMH^Glu and DMH^GABA neurons. Administration of a type 1 cannabinoid receptor (CB1R) antagonist alleviated PSD, potentially by disinhibiting DMH^Glu neurons and remodeling the integration of excitatory and inhibitory inputs onto DMH^GABA neurons.</p><h3>Conclusions</h3><p>DMH^Glu and DMH^GABA neurons differentially regulate PSD through distinct, CB1R-mediated presynaptic modulation, providing novel mechanistic insights into PSD and identifying potential therapeutic targets for its treatment.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00185-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148750770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative arterial pressure management: from fixed thresholds to physiology-guided perfusion support","authors":"Wanzhuo Xu,&nbsp;Jinjun Bian,&nbsp;Lulong Bo","doi":"10.1007/s44254-026-00187-w","DOIUrl":"10.1007/s44254-026-00187-w","url":null,"abstract":"","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00187-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148614938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous aprepitant for prevention of postoperative nausea and vomiting in adults at moderate-to-high risk in China: a multicenter, randomized, double-blind, placebo-controlled trial","authors":"Shichao Luo,&nbsp;Xiangqin Teng,&nbsp;YingYong Zhou,&nbsp;Qinghong Mao,&nbsp;Qingmei Zhang,&nbsp;Hong Luo,&nbsp;Liang Chen,&nbsp;Juan Wang,&nbsp;Hongmei Zhou,&nbsp;Jun Jing,&nbsp;Chuping Ye,&nbsp;Canlin Sun,&nbsp;Rui Zhan,&nbsp;Jinghua Ren,&nbsp;Chun Chen,&nbsp;Ping Qiang,&nbsp;Mingzhi Zheng,&nbsp;Wanyou Yu,&nbsp;Saiying Wang,&nbsp;Kaiming Duan","doi":"10.1007/s44254-026-00184-z","DOIUrl":"10.1007/s44254-026-00184-z","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;To evaluate whether peri-induction intravenous aprepitant 32mg/4.4ml improves the complete response (CR) to postoperative nausea and vomiting (PONV) within 24 h after surgery, as well as the 0–48 h net clinical effect, safety, and pharmacokinetic outcomes, in Chinese adults at moderate to high risk of PONV under a standardized rescue protocol.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;This multicenter, randomized, double-blind, placebo-controlled clinical trial was conducted in 30 hospitals in China. A total of 412 patients scheduled for abdominal or pelvic surgery with an Apfel simplified risk score ≥ 2 were randomized 1:1 to the aprepitant group (&lt;i&gt;n&lt;/i&gt; = 206) or placebo (&lt;i&gt;n&lt;/i&gt; = 206). Patients in the aprepitant group received intravenous aprepitant 32 mg before anesthesia induction, while those in the control group received placebo. Rescue antiemetics were administered only for clinically significant postoperative symptoms. The primary endpoint was CR within 24 h after surgery, defined as no vomiting or retching and no use of rescue antiemetic therapy during the first 24 postoperative hours. Secondary endpoints included time to first emesis within 48 h, incidence of moderate-to-severe nausea within 24 h, and rescue antiemetic use within 24 h after surgery. A pharmacokinetic substudy (&lt;i&gt;n&lt;/i&gt; = 28) measured plasma aprepitant concentration at 0 and 2 min, 5 min, 15 min, 1 h, 3 h, 6 h, 24 h and 48 h after completion of administration. Adverse events were recorded to assess safety.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Aprepitant significantly increased the rate of CR within 24 h compared with placebo (81.4% vs. 39.0%; &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Vomiting within 48 h occurred less frequently in the aprepitant group than in the control group (16.7% vs. 62.0%; &lt;i&gt;P&lt;/i&gt; &lt; 0.001), and time to first emesis within 48 h was significantly delayed with aprepitant (log-rank &lt;i&gt;P&lt;/i&gt; &lt; 0.001). The proportion of patients with no emesis was higher in the aprepitant group at both 24 h (84.8% vs. 40.0%; weighted risk difference, 45.07% [95% CI, 36.90%–53.24%]) and 48 h (83.3% vs. 38.0%; weighted risk difference, 45.55% [95% CI, 37.29%–53.81%]). Moderate-to-severe nausea within 24 h was reduced with aprepitant (16.7% vs. 33.2%; &lt;i&gt;P&lt;/i&gt; &lt; 0.001), as was rescue antiemetic use within 24 h (8.3% vs. 22.0%; &lt;i&gt;P&lt;/i&gt; &lt; 0.001). In the pharmacokinetic substudy, the mean (SD) &lt;i&gt;C&lt;/i&gt;&lt;sub&gt;max&lt;/sub&gt; was 4997.95 (1226.44) ng/mL, the median (range) &lt;i&gt;T&lt;/i&gt;&lt;sub&gt;max&lt;/sub&gt; was 0.035 (0.031–0.076), and the mean (SD) half-life (&lt;i&gt;T&lt;/i&gt;&lt;sub&gt;1/2&lt;/sub&gt;) was 9.08 (2.17). Adverse reaction profiles were similar between groups.&lt;/p&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Peri-induction intravenous aprepitant 32 mg substantially improved the 24 h CR rate in Chinese adults at moderate to high risk of PONV undergoing abdominal or pelvic surgery. This benefit was accompanied by delayed time to first emesis, reduced moderate-to-severe nausea, and lower rescue antiemetic use, with a safety profile comparabl","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00184-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148614143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the timing of labor epidural analgesia and maternal fever in nulliparous women: a retrospective cohort study","authors":"Yarui Zhang,&nbsp;Yinan Guo,&nbsp;Ying Shan,&nbsp;Weiyang Zhou,&nbsp;Yinghong Pan,&nbsp;Qing Xu,&nbsp;Yuhan Ouyang,&nbsp;Tao Luo","doi":"10.1007/s44254-026-00182-1","DOIUrl":"10.1007/s44254-026-00182-1","url":null,"abstract":"<div><h3>Background</h3><p>Epidural-related maternal fever has been attributed to non-infectious inflammatory mechanisms and thermoregulatory dysfunction. Its risk is hypothesized to increase with prolonged exposure to epidural analgesia; however, a comprehensive synthesis of evidence regarding the effect of epidural analgesia timing remains lacking.</p><h3>Methods</h3><p>This retrospective cohort study included 2,991 nulliparous women with term singleton pregnancies who received epidural analgesia at a single academic center between 2019 and 2020. Early initiation was defined as 0–2 cm cervical dilation, and late initiation as ≥ 3 cm. The primary outcome was maternal fever (≥ 38 °C). Propensity score matching and multivariable regression were performed to adjust for potential confounders.</p><h3>Results</h3><p>After propensity score matching, the incidence of maternal fever was significantly higher in the early epidural group than in the late epidural group (12.20% vs. 7.30%; <i>P</i> = 0.001). Multivariable logistic regression analysis showed that late initiation of epidural analgesia was associated with a reduced risk of maternal fever (aOR = 0.57, 95% CI, 0.41–0.80; <i>P </i>&lt; 0.001), uterine inertia (aOR = 0.68, 95% CI, 0.48–0.96; <i>P </i>= 0.028), oxytocin use (aOR = 0.73, 95% CI, 0.60–0.88; <i>P </i>= 0.001), cesarean delivery (aOR = 0.51, 95% CI, 0.38–0.69; <i>P </i>&lt; 0.001), and episiotomy (aOR = 0.41, 95% CI, 0.32–0.51; <i>P </i>&lt; 0.001). In addition, late initiation of epidural analgesia was associated with lower log-transformed blood loss during the first 24 hours after delivery (adjusted coefficient = −0.12, 95% CI, −0.17 to −0.07; <i>P </i>&lt; 0.001). Sensitivity analyses yielded consistent findings.</p><h3>Conclusion</h3><p>In this retrospective cohort study of nulliparous women with spontaneous labor, initiation of epidural analgesia (0–2 cm cervical dilation) was associated with an increased risk of intrapartum fever and several adverse maternal outcomes. These findings suggest a potential clinical relevance of epidural timing; however, causal inference cannot be drawn due to the observational study design. Prospective studies are warranted to confirm these associations and further clarify underlying mechanisms.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00182-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148614474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digitally and intelligently empowered perioperative care: a shift toward perioperative human-centered AI","authors":"Ruihao Zhou,&nbsp;Sammad Anwar,&nbsp;Ziyue Luo,&nbsp;Xiran Peng,&nbsp;Yaqiang Wang,&nbsp;Ke Li,&nbsp;Guo Chen,&nbsp;Xuechao Hao,&nbsp;Tao Zhu,&nbsp;the Anesthesiology, Intelligence Research Collaboration Group (AIR-CG)","doi":"10.1007/s44254-026-00183-0","DOIUrl":"10.1007/s44254-026-00183-0","url":null,"abstract":"","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00183-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148465550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Activation of DMV cholinergic neurons mediates the anti-inflammatory effects of electroacupuncture in knee osteoarthritis mice","authors":"Shiyue Lu,&nbsp;Baoshan Wang,&nbsp;Yifei Zhou,&nbsp;Huichun Luo,&nbsp;Song Zhang,&nbsp;Qionghui Zhan,&nbsp;Yingfu Jiao,&nbsp;Weifeng Yu,&nbsp;Jie Xiao,&nbsp;Po Gao,&nbsp;Liqun Yang","doi":"10.1007/s44254-026-00186-x","DOIUrl":"10.1007/s44254-026-00186-x","url":null,"abstract":"<div><h3>Background</h3><p>Knee osteoarthritis (KOA) is a leading cause of chronic disability in the elderly population. Although electroacupuncture (EA) has shown promising anti-inflammatory effects, the central neural mechanisms underlying its therapeutic efficacy remain incompletely elucidated.</p><h3>Methods</h3><p>A mouse model of KOA was established and treated with EA at the Zusanli (ST36) acupoint. Chemogenetic manipulation and fiber photometry recording were used to investigate the role of choline acetyltransferase (ChAT)-positive neurons in the dorsal motor nucleus of the vagus (DMV). Knee joint tissues were collected for histopathological evaluation using hematoxylin and eosin staining, Safranin O/Fast Green staining, and collagen II immunohistochemistry. Synovial levels of inflammatory cytokines (TNF-α, IL-1β, and IL-6) and dopamine (DA) were quantified by enzyme-linked immunosorbent assay (ELISA).</p><h3>Results</h3><p>EA at ST36 significantly alleviated cartilage damage and suppressed the upregulation of inflammatory cytokines in KOA mice. The DMV was identified as a key brain region responsive to EA stimulation, and activation of EA-responsive DMV neurons reproduced the therapeutic effects of EA. Furthermore, EA-responsive DMV neurons were found to be predominantly ChAT-positive, and chemogenetic inhibition of DMV^ChAT neurons abolished the anti-inflammatory effects of EA in KOA mice. Mechanistically, both EA treatment and activation of DMV^ChAT neurons were associated with increased DA release into the synovial tissue.</p><h3>Conclusions</h3><p>Our findings identify a central neural mechanism underlying the therapeutic effects of EA in KOA. Specifically, EA at ST36 activates DMV^ChAT neurons, which subsequently promote adrenal DA release, thereby inhibiting inflammatory cytokine production in the knee joint and alleviating KOA-associated inflammation. These findings provide novel insights into the central neural mechanisms through which EA exerts its therapeutic effects in KOA.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-026-00186-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148465190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative hemoglobin glycation index and postoperative complications after non-cardiac surgery: a retrospective cohort study","authors":"Yi Zhang,&nbsp;Ling Lan,&nbsp;Yuelun Zhang,&nbsp;Le Shen","doi":"10.1007/s44254-026-00179-w","DOIUrl":"10.1007/s44254-026-00179-w","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;Perioperative metabolic vulnerability is an important contributor to postoperative morbidity, yet preoperative risk stratification relies largely on conventional glycemic measures such as hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG). Hemoglobin glycation index (HGI) quantifies interindividual discordance between HbA1c and contemporaneous glycemia and may capture metabolic phenotypes not reflected by absolute glucose values. We investigated the association between preoperative HGI and postoperative outcomes in adults undergoing non-cardiac surgery.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;We conducted a retrospective single-center cohort study including adult inpatients who underwent non-cardiac surgery under general anesthesia between January 2013 and June 2024. Patients with both preoperative HbA1c and FPG measured within 60 days before surgery were included. HGI was calculated as the residual of observed HbA1c minus HbA1c predicted from FPG using a cohort-specific linear regression model. The primary outcome was any postoperative complication occurring before hospital discharge. Secondary outcomes included major complications (Clavien–Dindo grade ≥ III), organ-specific complications, deep-vein thrombosis, Intensive Care Unit (ICU) admission, hospital and postoperative length of stay, and in-hospital mortality. Associations were evaluated using multivariable regression models with HGI analyzed as a continuous variable (per 1–SD increase) and by quartiles (Q2 as reference), complemented by restricted cubic spline analyses and prespecified subgroup analyses.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 24,307 patients were included (mean age 58.8 ± 13.3 years; 51% women). Postoperative complications occurred in 8.4% of patients. In adjusted continuous models, higher HGI was independently associated with postoperative complications (odds ratio [OR] per 1–SD increase 1.068; 95% confidence interval [CI], 1.018–1.120; &lt;i&gt;P&lt;/i&gt; = 0.007), urinary complications (OR 1.155; 95% CI, 1.024–1.301; &lt;i&gt;P&lt;/i&gt; = 0.018), and longer total hospital length of stay (adjusted mean ratio 1.030; 95% CI, 1.017–1.043;&lt;i&gt; P&lt;/i&gt; = 0.001). Quartile analyses demonstrated the lowest risk of postoperative complications in the mid-range HGI group, with higher risks observed at extreme HGI values. Restricted cubic spline models revealed an approximately linear association between HGI and overall postoperative complications, while outcome-specific nonlinear relationships were observed for major complications, ICU admission, and in-hospital mortality. Associations were generally consistent across subgroups, with no statistically significant interaction detected across prespecified strata.&lt;/p&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Preoperative hemoglobin glycation index was independently associated with postoperative complications after non-cardiac surgery and identified nonlinear risk patterns for selected severe outcomes. HGI may serve as a complementary perioperative metabolic risk marker bey","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"4 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}