Microneedle technology has undergone a paradigm shift from basic transdermal drug delivery to intelligent,closed-loop theranostic systems.Hydrogel materials have emerged as core carriers due to their excellent biocomp...Microneedle technology has undergone a paradigm shift from basic transdermal drug delivery to intelligent,closed-loop theranostic systems.Hydrogel materials have emerged as core carriers due to their excellent biocompatibility,efficient drug loading capacity,and improved patient compliance.Moreover,critical bottlenecks in hydrogel microneedles,including poor mechanical strength,burst release of drugs,and delayed response to treatment,can be addressed via cross-scale integration of nanomaterials.This review systematically outlines several multiscale engineering strategies to overcome these limitations.The construction of nanotopological networks coupled with dynamic crosslinking modulation synergistically enhances the mechanical properties,stability of drug loading,and conductivity of hydrogel microneedles.Furthermore,responsive nanocarriers equipped with biosensors help establish a closed-loop linkage between monitoring and therapeutic functions.We highlight their synergistic theranostic advantages in scenarios such as wound regulation and tumor-immune microenvironments,while revealing the role in integrating flexible electronics with wearable systems in intelligent medicine.We also summarize the research advances on the biosafety and scalable manufacturing processes of nanocomposite hydrogel m icroneedles(NHMNs),providing examples of clinical translation to elucidate the path from fundamental research to industrial implementation.As a convergence of nanotechnology,biomaterials,and flexible electronics,NHMNs provide new standards for transdermal theranostics as well as a roadmap for iterative advancement of intelligent theranostic devices in personalized medicine.Their cross-scale collaborative design,which spans from the properties of materials to the functional integration of macroscopic devices,can facilitate potential breakthroughs in next-generation closed-loop theranostic systems.展开更多
BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for ...BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.展开更多
General anesthesia,pivotal for surgical procedures,requires precise depth monitoring to mitigate risks ranging from intraoperative awareness to postoperative cognitive impairments.Traditional assessment methods,relyin...General anesthesia,pivotal for surgical procedures,requires precise depth monitoring to mitigate risks ranging from intraoperative awareness to postoperative cognitive impairments.Traditional assessment methods,relying on physiological indicators or behavioral responses,fall short of accurately capturing the nuanced states of unconsciousness.This study introduces a machine learning-based approach to decode anesthesia depth,leveraging EEG data across different anesthesia states induced by propofol and esketamine in rats.Our findings demonstrate the model’s robust predictive accuracy,underscored by a novel intrasubject dataset partitioning and a 5-fold cross-validation method.The research diverges from conventional monitoring by utilizing anesthetic infusion rates as objective indicators of anesthesia states,highlighting distinct EEG patterns and enhancing prediction accuracy.Moreover,the model’s ability to generalize across individuals suggests its potential for broad clinical application,distinguishing between anesthetic agents and their depths.Despite relying on rat EEG data,which poses questions about real-world applicability,our approach marks a significant advance in anesthesia monitoring.展开更多
BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerv...BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.展开更多
BACKGROUND Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections(CSs),but ropivacaine has emerged as a potential alter-native.This meta-analysis compares the effic...BACKGROUND Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections(CSs),but ropivacaine has emerged as a potential alter-native.This meta-analysis compares the efficacy and safety of intrathecal hyper-baric bupivacaine vs hyperbaric ropivacaine for cesarean sections.AIM To systematically evaluate and compare the efficacy and safety of intrathecal hyperbaric bupivacaine and hyperbaric ropivacaine for spinal anesthesia in CSs.METHODS A thorough search of electronic databases was carried out to find pertinent randomized controlled trials(RCTs)comparing intrathecal hyperbaric ropi-vacaine and hyperbaric bupivacaine during CSs.PubMed,Cochrane database,Google Scholar,and Scopus were searched,and papers from January 2000 to January 2024 were deemed eligible and filtered using predetermined inclusion and exclusion criteria.Studies were assessed for methodological quality,and data were extracted for time to adequate anesthesia(sensory and motor blockade),duration of sensory and motor block,hemodynamic changes and side effect profile.The standardized mean difference with 95%CI was used for continuous data.Dichotomous variables were assessed using the Mantel-Haenszel test and the random effect model to compute the odds ratio.RESULTS Total 8 RCTs were selected from a pool of 119 search results for meta-analysis.The meta-analysis evaluated pooled effect sizes and assessed heterogeneity among the studies.The primary objective was to compare key outcomes to identify any significant variances in efficacy and safety profiles between two local anesthetics.The analysis revealed that the difference in the onset of sensory blockade between the two local anesthetics was statistically insignificant(P=0.1586).However,the onset of motor blockade appeared to be faster with bupivacaine(P=0.03589).Additionally,the regression of sensory and motor blockade occurred earlier in the ropivacaine group.Furthermore,the duration of the first analgesic effect was shorter with a significance level of P<0.05.Regarding side effects profile,including hypotension,nausea,and shivering,the study did not observe any significant differences between the two groups.CONCLUSION This meta-analysis offers insights into the effectiveness and safety of hyperbaric bupivacaine vs ropivacaine for cesarean sections.Hyperbaric ropivacaine had a comparable safety profile and faster regression of sensory and motor blockade than hyperbaric bupivacaine,perhaps aiding early mobilization of parturient and facilitating mother-child bonding.Choosing ropivacaine may offer benefits beyond efficacy for cesarean section patients and short surgical procedures.展开更多
Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environm...Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environment. Methods: This is a cross-sectional study carried out at Monkole hospital from May 2016 to May 2023. It concerns patients anesthetized for laparoscopic surgery. Perianesthetic data were collected and analyzed with SPSS 26.0 for p Results: Eighty-four patients (4.2%) were selected out of 2000 eligible patients. The median age was 31 years, the range between 15 and 30 years (40.5%), female gender and approved patients (70.3%) predominated. Comorbidities were: sickle cell disease, high blood pressure, thinness and obesity. The ASA class was: I (35.2%), II (36.3%) and III (28.6%). Anesthesia was general with intubation for all patients. Generally, the surgery lasted less than two hours and the anesthesia lasted more than two hours. Postoperative analgesia used morphine in 27.5%. The operative indications were dominated by lithiasis with or without cholecystitis (48.4%) and appendicitis (16.5%). Intraoperative complications (18.7%) were: hypotension, allergy, spasm, accidental gallbladder and bile duct perforation. Postoperative complications (9.9%) were: anemia, digestive fistula, septic shock, multi-organ failure, acute lung edema and two deaths. Alcohol consumption was associated with intraoperative complications. Anesthesia duration greater than two hours, ASA3 class, alcohol consumption and cholecystectomy were associated with postoperative complications. Conclusion: Celiosurgery is not yet established in Monkole probably due to the lack of permanent surgeons and the higher cost than open surgery.展开更多
Objective: This study evaluates the impact of handshake and information support on patients’ outcomes during laparoscopic cholecystectomy. It examines the effects on their physiological and psychological responses an...Objective: This study evaluates the impact of handshake and information support on patients’ outcomes during laparoscopic cholecystectomy. It examines the effects on their physiological and psychological responses and overall satisfaction with nursing care. Methods: A total of 84 patients scheduled for laparoscopic cholecystectomy were selected through convenient sampling and randomly assigned to either the control group or the intervention group using a random number table. Each group consisted of 42 patients. The control group received standard surgical nursing care. In addition to standard care, the intervention group received handshake and information support from the circulating nurse before anesthesia induction. Vital signs were recorded before surgery and before anesthesia induction. Anxiety levels were measured using the State-Trait Anxiety Inventory (STAI) and the State-Anxiety Inventory (S-AI), while nursing satisfaction was assessed using a numerical rating scale. Results: No significant differences were found between the two groups in systolic and diastolic blood pressures before surgery and anesthesia induction (P > 0.05). However, there was a significant difference in heart rate before anesthesia induction (P Conclusion: Providing handshake and information support before anesthesia induction effectively reduces stress, alleviates anxiety, and enhances comfort and satisfaction among patients undergoing laparoscopic cholecystectomy.展开更多
Background:Ketamine is a widely used anesthetic in animal research,but its use is strictly regulated in several countries,including Japan and China.As an alternative,the medetomidine-midazolam-butorphanol(MMB)combinat...Background:Ketamine is a widely used anesthetic in animal research,but its use is strictly regulated in several countries,including Japan and China.As an alternative,the medetomidine-midazolam-butorphanol(MMB)combination is commonly used in Japan.However,medetomidine is a racemic mixture containing the inactive Renantiomer,which may reduce anesthetic predictability and safety.Objective:The aim of the study was to evaluate the efficacy and safety of a modified anesthetic combination(d MMB),in which dexmedetomidine replaces medetomidine,across three commonly used mouse strains(ICR,C57BL/6,BALB/c).Methods:Male and female mice were administered either MMB or d MMB subcutaneously.Anesthetic depth,recovery profiles,heart rate,SpO_(2),body temperature,ocular opacity,and blood glucose levels were assessed.Atipamezole was used to reverse anesthesia,and thermoregulatory recovery was monitored postinjection.Results:d MMB produced similar anesthetic depth to MMB,with faster and more consistent recovery,particularly in males.Body temperature recovery was significantly enhanced in d MMB-treated B6 males.No significant differences in side effects(ocular opacity or blood glucose levels)were observed between protocols,though strainspecific glucose elevations were noted in d MMB-treated males.Conclusion:d MMB is a safe,effective,and ketamine-free injectable anesthetic protocol,offering advantages in recovery and thermoregulation.It may be a valuable alternative in research settings where ketamine is restricted and medetomidine may become unavailable.展开更多
Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendici...Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendicitis from February 2022 to February 2025 were selected as samples and randomly divided into two groups.The study group received combined spinal-epidural anesthesia,while the control group received epidural anesthesia.Anesthesia indicators,vital signs,and complication indicators were compared between the two groups.Results:The onset time of anesthesia in the study group was shorter than that in the control group,the visual analog scale(VAS)score was lower than that in the control group,and the highest plane of anesthesia block was lower than that in the control group(P<0.05).At 15 minutes after anesthesia induction and at the end of surgery,the heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(SPO2)in the study group were significantly different from those in the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).Conclusion:Combined spinal-epidural anesthesia for appendicitis surgery can reduce the impact of anesthesia on vital signs,shorten the onset time of anesthesia,and is highly effective and feasible.展开更多
Prosthetic devices designed to assist individuals with damaged or missing body parts have made significant strides,particularly with advancements in machine intelligence and bioengineering.Initially focused on movemen...Prosthetic devices designed to assist individuals with damaged or missing body parts have made significant strides,particularly with advancements in machine intelligence and bioengineering.Initially focused on movement assistance,the field has shifted towards developing prosthetics that function as seamless extensions of the human body.During this progress,a key challenge remains the reduction of interface artifacts between prosthetic components and biological tissues.Soft electronics offer a promising solution due to their structural flexibility and enhanced tissue adaptability.However,achieving full integration of prosthetics with the human body requires both artificial perception and efficient transmission of physical signals.In this context,synaptic devices have garnered attention as next-generation neuromorphic computing elements because of their low power consumption,ability to enable hardware-based learning,and high compatibility with sensing units.These devices have the potential to create artificial pathways for sensory recognition and motor responses,forming a“sensory-neuromorphic system”that emulates synaptic junctions in biological neurons,thereby connecting with impaired biological tissues.Here,we discuss recent developments in prosthetic components and neuromorphic applications with a focus on sensory perception and sensorimotor actuation.Initially,we explore a prosthetic system with advanced sensory units,mechanical softness,and artificial intelligence,followed by the hardware implementation of memory devices that combine calculation and learning functions.We then highlight the importance and mechanisms of soft-form synaptic devices that are compatible with sensing units.Furthermore,we review an artificial sensory-neuromorphic perception system that replicates various biological senses and facilitates sensorimotor loops from sensory receptors,the spinal cord,and motor neurons.Finally,we propose insights into the future of closed-loop neuroprosthetics through the technical integration of soft electronics,including bio-integrated sensors and synaptic devices,into prosthetic systems.展开更多
BACKGROUND Administering anesthesia to elderly patients undergoing gastroenteroscopy necessitates careful attention due to age-related physiological changes and an increased risk of complications.AIM To analyze the re...BACKGROUND Administering anesthesia to elderly patients undergoing gastroenteroscopy necessitates careful attention due to age-related physiological changes and an increased risk of complications.AIM To analyze the research trends in anesthesia management for elderly patients undergoing gastroenteroscopy.METHODS We performed a literature search using the Web of Science database to identify articles published between 2004 and 2023.Bibliometric and visual analyses were conducted using CiteSpace,R,and VOSviewer to explore the current research landscape of anesthesia administration in painless gastroenteroscopy for elderly patients and to identify future research directions by examining trends and emerging hotspots in this domain.RESULTS A total of 800 articles were examined,revealing a rising trend in annual pub-lication counts.The United States led with 181 articles,followed by China with 112,collectively contributing over 35%of the studies among the top ten countries.The majority of publications appeared in the United States journals,with the top three being Gastrointestinal Endoscopy[impact factor(IF)=7.7,H-index=26],Digestive Diseases and Sciences(IF=3.1),and Endoscopy(IF=9.3).Six primary research clusters were identified:Obstructive sleep apnea and airway manage-ment,surveillance and risk factors,colorectal cancer examination and treatment,sedation and safety of propofol and midazolam,patient satisfaction,and mortality and complications.These findings underscore the pivotal focus areas in anesthesia for elderly patients undergoing gastroenteroscopy.CONCLUSION A comprehensive understanding of current research trends and hotspots will aid anesthesiologists in developing more evidence-based practices,thereby improving the safety and outcomes for elderly patients undergoing gastroenteroscopy.展开更多
BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outc...BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outcomes.AIM To investigate the impact of music therapy and anesthesia recovery care on anesthesia recovery in patients with CRC undergoing laparoscopic radical resection.METHODS One hundred and twenty patients scheduled for elective laparoscopic CRC radical resection at Affiliated Hospital of Jiangnan University from January 2022 to May 2024 were enrolled.The patients were assigned to control(n=60,receiving standard nursing care)and observation groups(n=60,receiving music therapy,anesthesia recovery care,and standard nursing care).We comparatively analyzed the time to regain consciousness,extubation time,and length of stay in the postanesthesia care unit;heart rate,systolic blood pressure,and diastolic blood pressure before anesthesia and during recovery;cortisol,aldosterone,norepinephrine,and adrenaline levels before anesthesia and 24 hours postoperatively;Postoperative Quality of Recovery Scale scores;and complication rates between the groups.RESULTS The observation group exhibited a significantly shorter time to regain consciousness,extubation time,and postanesthesia care unit stay than the control group(P<0.05).During the recovery period,heart rate,systolic blood pressure,and diastolic blood pressure significantly increased in both groups compared with preanesthesia levels,with the levels in the observation group being significantly lower than those in the control group(P<0.05).At 24 hours postoperatively,cortisol,aldosterone,norepinephrine,and adrenaline levels were elevated in both groups compared with preanesthesia levels,with levels in the observation group being significantly lower than those in the control group(P<0.05).The observation group achieved significantly higher Postoperative Quality of Recovery Scale scores than the control group(P<0.05).Moreover,the complication rate in the observation group was significantly lower than that in the control group(10.00%vs 40.00%,P<0.05).CONCLUSION Music therapy combined with anesthesia recovery care remarkably boosted the quality of anesthesia recovery in patients undergoing laparoscopic CRC radical resection,mitigated fluctuations in vital signs and stress responses,improved postoperative recovery quality,and reduced complication rates,demonstrating substantial clinical value.展开更多
The current anesthetic standard for laryngoscopy in rats utilizes injectable intraperitoneal anesthesia.Injectable anesthesia is suboptimal for short procedures due to variability in anesthesia duration and anesthetic...The current anesthetic standard for laryngoscopy in rats utilizes injectable intraperitoneal anesthesia.Injectable anesthesia is suboptimal for short procedures due to variability in anesthesia duration and anesthetic side effects.Conversely,inhalational gas anesthesia offers precise titration with a rapid onset and offset.However,its use during laryngoscopy has not been documented due to existing administration techniques obstructing direct visualization of the larynx.The technique described here allows real-time visualization of the rat larynx with concurrent administration of inhaled anesthetic gas.This method is particularly well-suited for recurrent laryngeal nerve or vocal fold pathology studies,where repeat visualization of the larynx is necessary.展开更多
Rotary steering systems(RSSs)have been increasingly used to develop horizontal wells.A static push-the-bit RSS uses three hydraulic modules with varying degrees of expansion and contraction to achieve changes in the p...Rotary steering systems(RSSs)have been increasingly used to develop horizontal wells.A static push-the-bit RSS uses three hydraulic modules with varying degrees of expansion and contraction to achieve changes in the pushing force acting on the wellbore in different sizes and directions within a circular range,ultimately allowing the wellbore trajectory to be drilled in a predetermined direction.By analyzing its mathematical principles and the actual characteristics of the instrument,a vector force closed-loop control method,including steering and holding modes,was designed.The adjustment criteria for the three hydraulic modules are determined to achieve rapid adjustment of the vector force.The theoretical feasibility of the developed method was verified by comparing its results with the on-site application data of an imported rotary guidance system.展开更多
BACKGROUND In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient ou...BACKGROUND In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient outcomes remains crucial.Remimazolam,a short-acting benzodiazepine,shows potential for improving sedation and reducing patient anxiety.The effects of combining remimazolam with CSE anesthesia,compared to traditional CSE anesthesia alone,on patient anxiety,sedation depth,and hemodynamics during PPH surgery have not been fully elucidated.AIM To compare remimazolam-CSE vs CSE alone on State-Trait Anxiety Inventory-State scale(STAI-S)scores,sedation,and hemodynamics in PPH surgery.METHODS This study is a single-center,prospective,randomized controlled trial.Between November 23,2022,and August 6,2024,60 eligible patients were randomly assigned to the CSE anesthesia group or the remimazolam-combined CSE anesthesia group(30 patients each).STAI-S scores,Ramsay sedation scores,and hemodynamic parameters(systolic blood pressure,diastolic blood pressure,heart rate)were measured at multiple time points.Two-way mixed-effects ANOVA and posthoc analyses were performed.RESULTS The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room[mean:28.80 vs 54.03,mean difference(95%CI):25.23(21.24-29.23),P<0.001]and 24 hours post-operation[mean:45.07 vs 54.53,mean difference(95%CI):9.47(6.29-12.64),P<0.001]than the CSE group.Moreover,the Combined group achieved a deeper sedation level during intraoperative maintenance[median:5.00(IQR:5.00-5.00)vs 2.00(IQR:2.00-2.00);median difference(95%CI):3.00(3.00-3.00),P<0.001].Regarding hemodynamics,a significant intergroup difference in systolic blood pressure was observed at the start of the surgery[mean:128.8 vs 114.7 for the Combined and CSE groups,mean difference(95%CI):14.17(0.77-27.57),adjusted P=0.033].CONCLUSION Remimazolam-combined anesthesia outperformed CSE anesthesia in reducing STAI-S scores,enhancing intraoperative sedation,and stabilizing systolic blood pressure at a critical stage,indicating its superiority in perioperative management.展开更多
The evolution of acupuncture anesthesia(AA)has spanned six decades.Cardiothoracic surgery serves as a representative case study to illustrate this evolution.Reflecting on its historical development,the use of AA in ca...The evolution of acupuncture anesthesia(AA)has spanned six decades.Cardiothoracic surgery serves as a representative case study to illustrate this evolution.Reflecting on its historical development,the use of AA in cardiothoracic surgery has advanced from basic AA procedures in the 1960s to combined acupuncture and drug anesthesia techniques in the early 1980s.Since 2005,the innovative use of non-intubation AA combined anesthesia has been implemented extensively in cardiothoracic surgery.As the medical industry continues to evolve,the techniques applied in AA have expanded to encompass the entire perioperative period in cardiothoracic surgery,leading to the introduction of the concept of modern AA.The use of AA in cardiothoracic surgery exemplifies the ongoing advances and integration of traditional Chinese and Western medicine.Moving forward,it is imperative to enhance the theoretical framework of AA through the execution of rigorous multicenter clinical trials,to further strengthen the body of evidence supporting evidence-based medicine,and to finally explore the underlying mechanisms of AA.展开更多
Background:During the establishment of a model of acute kidney injury(AKI)in pigs,we observed a high prevalence of malignant hyperthermia(MH).These complications led us to refine the anesthetic protocol.This publicati...Background:During the establishment of a model of acute kidney injury(AKI)in pigs,we observed a high prevalence of malignant hyperthermia(MH).These complications led us to refine the anesthetic protocol.This publication describes the impact of the choice of anesthetics on the results obtained.Methods:Pigs were euthanized at the end of the procedure,without recovery from anesthesia.Three anesthetic protocols were used:sevoflurane inhalation(ProtocolA,n=5),a combination of ketamine,medetomidine and diazepam by intravenous infusion(ProtocolB,n=5),and a combination of ketamine,diazepam,medetomidine,glucose,and noradrenaline(ProtocolC,n=5).All pigs received morphine for analgesia.AKI was induced by interrupting renal perfusion for 90 min.MH was diagnosed based on clinical and biological parameters.Results:All MH pigs belonged to ProtocolA.MH pigs showed significantly higher maximum rectal temperature(p=0.04),maximum expired carbon dioxide(CO_(2);p=0.04),maximum heart rate(HR;p=0.03),plasma concentration of creatinine and potassium(p<0.0001).Protocol A pigs had a significantly higher maximum HR(p=0.01)and hyperkalemia compared to the two other groups(ProtocolB,p=0.005 and ProtocolC,p<0.0001).Pigs from ProtocolA had a significantly lower minimum mean arterial pressure(MAP)than ProtocolC group(p=0.03)and MAP remained below 60 mmHg for longer(p=0.004).In ProtocolB,minimum glycemia was lower than other groups(p=0.01).Conclusion:Sevoflurane use was associated with the occurrence of MH,hemodynamic alterations and changes in plasma concentration of creatinine and potassium.These modifications can have a major impact on the validation of an experimental AKI model.展开更多
Background:Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia.However,some clinical studies of acupuncture anesthesia lack specif...Background:Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia.However,some clinical studies of acupuncture anesthesia lack specific descriptions of randomization,allocation concealment,and blinding processes,with subsequent systematic reviews indicating a risk of bias.Objective:Clinical trial registration is essential for the enhancement of the quality of clinical trials.This study aims to summarize the status of clinical trial registrations for acupuncture anesthesia listed on the World Health Organization International Clinical Trials Registry Platform(ICTRP).Search strategy:We searched the ICTRP for clinical trials related to acupuncture anesthesia registered between January 1,2001 and May 31,2023.Additionally,related publications were retrieved from PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data.Registrations and publications were analyzed for consistency in trial design characteristics.Inclusion criteria:Clinical trials that utilized one of several acupuncture-related therapies in combination with pharmacological anesthesia during the perioperative period were eligible for this review.Data extraction and analysis:Data extracted from articles included type of surgical procedure,perioperative symptoms,study methodology,type of intervention,trial recruitment information,and publication information related to clinical enrollment.Results:A total of 166 trials related to acupuncture anesthesia from 21 countries were included in the analysis.The commonly reported symptoms in the included studies were postoperative nausea and vomiting(19.9%)and postoperative pain(13.3%).The concordance between the publications and the trial protocols in the clinical registry records was poor,with only 31.7%of the studies being fully compatible.Inconsistency rates were high for sample size(39.0%,16/41),blinding(36.6%,15/41),and secondary outcome indicators(24.4%,10/41).Conclusion:The volume of acupuncture anesthesia clinical trials registered in international trial registries over the last 20 years is low,with insufficient disclosure of results.Postoperative nausea and vomiting as well as postoperative pain,are the most investigated for acupuncture intervention.展开更多
BACKGROUND Gastric cancer is a major global health issue,and the perioperative period critic-ally influences patient outcomes.The different effects of sevoflurane inhalation anesthesia and propofol total intravenous a...BACKGROUND Gastric cancer is a major global health issue,and the perioperative period critic-ally influences patient outcomes.The different effects of sevoflurane inhalation anesthesia and propofol total intravenous anesthesia on intraoperative stability,postoperative complications,and long-term oncologic outcomes in patients with gastric cancer undergoing radical gastrectomy remain unclear.AIM To compare the effects of sevoflurane inhalation anesthesia and propofol total in-travenous anesthesia on clinical outcomes,including intraoperative indicators,postoperative complications,adverse effects,pain scores,and survival.METHODS This single-center retrospective cohort study included 204 patients who underw-ent radical gastrectomy for gastric cancer from February 2019 to December 2022.Patients were assigned to either the sevoflurane group(n=103)or the propofol group(n=101)based on intraoperative anesthetic regimen.Standardized protoc-ols for anesthesia management,intraoperative monitoring,and postoperative analgesia were applied.Baseline characteristics;intraoperative metrics;adverse events;complications;Visual Analog Scale(VAS)scores at 2,4,6,24,and 48 hours;and survival outcomes were retrospectively collected.Group comparisons were performed usingχ2 for categorical variables,t test for continuous variables,RESULTS Baseline demographic and clinical characteristics were similar between groups.No significant differences were observed in intraoperative indicators or most 30-day postoperative outcomes,including length of stay,emergency department visits,and readmission rates.The propofol group showed elevated mean VAS pain score at 24 hours postoperatively,but no differences were found at other time points.The propofol group also had significantly higher postoperative nausea incidence and transiently higher systolic/diastolic blood pressure and heart rate at the time of incision than the sevoflurane group.No significant differences were seen in overall rates or severity of postoperative complications,intraoperative adverse events,or in overall survival and progression-free survival.CONCLUSION In patients undergoing radical gastrectomy for gastric cancer,sevoflurane and propofol anesthesia demonstrated similar profiles regarding intraoperative safety,postoperative complications,adverse events,postoperative pain,and long-term survival.The selection of anesthesia can be personalized without significantly affecting periop-erative or oncologic outcomes.展开更多
Conventional open-loop deep brain stimulation(DBS)systems with fixed parameters fail to accommodate interindividual pathological differences in Parkinson's disease(PD)management while potentially inducing adverse ...Conventional open-loop deep brain stimulation(DBS)systems with fixed parameters fail to accommodate interindividual pathological differences in Parkinson's disease(PD)management while potentially inducing adverse effects and causing excessive energy consumption.In this paper,we present an adaptive closed-loop framework integrating a Yogi-optimized proportional–integral–derivative neural network(Yogi-PIDNN)controller.The Yogi-augmented gradient adaptation mechanism accelerates the convergence of general PIDNN controllers in high-dimensional nonlinear control systems while reducing control energy usage.In addition,a system identification method establishes input–output dynamics for pre-training stimulation waveforms,bypassing real-time parameter-tuning constraints and thereby enhancing closed-loop adaptability.Finally,a theoretical analysis based on Lyapunov stability criteria establishes a sufficient condition for closed-loop stability within the identified model.Computational validations demonstrate that our approach restores thalamic relay reliability while reducing energy consumption by(81.0±0.7)%across multi-frequency tests.This study advances adaptive neuromodulation by synergizing data-driven pre-training with stability-guaranteed real-time control,offering a novel framework for energy-efficient and personalized Parkinson's therapy.展开更多
基金supported by the National Key R esearch and Development Program of China(No.2023YFF0724300)the National Natural Science Foundation of China(No.32171373)+1 种基金the Fundamental Research Funds for the Central Universities(No.YG2025QNB08)the Natural Science Foundation of Shanghai(No.23ZR1414500).
文摘Microneedle technology has undergone a paradigm shift from basic transdermal drug delivery to intelligent,closed-loop theranostic systems.Hydrogel materials have emerged as core carriers due to their excellent biocompatibility,efficient drug loading capacity,and improved patient compliance.Moreover,critical bottlenecks in hydrogel microneedles,including poor mechanical strength,burst release of drugs,and delayed response to treatment,can be addressed via cross-scale integration of nanomaterials.This review systematically outlines several multiscale engineering strategies to overcome these limitations.The construction of nanotopological networks coupled with dynamic crosslinking modulation synergistically enhances the mechanical properties,stability of drug loading,and conductivity of hydrogel microneedles.Furthermore,responsive nanocarriers equipped with biosensors help establish a closed-loop linkage between monitoring and therapeutic functions.We highlight their synergistic theranostic advantages in scenarios such as wound regulation and tumor-immune microenvironments,while revealing the role in integrating flexible electronics with wearable systems in intelligent medicine.We also summarize the research advances on the biosafety and scalable manufacturing processes of nanocomposite hydrogel m icroneedles(NHMNs),providing examples of clinical translation to elucidate the path from fundamental research to industrial implementation.As a convergence of nanotechnology,biomaterials,and flexible electronics,NHMNs provide new standards for transdermal theranostics as well as a roadmap for iterative advancement of intelligent theranostic devices in personalized medicine.Their cross-scale collaborative design,which spans from the properties of materials to the functional integration of macroscopic devices,can facilitate potential breakthroughs in next-generation closed-loop theranostic systems.
文摘BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.
基金supported by grants from the Shanghai Municipal Health Commission(2023ZDFC0203)the National Natural Science Foundation of China(32171044).
文摘General anesthesia,pivotal for surgical procedures,requires precise depth monitoring to mitigate risks ranging from intraoperative awareness to postoperative cognitive impairments.Traditional assessment methods,relying on physiological indicators or behavioral responses,fall short of accurately capturing the nuanced states of unconsciousness.This study introduces a machine learning-based approach to decode anesthesia depth,leveraging EEG data across different anesthesia states induced by propofol and esketamine in rats.Our findings demonstrate the model’s robust predictive accuracy,underscored by a novel intrasubject dataset partitioning and a 5-fold cross-validation method.The research diverges from conventional monitoring by utilizing anesthetic infusion rates as objective indicators of anesthesia states,highlighting distinct EEG patterns and enhancing prediction accuracy.Moreover,the model’s ability to generalize across individuals suggests its potential for broad clinical application,distinguishing between anesthetic agents and their depths.Despite relying on rat EEG data,which poses questions about real-world applicability,our approach marks a significant advance in anesthesia monitoring.
文摘BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.
文摘BACKGROUND Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections(CSs),but ropivacaine has emerged as a potential alter-native.This meta-analysis compares the efficacy and safety of intrathecal hyper-baric bupivacaine vs hyperbaric ropivacaine for cesarean sections.AIM To systematically evaluate and compare the efficacy and safety of intrathecal hyperbaric bupivacaine and hyperbaric ropivacaine for spinal anesthesia in CSs.METHODS A thorough search of electronic databases was carried out to find pertinent randomized controlled trials(RCTs)comparing intrathecal hyperbaric ropi-vacaine and hyperbaric bupivacaine during CSs.PubMed,Cochrane database,Google Scholar,and Scopus were searched,and papers from January 2000 to January 2024 were deemed eligible and filtered using predetermined inclusion and exclusion criteria.Studies were assessed for methodological quality,and data were extracted for time to adequate anesthesia(sensory and motor blockade),duration of sensory and motor block,hemodynamic changes and side effect profile.The standardized mean difference with 95%CI was used for continuous data.Dichotomous variables were assessed using the Mantel-Haenszel test and the random effect model to compute the odds ratio.RESULTS Total 8 RCTs were selected from a pool of 119 search results for meta-analysis.The meta-analysis evaluated pooled effect sizes and assessed heterogeneity among the studies.The primary objective was to compare key outcomes to identify any significant variances in efficacy and safety profiles between two local anesthetics.The analysis revealed that the difference in the onset of sensory blockade between the two local anesthetics was statistically insignificant(P=0.1586).However,the onset of motor blockade appeared to be faster with bupivacaine(P=0.03589).Additionally,the regression of sensory and motor blockade occurred earlier in the ropivacaine group.Furthermore,the duration of the first analgesic effect was shorter with a significance level of P<0.05.Regarding side effects profile,including hypotension,nausea,and shivering,the study did not observe any significant differences between the two groups.CONCLUSION This meta-analysis offers insights into the effectiveness and safety of hyperbaric bupivacaine vs ropivacaine for cesarean sections.Hyperbaric ropivacaine had a comparable safety profile and faster regression of sensory and motor blockade than hyperbaric bupivacaine,perhaps aiding early mobilization of parturient and facilitating mother-child bonding.Choosing ropivacaine may offer benefits beyond efficacy for cesarean section patients and short surgical procedures.
文摘Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environment. Methods: This is a cross-sectional study carried out at Monkole hospital from May 2016 to May 2023. It concerns patients anesthetized for laparoscopic surgery. Perianesthetic data were collected and analyzed with SPSS 26.0 for p Results: Eighty-four patients (4.2%) were selected out of 2000 eligible patients. The median age was 31 years, the range between 15 and 30 years (40.5%), female gender and approved patients (70.3%) predominated. Comorbidities were: sickle cell disease, high blood pressure, thinness and obesity. The ASA class was: I (35.2%), II (36.3%) and III (28.6%). Anesthesia was general with intubation for all patients. Generally, the surgery lasted less than two hours and the anesthesia lasted more than two hours. Postoperative analgesia used morphine in 27.5%. The operative indications were dominated by lithiasis with or without cholecystitis (48.4%) and appendicitis (16.5%). Intraoperative complications (18.7%) were: hypotension, allergy, spasm, accidental gallbladder and bile duct perforation. Postoperative complications (9.9%) were: anemia, digestive fistula, septic shock, multi-organ failure, acute lung edema and two deaths. Alcohol consumption was associated with intraoperative complications. Anesthesia duration greater than two hours, ASA3 class, alcohol consumption and cholecystectomy were associated with postoperative complications. Conclusion: Celiosurgery is not yet established in Monkole probably due to the lack of permanent surgeons and the higher cost than open surgery.
文摘Objective: This study evaluates the impact of handshake and information support on patients’ outcomes during laparoscopic cholecystectomy. It examines the effects on their physiological and psychological responses and overall satisfaction with nursing care. Methods: A total of 84 patients scheduled for laparoscopic cholecystectomy were selected through convenient sampling and randomly assigned to either the control group or the intervention group using a random number table. Each group consisted of 42 patients. The control group received standard surgical nursing care. In addition to standard care, the intervention group received handshake and information support from the circulating nurse before anesthesia induction. Vital signs were recorded before surgery and before anesthesia induction. Anxiety levels were measured using the State-Trait Anxiety Inventory (STAI) and the State-Anxiety Inventory (S-AI), while nursing satisfaction was assessed using a numerical rating scale. Results: No significant differences were found between the two groups in systolic and diastolic blood pressures before surgery and anesthesia induction (P > 0.05). However, there was a significant difference in heart rate before anesthesia induction (P Conclusion: Providing handshake and information support before anesthesia induction effectively reduces stress, alleviates anxiety, and enhances comfort and satisfaction among patients undergoing laparoscopic cholecystectomy.
文摘Background:Ketamine is a widely used anesthetic in animal research,but its use is strictly regulated in several countries,including Japan and China.As an alternative,the medetomidine-midazolam-butorphanol(MMB)combination is commonly used in Japan.However,medetomidine is a racemic mixture containing the inactive Renantiomer,which may reduce anesthetic predictability and safety.Objective:The aim of the study was to evaluate the efficacy and safety of a modified anesthetic combination(d MMB),in which dexmedetomidine replaces medetomidine,across three commonly used mouse strains(ICR,C57BL/6,BALB/c).Methods:Male and female mice were administered either MMB or d MMB subcutaneously.Anesthetic depth,recovery profiles,heart rate,SpO_(2),body temperature,ocular opacity,and blood glucose levels were assessed.Atipamezole was used to reverse anesthesia,and thermoregulatory recovery was monitored postinjection.Results:d MMB produced similar anesthetic depth to MMB,with faster and more consistent recovery,particularly in males.Body temperature recovery was significantly enhanced in d MMB-treated B6 males.No significant differences in side effects(ocular opacity or blood glucose levels)were observed between protocols,though strainspecific glucose elevations were noted in d MMB-treated males.Conclusion:d MMB is a safe,effective,and ketamine-free injectable anesthetic protocol,offering advantages in recovery and thermoregulation.It may be a valuable alternative in research settings where ketamine is restricted and medetomidine may become unavailable.
文摘Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendicitis from February 2022 to February 2025 were selected as samples and randomly divided into two groups.The study group received combined spinal-epidural anesthesia,while the control group received epidural anesthesia.Anesthesia indicators,vital signs,and complication indicators were compared between the two groups.Results:The onset time of anesthesia in the study group was shorter than that in the control group,the visual analog scale(VAS)score was lower than that in the control group,and the highest plane of anesthesia block was lower than that in the control group(P<0.05).At 15 minutes after anesthesia induction and at the end of surgery,the heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(SPO2)in the study group were significantly different from those in the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).Conclusion:Combined spinal-epidural anesthesia for appendicitis surgery can reduce the impact of anesthesia on vital signs,shorten the onset time of anesthesia,and is highly effective and feasible.
基金supported by the National Research Foundation of Korea(NRF)grant funded by the Korean government(MSIT)(No.2020R1C1C1005567)supported by the NAVER Digital Bio Innovation Research Fund,funded by NAVER Corporation(Grant No.[37-2023-0040])+3 种基金supported by Institute of Information&communications Technology Planning&Evaluation(IITP)grant funded by the Korea government(MSIT)(No.2020-0-00261,Development of low power/low delay/self-power suppliable RF simultaneous information and power transfer system and stretchable electronic epineurium for wireless nerve bypass implementation)supported by Institute for Basic Science(IBS-R015-D1,IBSR015-D2)supported by a grant of the Korea-US Collaborative Research Fund(KUCRF)funded by the Ministry of Science and ICT and Ministry of Health&Welfare,Republic of Korea(Grant Number.RS-2024-00467213)。
文摘Prosthetic devices designed to assist individuals with damaged or missing body parts have made significant strides,particularly with advancements in machine intelligence and bioengineering.Initially focused on movement assistance,the field has shifted towards developing prosthetics that function as seamless extensions of the human body.During this progress,a key challenge remains the reduction of interface artifacts between prosthetic components and biological tissues.Soft electronics offer a promising solution due to their structural flexibility and enhanced tissue adaptability.However,achieving full integration of prosthetics with the human body requires both artificial perception and efficient transmission of physical signals.In this context,synaptic devices have garnered attention as next-generation neuromorphic computing elements because of their low power consumption,ability to enable hardware-based learning,and high compatibility with sensing units.These devices have the potential to create artificial pathways for sensory recognition and motor responses,forming a“sensory-neuromorphic system”that emulates synaptic junctions in biological neurons,thereby connecting with impaired biological tissues.Here,we discuss recent developments in prosthetic components and neuromorphic applications with a focus on sensory perception and sensorimotor actuation.Initially,we explore a prosthetic system with advanced sensory units,mechanical softness,and artificial intelligence,followed by the hardware implementation of memory devices that combine calculation and learning functions.We then highlight the importance and mechanisms of soft-form synaptic devices that are compatible with sensing units.Furthermore,we review an artificial sensory-neuromorphic perception system that replicates various biological senses and facilitates sensorimotor loops from sensory receptors,the spinal cord,and motor neurons.Finally,we propose insights into the future of closed-loop neuroprosthetics through the technical integration of soft electronics,including bio-integrated sensors and synaptic devices,into prosthetic systems.
文摘BACKGROUND Administering anesthesia to elderly patients undergoing gastroenteroscopy necessitates careful attention due to age-related physiological changes and an increased risk of complications.AIM To analyze the research trends in anesthesia management for elderly patients undergoing gastroenteroscopy.METHODS We performed a literature search using the Web of Science database to identify articles published between 2004 and 2023.Bibliometric and visual analyses were conducted using CiteSpace,R,and VOSviewer to explore the current research landscape of anesthesia administration in painless gastroenteroscopy for elderly patients and to identify future research directions by examining trends and emerging hotspots in this domain.RESULTS A total of 800 articles were examined,revealing a rising trend in annual pub-lication counts.The United States led with 181 articles,followed by China with 112,collectively contributing over 35%of the studies among the top ten countries.The majority of publications appeared in the United States journals,with the top three being Gastrointestinal Endoscopy[impact factor(IF)=7.7,H-index=26],Digestive Diseases and Sciences(IF=3.1),and Endoscopy(IF=9.3).Six primary research clusters were identified:Obstructive sleep apnea and airway manage-ment,surveillance and risk factors,colorectal cancer examination and treatment,sedation and safety of propofol and midazolam,patient satisfaction,and mortality and complications.These findings underscore the pivotal focus areas in anesthesia for elderly patients undergoing gastroenteroscopy.CONCLUSION A comprehensive understanding of current research trends and hotspots will aid anesthesiologists in developing more evidence-based practices,thereby improving the safety and outcomes for elderly patients undergoing gastroenteroscopy.
文摘BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outcomes.AIM To investigate the impact of music therapy and anesthesia recovery care on anesthesia recovery in patients with CRC undergoing laparoscopic radical resection.METHODS One hundred and twenty patients scheduled for elective laparoscopic CRC radical resection at Affiliated Hospital of Jiangnan University from January 2022 to May 2024 were enrolled.The patients were assigned to control(n=60,receiving standard nursing care)and observation groups(n=60,receiving music therapy,anesthesia recovery care,and standard nursing care).We comparatively analyzed the time to regain consciousness,extubation time,and length of stay in the postanesthesia care unit;heart rate,systolic blood pressure,and diastolic blood pressure before anesthesia and during recovery;cortisol,aldosterone,norepinephrine,and adrenaline levels before anesthesia and 24 hours postoperatively;Postoperative Quality of Recovery Scale scores;and complication rates between the groups.RESULTS The observation group exhibited a significantly shorter time to regain consciousness,extubation time,and postanesthesia care unit stay than the control group(P<0.05).During the recovery period,heart rate,systolic blood pressure,and diastolic blood pressure significantly increased in both groups compared with preanesthesia levels,with the levels in the observation group being significantly lower than those in the control group(P<0.05).At 24 hours postoperatively,cortisol,aldosterone,norepinephrine,and adrenaline levels were elevated in both groups compared with preanesthesia levels,with levels in the observation group being significantly lower than those in the control group(P<0.05).The observation group achieved significantly higher Postoperative Quality of Recovery Scale scores than the control group(P<0.05).Moreover,the complication rate in the observation group was significantly lower than that in the control group(10.00%vs 40.00%,P<0.05).CONCLUSION Music therapy combined with anesthesia recovery care remarkably boosted the quality of anesthesia recovery in patients undergoing laparoscopic CRC radical resection,mitigated fluctuations in vital signs and stress responses,improved postoperative recovery quality,and reduced complication rates,demonstrating substantial clinical value.
基金NIDCD(National Institute of Deafness and Other Communication Disorders),Grant/Award Number:K08 DC019957。
文摘The current anesthetic standard for laryngoscopy in rats utilizes injectable intraperitoneal anesthesia.Injectable anesthesia is suboptimal for short procedures due to variability in anesthesia duration and anesthetic side effects.Conversely,inhalational gas anesthesia offers precise titration with a rapid onset and offset.However,its use during laryngoscopy has not been documented due to existing administration techniques obstructing direct visualization of the larynx.The technique described here allows real-time visualization of the rat larynx with concurrent administration of inhaled anesthetic gas.This method is particularly well-suited for recurrent laryngeal nerve or vocal fold pathology studies,where repeat visualization of the larynx is necessary.
基金supported by the Opening Foundation of China National Logging Corporation(CNLC20229C06)the China Petroleum Technical Service Corporation's science project'Development and application of 475 rotary steering system'(2024T-001001)。
文摘Rotary steering systems(RSSs)have been increasingly used to develop horizontal wells.A static push-the-bit RSS uses three hydraulic modules with varying degrees of expansion and contraction to achieve changes in the pushing force acting on the wellbore in different sizes and directions within a circular range,ultimately allowing the wellbore trajectory to be drilled in a predetermined direction.By analyzing its mathematical principles and the actual characteristics of the instrument,a vector force closed-loop control method,including steering and holding modes,was designed.The adjustment criteria for the three hydraulic modules are determined to achieve rapid adjustment of the vector force.The theoretical feasibility of the developed method was verified by comparing its results with the on-site application data of an imported rotary guidance system.
基金Supported by the Health Commission of Hunan Province,No.202204115263the Fundamental Research Funds for the Central Universities of Central South University,No.2024XQLH027.
文摘BACKGROUND In the field of anesthesia for procedure for prolapse and hemorrhoids(PPH)surgery,combined spinal-epidural(CSE)anesthesia has been a common approach.However,exploring new combinations to optimize patient outcomes remains crucial.Remimazolam,a short-acting benzodiazepine,shows potential for improving sedation and reducing patient anxiety.The effects of combining remimazolam with CSE anesthesia,compared to traditional CSE anesthesia alone,on patient anxiety,sedation depth,and hemodynamics during PPH surgery have not been fully elucidated.AIM To compare remimazolam-CSE vs CSE alone on State-Trait Anxiety Inventory-State scale(STAI-S)scores,sedation,and hemodynamics in PPH surgery.METHODS This study is a single-center,prospective,randomized controlled trial.Between November 23,2022,and August 6,2024,60 eligible patients were randomly assigned to the CSE anesthesia group or the remimazolam-combined CSE anesthesia group(30 patients each).STAI-S scores,Ramsay sedation scores,and hemodynamic parameters(systolic blood pressure,diastolic blood pressure,heart rate)were measured at multiple time points.Two-way mixed-effects ANOVA and posthoc analyses were performed.RESULTS The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room[mean:28.80 vs 54.03,mean difference(95%CI):25.23(21.24-29.23),P<0.001]and 24 hours post-operation[mean:45.07 vs 54.53,mean difference(95%CI):9.47(6.29-12.64),P<0.001]than the CSE group.Moreover,the Combined group achieved a deeper sedation level during intraoperative maintenance[median:5.00(IQR:5.00-5.00)vs 2.00(IQR:2.00-2.00);median difference(95%CI):3.00(3.00-3.00),P<0.001].Regarding hemodynamics,a significant intergroup difference in systolic blood pressure was observed at the start of the surgery[mean:128.8 vs 114.7 for the Combined and CSE groups,mean difference(95%CI):14.17(0.77-27.57),adjusted P=0.033].CONCLUSION Remimazolam-combined anesthesia outperformed CSE anesthesia in reducing STAI-S scores,enhancing intraoperative sedation,and stabilizing systolic blood pressure at a critical stage,indicating its superiority in perioperative management.
基金the Shanghai Acupuncture Clinical Medical Research Center project(No.20MC1920500)National Key Disciplines Construction Project of High-level Traditional Chinese Medicine of China(No.zyyzdxk-2023068)+1 种基金National Natural Science Foundation of China(No.82074163)Shanghai Science and Technology Commission Project(No.21Y31920100)。
文摘The evolution of acupuncture anesthesia(AA)has spanned six decades.Cardiothoracic surgery serves as a representative case study to illustrate this evolution.Reflecting on its historical development,the use of AA in cardiothoracic surgery has advanced from basic AA procedures in the 1960s to combined acupuncture and drug anesthesia techniques in the early 1980s.Since 2005,the innovative use of non-intubation AA combined anesthesia has been implemented extensively in cardiothoracic surgery.As the medical industry continues to evolve,the techniques applied in AA have expanded to encompass the entire perioperative period in cardiothoracic surgery,leading to the introduction of the concept of modern AA.The use of AA in cardiothoracic surgery exemplifies the ongoing advances and integration of traditional Chinese and Western medicine.Moving forward,it is imperative to enhance the theoretical framework of AA through the execution of rigorous multicenter clinical trials,to further strengthen the body of evidence supporting evidence-based medicine,and to finally explore the underlying mechanisms of AA.
文摘Background:During the establishment of a model of acute kidney injury(AKI)in pigs,we observed a high prevalence of malignant hyperthermia(MH).These complications led us to refine the anesthetic protocol.This publication describes the impact of the choice of anesthetics on the results obtained.Methods:Pigs were euthanized at the end of the procedure,without recovery from anesthesia.Three anesthetic protocols were used:sevoflurane inhalation(ProtocolA,n=5),a combination of ketamine,medetomidine and diazepam by intravenous infusion(ProtocolB,n=5),and a combination of ketamine,diazepam,medetomidine,glucose,and noradrenaline(ProtocolC,n=5).All pigs received morphine for analgesia.AKI was induced by interrupting renal perfusion for 90 min.MH was diagnosed based on clinical and biological parameters.Results:All MH pigs belonged to ProtocolA.MH pigs showed significantly higher maximum rectal temperature(p=0.04),maximum expired carbon dioxide(CO_(2);p=0.04),maximum heart rate(HR;p=0.03),plasma concentration of creatinine and potassium(p<0.0001).Protocol A pigs had a significantly higher maximum HR(p=0.01)and hyperkalemia compared to the two other groups(ProtocolB,p=0.005 and ProtocolC,p<0.0001).Pigs from ProtocolA had a significantly lower minimum mean arterial pressure(MAP)than ProtocolC group(p=0.03)and MAP remained below 60 mmHg for longer(p=0.004).In ProtocolB,minimum glycemia was lower than other groups(p=0.01).Conclusion:Sevoflurane use was associated with the occurrence of MH,hemodynamic alterations and changes in plasma concentration of creatinine and potassium.These modifications can have a major impact on the validation of an experimental AKI model.
基金supported by grants from Shanghai Municipal Health Commission and Shanghai Municipal Administration of TCM—Standardization of TCM in 2023“Clinical Practice Guide for Combined Acupuncture-Drug Anesthesia”(No.2023JS05)Shanghai Clinical Medical Research Center of Acupuncture and Moxibustion(No.20MC1920500)+1 种基金Shanghai master Chinese medicine practitioners academic experience research studio construction project(No.SHGZS-202212)Shanghai Key Clinical Specialties 2019 Accreditation Program(No.shslczdzk04701)。
文摘Background:Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia.However,some clinical studies of acupuncture anesthesia lack specific descriptions of randomization,allocation concealment,and blinding processes,with subsequent systematic reviews indicating a risk of bias.Objective:Clinical trial registration is essential for the enhancement of the quality of clinical trials.This study aims to summarize the status of clinical trial registrations for acupuncture anesthesia listed on the World Health Organization International Clinical Trials Registry Platform(ICTRP).Search strategy:We searched the ICTRP for clinical trials related to acupuncture anesthesia registered between January 1,2001 and May 31,2023.Additionally,related publications were retrieved from PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data.Registrations and publications were analyzed for consistency in trial design characteristics.Inclusion criteria:Clinical trials that utilized one of several acupuncture-related therapies in combination with pharmacological anesthesia during the perioperative period were eligible for this review.Data extraction and analysis:Data extracted from articles included type of surgical procedure,perioperative symptoms,study methodology,type of intervention,trial recruitment information,and publication information related to clinical enrollment.Results:A total of 166 trials related to acupuncture anesthesia from 21 countries were included in the analysis.The commonly reported symptoms in the included studies were postoperative nausea and vomiting(19.9%)and postoperative pain(13.3%).The concordance between the publications and the trial protocols in the clinical registry records was poor,with only 31.7%of the studies being fully compatible.Inconsistency rates were high for sample size(39.0%,16/41),blinding(36.6%,15/41),and secondary outcome indicators(24.4%,10/41).Conclusion:The volume of acupuncture anesthesia clinical trials registered in international trial registries over the last 20 years is low,with insufficient disclosure of results.Postoperative nausea and vomiting as well as postoperative pain,are the most investigated for acupuncture intervention.
文摘BACKGROUND Gastric cancer is a major global health issue,and the perioperative period critic-ally influences patient outcomes.The different effects of sevoflurane inhalation anesthesia and propofol total intravenous anesthesia on intraoperative stability,postoperative complications,and long-term oncologic outcomes in patients with gastric cancer undergoing radical gastrectomy remain unclear.AIM To compare the effects of sevoflurane inhalation anesthesia and propofol total in-travenous anesthesia on clinical outcomes,including intraoperative indicators,postoperative complications,adverse effects,pain scores,and survival.METHODS This single-center retrospective cohort study included 204 patients who underw-ent radical gastrectomy for gastric cancer from February 2019 to December 2022.Patients were assigned to either the sevoflurane group(n=103)or the propofol group(n=101)based on intraoperative anesthetic regimen.Standardized protoc-ols for anesthesia management,intraoperative monitoring,and postoperative analgesia were applied.Baseline characteristics;intraoperative metrics;adverse events;complications;Visual Analog Scale(VAS)scores at 2,4,6,24,and 48 hours;and survival outcomes were retrospectively collected.Group comparisons were performed usingχ2 for categorical variables,t test for continuous variables,RESULTS Baseline demographic and clinical characteristics were similar between groups.No significant differences were observed in intraoperative indicators or most 30-day postoperative outcomes,including length of stay,emergency department visits,and readmission rates.The propofol group showed elevated mean VAS pain score at 24 hours postoperatively,but no differences were found at other time points.The propofol group also had significantly higher postoperative nausea incidence and transiently higher systolic/diastolic blood pressure and heart rate at the time of incision than the sevoflurane group.No significant differences were seen in overall rates or severity of postoperative complications,intraoperative adverse events,or in overall survival and progression-free survival.CONCLUSION In patients undergoing radical gastrectomy for gastric cancer,sevoflurane and propofol anesthesia demonstrated similar profiles regarding intraoperative safety,postoperative complications,adverse events,postoperative pain,and long-term survival.The selection of anesthesia can be personalized without significantly affecting periop-erative or oncologic outcomes.
基金supported by the National Natural Science Foundation of China(Grant Nos.12372064 and 12172291)the Youth and Middle-Aged Science and Technology Development Program of Shanghai Institute of Technology(Grant No.ZQ2024-10)。
文摘Conventional open-loop deep brain stimulation(DBS)systems with fixed parameters fail to accommodate interindividual pathological differences in Parkinson's disease(PD)management while potentially inducing adverse effects and causing excessive energy consumption.In this paper,we present an adaptive closed-loop framework integrating a Yogi-optimized proportional–integral–derivative neural network(Yogi-PIDNN)controller.The Yogi-augmented gradient adaptation mechanism accelerates the convergence of general PIDNN controllers in high-dimensional nonlinear control systems while reducing control energy usage.In addition,a system identification method establishes input–output dynamics for pre-training stimulation waveforms,bypassing real-time parameter-tuning constraints and thereby enhancing closed-loop adaptability.Finally,a theoretical analysis based on Lyapunov stability criteria establishes a sufficient condition for closed-loop stability within the identified model.Computational validations demonstrate that our approach restores thalamic relay reliability while reducing energy consumption by(81.0±0.7)%across multi-frequency tests.This study advances adaptive neuromodulation by synergizing data-driven pre-training with stability-guaranteed real-time control,offering a novel framework for energy-efficient and personalized Parkinson's therapy.
