Objective To investigate the influence of plasma infusion during orthotopic liver transplantation on the incidence of acute kidney injury (AKI) in recipients. Methods Cinical data of 473 liver transplant recipients who underwent orthotopic liver transplantation at Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2016 to December 2020 were retrospectively collected. The study included 354 recipients who received plasma infusion during the operation (plasma group) and 119 recipients who did not receive plasma infusion during the operation (control group). Preoperative conditions, donor conditions, intraoperative conditions, main outcome indicators and secondary outcome indicators of the two groups were analyzed and compared. Receiver operating characteristic curve was drawn to calculate the maximum cut-off value of intraoperative plasma infusion volume that affected the occurrence of AKI within 7 days after surgery. Logistic regression analysis was performed to analyze the correlation between intraoperative plasma infusion volume and the incidence of AKI within 7 days after surgery. Results Before propensity score matching, the incidence of AKI within 7 days after surgery and the incidence of grade Ⅲ AKI in the plasma group were higher than those in the control group (both P<0.05). After propensity score matching, 62 recipients were included in each group. There was no statistically significant difference in the incidence of AKI within 7 days after surgery between the plasma group and the control group, but the incidence of grade Ⅲ AKI within 7 days after surgery in the plasma group was higher than that in the control group (P=0.041). Logistic regression analysis showed that intraoperative plasma infusion volume >900 mL was a potential risk factor for AKI within 7 days after surgery (odds ratio=1.936, 95% confidence interval 1.193-3.142, P=0.007). There were no statistically significant differences in the incidence of 365-day postoperative fatality, reperfusion syndrome, and postoperative 30-day complications between the two groups before and after propensity score matching. In addition, the postoperative albumin, fibrinogen levels, and international normalized ratio in the plasma group were better than those in the control group before and after matching (all P<0.05). Conclusions Large amount of intraoperative plasma infusion is associated with an increased risk of grade Ⅲ AKI after orthotopic liver transplantation. Intraoperative plasma infusion volume >900 mL may increase the risk of AKI within 7 days after surgery.

Objective To investigate the risk factors for postoperative pulmonary infection in pa-tients undergoing liver transplantation.Methods Clinical data of 1 358 patients who underwent liver trans-plantation for the first time from June 2005 to June 2013 at three clinical medical centers were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed lung infection within 30 days after surgery:the infection group and the non-infection group.General,intrao-perative and postoperative data were collected,and risk factors for pulmonary infection after liver transplan-tation were analyzed using univariate analysis and binary logistic regression.Results Lung infections after liver transplantation occurred in 316 patients(23.3%),of whom 21 patients(6.7%)died.Compared with the non-infection group,the proportion of preoperative diagnosis of chronic severe hepatitis,hepatocellular carcinoma,hepatitis C cirrhosis,congenital liver disease and liver failure,preoperative combined hepatore-nal syndrome,hepatic coma and diabetes mellitus,preoperative creatinine concentration were significantly increased in the infection group(P＜0.05),preoperative total protein and albumin concentrations were significantly decreased(P＜0.05),and the duration of the hepatic-free period,the duration of postoperative awakening,and the duration of postoperative extubation were significantly prolonged(P＜0.05),intraoperative blood loss was significantly increased(P＜0.05),intraoperative urine output was significantly decreased(P＜0.05),the proportion of intraoperative phenylephrine,atropine,lidocaine,and furosemide drugs were significantly decreased(P＜0.05),and postoperative mortality rate was signifi-cantly increased in the infection group(P＜0.05).The results of binary logistic regression analysis showed that chronic severe hepatitis,hepatitis C cirrhosis,liver failure,preoperative diabetes mellitus,intraopera-tive blood loss＞1 900 ml,and postoperative awakening time＞7.3 hours were the risk factors for postoper-ative pulmonary infections in liver transplant patients,and the surgical method(classical non-transfusion in situ liver transplantation),the use of lidocaine during surgery,preoperative total protein＞64.6 g/L,and intraoperative urine volume＞1 800 ml were protective factors for postoperative pulmonary infections in liver transplantation patients.Conclusion Preoperative diagnosis of chronic severe hepatitis,hepatitis C cirrho-sis,liver failure,preoperative combined diabetes mellitus,intraoperative blood loss＞1 900 ml,and post-operative awakening time＞7.3 hours are risk factors for pulmonary infection after liver transplantation.

The effective analysis of electroencephalography(EEG)data to objectively reflect the changes of nociception has been a hot topic of research in recent years.The incidence of moderate to severe postoperative acute pain remains high.Postoperative acute pain seriously affects patients'physical and psy-chological health,yet there is no objective gold standard for measuring perioperative nociception to guide perioperative analgesia.The results of current studies on the characteristics of EEG changes during nociception are contradictory.This paper presents the EEG characteristics of nociception in order to provide a reference for future research design.

Perioperative neurocognitive disorders(PND)are common perioperative diseases,which bring heavy burden to patients and society.Due to complex pathogenesis of PND and the lack of relia-ble diagnosis and intervention means,and electroencephalography(EEG)and magnetic resonance imaging(MRI)have the advantage of providing objective indicators,so their application in the study of PND has gradually become a hot topic.In this review,the intraoperative processed EEG indices,EEG spectral analy-sis,EEG functional connectivity analysis,EEG nonlinear dynamics analysis,and perioperative MRI analysis in patients with PND are reviewed,aiming to explore the clinical value of EEG and MRI in predic-ting and diagnosing PND.

Objective To investigate the effect of transcutaneous electrical acupoint stimulation(TEAS)on emergence agitation(EA)in children undergoing selective posterior rhizotomy(SPR).Methods Forty-two children with cerebral palsy undergoing SPR were selected,20 males and 22 females,aged 6-12 years,BMI 13-24 kg/m2,ASA physical status Ⅰ or Ⅱ,randomly divided into two groups:TEAS group(group T)and control group(group C),21 children in each group.Children in group T re-ceived TEAS at the bilateral acupoints of Neiguan and Hegu from 30 minutes before anesthesia induction to the end of surgery.In group C,electrodes were placed on the same acupoints without electrical stimulation.All children in both groups received total intravenous anesthesia.HR and MAP were recorded at the time of entry,extubation,5,15,30 minutes after extubation.The consumption of remifentanil and propofol during the procedure were recorded.The time of operation and extubation were recorded.The Wong-Baker faces pain scale-revised(FPS-R)and the pediatric anesthesia emergence delirium(PAED)were recorded at 15 minutes after extubation,and the incidence of EA was assessed by PAED.While,the occurrence of post-operative nausea and vomiting(PONV)was recorded.Results Compared with that at the time of entry,HR at the time of extubation,5,15 minutes after extubation and MAP at the time of extubation,5,15,30 minutes after extubation in group C were significantly increased(P＜0.05),HR and MAP at the time of extubation,5,15 minutes after extubationin group T were significantly increased(P＜0.05).Compared with group C,HR was significantly slower and MAP was significantly lower in group T at the time of extuba-tion,5,15,30 minutes after extubation(P＜0.05).Compared with group C,the consumption of remifen-tanil during operation was reduced,the time of extubation was significantly shortened,the FPS-R and PAED were significantly decreased,and the incidence of EA were significantly reduced(P＜0.05).There were no significant differences in the time of operation,the consumption of propofol during operation and the inci-dence of PONV.Conclusion TEAS is beneficial to prevent the occurrence of EA in pediatric patients un-dergoing SPR,stabilize hemodynamics,reduce the dosage of opioids during surgery,reduce the postopera-tive pain,andaccelerate the time of anesthesia resuscitation.

The exploration of anesthesia and consciousness has always been an important subject in neuroscience,but the underlying neural mechanisms of consciousness are still unclear,which limits the de-velopment of anesthesia monitoring and consciousness evaluation systems.The neural correlates of conscious-ness(NCC)cannot be determined by a single brain region or mechanism,suggesting that consciousness may arise from complex interactions of brain functions on space and time scales.In order to characterize these interactions,network science has been introduced in exploring the mechanisms of consciousness.In this paper,the basic concepts and common indicators of brain network research are introduced,and the lat-est progress of brain network research in anesthesia is reviewed,so as to provide new ideas for the applica-tion of brain network indicators in clinical monitoring and provide directions for the exploration of NCC.

In recent years,the rapid development of fascia plane block technique has played a cru-cial role in the development of multi-modal analgesic strategies in spinal surgery.Compared with traditional intraspinal anesthesia,fascia plane block has the advantages of simple operation,safety,good analgesic effect,no interference to intraoperative nerve monitoring and early postoperative inspection.In this artical,we reviewed the clinical application advances of fascia plane blocks commonly used in spinal surgery,such as transversal abdominis plane block(TAPB),thoracolumbar interfascial plane block(TLIPB),erector spinae plane block(ESPB),mid-point transverse process to pleura block(MTPB),multifidus plane block(MPB),and inter semispinal plane block(ISPB),in order to provide reference for multi-mode analgesia in spinal surgery.

Objective To evaluate the association between 5-factor modified frailty index(mFI-5)with prognosis in elderly patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods Retrospective data were collected from elderly patients who underwent OPCABG between January 2019 and May 2022.The patients were divided into three groups based on preoperative mFI-5:non frailty group(mFI-5=0),pre-frailty group(mFI-5=1),and frailty group(mFI-5 ≥2).Baseline,intraopera-tive,and prognostic indicators of the three groups were collected and compared.Multivariate(logistic re-gression and linear regression)analyses were used to evaluate the association between mFI-5 with prognosis in elderly patients undergoing OPCABG.Results A total of 244 patients were included in the analysis,in-cluding 35 patients(14.3％)in the non-frailty group,82 patients(33.6％)in the pre-frailty group,and 127 patients(52.1％)in the frailty group.Compared with the non-frailty group,the pre-frailty group had higher incidence of acute kidney injury(P＜0.05);the frailty group had lower preoperative LVEF and in-traoperative urine volume,and higher incidence of acute kidney injury and mortality(P＜0.05).Compared with the pre-frailty group,the frailty group had lower intraoperative urine volume,prolonged ICU stay,and higher incidence of mortality(P＜0.05).Multivariate logistic regression analysis showed that for every point increase in mFI-5,the length of stay in ICU was extended by 3.189 days(95％CI 1.457-4.920 days,P＜0.001),and the total length of stay was extended by 2.890 days(95％CI 1.070-4.709 days,P=0.002).Linear regression analysis showed that elevated mFI-5 was associated with complications during hospitalization,including acute kidney injury(OR=1.519,95％CI 1.076-2.145,P=0.017),pulmonary complications(OR=1.453,95％CI 1.075-1.965,P=0.015)and death(OR=3.730,95％CI 1.980-7.027,P＜0.001).Conclusion mFI-5 is a simple and practical screening tool for frail-ty,and using the mFI-5 scale for frailty assessment in elderly patients undergoing OPCABG can screen high-risk patients with poor prognosis during hospitalization.

Objective:To analyze the current status of internet-based patient education materials related to labor analgesia in China.Methods:Labor analgesia-related materials were retrieved and screened according to the search habits of Chinese search engine users. The coverage and accuracy of the content were evaluated by 3 anesthesiologists. The Chinese version of the Patient Education Materials Assessment Tool for Print Materials was used to subjectively assess comprehensibility and operability from a medical text perspective. The consistency of the evaluation results of the three anesthesiologists was analyzed using the intraclass correlation coefficient method. A machine learning method combined with ChatGPT-4.0 was employed to establish a Chinese readability classification model to objectively evaluate the readability difficulty of the included materials from a Chinese text perspective.Results:A total of 97 web pages were retrieved, with 21 valid materials included in the study. The coverage rate of contraindications for labor analgesia was only 62% (13/21), and the accuracy rate of materials exceeding 90% was 71% (15/21). Internet-based materials that were easy to understand accounted for 81% (17/21), while the constituent ratio of internet-based materials with instructional significance were only 5% (1/21). The intraclass correlation coefficient values of consistency evaluation for coverage rate, accuracy rate, and comprehensibility and operability were 0.975, 0.833, 0.758, and 0.773, respectively ( P<0.001). Internet-based materials suitable for compulsory education level were only 5% (1/21), while those suitable for high school and above education level accounted for 43% (9/21). Conclusions:There are numerous internet-based patient education materials related to labor analgesia in China, but the quality needs improvement. In the future, a collaborative model of " anesthesiology+ linguistics" should be developed to provide patients with more comprehensive, accurate, and pregnant-friendly patient education materials.

Objective:To evaluate the role of G-protein coupled receptor 37 (GPR37) in cognitive dysfunction in a mouse model of neuropathic pain.Methods:SPF-grade healthy male C57BL/6 mice and GPR37 knockout (GPR37-KO) mice, aged 3 months, with a body weight of approximately 20 g, were divided into 4 groups ( n=6 each) using a random number table method: control group (Con group), neuropathic pain group (NPP group), GPR37-KO+ control group (GPR37-KO Con group) and GPR37-KO+ neuropathic pain group (GPR37-KO NPP group). The mouse model of neuropathic pain was established by ligation of the sciatic nerve. The thermal paw withdrawal latency (TWL) and mechanical paw withdrawal threshold (MWT) were measured at 7 days after surgery. The open field test and Morris water maze test were performed at 28 days after surgery. The mice were subsequently sacrificed, and the medial prefrontal cortex (mPFC) was obtained for determination of the level of phosphorylated calcium/calmodulin-dependent protein kinase Ⅱ(p-CAMKⅡ) and expression of brain-derived neurotrophic factor (BDNF) and postsynaptic density protein 95 (PSD-95). Results:Compared to Con group, no significant changes were found in the parameters in GPR37-KO Con group ( P>0.05), and TWL was significantly shortened, MWT was decreased, the time the animal spent in central area was prolonged and the platform-crossing times were increased in the open field test, and the escape latency was prolonged and platform-crossing times were decreased in the Morris water maze test, and the expression of p-CAMKⅡ, BDNF and PSD-95 in the mPFC was down-regulated in NPP group ( P<0.05). Compared with NPP group, TWL was significantly shortened, MWT was decreased, the time the animal spent in central area was prolonged and the platform-crossing times were increased in the open field test, and the escape latency was prolonged and platform-crossing times were decreased in the Morris water maze test, and the expression of p-CAMKⅡ, BDNF and PSD-95 in the mPFC was down-regulated in GPR37-KO NPP group ( P<0.05). Conclusions:GPR37 is involved in the development of cognitive dysfunction in mice with neuropathic pain, and the mechanism may be related to its modulation of synaptic plasticity.