Neuraxial anesthesia is often challenging in patients with obesity, spinal deformity, prior spinal surgery, ankylosing spondylitis, or of advanced age, as conventional landmark-based techniques frequently fail in this population. Ultrasound guidance has improved puncture accuracy; however, commonly used approaches may still be limited by patient positioning and the side from which the operator prefers to work. We report five cases of extremely difficult neuraxial anesthesia in which the procedure was successfully performed using an ultrasound-guided paramedian sagittal long-axis out-of-plane approach. This technique allows continuous visualization of the lamina and the anterior–posterior complex, providing a short and direct puncture path with real-time guidance. All procedures were completed successfully on the first attempt, with short puncture times and no anesthesia-related complications. These cases suggest that the ultrasound-guided long-axis out-of-plane approach is a safe, effective, and flexible option for managing difficult neuraxial anesthesia.

Purpose: To explore the effect of electrode structure on welding quality by modifying the structure of magnesium alloy electrode. Methods: Two novel electrodes were designed in this study, including one with a circle (C) surface and the other with a square and arched (SA) surface. The designed electrodes were compared to a control electrode with a smooth surface in terms of temperature distribution, thermal damage to tissue, and effective welding area. Finite element analysis was used to analyze the stress and strain of all electrodes and thermal damage to the tissue. Results: Pressure applied to the designed electrodes was within the elastic limit, and the deformation was less than 1%. The highest temperature of SA electrode (99.6 ℃) was similar to that of the control (100 ℃), while that of C electrode (106 ℃) was higher than the control. The mean temperature at the welding site in intestine of the control electrode was significantly higher than that of the other two electrodes. Besides, the mean temperature of C electrode was also slightly higher than that of SA electrode. The tissues welded by the control electrode, C electrode and SA electrode were completely necrotic within an axial distance of 2.546 mm, 2.079 mm, and 1.835 mm from the edge of the welding area, respectively. Conclusion: SA electrode has the lowest thermal damage compared with the other two electrodes due to smaller effective welding area. Therefore, SA electrode is better than the other two electrodes.

Background: Irreversible electroporation (IRE) is an emerging tissue ablation technique that offers advantages over traditional catheter ablation, such as minimal thermal damage and reduced treatment time. However, as this technique also involves delivering energy through a catheter to target tissue, there are still challenges regarding the contact between the catheter and the targeted tissue, and there is a lack of relevant studies. In this study, we examined this issue using potato models with three groups of experiments. Methods: First, the relationship between the effect of biphasic and monophasic output modes and contact force (CF) was studied. Next, the effect of different voltages on biphasic output mode was examined. Finally, impedance analysis was conducted to test the contact impedance under different CFs. Results: The IRE ablation efficacy increased with the increase of CF in both monophasic and biphasic output modes, and there was a strong correlation between the ablation efficacy and the CF. In addition, at three voltage levels, the IRE ablation efficacy increased with increasing CF, and there was a strong correlation between the ablation efficacy and the CF. Conclusion: The results indicate that, under common IRE electrical parameter configuration, the effect of IRE on the tissue has a positive response to the CF of the electrode in the potato model. This finding has important implications for the design of electrodes used in IRE for the treatment of atrial fibrillation.

Objectives: This study aimed to identify acupoint selection patterns for breast cancer-related pain using the Knowledge Discovery in Databases (KDD) method, construct a data-informed candidate acupoint prescription, and preliminarily evaluate its clinical efficacy when combined with the World Health Organization three-step analgesic ladder. Methods: Databases including China National Knowledge Infrastructure, VIP Information, WanFang, PubMed, and Web of Science were searched from inception to May 2024. An Excel-based dataset was developed to analyze acupoint frequency and meridian attribution. Acupuncture prescriptions for cancer pain without specifying cancer type were retained as potentially informative references for breast cancer-related pain. Sixty eligible patients were randomized into two groups. The control group received standard three-step analgesics, including celecoxib, tramadol sustained-release, or oxycodone sustained-release according to pain severity. The intervention group received the same regimen plus a KDD-derived acupuncture prescription consisting of bilateral Hegu (LI4), Zusanli (ST36), Neiguan (PC6), Taichong (LR3), Sanyinjiao (SP6), and Ashi points. Needles were retained for 30 minutes using balanced stimulation, five sessions per week for three weeks. Outcomes included pain intensity, breakthrough pain frequency, duration of pain relief, Karnofsky Performance Status, sleep quality, depressive symptoms, analgesic efficacy, quality of life, and safety. Results: The KDD-derived candidate prescription was associated with a higher overall response rate than analgesics alone. Patients receiving adjunctive acupuncture showed greater reductions in pain intensity and breakthrough pain episodes, as well as improvements in functional status, sleep quality, and depressive symptoms. Fewer adverse events were reported in the acupuncture group. Conclusions: This study proposes a potential acupoint combination for relieving breast cancer-related pain based on distal meridian points and local tender points. Combined acupuncture and conventional pharmacotherapy may improve analgesic outcomes, quality of life, and psychological status, with a favorable safety profile.

In contrast to conventional oximeters, near-infrared spectroscopy-based brain tissue oximetry monitoring devices are capable of non-invasive, continuous, and real-time quantitative monitoring of cerebral oximetry parameters. Initially, these devices were utilized for intensive care or surgical monitoring of oxygen saturation. Due to the rapid advancement of optoelectronic sensing and measurement technologies over the past decade, the derived functional near-infrared brain imaging devices have been widely used in a variety of fields. This paper first introduces the basic principles of near-infrared spectroscopy-based cerebral oxygenation parameter detection, then focuses on the most recent developments in this field of study. Finally, a prospect on their future application in practical settings is also provided.

Sepsis is a systemic inflammatory response syndrome triggered by infection. It presents with simultaneous overactive immune activation and immune paralysis, leading to a cytokine storm, tissue injury, and multiple organ failure. The molecular mechanisms and pathological characteristics of the septic cytokine storm are comprehensively interpreted from multiple perspectives, including immune regulation, signaling pathways, cellular interactions, metabolic state reprogramming, and microcirculatory dysfunction. The cross-activation of signaling pathways, including NF-κB, JAK/STAT, mitogen-activated protein kinase (MAPK), and NLRP3 inflammasome, underlies the core mechanism for the enhancement of the inflammatory response via continued release of proinflammatory cytokines and also is involved in maintaining immune balance. In the latestage immunosuppressive phase, Treg cells, myeloid-derived suppressor cells (MDSCs) and regulatory macrophages play pivotal roles in reestablishing host homeostasis through negative feedback, and their dysfunction is closely associated with secondary infections and high mortality. This review consolidates the latest developments in precision medicine and multidimensional biomarkers, emphasizing the prospective value of several markers such as lactate and CD64, pentraxin 3 (PTX3), and BMP9 for early diagnosis and rognosis evaluation. Moreover, it reviews novel immunomodulators, for instance, bee venom peptides, GDF15, N-(1,3,4-oxadiazol-2-yl) guanidine (NWG), 4-octyl itaconate  (4-OI), and nanoparticle drug delivery systems that inhibit inflammatory signaling cascades, restore energy metabolism, and provide organ protection. Taken together, the pathogenic mechanisms of sepsis are non-linear and dynamic, which may render single-target therapy insufficient for successful management. Personalized interventions targeting multi-target network regulation based on omics and AI models may accomplish precision monitoring and stratified treatment of inflammatory responses, also providing new theoretical and clinical strategies to reduce sepsis-related mortality.