Ultrasound-guided nerve block is a safe and effective regional anesthesia technique; however, accurate identification of the brachial plexus remains challenging due to its small size and low contrast in ultrasound images. Recent advances in deep learning offer promising solutions to enhance brachial plexus segmentation and improve perioperative regional anesthesia precision and safety. This review systematically summarizes current deep learning approaches applied to ultrasound-based brachial plexus segmentation. We highlight key models, including Convolutional Neural Networks, the U-shaped Convolutional Neural Networks and their variants, Mask RegionBased Convolutional Neural Networks, and Generative Adversarial Network-based architectures, and compare their reported performances, with Dice Similarity Coefficients ranging from 0.5865 to 0.882 and Intersection over Union values up to 0.6957. Among them, U-Net remains the most frequently employed due to its balance of accuracy and computational efficiency. Moreover, novel models such as multi-objective brachial plexus segmentation network and BPMSegNet have demonstrated superior segmentation performance by incorporating attention mechanisms and spatial contrast features. Notwithstanding these advancements, challenges persist, particularly limited dataset availability and insufficient model generalization. This review provides a comprehensive overview of recent progress, evaluates comparative performance metrics, and outlines future directions to improve model robustness and clinical applicability and clinical applicability in the perioperative setting.

Objective: Skin is a complex tissue whose health is modulated by multiple factors. Exposure to the environment causes damage to skin cells and skin tissue. Identification of factors that can improve skin cell function potentially can prevent or reverse skin aging. Fibroblast growth factors (FGFs) induce growth of skin cells and regulate multiple genes important for skin function. However, FGFs cannot penetrate skin and thus cannot be used as therapeutic factors. Methods: Here we tested three proline-containing tripeptides for their ability to induce skin cell growth, change gene expression within these cells, and protect cells from harmful agents. We also tested the ability of one peptide to penetrate skin, a prerequisite to influence skin cells in vivo. Results: We identified three short proline-containing tripeptides that increase both fibroblast and keratinocyte cell growth, increase the abundance of COL1A1 (collagen type 1) and AQP3 (aquaporin 3) mRNA transcripts and decrease IL6 (interleukin-6) transcripts, all features of improved skin health. These tripeptides, when used as a pretreatment, prevent an increase in the abundance of MMP1 (matrix metalloprotease 1), a biomarker of skin damage when these cells are treated with an aging compound. Finally, we show that one of these tripeptides can penetrate skin. Conclusions: Proline-containing tripeptides have properties that indicate they can be used to reduce or reverse skin damage.

Objective: To compare the efficacy and adverse reactions between 0.15% ropivacaine combined with sufentanil and 0.1% ropivacaine combined with sufentanil for labor analgesia in primiparous women with severe pain. Method: 195 full-term singleton primiparous women with severe pain (visual pain assessment [VAS] ≥6) were randomly allocated to two epidural analgesia groups using different drug formulations. One group received 0.1%  ropivacaine + 0.3 μg/mL sufentanil (control group, n=98). The other group was treated with 0.15% ropivacaine and 0.3 μg/mL sufentanil (experiment group, n=97). The following parameters were recorded: analgesia onset time; maximum VAS scores before analgesia, at 20 min after epidural administration, and during labor; number of analgesic pump presses; number of rescue analgesia events; total analgesic drug consumption; modified Bromage score; maternal satisfaction; duration of labor stages; mode of delivery; neonatal Apgar scores at 1 min and 5 min; and incidence of adverse reactions during labor analgesia, such as skin itching, nausea and vomiting, urinary retention, and fever. Result: The onset time of analgesia in the experimental group was significantly shorter than that in the control group (P<0.05). While the maximum VAS scores in both groups were significantly lower at 20 minutes post-epidural administration and during labor than before delivery analgesia (P<0.05), no statistically significant inter-group differences were observed in VAS scores or in the number of pump compressions, rescue analgesia events, dosage of anesthetic drugs, modified Bromage score, or satisfaction ratings. Similarly, no significant differences were found between the two groups in the duration of labor, mode of delivery, and Apgar scores of newborns at 1 and 5 minutes, or the incidence of pruritus, nausea/vomiting, urinary retention, or intrapartum fever. Conclusion: For primiparous women with severe labor pain, initial use of 0.15% ropivacaine combined with sufentanil significantly shortens the onset time, provides more comprehensive analgesic effects, achieves higher satisfaction, and does not increase short-term adverse reactions (including motor block) compared to the conventional 0.1% concentration regimen.

Perioperative pain management remains challenging, as inadequate analgesia may delay recovery and increase opioid exposure. Multidisciplinary pain management (MPM) emphasizes multimodal and collaborative strategies, creating opportunities for integrating non-pharmacological interventions. Acupuncture anesthesia (AA), derived from traditional Chinese medicine, has re-emerged as a potential adjunct in perioperative care through modulation of nociceptive transmission, stress responses, and opioid requirements. This review summarizes the historical development, proposed neuroimmune mechanisms, and current clinical applications of AA in modern perioperative settings. Evidence from randomized controlled trials and meta-analyses suggests that AA may reduce postoperative pain scores, opioid consumption, and postoperative nausea and vomiting, and facilitate recovery in selected procedures. Moderate-level evidence supports its adjunctive role in gastrointestinal, orthopedic, and gynecological surgeries, whereas evidence in thoracic, cardiac, and highly invasive procedures remains limited and inconsistent. Critically, current evidence is constrained by small sample sizes, heterogeneous acupuncture protocols, inadequate blinding, regional concentration of studies, and insufficient long-term outcome reporting. These limitations reduce external validity and hinder guideline-level recommendations. Overall, AA shows promise as part of MPM pathways, particularly in enhanced recovery protocols, but standardized intervention protocols and large multicenter high-quality trials are needed before broader implementation in perioperative anesthesia practice.

Cycloastragenol, a key bioactive compound extracted from Astragalus membranaceus, has attracted increasing attention for its therapeutic potential in anti-aging, cancer treatment, and fibrosis prevention. This review summarizes the pharmacological activities of Cycloastragenol at molecular, cellular, and systemic levels, and discusses its efficacy across various disease models and potential perioperative applications. Current evidence demonstrates that Cycloastragenol exerts dose-dependent therapeutic efficacy through specific molecular targets. However, its clinical translation remains limited, particularly in surgical recovery contexts, underscoring the need for further validation through well-designed clinical trials focused on perioperative outcomes.

Sepsis is typically initiated by bacterial infection and the associated immune dysregulation displays a complex, dynamic biphasic immune response characterized by hyperinflammation followed by immunosuppression. In the initial period, pathogens activate the innate immune system through receptors such as Toll-like receptors (TLRs) and NOD-like receptors (NLRs), resulting in the massive release of cytokines, including IL-1β, IL-6, and IFN-γ, thereby initiating a "cytokine storm" that leads to vascular endothelial damage, complement activation, and the induction of abnormal cellular aggregation. Sustained activation of inflammatory signals initiates inflammasome-mediated cell death, including pyroptosis-apoptosis-necroptosis (PANoptosis), leading to systemic inflammation and organ dysfunction. Later, the host develops an immunosuppressive phase characterized by increased anti-inflammatory mediators (e.g., IL-10 and TGF-β), exhaustion of B, T, and NK cells, and immune checkpoint-mediated immune paralysis. The stepwise progression of these two stages suggests that sepsis is not simply a consequence of uncontrolled inflammation but rather reflects immune system reprogramming. A better understanding of the molecular basis of inflammation and immunosuppression, particularly the crosstalk among cell death pathways, metabolic reprogramming, and immune regulation, may facilitate timely precision interventions and the restoration of host immune homeostasis in sepsis.

Objective: Due to the shortcomings of large size, operational complexity, infection risks, and high costs, traditional endoscopic shaving systems are limited in complex surgical procedures and primary healthcare settings. To address these limitations, this study proposes the design of a portable endoscopic surgical shaving system as an alternative to traditional systems. Methods: Wireless operation was achieved by integrating the control, power supply, and sensing modules into a detachable handle unit, thereby eliminating dependence on external host devices and cables while reducing the cost of fabrication. Additionally, the system performance was systematically evaluated and compared with thereby eliminating clinical products. Results: Experimental results suggest that the system meets clinical requirements in terms of power output, mechanical characteristics, noise emission, and cutting efficiency of the shaving head. While achieving the functional equivalence to conventional systems, it effectively addresses their inherent limitations. In addition, the cleaning efficiency is significantly improved by the modular detachable design, thereby reducing infection risk. The wireless connection function realized by Bluetooth technology can be linked with the tablet device for real-time speed adjustment and performance monitoring, which greatly improves the intelligence level of the system. Conclusion: The portable endoscope shaving system proposed in this paper, through portable engineering design, achieves structural innovation, cost reduction, and infection risk control. Its properties are comparable to the clinical products, which meet the needs of minimally invasive orthopedic surgery, and show a good clinical application prospect.