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[...]in the results section, the authors found that median opioid consumption during the initial 3 postoperative days in patients with TAP blocks was 56 mg intravenous morphine milligram equivalents (MMEs), which was 60% higher than the median opioid consumption in patients with epidural analgesia (35 mg). [...]in Supplemental Table 5 of Turan et al’ article reporting opioid consumption in 12-h intervals after surgery, we found that MMEs of median opioid consumptions in first, second and third 24 h postoperatively were 43.6, 36.2 and 29.1 mg in patients with TAP blocks, and 24.6, 24.7 and 20.1 mg in patients with epidural analgesia. [...]the results of a recent meta-analysis by Desai et al. comparing the postoperative analgesic efficacy and side-effect profile of TAP blocks with epidural analgesia in patients undergoing abdominal surgery also support the opioid-sparing effect of epidural analgesia [4].

The letter to the editor was written in response to “The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial”, which was recently published by Li et al. (J Cardiothorac Surg 18(1):128, 2023). In this article, Li et al. showed that addition of a preoperative intercostal nerve block to the multimodal analgesic strategy significantly reduced the pain scores within 48 h after surgery. However, we noted several issues in this study that were not well addressed. They were no use of a standard opioid-sparing multimodal analgesic strategy recommended in the current Enhanced Recovery After Surgery protocols for thoracic surgery, the lack of clear description for reasonable selection of rescue analgesics, the interpretion of between-group differences in the postoperative pain scores based on only statistical differences rather than clinically meaningful differences, inclusion of patients who were not blinded to study intervention, not reporting cumulative opioid consumption and complications of intercostal nerve block. We believe that clarification of these issues is not only useful for improving design quality of randomized clinical trials which assess postoperative analgesic efficacy of nerve blocks, but also is helpful for the readers who want to use an opioid-sparing multimodal protocol including a nerve block in patients undergoing thoracoscopic surgery.

[...]we argue that only the between-group differences in static and dynamic pain NRS scores within the first 2 h postoperatively may be considered as clinically significant. [...]in this study, intravenous tramadol (1 mg/kg) was administered as rescue analgesia, if the NRS pain score was 4 or more and the proportion of patients needing rescue analgesia was significantly reduced in the M-TAPA group. [...]like most previous studies assessing the efficacy of abdominal fascial plane blocks for pain control after laparoscopic cholecystectomy [6, 7], this study did not report any outcome variables of Enhanced Recovery After Surgery protocols, such as the times of first feeding and first getting off to bed after surgery, time to restore bowel function, length of hospital stay, quality of recovery, and 90-day readmission [2]. Because of this design limitation, an important issue that this study cannot answer is whether improved postoperative pain control and patient satisfaction with the M-TAPA can be translated into real benefits associated with the current Enhanced Recovery After Surgery protocols in patients undergoing laparoscopic cholecystectomy.

[...]the between-groups differences in postoperative pain numerical rating scale (NRS) scores at 30 min, 4 h, 24 h, and 48 h were statistically significant, but the net between-groups differences in mean NRS scores at all observed points were only 1.2 or less. [...]as early mobilization is one of the cornerstones of enhanced recovery after surgery protocols for lower limb surgery [5], distal peripheral nerve blocks have become popular as they minimize postoperative pain and opioid requirements while preserving motor function. Unfortunately, this study did not assess and compare the effects of the two combinations on early postoperative ambulation and recovery. [...]an important issue that this study cannot answer is whether a combination of ACB with LFCN block may provide more benefits of enhanced recovery after surgery when compared to a combination of FNB with LFCN block.

Since high myopia in the younger generation may differ etiologically from high myopia in older generations, we examined whether education-related parameters differ between high myopia in today´s school children and high pathological myopia in today´s elderly generation. The investigation included the adult populations of the population-based Beijing Eye Study (BES) (3468 adults;mean age:64.6±9.8years;range:50-93years) and Central India Eye and Medical Study (CIEMS) (4711 adults;age:49.±13.2years;range:30-100years), and the children and teenager populations of the Shandong Children Eye Study (SCES) (6026 children;age:9.7±3.3years;range:4-18years;cycloplegic refractometry), Gobi Desert Children Eye Study (1565;age:11.9±3.5years;range:6-21 years;cycloplegic refractometry), Beijing Pediatric Eye Study (681 children;age:7.7±1.6years;range:5-13 years;non-cycloplegic refractometry,calculation of axial length to corneal curvature radius ratio), Beijing Children Eye Study (15066 children;age:13.2±3.4years;range:7-18years;non-cycloplegic refractometry), Beijing High School Teenager Eye Study (4677 children;age:16.9±0.7years;range:16-18years;non-cycloplegic refractometry). In the BES and CIEMS, educational level did not differ significantly between, or was significantly lower in the highly myopic group (myopic refractive error ≥6 diopters) than in the non-highly myopic group. In all non-adult study populations, higher prevalence of high myopia was significantly associated with higher degree of education related parameters such as attendance of high-level schools, and more time spent for indoors near work versus time spent outdoors. Comparing associations of old or genetic high myopia in adults with new or acquired high myopia in school children revealed that education-related parameters did not show a clear association with old or genetic high myopia, while in contrast, new high myopia showed strong associations with education. It confirms previous studies that the two forms of high myopia not only differed in age of onset, but also in associations with education as well. The data support the notion of two types of high myopia. Future studies may assess whether the risk of pathologic myopic maculopathy and high myopia associated open-angle glaucoma differs between both types of high myopia.

The study is aimed to assess whether the addition of contourlet-based hippocampal magnetic resonance imaging (MRI) texture features to multivariant models improves the classification of Alzheimer’s disease (AD) and the prediction of mild cognitive impairment (MCI) conversion, and to evaluate whether Gaussian process (GP) and partial least squares (PLS) are feasible in developing multivariant models in this context. Clinical and MRI data of 58 patients with probable AD, 147 with MCI, and 94 normal controls (NCs) were collected. Baseline contourlet-based hippocampal MRI texture features, medical histories, symptoms, neuropsychological tests, volume-based morphometric (VBM) parameters based on MRI, and regional CMgl measurement based on fluorine-18 fluorodeoxyglucose-positron emission tomography were included to develop GP and PLS models to classify different groups of subjects. GPR1 model, which incorporated MRI texture features and was based on GPG, performed better in classifying different groups of subjects than GPR2 model, which used the same algorithm and had the same data as GPR1 except that MRI texture features were excluded. PLS model, which included the same variables as GPR1 but was based on the PLS algorithm, performed best among the three models. GPR1 accurately predicted 82.2% (51/62) of MCI convertors confirmed during the 2-year follow-up period, while this figure was 53 (85.5%) for PLS model. GPR1 and PLS models accurately predicted 58 (79.5%) vs. 61 (83.6%) of 73 patients with stable MCI, respectively. For seven patients with MCI who converted to NCs, PLS model accurately predicted all cases (100%), while GPR1 predicted six (85.7%) cases. The addition of contourlet-based MRI texture features to multivariant models can effectively improve the classification of AD and the prediction of MCI conversion to AD. Both GPR and LPS models performed well in the classification and predictive process, with the latter having significantly higher classification and predictive accuracies. Advances in knowledge: We combined contourlet-based hippocampal MRI texture features, medical histories, symptoms, neuropsychological tests, volume-based morphometric (VBM) parameters, and regional CMgl measurement to develop models using GP and PLS algorithms to classify AD patients.