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Anesthesia is correlated with the prognosis of cancer surgery. However, evidence from prospective studies focusing on breast cancer is currently limited. This systematic review aimed to investigate the effect of anesthesia-related interventions on oncological outcomes following breast cancer surgery in prospective studies. Literature searches were performed from inception to June. 2023 in the Pubmed, Web of Science, Embase, and ClinicalTrials databases. The main inclusion criteria comprised a minimum of one-year follow-up duration, with oncological outcomes as endpoints. Anesthesia-related interventions encompassed, but were not limited to, type of anesthesia, anesthetics, and analgesics. The risk of bias was assessed using the Cochrane Risk of Bias Tool. A total of 9 studies were included. Anesthesia-related interventions included paravertebral nerve block (3), pectoral nerve block (1), sevoflurane (2), ketorolac (2), and infiltration of lidocaine (1). Cancer recurrence, metastasis, disease-free survival, or (and) overall survival were assessed. Among all included studies, only infiltration of lidocaine was found to prolong disease-free survival and overall survival. Regional anesthesia and propofol did not improve oncological outcomes following breast cancer surgery. The anti-tumorigenic effect of ketorolac warrants future studies with larger sample sizes. Perioperative infiltration of lidocaine around the tumor may be a promising anti-tumorigenic intervention that can prolong overall survival in patients with early breast cancer.

Ketamine, as a sedative, has been administered during mechanical ventilation in critically ill patients; however, its impact on survival outcomes in this patient population remains uncertain. This retrospective cohort study extracted data from the Medical Information Mart for Intensive Care (MIMIC-IV) database, version 3.0. Patients were categorized into the ketamine group and the control group based on whether ketamine was administered during mechanical ventilation. Propensity score matching was performed to adjust for demographic variables and coexisting conditions. The primary outcome was 28-day mortality. Secondary outcomes included 14-day and 90-day mortality rates, as well as hospital and ICU lengths of stay. The study included a total of 8569 patients, with 330 in the ketamine group and 8239 in the control group. After propensity score matching, significant differences in mechanical ventilation duration and the proportion of patients with acute respiratory distress syndrome remained between groups. No significant differences were observed in 28-day and 90-day mortality rates between the groups. Subgroup analysis indicated that ketamine was associated with lower 14-day mortality rates among younger patients, those with acute respiratory distress syndrome, and norepinephrine users. Ketamine administration was also found to correlate with increased lengths of stay in both the hospital and ICU. Ketamine was more frequently selected for patients requiring prolonged mechanical ventilation. The administration of ketamine was associated with reduced 14-day but not with 28-day or 90-day mortality rates.

ObjectiveThis study investigates the effects of dexmedetomidine on short-term and long-term survival rates in intensive care unit (ICU) patients with ischaemic stroke.DesignThis is a retrospective study.SettingData were sourced from the Medical Information Mart for Intensive Care IV database.ParticipantsThis study analysed 2816 patients with ischaemic stroke from the US Intensive Care database.InterventionsDexmedetomidine administration during the ICU stay was defined as the exposure.MethodsPatients were categorised into the dexmedetomidine group and the control group. Cox regression analysis was used to identify factors that may influence the 28-day mortality rate of patients with ischaemic stroke. High-risk factors were incorporated as covariates, and a 1:1 propensity score matching using the logit model was constructed to compare the prognosis between the two groups.Primary and secondary outcome measuresThe primary outcome was 28-day mortality. The secondary outcomes included in-hospital mortality, ICU length of stay, hospital length of stay, mechanical ventilation duration and 180-day mortality in discharged patients.ResultsA total of 2816 patients were included. Cox regression analysis revealed that dexmedetomidine use was associated with a reduced risk of 28-day mortality. Following propensity score matching, each group comprised 407 patients. Dexmedetomidine was found to improve 28-day mortality (27.8% vs 36.6%, p=0.007). However, it was also associated with the prolonged length of hospital and ICU stay (p=0.002). Among discharged patients, dexmedetomidine use was also associated with an improved 180-day mortality rate (p=0.0019).ConclusionThe use of dexmedetomidine is associated with improved short-term and long-term prognosis in patients with ischaemic stroke and could potentially confer benefits in those receiving mechanical ventilation.

Shoulder pain frequently follows hepatectomy. However, the influence of surgical procedures on shoulder pain is unclear. In this observational study, patients who underwent hepatectomy were enrolled in Shanghai Cancer Center. Shoulder pain and surgical pain were assessed using the numeric rating scale 2 days after surgery. The incidence of shoulder pain was the outcome of the cohort study. Nested case–control analyses were further applied. Three hundred and twelve patients were finally enrolled in this study. Nested case–control analysis showed that there were no significant differences in the number of surgical segments between the two groups ( P  = 0.09). In addition, minor hepatectomy did not reduce the incidence of shoulder pain compared with major hepatectomy ( P  = 0.37). The drainage volume within 2 days after surgery was significantly more in those patients with shoulder pain ( P  = 0.017). In open surgery, surgical sites involving the right anterior lobe (OR (95% CI) 2.021 (1.075, 3.802), P  = 0.029) and right posterior lobe (OR (95% CI) 2.322 (1.193, 4.522), P  = 0.013) were both independent risk factors for shoulder pain. Left shoulder pain also occurred in patients who did not receive left lateral hepatectomy. The preventive phrenic nerve block was not suitable for post-hepatectomy shoulder pain. Stronger preventative intervention should be used in those high-risk patients.

Background The high dropout rate among Methadone Maintenance Treatment (MMT) patients poses a significant challenge to drug dependence treatment programs, especially in regions with prevalent drug use and HIV transmission risks. This study aimed to analyze factors of dropout in MMT clinics over an 18-year period in Dehong Prefecture, Yunnan Province, China. Methods A retrospective cohort study was conducted using data from China’s HIV/AIDS Comprehensive Response Information Management System (CRIMS). Participants included individuals who enrolled in MMT between June 2005 and December 2023 and completed baseline surveys. Cox proportional hazards regression identified independent predictors, while decision tree modeling (CART algorithm) captured variable interactions. The decision tree employed Gini impurity minimization, a 70:30 training-test split, and pruning to prioritize factors like treatment duration and urine test results. Results The study included 9,435 MMT participants, with a male-to-female ratio of 26:1 (9,086 males and 349 females). The median duration of treatment was 12.2 months (ranging from 2.7 to 43.9 months), with a minimum of 1 day and a maximum of 217 months. From 2005 to 2023, the cumulative dropout rate among MMT patients in Dehong Prefecture reached 89.6% (8,458/9,435), with an incidence rate of 34.75 dropouts per 100 person-years over 24,354.98 person-years of follow-up. The Cox proportional hazards regression identified that participants with occupations as farmers (AHR = 1.52, 95% CI: 1.41–1.62) or positive urine test results (AHR = 2.47, 95% CI: 2.35–2.59) exhibited significantly higher dropout risks. Protective factors included enrollment age > 35 years (AHR = 0.86), being married (AHR = 0.81), higher education levels (AHR = 0.94), good family relationships (AHR = 0.30), and methadone doses > 60 ml/day (AHR = 0.60). The decision tree model prioritized treatment duration as the root node, followed by urine test results, family relationships, education level, and methadone dosage. Patients with ≤ 12 months of treatment and positive urine tests faced the highest dropout probability (98.9%), while those with > 12 months of treatment but poor family relationships and doses ≤ 60 ml showed intermediate risks (82.3%). Conclusion Between 2005 and 2023, the dropout rate among MMT patients in Dehong Prefecture was relatively high, driven by modifiable factors (low methadone doses, positive urine tests) and contextual hierarchies (early-phase treatment duration). By integrating Cox regression and decision trees, we advance both epidemiological risk assessment and precision intervention design. Policymakers should prioritize dose optimization and targeted monitoring for high-risk subgroups (e.g., patients ≤ 12 months with concurrent drug use) to improve retention in resource-limited settings.

To explore whether mouse short interspersed nuclear element B1 antisense RNA (B1 antisense RNA, B1 asRNA) could improve the proliferation activity and killing tumor function of spleen lymphocytes from aged mice and to investigate the underlying mechanisms, we transfected B1 asRNA into spleen lymphocytes isolated from 12-month-old mice. We found that B1 asRNA substantially increased the proliferative rate of lymphocytes, the number of EdU-positive cells and the number of S phase cells. B1 asRNA decreased the apoptosis of lymphocytes and regulated the mRNA expression levels of senescence-related genes and transcription factor genes. B1 asRNA enhanced the ability of killing S180 and H22 tumor cells of lymphocytes. The immunofluorescence results showed that B1 asRNA increased the fluorescence intensity of ZFP92 protein in the nuclei, and the ChIP-qPCR results indicated that B1 asRNA promoted the binding of ZFP92 protein to DNA sequences of Nanog, Oct4, Sox2, Klf4 and Myc genes. We believe that B1 asRNA regulates the expression of senescence-related genes, cell cycle genes and transcription factor genes and that ZFP92 protein may play an important role in the process of B1 asRNA regulating gene expression. These studies suggest that B1 asRNA can enhance immune functions of senescent lymphocytes.

Despite the proven virological advantages, there remains some controversy regarding whether first-line integrase strand transfer inhibitors (INSTIs)-based antiretroviral therapy (ART) contributes to reducing mortality of people living with HIV (PLHIV) in clinical practice. Here we report a retrospective study comparing all-cause mortality among PLHIV in China who were on different initial ART regimens (nevirapine, efavirenz, dolutegravir, lopinavir, and others [including darunavir, raltegravie, elvitegravir and rilpivirine]) between 2017 and 2019. A total of 41,018 individuals were included across China, representing 21.3% of newly reported HIV/AIDS cases collectively in the country during this period. Only the differences in all-cause mortality of PLHIV between the efavirenz group and the nevirapine group, the dolutegravir group and the nevirapine group, and the lopinavir group and the nevirapine group, were observed in China. After stratifying the cause of mortality, we found that the differences in mortality between initial ART regimens were mainly observed in AIDS-related mortality. First-line integrase strand transfer inhibitors are commonly used for people with HIV. Here, Wu et al. report results from a multicenter cohort study in China observing significant differences in all-cause mortality among patients between various treatment groups.

IntroductionPostoperative sleep disturbances significantly impair postoperative recovery. The administration of intravenous esketamine has been shown to potentially improve postoperative sleep quality. However, the effectiveness of epidural esketamine in improving postoperative sleep quality remains to be elucidated. This study aims to explore the impact of both intraoperative and postoperative use of epidural esketamine on the postoperative sleep quality of patients undergoing minimally invasive lower abdominal surgeries.Methods and analysisThis randomised, double-blind, parallel-group, placebo-controlled trial will be conducted at the Fudan University Shanghai Cancer Centre. A total of 128 adults undergoing minimally invasive lower abdominal surgeries will be randomly allocated in a 1:1 ratio to either the esketamine group or the placebo group. In the esketamine group, epidural esketamine will be administered intraoperatively (0.2 mg/kg) and postoperatively (25 mg). Postoperatively, all patients will receive epidural analgesia. The primary outcome of the study is the incidence of poor sleep quality on the third day after surgery. The sleep quality assessment will be conducted using the Pittsburgh Sleep Quality Index and a Numeric Rating Scale of sleep. The main secondary outcomes include postoperative pain and anxiety and depression scores. The postoperative pain, both rest pain and movement pain, will be assessed using a Numerical Rating Scale within 5 days after surgery. Anxiety and depression scores will be evaluated using the Hospital Anxiety and Depression Scale both before and after the surgery. Safety outcomes will include delirium, fidgeting, hallucinations, dizziness and nightmares. The analyses will be performed in accordance with intention-to-treat principleEthics and disseminationEthics approval has been obtained from the Ethics Committee of the Shanghai Cancer Centre (2309281-9). Prior to participation, all patients will provide written informed consent. The results of the trial are intended to be published in a peer-reviewed journal.Trial registration numberChiCTR2300076862.

Background The impact of human immunodeficiency virus (HIV) low-level viremia (LLV) on CD4 + T lymphocyte (CD4) cell count recovery during antiretroviral therapy (ART) remains unknown in China. This study aimed to investigate the association between LLV and CD4 count recovery among adults on ART in Southwest China. Methods A longitudinal cohort study of persons living with HIV (PLHIV) were conducted in Dehong Prefecture, Southwest China. Incidence of CD4 count recovery (CD4 cell count ≥ 500 cells/µl) was calculated for each follow-up year and characteristics of LLV (VL between 50 and 999 copies/ml) were described. Group-based trajectory model (GBTM) was used to identify and characterize the trajectories of CD4 cell count and VL during follow up. Longitudinal associations between LLV and CD4 count recovery were examined using a generalized estimating equation (GEE) with LLV as a time-updated variable. Results The study included a total of 7,485 PLHIV who received ART between 2008 and 2021 in Dehong. The median follow-up duration was 8.5 years. At baseline, the participants had a median age of 36 years, with males accounting for 60.5%. The median CD4 cell count at baseline was 268 cells/µl. Results of GBTM demonstrated that 730 patients (9.8%) experience LLV trajectories and 2,125 patients (28.4%) reached CD4 count recovery during follow-up. Compared to participants with the trajectory of VL < 50 copies/ml, the probability of CD4 count recovery were lower among participants with the trajectories of LLV 50–199 copies/ml (adjusted odds ratio [aOR] 0.69, 95% confidence interval [CI] 0.63–0.76) and LLV 200–999 copies/ml (aOR 0.51, 95% CI 0.45–0.59), Conclusion Sustained LLV is associated with poorer CD4 recovery among HIV patients who are receiving ART. Interventions to ensure that PLHIV maintain durably undetectable VL during treatment should be prioritized to achieve immune recovery.

Background Shoulder pain is commonly reported after hepatic surgery; however, the factors affecting post-hepatectomy shoulder pain remain unclear. This study aimed to determine the incidence and risk factors of shoulder pain after hepatectomy. Methods This prospective cohort study recruited 218 patients who underwent hepatic resection at our hospital from June to September 2022. Data were obtained from electronic medical records and follow-up assessments on the second postoperative day. All patients denied chronic pain before surgery. In this cohort study, patients were grouped according to the appearance of shoulder pain. Demographic information and perioperative data were compared between the two groups. The relationship between shoulder pain and independent variables was assessed using univariate binary logistic regression analysis. The potential risk factors were analyzed using multivariable binary logistic regression. Results Of the 218 patients enrolled in this cohort study, 91 (41.7%) reported shoulder pain. Patients in the case group were significantly younger than those in the control group ( P  = 0.001). Epidural anesthesia was used more frequently in the case group ( P  = 0.012). Patients over 60 years of age showed a lower incidence of shoulder pain than younger patients ( P  = 0.028). According to multivariable binary logistic regression analysis, advanced age and epidural anesthesia were associated with risk of shoulder pain (advanced age: odds ratio [OR] [95% confidence interval (CI)]: 0.96 [0.94, 0.99], P  = 0.002; epidural anesthesia: OR [95% CI]: 2.08 [1.18, 3.69], P  = 0.012). Conclusions The incidence of acute shoulder pain after hepatectomy is 41.7%. The application of epidural anesthesia is an independent risk factor for shoulder pain after hepatectomy, whereas advanced age is a protective factor.