Volume 106 · Issue 34 · 2026

Spinal deformity, characterized by complex anatomical structures and significant individual heterogeneity, is a highly challenging disease in the field of orthopedics. The traditional "experience-driven" clinical decision-making model has limitations, such as strong subjectivity and insufficient standardization. The application of artificial intelligence (AI) technology, especially deep learning in medical image analysis, risk prediction, and surgical planning, has brought revolutionary opportunities to spinal deformity surgery. From the perspectives of clinical experts, this article systematically expounds on the application progress and value of AI in core links, such as imaging parameter measurement, surgical risk prediction, and individualized plan formulation, analyzes the bottlenecks in technology promotion, and looks forward to the development direction of "human-machine co-intelligence". The article emphasizes that through the integration with clinical experience, AI promotes the transformation of the discipline from "standardized treatment" to "individualized precision treatment", and constructs an intelligent diagnosis and treatment system.

The concept of "brain enhanced recovery after surgery (Brain-ERAS)" has emerged against the backdrop of population aging, a renewed recognition of the profound consequences of postoperative cerebral complications, the growing accumulation of evidence-based clinical data, and the continuous refinement of the enhanced recovery after surgery (ERAS) paradigm. It represents a multimodal intervention strategy centered on postoperative cognitive recovery and neuroprotection in elderly surgical patients. In this article, we systematically review the latest advances in the clinical application of Brain-ERAS, with a particular focus on a multidisciplinary collaborative management framework spanning the perioperative period. This framework encompasses preoperative cognitive screening and prehabilitation, intraoperative monitoring of cerebral oxygen supply-demand balance and optimization of anesthetic depth, multimodal analgesic regimens, pharmacological and non-pharmacological neuroprotective approaches, as well as early postoperative cognitive training and prevention of complications. By incorporating evidence-based findings into individualized perioperative care, Brain-ERAS has been shown to effectively reduce the incidence of postoperative delirium and cognitive dysfunction, shorten hospital length of stay, and improve long-term neurological prognosis in older adults. Future research should prioritize high-quality clinical trials, the development of standardized implementation protocols, and the promotion of standardized adoption of Brain-ERAS in elderly patients undergoing anesthesia and surgery.

Eosinophil associated diseases (EAD) are heterogeneous disorders characterized by increased and/or activated eosinophils in blood or tissues, with potential involvement of the respiratory, cutaneous, gastrointestinal, cardiovascular, neurological and hematological systems. Under-recognition and delayed diagnosis are common in clinical practice. To establish a standardized cross-disease, cross-organ and multidisciplinary clinical pathway, the National Collaborative Project of Standardized Diagnosis and Treatment Centers for Eosinophil Associated Diseases convened a multidisciplinary expert panel. Domestic and international guidelines, expert consensuses, systematic reviews and clinical studies were reviewed. Recommendations were developed using grading of recommendations assessment, development and evaluation (GRADE)-informed evidence appraisal and a modified Delphi process. This consensus addresses 14 clinical questions, including disease spectrum recognition, eosinophil assessment, multidisciplinary management, therapy, and longitudinal follow-up. It aims to provide practical guidance for early identification, etiologic screening, and standardized management of adults with suspected or confirmed EAD.

With the accelerating population aging in China, elderly aspiration has become a prevalent and high-risk clinical problem characterized by high incidence rate and severe adverse outcomes. However, standardized, unified whole-process prevention and control systems for elderly aspiration are still lacking in clinical practice. To fill this clinical gap and standardize relevant clinical behaviors, five academic institutions jointly organized multidisciplinary expert panels to formulate this expert consensus. Complying with World Health Organization guideline development specifications and the grading of recommendations assessment, development and evaluation (GRADE) evidence grading system, this consensus was formulated based on high-quality domestic and international literature evidence and extensive clinical experience, through multiple rounds of expert discussions and rigorous argumentation, finally forming 15 core clinical recommendations. Targeting the Chinese elderly population, it applies to professional medical staff in various medical and community health institutions, pension institution practitioners, and family caregivers involved in elderly health management. This consensus systematically expounds the definition, classification, epidemiological characteristics, risk factors and pathological mechanisms of elderly aspiration. It standardizes dynamic risk assessment strategies for admission and disease progression, and unifies standardized screening and diagnostic procedures for aspiration. Focusing on full-cycle clinical management, it sorts out standardized intervention measures covering oral care, dietary and postural management, medication optimization, rehabilitation training and stratified nursing, and emphasizes the value of multidisciplinary collaborative management and innovative technical applications. This consensus is dedicated to standardizing the whole-process system of screening, prevention, diagnosis, treatment and daily management of elderly aspiration, so as to reduce aspiration-related adverse events and improve the health management level of the elderly in China.

To develop a machine learning-based prediction model for postoperative coronal imbalance (CIB) in patients with degenerative scoliosis (DS).

The data of patients with DS who underwent corrective surgery at Xuanwu Hospital, Capital Medical University, between January 2018 and January 2023 were retrospectively collected. Based on the coronal alignment at the final postoperative follow-up, patients were categorized into a coronal balance (CB) group and a CIB group (defined as coronal vertical axis>3 cm). A total of 26 preoperative and intraoperative variables were considered as candidate predictors. Feature selection was performed using three machine learning algorithms, including least absolute shrinkage and selection operator (LASSO) regression, recursive feature elimination (RFE), and Boruta algorithm, and the intersection of the selected features was used as the final input variables. The dataset was randomly divided into a training set and a test set at a 7∶3 ratio using stratified sampling. Five machine learning algorithms, including logistic regression, random forest, extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and multilayer perceptron, were employed to construct predictive models for postoperative CIB. Model performance was evaluated using six metrics: area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The SHapley Additive exPlanations (SHAP) method was used to assess the contribution and importance of each predictor.

A total of 168 patients aged (64.6±8.0) years were included in the study, with 49 males and 119 females. Among them, 115 patients achieved postoperative coronal balance (CB group), whereas 53 developed postoperative coronal imbalance (CIB group). Compared with the CB group, patients in the CIB group had a significantly higher prevalence of preoperative frailty [39.6% (21/53) vs 14.8% (17/115), P<0.001], were more likely to undergo a posterior-only surgical approach [81.1% (43/53) vs 57.4% (66/115), P=0.003], and had a higher proportion of type Ⅱ DS [71.7% (38/53) vs 41.7% (48/115), P<0.001]. In addition, the CIB group exhibited a significantly greater correction ratio between the two curves (1.3±0.6 vs 0.8±0.5, P<0.001), a larger preoperative lumbosacral Cobb angle (22.3°±5.8° vs 18.4°±6.4°, P<0.001), and greater preoperative coronal displacement [(3.3±1.0) cm vs (2.5±1.4) cm, P<0.001]. Five key predictors were ultimately selected for model development: correction ratio between the two curves, preoperative coronal displacement, DS classification, frailty, and surgical approach. Among the five machine learning models evaluated, the random forest model demonstrated the best overall performance, achieving an AUC of 0.857 (95%CI: 0.737-0.977), with an accuracy of 0.814 (95%CI: 0.674-0.903), sensitivity of 0.643 (95%CI: 0.388-0.837), specificity of 0.897 (95%CI: 0.736-0.964), positive predictive value of 0.750 (95%CI: 0.468-0.911), negative predictive value of 0.839 (95%CI: 0.674-0.929), and a Brier score of 0.152. The calibration curve showed good agreement between predicted and observed probabilities, while decision curve analysis demonstrated a positive net clinical benefit across a wide range of threshold probabilities (10%-85%). SHAP analysis revealed that the most influential predictors of postoperative CIB, ranked in descending order of importance, were a higher correction ratio between the two curves (0.157), greater preoperative coronal displacement (0.104), type Ⅱ DS (0.073), preoperative frailty (0.046), and a posterior-only surgical approach (0.042).

The machine learning-based prediction model demonstrated good predictive performance for postoperative CIB in patients with DS, offering valuable insights to support the optimization of surgical strategies.

To predict the risk of proximal junctional kyphosis (PJK) following modified grade Ⅳ osteotomy for thoracolumbar old fractures with kyphosis based on machine learning (ML).

A retrospective analysis was conducted, including patients with thoracolumbar old fractures and kyphotic deformity who underwent modified grade Ⅳ osteotomy at department of orthopedics, the first affiliated hospital of Soochow University between January 2011 and June 2023. All patients had a minimum follow-up of two years. Patients were divided into the PJK group and the non-PJK group based on the occurrence of PJK, and the clinical indicators were compared between the two groups. After performing multicollinearity diagnosis using Least Absolute Shrinkage and Selection Operator (LASSO) regression, multivariate logistic regression was conducted to identify risk factors for PJK. Five machine learning models including optimized XGBoost, GradientBoosting, Random Forest, linear discriminant analysis (LDA) and model driven architecture (MDA) were constructed and trained, with their predictive performances evaluated subsequently. The Shapley Additive Explanations (SHAP) method was employed for model interpretation and feature importance ranking.

The study included 128 patients (47 men, 81 women), with a mean age of (68.8±7.2) years.The local kyphosis angle improved from 32.65°±8.17° preoperatively to 2.83°±1.99° at 2 weeks postoperatively in the non-PJK group, and from 32.97°± 8.51° preoperatively to 3.01°±1.72° at 2 weeks postoperatively in the PJK group (both P<0.01). Significant differences were found between the non-PJK and PJK groups in body mass index (BMI), bone mineral density (BMD), upper instrumented vertebra-cemented screw (UIV-CS), relative sagittal alignment (RSA), relative functional cross-sectional area of the paraspinal muscles (rFCSA), and functional muscle-fat index (FMFI) (all P<0.05). LASSO regression identified moderate multicollinearity between rFCSA (VIF=5.0) and FMFI (VIF=4.96); therefore, the variant FMFI was excluded. Multivariate logistic regression was then performed including BMI, UIV-CS, BMD, RSA, and rFCSA. The results indicated that smaller rFCSA (OR=0.990, 95%CI: 0.981-0.999), lower BMD (OR=0.680, 95%CI: 0.471-0.983), and higher BMI (OR=1.206, 95%CI: 1.036-1.403) were independent risk factors of PJK. Based on PJK risk variables, five ML models were constructed. In the test set, the optimized XGBoost model achieved the highest area under the receiver operating characteristic curve (AUC) of 0.841 (95%CI: 0.675-0.972), followed by RandomForest [0.813 (95%CI: 0.632-0.941)], LDA[0.786 (95%CI: 0.613-0.956)], GradientBoosting[0.782 (95%CI: 0.601-0.967)] and MDA[0.724 (95%CI: 0.514-0.896)]. The XGBoost model demonstrated high specificity (96.4%), positive predictive value (83.3%), and accuracy (82.05%). SHAP visualization of the XGBoost model revealed that the importance of features for predicting PJK risk was in the following descending order: rFCSA (42.1%)、BMD (33.6%)、BMI (24.3%).

The ML-based XGBoost model can effectively predict the risk of PJK following modified grade IV osteotomy for old thoracolumbar fractures with kyphosis. Within the context of this disease model, degeneration of the paraspinal muscles, bone mineral density and BMI were identified as significant risk factors of postoperative PJK.

To compare the clinical efficacy of a 3D-printed intelligently manufactured biomimetic artificial cervical disc (with independent intellectual property rights) versus the Prestige LP artificial cervical disc in the treatment of degenerative cervical spondylosis.

A retrospective analysis was conducted on clinical data from patients who underwent cervical disc replacement with either the Prestige LP or a domestically produced 3D-printed artificial cervical disc at Xi′an Honghui Hospital, Xi′an Jiaotong University, between May 2019 and December 2022, and all completed the follow-up. The two groups of patients were compared in terms of clinical efficacy [including Visual Analogue Scale (VAS) of pain, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Odom′s criteria], operative time, intraoperative blood loss, early complications (intraoperative adjacent organ injury, hematoma formation), postoperative cervical range of motion (ROM), incidence of heterotopic ossification (HO), and adjacent segment degeneration (ASD).

A total of 68 patients were enrolled, including 36 males and 32 females, with a mean age of (48.2±2.8) years. Among them, 33 patients received the Prestige LP disc, and 35 received the 3D-printed disc. The mean follow-up duration was (34.6±2.0) months in the Prestige LP group and (32.8±3.0) months in the 3D-printed group. There were no significant differences in baseline data, blood loss, drainage, or total hospitalization costs between groups (all P>0.05). The 3D-printed group had significantly shorter operative time (P=0.020) but significantly longer hospital stay (P=0.001) than the Prestige LP group. At the final follow-up, the VAS score in the Prestige LP group decreased from (7.0±1.6) to (1.7±0.1), and the Neck Disability Index (NDI) score decreased from (26.0±4.1) to (9.6±1.2); in the 3D-printed group, the VAS score decreased from (6.3±1.6) to (1.6±0.2), and the NDI score decreased from (29.0±3.7) to (10.1±1.7) (all P<0.05), of which intergroup differences were not statistically significant (all P>0.05). The JOA recovery rate was 78.9%±13.6% in the Prestige LP group and 82.2%±12.4% in the 3D-printed group, with no significant difference (P=0.845). The excellent-to-good rate was 90.9% (30/33) in the Prestige LP group and 88.6% (31/35) in the 3D-printed group, also without significant difference (P=0.800). Radiographically, no significant loss of segmental ROM was observed in either group at the final follow-up (both P>0.05). The incidences of HO and ASD at the final follow-up were significantly lower in the 3D-printed group [8.6% (3/35) and 5.7% (2/35), respectively] compared with the Prestige LP group [15.2% (5/33) and 12.1% (4/33), respectively] (both P<0.05). No severe perioperative complications occurred in either group, and no reoperations related to the index surgery were reported during the follow-up period.

The 3D-printed artificial cervical disc achieves comparable clinical efficacy to the Prestige LP artificial cervical disc. Moreover, during early follow-up, it demonstrates advantages over the Prestige LP disc in terms of lower rates of subsidence, loosening, heterotopic ossification, and adjacent segment degeneration.

To investigate the mid-term clinical efficacy of O-arm navigation system-assisted fully visualized precision osteotomy in the treatment of thoracolumbar kyphosis deformity in patients with ankylosing spondylitis (AS).

A retrospective cohort study was conducted to analyze the clinical data of 37 patients with AS-related thoracolumbar kyphotic deformity who were admitted to the Department of Spine and Spinal Cord Surgery, Henan Provincial People′s Hospital, from January 2019 to December 2023. According to the surgical modality, the patients were divided into the navigation group (n=19, treated with O-arm navigation-assisted surgery) and the conventional group (n=18, treated with two-dimensional C-arm fluoroscopy). Operative time, intraoperative blood loss, clinically acceptable screw placement accuracy (Gertzbein-Robbins grades A+B), osteotomy time per segment, achievement rate of preoperative planning, osteotomy fusion rate, radiographic parameters [global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI)], and 36-Item Short Form Health Survey (SF-36) scores were compared between the two groups.

Among the 37 patients, 31 were male and 6 were female, with an age of (30.6±5.1) years. The follow-up duration was (24.6±5.8) months in the navigation group and (23.8±6.2) (range: 12-35) months in the conventional group; the age was (30.2±4.6) (range: 20.0-37.8) years in the navigation group and (31.1±5.7) (range: 23.4-47.8) years in the conventional group; and preoperative GK was (72.8°±8.1°) (range: 66°-85°) in the navigation group and (72.1°±8.9°) (range: 65°-88°) in the conventional group. Compared with the conventional group, the navigation group had significantly shorter operative time [(228.4±28.1) vs (295.6±35.4) min, P<0.001], less intraoperative blood loss [(910±164) ml vs (1 354±235) ml, P<0.001], and shorter osteotomy time per segment [(47.3±5.8) vs (65.2±9.1) min, P<0.001]. The clinically acceptable screw placement accuracy(Gertzbein-Robbins grades A+B) was higher in the navigation group than in the conventional group [98.5% (317/322) vs 85.2% (259/304), P<0.001], and the achievement rate of preoperative planning was also higher [(95.2±2.8)% vs (80.5±6.1)%, P<0.001]. At the final follow-up, osteotomy-site bony fusion was achieved in all 19 patients in the navigation group and in 17 patients in the conventional group, with no significant difference in osteotomy fusion rate between the two groups (19/19 vs 17/18, P=0.486). At 2 weeks postoperatively and at the final follow-up, GK, LL, SVA, PT, and SS have all improved in both groups compared with the preoperative values (all P<0.001), and the improvements in these radiographic parameters were superior in the navigation group (all P<0.05). At the final follow-up, all SF-36 domain scores improved in both groups compared with the preoperative scores (all P<0.05), and the navigation group had higher bodily pain and social functioning scores than the conventional group (all P<0.05).

O-arm navigation system-assisted fully visualized precision osteotomy can improve surgical accuracy and osteotomy efficiency in the treatment of thoracolumbar kyphotic deformity in AS patients, improve sagittal spinal balance, achieve better radiographic correction, and provide superior bodily pain and social functioning scores at the final follow-up.

To compare the clinical efficacy of robot-assisted versus fluoroscopy-guided free-hand minimally invasive unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF) in the treatment of lumbar degenerative diseases.

A retrospective analysis was conducted on the clinical data of patients with lumbar degenerative diseases who underwent UBE-LIF at Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2020 to January 2023. The patients were divided into two groups according to the surgical modalities: the robot-assisted UBE-LIF group (robot group, n=45) and the fluoroscopy-guided free-hand UBE-LIF group (fluoroscopy group, n=48). The following indicators were compared between the two groups: operation time, intraoperative blood loss, radiation exposure time, length of hospital stay, pre-and post-operative visual analogue scale (VAS) scores for pain, Oswestry disability index (ODI), accuracy of pedicle screw placement, facet joint violation (FJV), intervertebral fusion, and complications.

A total of 93 patients were included, with a mean age of (53.0±7.4) years, among whom 38 males (40.9%) and 55 females (59.1%). There were no statistically significant differences between the robotic group and the fluoroscopy-assisted group in terms of operative duration, radiation exposure time, intraoperative blood loss, and interbody fusion status (all P>0.05). The length of hospital stay was significantly shorter in the robotic group than in the fluoroscopy-assisted group [(6.8±1.0) days vs (7.5±0.9) days, P=0.001]. The VAS scores and ODI scores at all postoperative time points were significantly lower than the preoperative values in both groups (P<0.05). The 3-day postoperative lumbar VAS score was markedly lower in the robotic group compared with the fluoroscopy-assisted group [(2.7±0.5) vs (3.1±0.7), P<0.001]. No intergroup differences in ODI scores between the two groups were observed at any postoperative follow-up time point (all P>0.05). The robotic group achieved a higher rate of grade A pedicle screw accuracy [87.8% (158/180) vs 70.3% (135/192), P<0.001], while the fluoroscopy-assisted group presented a higher FJV rate [32.3% (62/192) vs 9.4% (17/180), P<0.001]. The reduction in cranial adjacent segment disc height was smaller in the robotic group than in the fluoroscopy-assisted group [(0.63±0.18) mm vs (0.94±0.15) mm, P<0.001]. Four complications occurred in the robotic group and five in the fluoroscopy-assisted group; all patients with complications obtained substantial relief after conservative management.

Compared with fluoroscopy-assisted UBE-LIF, robot-assisted UBE-LIF demonstrates higher accuracy in pedicle screw placement, better improvement in early postoperative low back pain, shorter hospital stays, lower rates of facet joint violation, and less severe adjacent segment degeneration, making it a safe and effective option.

To evaluate the agreement between cervical magnetic resonance imaging (MRI) parameters measured by the Cervi-AI model and expert assessments, and to investigate the association between these parameters and the selection of anterior or posterior surgical approaches in patients with multilevel degenerative cervical myelopathy (DCM).

This retrospective study included patients with DCM who underwent cervical spine surgery at the Second Affiliated Hospital of Naval Medical University between June 2023 and October 2024. Patients were categorized into anterior and posterior surgical approach groups according to the actual surgical procedure performed. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to compare the consistency of cervical spinal stenosis (CSS) grade, involved segments, and maximum spinal cord compression (MSCC) index assessed by Cervi-AI with the expert-measured reference standard. Multivariable logistic regression analysis was performed to identify factors associated with surgical approach selection. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC) was calculated to evaluate the predictive performance of clinical and imaging parameters for surgical approach selection.

A total of 146 patients were included (77 males and 69 females), with a mean age of (52.0±12.0) years. Eighty-six patients underwent anterior surgery, and 60 underwent posterior surgery. No significant differences were observed between the two groups in terms of symptom type or symptom duration (all P values>0.05). Cervi-AI measurements showed excellent agreement with expert assessments for the number of involved CSS levels, maximum stenosis grade, and MSCC index, with ICCs of 0.970, 0.958, and 0.984, respectively. Multivariable logistic regression analysis revealed that longer symptom duration (per 12-month increase: OR=0.752, 95%CI: 0.576-0.957, P=0.020), a greater number of involved CSS levels (per additional level: OR=0.058, 95%CI: 0.014-0.162, P<0.001), and the presence of ossification of the posterior longitudinal ligament (OPLL) (OR=0.103, 95%CI: 0.027-0.328, P<0.001) were independently associated with selecting an posterior surgical approach. ROC curve analysis demonstrated that the number of involved CSS levels had the highest predictive performance for surgical approach selection (AUC=0.903, 95%CI: 0.852-0.955, P<0.001).

The Cervi-AI model can provide highly consistent and standardized measurements of key cervical MRI parameters compared with expert assessments. Symptom duration, the extent of cervical spinal stenosis, and the presence of OPLL are independently associated with the selection of anterior versus posterior surgical approaches in patients with multilevel DCM.

To analyze the factors influencing prognosis in patients with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT) after cardiac surgery.

The data of patients who developed postoperative AKI and received CRRT after cardiac surgery at Fuwai Huazhong Cardiovascular Disease Hospital from January 1, 2018 to December 31, 2020, were retrospectively analyzed. All patients were followed up for 90 days after surgery. The primary endpoint was a composite of dialysis dependence or death at 90 days postoperatively. Patients were divided into a successful renal replacement therapy (RRT) group and a failed RRT group according to whether the endpoint occurred. The clinical data were compared between the two groups. A logistic regression model was used to identify independent risk factors for 90-day RRT failure in AKI patients treated with CRRT after surgery, and the area under the receiver operating characteristic (ROC) curve was calculated to evaluate the predictive performance of the model.

A total of 113 patients aged (57.7±12.3) years were enrolled, including 55 males and 58 females. There were 56 patients in the successful RRT group and 57 in the failed RRT group, respectively. Compared with the successful RRT group, patients in the failed RRT group had a higher preoperative prevalence of diabetes mellitus [29.8% (17/57) vs 3.6% (2/56)], lower intraoperative transfused red blood cell volume [(474±188) ml vs (559±195) ml] and platelet units [(1.2±0.6) U vs (1.5±0.7) U], higher serum creatinine at discharge [(230±167) μmol/L vs (129±80) μmol/L], and a larger proportion of dialysis dependence at discharge [80.7% (46/57) vs 39.3% (22/56)] (all P<0.05). Multivariate logistic regression analysis showed that male sex (OR=2.930, 95%CI: 1.086-7.904, P=0.034), preoperative diabetes mellitus (OR=12.033, 95%CI: 2.136-67.780, P=0.005), serum creatinine at discharge (OR=1.006, 95%CI: 1.002-1.010, P=0.005), and dialysis dependence at discharge (OR=5.147, 95%CI: 1.762-15.036, P=0.003) were independent risk factors for 90-day RRT failure in AKI patients receiving CRRT after cardiac surgery. The risk prediction model constructed with male sex, preoperative diabetes mellitus, serum creatinine at discharge and dialysis dependence at discharge yielded an area under the ROC curve of 0.850 (95%CI: 0.782-0.918, P<0.001).

Male sex, preoperative diabetes mellitus, and elevated serum creatinine and dialysis dependence at discharge are risk factors for 90-day RRT failure in AKI patients treated with CRRT after cardiac surgery.

To explore the factors influencing major adverse cardiovascular events (MACE) in elderly patients undergoing major thoracic and abdominal surgery.

The perioperative data of elderly patients (≥65 years) who underwent elective non-cardiac major thoracic and abdominal surgery (≥2 hours) under general anesthesia at Peking University First Hospital from November 1, 2021 to July 31, 2023, were retrospectively collected. The data included age, sex, body mass index (BMI), comorbidities, smoking history, American Society of Anesthesiologists (ASA) classification, laboratory test results, use of regional blockade, anesthesia duration, type of surgery, surgical duration, and fluid intake and output. Patients were divided into a MACE group and a non-MACE group according to whether MACE occurred postoperatively. Multivariate logistic regression analysis was used to identify the influencing factors for postoperative MACE.

A total of 1 915 patients were enrolled, including 1 252 males and 663 females, with a mean age of (72±5) years. The incidence of perioperative MACE was 4.6% (88/1 915). Multivariate logistic regression analysis revealed that older age (OR=1.051, 95%CI: 1.007-1.097, P=0.023), higher BMI (OR=1.111, 95%CI: 1.033-1.195, P=0.005), preoperative coronary heart disease (OR=1.934, 95%CI: 1.107-3.381, P=0.021), preoperative hyperthyroidism (OR=28.691, 95%CI: 3.207-256.640, P=0.003), higher preoperative alanine transaminase (ALT) (OR=1.007, 95%CI: 1.001-1.014, P=0.021), higher preoperative B-type natriuretic peptide (BNP)(OR=1.003, 95%CI: 1.002-1.004, P<0.001), and longer surgical duration (OR=1.003, 95%CI: 1.001-1.005, P=0.011) were risk factors for postoperative MACE, whereas intraoperative regional blockade was identified as a protective factor against postoperative MACE (OR=0.310, 95%CI: 0.189-0.508, P<0.001).

Older age, higher BMI, preoperative hyperthyroidism, higher preoperative ALT and BNP levels, and longer surgical duration are associated with an increased risk of postoperative MACE in elderly patients undergoing major thoracic and abdominal surgery, while intraoperative regional blockade may have a protective effect against postoperative MACE.

To evaluate the efficacy and safety of transcutaneous auricular vagus nerve stimulation (taVNS) during the acute phase in middle-aged and elderly patients with herpes zoster (HZ) comorbid depressive and anxiety states.

This was a randomized controlled trial. Forty middle-aged and elderly patients with acute-phase HZ who attended the Department of Dermatology at Xuanwu Hospital, Capital Medical University, from June 2024 to June 2025 were enrolled and randomly assigned in a 1∶1 ratio using a random number table to receive either taVNS (n=20) or sham stimulation (n=20) for 5 consecutive days. Both groups received antiviral therapy and on-demand rescue analgesia. Pain, anxiety/depression, and sleep quality were evaluated using the Visual Analog Scale (VAS), the 4-item Patient Health Questionnaire (PHQ-4), and the Insomnia Severity Index (ISI), respectively. The primary outcome was the incidence of subacute pain at 30 days post-rash onset. Secondary outcomes included cumulative analgesic consumption at 1 and 2 weeks after treatment, the changes from baseline (Δ values) in PHQ-4 and ISI scores at 2 weeks, and the incidence of postherpetic neuralgia (PHN) at 90 days post-rash onset.

In the taVNS group, 7 patients (35%) were female, with a mean age of (64.1±9.7) years; in the sham group, 10 patients (50%) were female, with a mean age of (61.5±8.5) years. There were no statistically significant differences between the two groups in baseline VAS, PHQ-4, or ISI scores (all P>0.05). The incidence of subacute pain was significantly lower in the taVNS group than in the sham group [5% (1/20) vs 35% (7/20), RD=-30.0% (95%CI:-52.1%--4.9%); RR=0.14 (95%CI: 0.02-1.06); P=0.044]. At 2 weeks after treatment, the Δ values of PHQ-4 and ISI in the taVNS group were significantly greater than those in the sham group. The proportion of patients taking Lofentadine and the cumulative Lofentadine consumption at weeks 1 and 2 were both lower in the taVNS group than in the sham group (all P<0.05). No serious adverse events occurred in either group, and the difference in PHN incidence between groups was not statistically significant (P>0.05).

Acute-phase taVNS appears to be feasible and safe in middle-aged and elderly patients with HZ and comorbid depressive and anxiety, effectively reducing subacute pain and improving emotional and sleep outcomes.

This article reports the diagnosis and treatment of a patient with sporadic fibronectin glomerulopathy (FNG). The patient, a 54-year-old male, was admitted to the Department of Nephrology at the Affiliated Hospital of Qingdao University on April 23, 2024, due to "intermittent edema of both lower limbs for six months and increased blood creatinine for one week". The patient had no family history of nephropathy and was diagnosed with stage 4 chronic kidney disease and proteinuria in the range of nephropathy. Combined with the results of renal biopsy and genetic testing, it was considered that the patient carried a new type of nephropathy.FN1Sporadic FNG at the mutant site (c.3049T>G). Urinary protein decreased and renal function partially improved after glucocorticoid and optimized support treatment. After 23 months of follow-up, renal function was basically stable. The non-specific clinical manifestations of FNG increase the difficulty of clinical diagnosis. This case helps to raise clinicians' awareness of FNG and emphasizes the importance of timely renal biopsy pathology and genetic testing.

Age-related hearing loss (ARHL) is a common sensory degenerative disease in the elderly population. In addition to peripheral auditory organ damage, the complex remodeling of the central nervous system has become the focus of research in recent years. This paper focuses on the research of multimodal neuroimaging and electrophysiology techniques in the auditory central mechanism of senile deafness. Using the dynamic integration framework of "peripheral input reduction - central compensation - decompensation", it presents the core findings of each technique, analyzes the contributions and limitations of each modality, and focuses on exploring the temporal laws of structural-functional-metabolic changes, cross-modality plasticity characteristics and clinical translation potential, aiming to provide a new perspective for the early precise identification and individualized diagnosis and treatment of ARHL.