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Objective To investigate the accuracy of surgical pleth index (SPI) in monitoring patients with nociceptive stimulation and its predictability for cardiovascular response to nociceptive stimulation in total intravenous anesthesia (TIVA). Methods A total of 102 patients (aged 18 to 65 years, ASAⅠtoⅡ, and BMI of 18.5 to 30 kg/㎡) who underwent elective thyroid surgery in our hospital from February to June 2022 were enrolled in this study. Each patient was induced by intravenous anesthesia, maintained by target-controlled infusion of propofol and remifentanil, and monitored by SPI for analgesia depth. The absolute values of SPI, heart rate (HR) and mean arterical pressure (MAP) of patients 2 min before and during nociceptive stimulation and the maximum values of SPI, HR and MAP within 2 min after nociceptive stimulation were recorded. Receiver operating characteristic (ROC) curve was used to analyze the accuracy of SPI, HR and MAP in monitoring nociceptive stimulation and the predictability of SPI in cardiovascular response to nociceptive stimulation. Results ROC curve analysis indicated that SPI (AUC=0.931, Cutoff value=30) was superior to HR (AUC=0.804, Cutoff value=68) and MAP (AUC=0.759, Cutoff value=80) in monitoring accuracy of tracheal intubation stimulation, ΔSPI (AUC=0.990, Cutoff value=4) was better than ΔHR (AUC=0.972, Cutoff value=3) and ΔMAP (AUC=0.854, Cutoff value=3), ΔSPI was better than SPI, ΔHR was better than HR, and ΔMAP was better than MAP, with their AUC values statistically different (P < 0.05). In terms of monitoring the accuracy of skin incisions, SPI (AUC=0.925, Cutoff value=43) was superior to HR (AUC=0.587, Cutoff value=65) and MAP (AUC=0.804, Cutoff value=76), ΔSPI (AUC=0.998, Cutoff value=7) was better than ΔHR (AUC=0.833, Cutoff value=1) and ΔMAP (AUC=0.943, Cutoff value=3), ΔSPI was better than SPI, ΔHR was better than HR, and ΔMAP was better than MAP, and the above AUC differences were statistically significant (P < 0.05); SPI had predictive value for the cardiovascular response stimulated by tracheal intubation (AUC=0.662, Cutoff value=17, P < 0.05), but had no predictive significance for the cardiovascular response stimulated by skin incisions (P>0.05). Conclusion The absolute value and change of SPI are better than the traditional hemodynamic indexes HR and MAP in monitoring the accuracy of nociceptive stimulation, which can accurately monitor nociceptive stimulation during operation. SPI has predictive value for the cardiovascular response stimulated by intubation stimulation, and has important clinical significance for judging the appropriate timing of intubation.

Background: Delirium, marked by acute cognitive decline, poses a life-threatening issue among older individuals, especially after cardiac surgery, with prevalence ranging from 15 to 80%. Postoperative delirium is linked to increased morbidity and mortality. Although clinical trials suggest preventability, there is limited research on intranasal insulin (INI) for cardiac surgery-related delirium. INI has shown promise in managing cognitive disorders. It rapidly elevates brain hormone levels, enhancing memory even in non-impaired individuals. While effective in preventing delirium in gastrointestinal surgery, its impact after cardiac surgery remains understudied, especially for middle-aged patients. Method: This is a prospective randomized, double-blind, single-center controlled trial. A total of 76 eligible participants scheduled for elective on-pump cardiac surgery will be enrolled and randomly assigned in a 1:1 ratio to either receive Intranasally administered insulin (INI) or intranasally administered normal saline. The primary outcome of our study is the incidence of postoperative delirium (POD). Secondary outcomes include duration of ICU, postoperative hospital length of stay, all in-hospital mortality, the change in MMSE scores pre- and post-operation, and incidence of postoperative cognitive dysfunction at 1 month, 3 months, and 6 months after operation. Moreover, we will subjectively and objectively evaluate perioperative sleep quality to investigate the potential impact of nasal insulin on the development of delirium by influencing sleep regulation. Discussion: Our study will aim to assess the impact of intranasal administration of insulin on the incidence of postoperative delirium in middle-aged patients undergoing on-pump elective cardiac surgery. If intranasal insulin proves to be more effective, it may be considered as a viable alternative for preventing postoperative delirium. Trial registration: ChiCTR ChiCTR2400081444. Registered on March 1, 2024. [ABSTRACT FROM AUTHOR]

W‐plasty is a very popular scar excisional revision technique. The core of the technique is to break up the scar margins into small triangular components, so as to cause light scattering and make the scar less noticeable. However, due to skin tension, facial incision scars tend to spread. Applying W‐plasty alone cannot achieve the ideal repair effect of facial scars. In this study, we proposed a scar revision technique combined W‐plasty with continuous tension‐reduction (CTR) technique to improve the appearance of facial scars. Sixty patients with facial scar were comprised in this retrospective study. Scars were assessed independently using the scar scale before and at 12‐month follow‐up. Clinical results showed a significant difference in scar appearance between different groups at 12‐month follow‐up. Vancouver scar scale (VSS), visual analogue scale (VAS) scores, and patient satisfaction were significant better in W‐plasty and CTR than other groups at 12‐month follow‐up. No severe complications were reported. The application of the tension offloading device provides an environment where the tension is continuously reduced, which could greatly decrease tension on the surgical incision. Combined with W‐plasty, this technique could significantly improve the scar's aesthetic appearance. [ABSTRACT FROM AUTHOR]

Tendon development requires the coordinated interaction of muscles and tendons. Muscle-derived cells (MDCs), a mixed cell population containing both myogenic and fibroblastic cell subsets, have been found to be ideal seed cells for tendon regeneration. However, the necessity of these cell types for tendon regeneration has not yet been tested. In this study, we aim to explore the possible synergistic effects of myogenic cells and fibroblasts in engineered tendon regeneration. MDCs were separated into rapidly adhering cell (RAC; fibroblasts) and slowly adhering cell (SAC; myogenic cells) populations. Myogenic- and tenogenic-related molecules were analyzed by immunofluorescent staining, RT-PCR and real-time PCR. The proliferative abilities of MDCs, RACs and SACs were also evaluated. Cell-scaffold constructs were implanted into nude mice, and subsequently evaluated for their histologic, ultrastructure, gene expression, and biomechanical characteristics. MDCs have better proliferative activity than RAC and SAC population. RACs could express higher levels of tenogenic-related molecules tenomodulin (TNMD) and scleraxis (SCX) than SACs. Whereas SACs only expressed myogenic-related molecules MyoD. In contrast to the tendons engineered using RACs and SACs, the tendons engineered using MDCs exhibited a relatively more mature and well-organized tissue structure and ultrastructure as well as better mechanical properties. Fibroblasts in muscle may be the primary cell population involved in tendon regeneration and that myogenic cells are an important component of the niche and control the fibroblast activity during tendon regeneration. The synergistic effects between fibroblasts and myogenic cells significantly contribute to efficient and effective regeneration of engineered tendons. [ABSTRACT FROM AUTHOR]