Excitation functions for fast neutron induced reactions on iron and lead

Cross sections of the 54Fe(n,p)54Mn, 54Fe(n,α)51Cr, 56Fe(n,p)56Mn and 204Pb (n,2n)203Pb reactions induced by D-T neutrons were obtained with activation method and γ-ray spectrometry technique. Experimental values measured in this work are consistent with most of the previous literature data. These reactions cross sections were theoretically calculated by using the TALYS-1.96 and EMPIRE-3.2.3 codes from threshold up to 20 MeV, and significant discrepancies were found between calculated results and experiment data. In addition, experimental values are compared with evaluated nuclear data of the CENDL-3.2, ENDF/B-VIII.0, JENDL-5, BROND-3.1 and JEFF-3.3 libraries, and significant difference was found for the 54Fe(n,α)51Cr reaction in ENDF/B-VIII.0 library but not for other reactions.

Dynamic Cortical Connectivity During Propofol Sedation in Glioma Patients

BACKGROUND

The behavioral manifestations and neurophysiological responses to sedation can assist in understanding brain function after neurological damage, and can be described by cortical functional connectivity. Glioma patients may experience neurological deficits that are not clinically detectable before sedation. We hypothesized that patients with gliomas exhibit distinct cortical connectivity patterns compared to non-neurosurgical patients during sedation.

METHODS

This is a secondary analysis of a previously published prospective observational study. Patients scheduled for resection of supratentorial glioma (n=21) or a non-neurosurgical procedure (n=21) under general anesthesia were included in this study. Frontal electroencephalography (EEG) signals were recorded at different sedation levels as assessed by the Observer Assessment of Alertness/Sedation (OAA/S) score. Kernel principal component analysis and k-means clustering were used to determine possible temporal dynamics from the weighted phase lag index characteristics.

RESULTS

Ten EEG connectivity states were identified by clustering (76% consistency), each with unique properties. At OAA/S 3, the median (Q1, Q3) occurrence rates of state 6 (glioma group, 0.110 [0.083, 0.155] vs. control group, 0.070 [0.030, 0.110]; P=0.008) and state 7 (glioma group, 0.105 [0.083, 0.148] vs. control group: 0.065 [0.038, 0.090]; P=0.001), which are dominated by beta connectivity, were significantly different between the 2 groups, reflecting differential conversion of the beta band between the left and right brain regions. In addition, the temporal dynamics of the brain's functional connectivity was also reflected in the transition relationships between metastable states.

CONCLUSIONS

There were differences in EEG functional connectivity, which is dynamic, between the glioma and nonglioma groups during sedation.

Intensive Versus Standard Blood Pressure Management after Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-analysis

Prospective clinical studies on blood pressure (BP) management targets after endovascular therapy (EVT) for acute ischemic stroke (AIS) have recently been published. Our objective was to assess the impact on clinical outcomes of BP management guided by established systolic BP (SBP) targets within the first 24 hours after successful EVT. Four randomized controlled trials (RCTs) including 1556 participants across 5 SBP target settings identified from 5 databases up to September 6, 2023 were included in this systematic review and meta-analysis. All the intensive SBP target groups in these RCTs were combined to facilitate head-to-head comparisons. Patients receiving intensive SBP management had lower risk of 90-day functional independence as assessed by the modified Rankin scale score (relative risk [RR], 0.81; 95% confidence interval [CI], 0.72 to 0.91; I2, 12%), excellent outcomes (RR,0.86; 95% CI, 0.75 to 0.99; I2, 7%), favorable outcomes (RR, 0.85; 95% CI, 0.78 to 0.92; I2, 0%), and quality of life (standardized mean difference, -0.22; 95% CI, -0.35 to -0.10; I2,0%). There were no differences in the probability of any intracerebral hemorrhage (RR, 1.04; 95% CI, 0.92 to 1.19; I2,0%), symptomatic intracerebral hemorrhage (RR, 1.10; 95% CI, 0.76 to 1.60; I2, 0%), stroke-related death (RR, 1.16; 95% CI, 0.80 to 1.68; I2, 0%), or parenchymal hematoma (RR, 1.71; 95% CI, 0.74 to 3.98; I2, 47%) between SBP targets. This meta-analysis provides evidence from RCTs suggesting that intensive SBP control (target<160 mm Hg) may be detrimental to clinical outcomes in AIS patients with successful reperfusion after EVT.

Diagnosis and treatment of recurrent patellar dislocation with knee extensor device combined with rearrangement

OBJECTIVE

This study aimed to investigate the clinical effects of combining knee extension mechanism (EM) with rearrangement in the treatment of recurrent patellar dislocation (RPD).

PATIENTS AND METHODS

Eighty-four patients with RPD admitted to the First Affiliated Hospital of Kunming Medical University were included. In this work, all patients received routine computed tomography (CT) examinations. In addition, the evaluation factors of EM combined with rearrangement therapy in RPD patients were analyzed using logistic regression.

RESULTS

Lysholm and Kujula scores, femoral canal width, patellar canal width, patellar tilt angle (PTA), and lateral patellar displacement (LPD) were significantly increased at 1 and 3 years after treatment (p < 0.05). LPA was significantly decreased, while the tibial tuberosity trochlear groove of the femur (TT-TG) demonstrated no considerable differences (p > 0.05). The good rate of the short-term Insall-Salvati index was 78.6%, and that of the long-term Insall-Salvati index was 76.1%. The combination of the knee extension device and rearrangement therapy has a higher rate of short-term and long-term Insall-Salvati index (ISI) excellence. In addition, the range of motion of the knee joint increased significantly, and the Q Angle decreased significantly (p < 0.05). Logistic regression analysis showed that age and ISI were highly correlated with the evaluation of therapeutic effects in patients with RPD.

CONCLUSIONS

EM combined with rearrangement in the treatment of RPD had positive short-term and long-term efficacy, high application value, and age, which can be popularized in clinical applications and have positive diagnostic value.

A Global Review of the Perioperative Care of Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Microsurgical Repair of Ruptured Intracerebral Aneurysm

INTRODUCTION

To describe the perioperative care of patients with aneurysmal subarachnoid hemorrhage (aSAH) who undergo microsurgical repair of a ruptured intracerebral aneurysm.

METHODS

An English language survey examined 138 areas of the perioperative care of patients with aSAH. Reported practices were categorized as those reported by <20%, 21% to 40%, 41% to 60%, 61% to 80%, and 81% to 100% of participating hospitals. Data were stratified by Worldbank country income level (high-income or low/middle-income). Variation between country-income groups and between countries was presented as an intracluster correlation coefficient (ICC) and 95% confidence interval (CI).

RESULTS

Forty-eight hospitals representing 14 countries participated in the survey (response rate 64%); 33 (69%) hospitals admitted ≥60 aSAH patients per year. Clinical practices reported by 81 to 100% of the hospitals included placement of an arterial catheter, preinduction blood type/cross match, use of neuromuscular blockade during induction of general anesthesia, delivering 6 to 8 mL/kg tidal volume, and checking hemoglobin and electrolyte panels. Reported use of intraoperative neurophysiological monitoring was 25% (41% in high-income and 10% in low/middle-income countries), with variation between Worldbank country-income group (ICC 0.15, 95% CI 0.02-2.76) and between countries (ICC 0.44, 95% CI 0.00-0.68). The use of induced hypothermia for neuroprotection was low (2%). Before aneurysm securement, variable in blood pressure targets was reported; systolic blood pressure 90 to 120 mm Hg (30%), 90 to 140 mm Hg (21%), and 90 to 160 mmHg (5%). Induced hypertension during temporary clipping was reported by 37% of hospitals (37% each in high and low/middle-income countries).

CONCLUSIONS

This global survey identifies differences in reported practices during the perioperative management of patients with aSAH.

Red blood cell transfusion in neurocritical patients: a systematic review and meta-analysis

BACKGROUND

Anemia can lead to secondary brain damage by reducing arterial oxygen content and brain oxygen supply. Patients with acute brain injury have impaired self-regulation. Brain hypoxia may also occur even in mild anemia. Red blood cell (RBC) transfusion is associated with increased postoperative complications, poor neurological recovery, and mortality in critically ill neurologic patients. Balancing the risks of anemia and red blood cell transfusion-associated adverse effects is challenging in neurocritical settings.

METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and MEDLINE (PubMed) from inception to January 31, 2024. We included all randomized controlled trials (RCTs) assessing liberal versus restrictive RBC transfusion strategies in neurocritical patients. We included all relevant studies published in English. The primary outcome was mortality at intensive care unit (ICU), discharge, and six months.

RESULTS

Of 5195 records retrieved, 84 full-text articles were reviewed, and five eligible studies were included. There was no significant difference between the restrictive and liberal transfusion groups in ICU mortality (RR: 2.53, 95% CI: 0.53 to 12.13), in-hospital mortality (RR: 2.34, 95% CI: 0.50 to 11.00), mortality at six months (RR: 1.42, 95% CI: 0.42 to 4.78) and long-term mortality (RR: 1.22, 95% CI: 0.64 to 2.33). The occurrence of neurological adverse events and most major non-neurological complications was similar in the two groups. The incidence of deep venous thrombosis was lower in the restrictive strategy group (RR: 0.41, 95% CI: 0.18 to 0.91).

CONCLUSIONS

Due to the small sample size of current studies, the evidence is insufficiently robust to confirm definitive conclusions for neurocritical patients. Therefore, further investigation is encouraged to define appropriate RBC transfusion thresholds in the neurocritical setting.

Effect of esketamine combined with pregabalin on acute postsurgical pain in patients who underwent resection of spinal neoplasms: a randomized controlled trial

ABSTRACT

Moderate-to-severe acute postsurgical pain (APSP) can prolong the recovery and worsen the prognosis of patients who undergo spinal surgery. Esketamine and pregabalin may resolve APSP without causing hyperpathia or respiratory depression after surgery. However, there are other risks, such as dissociative symptoms. We designed a randomized controlled trial to investigate the effect of the combination of these 2 drugs on the incidence of APSP in patients who underwent resection of spinal neoplasms. Patients aged 18 to 65 years were randomized to receive esketamine (a bolus dose of 0.5 mg·kg-1 and an infusion dose of 0.12 mg·kg-1·h-1 for 48 hours after surgery) combined with oral pregabalin (75-150 mg/day, starting 2 hours before surgery and ending at 2 weeks after surgery) or an identical volume of normal saline and placebo capsules. The primary outcome was the proportion of patients with moderate-to-severe APSP (visual analog scale score ≥ 40) during the first 48 hours after surgery. Secondary outcomes included the incidence of drug-related adverse events. A total of 90 patients were randomized. The incidence of moderate-to-severe APSP in the combined group (27.3%) was lower than that in the control group (60.5%) during the first 48 hours after surgery (odds ratio = 0.25, 95% CI = 0.10-0.61; P = 0.002). The occurrence of mild dissociative symptoms was higher in the combined group than in the control group (18.2% vs 0%). In conclusion, esketamine combined with pregabalin could effectively alleviate APSP after spinal surgery, but an analgesic strategy might increase the risk of mild dissociative symptoms.

Fast neutron induced reaction cross sections on natural manganese and tantalum

The cross sections for the 55Mn(n,2n)54Mn, 181Ta(n,2n)180gTa, and 181Ta(n,p)181Hf reactions were measured to be 705.1 ± 26.1 mb at 14.0 MeV, 1362.7 ± 87.2 mb at 13.6 MeV, and 2.31 ± 0.09 mb at 13.6 MeV, respectively, by using an off-line γ-ray spectroscopic technique. The neutrons were produced via the 3H(d,n)4He reaction. The monitor reactions 27Al(n,α)24Na and 93Nb(n,2n)92mNb were used for neutron flux determination. The results from the present work were compared with those of the literature and the evaluated data from ENDF/B-VIII.0, JEFF-3.3, JENDL-5, CENDL-3.2, and BROND-3.1 libraries. Besides, the cross sections were also estimated with the TALYS-1.96 nuclear model code using different level density models for a better description of the present work and literature data. The present experimental results were found to be in good agreement with most of the available literature data and with the evaluated data.

Measurement and analysis of leakage neutron spectra from Lead slab samples with D-T neutrons

The leakage neutron spectra from three different sizes of Lead samples were measured by a TOF technique at 60° and 120°. The essential characteristic properties of the experimental measurement spectra can be reproduced well by MCNP code simulations with the ENDF/B-VIII.0, CENDL-3.2, JENDL-5.0, JEFF-3.3 and TENDL-2021 evaluated nuclear data libraries. The calculated results of JENDL-5.0 and JEFF-3.3 libraries agree better with the experimental data in the whole energy range. The results from ENDF/B-VIII.0 and CENDL-3.2 are overestimated in the 4-9 MeV range at 60° and in the 4-12.5 MeV range at 120°. The differences of the leakage neutron spectra by MCNP simulations using five evaluated nuclear data libraries mainly originate from the differences of the spectrum distributions of neutron reaction channels in these libraries. And the secondary neutron energy distribution and angular distribution from the five libraries have been present to explain it.

General anesthesia versus nongeneral anesthesia during endovascular therapy for acute ischemic stroke: A systematic review and meta-analysis

OBJECTIVE

This study compares the safety and efficacy of general anesthesia (GA) and nongeneral anesthesia (non-GA) on functional outcomes in patients receiving endovascular therapy for ischemic stroke.

METHODS

All available studies on the anesthetic management of patients with acute ischemic stroke in PubMed, the Cochrane Central Register of Controlled Trials, and Embase were included. We also compared the clinical outcomes in the studies with subgroup analyses of the occlusion site (anterior vs. posterior circulation) and preretriever group versus retriever group. Functional independence, mortality, successful recanalization, hemodynamic instability, intracerebral hemorrhage, and respiratory complications were considered primary or secondary outcomes.

RESULTS

A total of 24,606 patients in 60 studies were included. GA had a lower risk of 90-day functional independence (OR = 0.67, 95% CI 0.58 to 0.77), higher risk of 90-day mortality (OR = 1.29; 95% CI 1.15 to 1.45), and successful reperfusion (OR = 1.18; 95% CI 1.94 to 6.82). However, there were no differences in functional independence and mortality between GA and non-GA at 90 days after the procedure.

CONCLUSION

The study shows poorer results in the GA group, which may be due to the inclusion of nonrandomized studies. However, analysis of the RCTs suggested that the outcomes do not differ between the two groups (GA vs. non-GA). Thus, general anesthesia is as safe as nongeneral anesthesia under standardized management.

Early stellate ganglion block for improvement of postoperative cerebral blood flow velocity after aneurysmal subarachnoid hemorrhage: results of a pilot randomized controlled trial

OBJECTIVE

Stellate ganglion block (SGB) is a commonly used sympathetic nerve block technique that may have benefits for patients with aneurysmal subarachnoid hemorrhage (aSAH) in the early stage. Cerebral vasospasm (CVS), one of the most common complications of aSAH, is accompanied by an abnormal increase in cerebral blood flow velocity (CBFV) and neurological dysfunction. In this pilot study the authors sought to determine the feasibility of early SGB for CVS in aSAH patients by observing the incidence of symptomatic CVS.

METHODS

Prior to receiving surgical treatment, patients with aSAH were randomly assigned to the SGB group or the non-SGB group. The primary outcome was the incidence of symptomatic CVS within 14 ± 2 days after the onset of aSAH. As a higher CBFV is often associated with CVS and a poor prognosis, the mean CBFV of the middle cerebral artery was observed immediately after surgery and on postoperative days 1, 2, 3, 5, and 7. Other secondary outcomes included transcranial Doppler (TCD)/CTA-type CVS, delayed cerebral ischemia during hospitalization, new cerebral infarction within 3 months, adverse events (AEs), and clinical prognosis.

RESULTS

Symptomatic CVS occurred in 40% of patients in the non-SGB group and in 20% in the SGB group (RR 0.50, 95% CI 0.22-1.16). Continuous TCD sonography revealed that the postoperative mean CBFV was lower in the SGB group than in the non-SGB group (F = 3.608, p = 0.02). In addition, the percentages of patients with CVS evaluated by TCD (TCD-CVS) and total new infarctions within 3 months were also significantly lower than those in patients with CVS (TCD-CVS 36.7% vs 70%, RR 0.52, 95% CI 0.31-0.89, and total new infarctions 26.7% vs 53.3%, RR 0.50, 95% CI 0.25-0.99). In terms of AEs and mortality, there were no significant differences between the two groups.

CONCLUSIONS

This pilot study demonstrated for the first time, to the authors' knowledge, that early SGB is feasible and has the potential to reduce the risk of CVS and improve the prognosis of aSAH. This method may be a new treatment for patients with aSAH that may have more advantages than traditional therapeutic drugs and is worth further study. Clinical trial registration no.: NCT04691271 (ClinicalTrials.gov).

Effect of intraoperative muscle relaxation reversal on the success rate of motor evoked potential recording in patients undergoing spinal surgery: a randomized controlled trial

BACKGROUND

Partial neuromuscular blockade (NMB) has been applied for some surgeries to reduce bleeding and prevent patient movement for spinal surgery. Sugammadex selectively binds to rocuronium in the plasma and consequently lowers the rocuronium concentration at the neuromuscular junction. In this study, we aimed to observe whether the success rate of transcranial motor-evoked potential (TceMEP) can be increased by sugammadex compared with partial NMB during spinal surgery.

METHODS

Patients who underwent elective spinal surgery with TceMEP monitoring were randomly assigned to the sugammadex group and control group. Rocuronium was continuously infused to maintain the train of four counts (TOFc) = 2. The sugammadex group discontinued rocuronium infusion at the time of TceMEP monitoring and was infused with 2 mg/kg sugammadex; the control group was infused with the same dose of saline.

RESULTS

A total of 171 patients were included. The success rate of TceMEP monitoring in the sugammadex group was significantly higher than that in the control group. TceMEP amplitudes were greater in the sugammadex group than in the control group at 5 min, 10 min, and 20 min after the start of motor-evoked potential monitoring. The latencies of upper extremity TceMEPs monitoring showed no difference between groups. TOF ratios were greater in the sugammadex group at 5 min, 10 min, and 20 min after the start of motor-evoked potential monitoring. There were no adverse effects caused by sugammadex.

CONCLUSIONS

Sugammadex can improve the success rate of motor-evoked potential monitoring compared with moderate neuromuscular blockade induced by continuous infusion of rocuronium in spinal surgery.

TRIAL REGISTRATION

The study was registered on clinicaltrials.gov.cn on 29/10/2020 (trial registration number: NCT04608682).

Association of Admission Glucose and Outcomes After Endovascular Treatment for Acute Stroke: Data From the ANGEL-ACT Registry

BACKGROUND

The association between admission glucose levels and clinical outcomes after stroke has not been effectively elucidated. This study assessed the association among admission glucose levels, admission hyperglycemia, diabetes mellitus, and 90-day neurological outcomes in patients with acute ischemic stroke undergoing endovascular therapy.

METHODS

The ANGEL-ACT registry enrolled adults with acute ischemic stroke undergoing endovascular therapy between 2017 and 2019 in China and patients with available admission glucose data were included. Restricted cubic spline regression was used to determine the knots of blood glucose levels. Binary or ordinal logistic regression models were used to examine the impact of different admission glucose levels on neurological outcomes and 90-day mortality.

RESULTS

In total, 1684 participants with available admission glucose concentrations were evaluated. The admission glucose level was divided into 4 levels according to the restricted cubic spline curves: level 1 (<5.3 mmol/L), level 2 (5.3 to 7.0 mmol/L), level 3 (7.0 to 11.6 mmol/L), and level 4 (≥11.6 mmol/L). Level 4 admission glucose was associated with a decreased incidence of a modified Rankin scale score of 0 to 2 (hazard ratio, 0.59; 95% CI, 0.40-0.87) and an increased risk of mortality (hazard ratio, 1.74; 95% CI, 1.06-2.85). Levels 3 and 4, hyperglycemia, and diabetes mellitus independently predicted symptomatic intracranial hemorrhage (sICH). Admission glucose levels showed J-shaped relationships with sICH.

CONCLUSIONS

Higher admission glucose levels (≥11.6 mmol/L) were associated with a decreased likelihood of a modified Rankin scale score of 0 to 2 and an increased risk of mortality and sICH.

General Anesthesia Versus Nongeneral Anesthesia for Patients With Acute Posterior Circulation Stroke Undergoing Endovascular Therapy: A Systematic Review and Meta-analysis

There is continued controversy regarding the optimal anesthetic technique for endovascular therapy in patients with acute posterior circulation ischemic stroke. To compare the clinical outcomes general anesthesia (GA) and non-GA, we performed a systematic review and meta-analysis of randomized controlled trials and observational studies focused on the anesthetic management for endovascular therapy in patients with acute posterior circulation stroke, without language restriction. In addition, we compared clinical outcomes among the studies with different non-GA types (conscious sedation or local anesthesia). Outcome variables were functional independence, excellent outcomes, favorable outcomes, mortality, successful recanalization, hemodynamic instability, intracerebral hemorrhage, and respiratory or vascular complications. Eight studies including 1777 patients were identified. Although GA was associated with a lower odds of functional independence at 90 days (odds ratio [OR]: 0.55; 95% confidence interval [CI] 0.38 to 0.81; P =0.009), substantial heterogeneity was noted ( I2 =65%). Subgroup analysis showed that GA was associated with higher odds of mortality than conscious sedation (OR: 1.83; 95% CI, 1.30 to 2.57; I2 =0%), but there was no difference between GA and local anesthesia ( I2 =0%). Interestingly, subgroup analysis did not identify a relationship between functional independence and GA compared with local anesthesia (OR: 0.90; 95% CI, 0.64 to 1.25; P =0.919; I2 =0%). This meta-analysis demonstrates that GA is associated with worse outcomes in patients with acute posterior circulation stroke undergoing endovascular therapy based on current studies.

Hierarchical fluctuation shapes a dynamic flow linked to states of consciousness

Consciousness arises from the spatiotemporal neural dynamics, however, its relationship with neural flexibility and regional specialization remains elusive. We identified a consciousness-related signature marked by shifting spontaneous fluctuations along a unimodal-transmodal cortical axis. This simple signature is sensitive to altered states of consciousness in single individuals, exhibiting abnormal elevation under psychedelics and in psychosis. The hierarchical dynamic reflects brain state changes in global integration and connectome diversity under task-free conditions. Quasi-periodic pattern detection revealed that hierarchical heterogeneity as spatiotemporally propagating waves linking to arousal. A similar pattern can be observed in macaque electrocorticography. Furthermore, the spatial distribution of principal cortical gradient preferentially recapitulated the genetic transcription levels of the histaminergic system and that of the functional connectome mapping of the tuberomammillary nucleus, which promotes wakefulness. Combining behavioral, neuroimaging, electrophysiological, and transcriptomic evidence, we propose that global consciousness is supported by efficient hierarchical processing constrained along a low-dimensional macroscale gradient.

Cerebral tissue oximeter suitable for real-time regional oxygen saturation monitoring in multiple clinical settings

Maintenance of adequate blood perfusion and oxygen delivery is essential for cerebral metabolism. Cerebral oximeters based on near-infrared spectroscopy (NIRS) have been used for noninvasive, continuous, real-time monitoring of cerebral oxygen saturation and management of cerebral oxygen adequacy perioperatively and intraoperatively in various clinical situations, such as cardiac surgery, anesthesia, and cerebral auto-regulation. In this study, a portable and modular cerebral tissue oximeter (BRS-1) was designed for real-time detection of regional oxygen saturation over the brain, finger, or other targeted body tissues, as well as for wireless cerebral oxygenation monitoring. The compact and lightweight design of the system makes it easy to use during ambulance transport, in an emergency cart, or in an intensive care unit. The system performance of the BRS-1 oximeter was evaluated and compared with two US FDA-cleared cerebral oximeters during a controlled hypoxia experiment. The results showed that the BRS-1 oximeter can be used for real-time detection of cerebral desaturation with an accuracy similar to the two commercial oximeters. More importantly, the BRS-1 oximeter is capable of capturing cerebral oxygen saturation wirelessly. The BRS-1 cerebral oximeter can provide valuable insights for clinicians for real-time monitoring of cerebral/tissue perfusion and management of patients in prehospital and perioperative periods.

Choice of anaesthesia in microelectrode recording-guided deep-brain stimulation for Parkinson's disease (CHAMPION): study protocol for a single-centre, open-label, non-inferiority randomised controlled trial

INTRODUCTION

Deep brain stimulation (DBS) implantation under general anaesthesia (GA) has been applied to patients with Parkinson's disease (PD) with severe comorbidities or disabling off-medication symptoms. However, general anaesthetics may affect intraoperative microelectrode recording (MER) to varying degrees. At present, there are few studies on the effects of sedatives or general anaesthetics on multiunit activity characteristics performed by MER in patients with PD during DBS. Therefore, the effect of the choice of anaesthesia on MER remains unclear.

METHODS/DESIGN

This is a prospective randomised controlled, non-inferiority study that will be carried out at Beijing Tiantan Hospital, Capital Medical University. Patients undergoing elective bilateral subthalamic nucleus (STN)-DBS will be enrolled after careful screening for eligibility. One hundred and eighty-eight patients will be randomised to receive either conscious sedation (CS) or GA at a 1:1 ratio. The primary outcome is the proportion of high normalised root mean square (NRMS) recorded by the MER signal.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of Beijing Tiantan Hospital of Capital Medical University (KY2022-147-02). Negative study results will indicate that GA using desflurane has a non-inferior effect on MER during STN-DBS compared with CS. The results of this clinical trial will be presented at national or international conferences and submitted to a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT05550714.

Effect of driving pressure on early postoperative lung gas distribution in supratentorial craniotomy: a randomized controlled trial

BACKGROUND

Neurosurgical patients represent a high-risk population for postoperative pulmonary complications (PPCs). A lower intraoperative driving pressure (DP) is related to a reduction in postoperative pulmonary complications. We hypothesized that driving pressure-guided ventilation during supratentorial craniotomy might lead to a more homogeneous gas distribution in the lung postoperatively.

METHODS

This was a randomized trial conducted between June 2020 and July 2021 at Beijing Tiantan Hospital. Fifty-three patients undergoing supratentorial craniotomy were randomly divided into the titration group or control group at a ratio of 1 to 1. The control group received 5 cmH₂O PEEP, and the titration group received individualized PEEP targeting the lowest DP. The primary outcome was the global inhomogeneity index (GI) immediately after extubation obtained by electrical impedance tomography (EIT). The secondary outcomes were lung ultrasonography scores (LUSs), respiratory system compliance, the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO₂/FiO₂) and PPCs within 3 days postoperatively.

RESULTS

Fifty-one patients were included in the analysis. The median (IQR [range]) DP in the titration group versus the control group was 10 (9-12 [7-13]) cmH₂O vs. 11 (10-12 [7-13]) cmH₂O, respectively (P = 0.040). The GI tract did not differ between groups immediately after extubation (P = 0.080). The LUS_S was significantly lower in the titration group than in the control group immediately after tracheal extubation (1 [0-3] vs. 3 [1-6], P = 0.045). The compliance in the titration group was higher than that in the control group at 1 h after intubation (48 [42-54] vs. 41 [37-46] ml·cmH₂O^-1, P = 0.011) and at the end of surgery (46 [42-51] vs. 41 [37-44] ml·cmH₂O^-1, P = 0.029). The PaO₂/FiO₂ ratio was not significantly different between groups in terms of the ventilation protocol (P = 0.117). At the 3-day follow-up, no postoperative pulmonary complications occurred in either group.

CONCLUSIONS

Driving pressure-guided ventilation during supratentorial craniotomy did not contribute to postoperative homogeneous aeration, but it may lead to improved respiratory compliance and lower lung ultrasonography scores.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov NCT04421976.

Electroencephalography characteristics of patients with supratentorial glioma in different consciousness states induced by propofol

Gliomas are the most common primary intracranial malignant tumors. Some of these patients exhibit previously clinically undetected neurological deficits after sedation. The absence of neurophysiological evidence for this phenomenon limits the use of time-sensitive monitoring methods. The study aims to compare differences between glioma patients under sedation and those without intracranial lesions by comparing their EEG features. Twenty-one patients without intracranial tumors and 21 with frontal lobe supratentorial gliomas were enrolled. The EEG power spectrum of the glioma group was comparable to that of the control group for both sides of the brain (P>0.05 for all frequencies). Compared with those without intracranial lesions, the weighted phase lag index (wPLI) in the alpha and beta bands on the non-occupied side decreased. Glioma patients had weaker functional connectivity during sedation than patients without intracranial lesions, manifesting as reduced functional connectivity on the non-occupied side.

Effects of Ketamine on Chronic Postsurgical Pain in Patients Undergoing Surgery: A Systematic Review and Meta-analysis

BACKGROUND

Chronic postsurgical pain (CPSP) has become a common complication during the perioperative period. The efficacy of one of the most potent strategies, ketamine, remains unclear.

OBJECTIVES

The aim of this meta-analysis was to evaluate the effect of ketamine on CPSP in patients undergoing common surgeries..

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

English-language randomized controlled trials (RCTs) published in MEDLINE, Cochrane Library, and EMBASE from 1990 through 2022 were screened. RCTs with a placebo control group that evaluated the effect of intravenous ketamine on CPSP in patients undergoing common surgeries were included. The primary outcome was the proportion of patients who experienced CPSP 3 - 6 months postsurgery. The secondary outcomes included adverse events, emotional evaluation, and 48 hour postoperative opioid consumption. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Pooled effect sizes were measured using the common-effects model or random-effects model, and several subgroup analyses were conducted.

RESULTS

Twenty RCTs were included with 1,561 patients. Our pooled meta-analysis showed a significant difference between ketamine and placebo in the treatment of CPSP (Relative Risk [RR] = 0.86; 95% CI, 0.77 - 0.95; P = 0.02; I2 = 44%). In the subgroup analyses, our results indicated that compared with placebo, intravenous ketamine might decrease the prevalence of CPSP 3 - 6 months postsurgery (RR = 0.82; 95% CI, 0.72 - 0.94; P = 0.03; I2 = 45%). For adverse events, we observed that intravenous ketamine might lead to hallucinations (RR = 1.61; 95% CI, 1.09 - 2.39; P = 0.27; I2 = 20%) but did not increase the incidence of postoperative nausea and vomiting (RR = 0.98; 95% CI, 0.86 - 1.12; P = 0.66; I2 = 0%).

LIMITATIONS

Inconsistent assessment tools and follow-up for chronic pain may contribute to the high heterogeneity and limitation of this analysis.

CONCLUSIONS

We discovered that intravenous ketamine may reduce the incidence of CPSP in patients undergoing surgery, especially 3 - 6 months postsurgery. Because of the small sample size and high heterogeneity of the included studies, the effect of ketamine in the treatment of CPSP still needs to be explored in future large-sample, standardized-assessment studies.

Effect of Sugammadex During Transcranial Electrical Motor Evoked Potentials Monitoring in Spinal Surgery: A Randomized Controlled Trial

INTRODUCTION

Neuromuscular blockade suppresses transcranial electrical motor evoked potential (TceMEP) amplitude and is usually avoided during TceMEP monitoring. In this randomized controlled trial, we investigated whether rocuronium-induced suppression of TceMEP amplitude could be reversed by sugammadex in patients undergoing spine surgery.

METHODS

Seventy-six patients undergoing spinal surgery were randomly allocated into sugammadex and control groups. In the sugammadex group, a rocuronium infusion was titrated to maintain moderate neuromuscular blockade (2 twitches on train-of-four) until dural opening when the rocuronium infusion was discontinued and 2 mg/kg sugammadex administered. In the control group, no neuromuscular blockade was administered after induction of anesthesia. The primary outcome was a comparison between sugammadex and control groups of mean TceMEP amplitudes in the abductor pollicis brevis muscles of both upper extremities 5 minutes after dural. Secondary outcomes included TceMEP amplitudes at 10, 20, 30, and 60 minutes after dural opening.

RESULTS

Sixty-six patients were included in the analysis. TceMEP amplitudes were significantly greater in the sugammadex group (629 μV, interquartile range: 987 μV) than in the control group (502 μV, interquartile range: 577 μV; P =0.033) at 5 minutes after dural opening. TceMEP amplitudes were also greater in the sugammadex group at 10 minutes ( P =0.0010), 20 minutes ( P =0.003), 30 minutes ( P =0.001), and 60 minutes ( P =0.003) after dural opening.

CONCLUSIONS

Moderate neuromuscular blockade induced by continuous infusion of rocuronium was effectively reversed by sugammadex. This suggests that sugammadex could be used to enhance TceMEP waveform monitoring during spine surgery requiring muscle relaxation.

Effect of butorphanol on visceral pain in patients undergoing gastrointestinal endoscopy: a randomized controlled trial

BACKGROUND

Butorphanol slightly influences the respiratory and circulatory systems, has a better effect on relieving the discomfort caused by mechanical traction, and has a low incidence of postoperative nausea and vomiting (PONV). Combined butorphanol and propofol may suppress postoperative visceral pain, which is avoidable in gastrointestinal endoscopy. Thus, we hypothesized that butorphanol could decrease the incidence of postoperative visceral pain in patients undergoing gastroscopy and colonoscopy.

METHODS

This was a randomized, placebo-controlled, and double-blinded trial. Patients undergoing gastrointestinal endoscopy were randomized to intravenously receive either butorphanol (Group I) or normal saline (Group II). The primary outcome was visceral pain after the procedure 10 min after recovery. The secondary outcomes included the rate of safety outcomes and adverse events. Postoperative visceral pain was defined as a visual analog scale (VAS) score ≥ 1.

RESULTS

A total of 206 patients were enrolled in the trial. Ultimately, 203 patients were randomly assigned to Group I (n = 102) or Group II (n = 101). In total, 194 patients were included in the analysis: 95 in Group I and 99 in Group II. The incidence of visceral pain at 10 min after recovery was found to be statistically lower with butorphanol than with the placebo (31.5% vs. 68.5%, respectively; RR: 2.738, 95% CI [1.409-5.319], P = 0.002), and the notable difference was in pain level or distribution of visceral pain (P = 0.006).

CONCLUSIONS

The trial indicated that adding butorphanol to propofol results in a lower incidence of visceral pain after surgery without noticeable fluctuations in circulatory and respiratory functions for gastrointestinal endoscopy patients.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04477733 (PI: Ruquan Han; date of registration: 20/07/2020).

Activation cross sections for reactions induced by 14 MeV neutrons on natural titanium

Cross sections for the neutrons around 14 MeV interaction with natural titanium were precisely measured by neutron activation and off-line measurement technique. The fast neutrons were produced by ³H(d,n)⁴He reaction and the neutron energy was obtained by using the cross section ratio method of ⁹⁰Zr(n,2n)⁸⁹Zr to ⁹³Nb(n,2n)^92mNb reactions. Experimental cross sections have been acquired for ^natTi(n,x)⁴⁶Sc, ^natTi(n,x)⁴⁷Sc, ⁵⁰Ti(n,x)⁴⁷Ca and ⁴⁸Ti(n,x)⁴⁸Sc reactions. The measured cross section data are compared with the experimental data available in the previous literature and evaluated nuclear data from the ENDF/B-VIII.0, JEFF-3.3, JENDL-5, BROND-3.1, CENDL-3.2 and FENDL-3.2b libraries. Furthermore, excitation functions for these reactions were calculated by using the theoretical model based on Talys-1.96 code with default and adjusted parameters. Within experimental error, evaluated nuclear data are mostly consistent with experimental data. The excitation function with adjusted parameters can roughly reproduce the experimental data.

Esketamine combined with pregabalin on acute postoperative pain in patients undergoing resection of spinal neoplasms: study protocol for a randomized controlled trial

BACKGROUND

Perioperative pain management is one of the most challenging issues for patients with spinal neoplasms. Inadequate postoperative analgesia usually leads to severe postsurgical pain, which could cause patients to suffer from many other related complications. Meanwhile, there is no appropriate analgesic strategy for patients with spinal neoplasms.

METHODS/DESIGN

This is a protocol for a randomized double-blind controlled trial to evaluate the effect of esketamine combined with pregabalin on postsurgical pain in spinal surgery. Patients aged 18 to 65 years scheduled for spinal neoplasm resection will be randomly allocated into the combined and control groups in a 1:1 ratio. In the combined group, esketamine will be given during the during the surgery procedure until 48-h postoperative period, and pregabalin will be taken from 2 h before the surgery to 2 weeks postoperatively. The control group will receive normal saline and placebo capsules at the same time points. Both groups received a background analgesic regimen by using patient-controlled intravenous analgesia (containing 100 μg sufentanil and 16 mg ondansetron) until 2 days after surgery. To ensure the accuracy and reliability of this trial, all the researchers and patients will be blinded until the completion of this study. The primary outcome will be the proportion of patients with acute moderate-to-severe postsurgical pain (visual analog scale, VAS ≥ 40, range: 0-100, with 0, no pain; 100, the worst pain) during the 48-h postoperative period. The secondary outcomes will include the maximal VAS scores (when the patients felt the most intense pain over the last 24 h before being interviewed) at 0-2 h, 2-24 h, 24-48 h, and 48-72 h after leaving the operating room and 24 h before discharge; the incidence of acute moderate-to-severe postsurgical pain at each other time point; chronic postsurgical pain assessment; neuropathic pain assessment; and the incidence of drug-related adverse events and other postoperative complications, such as postoperative delirium and postoperative nausea and vomiting (PONV).

DISCUSSION

The aim of this study was to evaluate the effect of esketamine combined with pregabalin on acute postsurgical pain in patients undergoing resection of spinal neoplasms. The safety of this perioperative pain management strategy will also be examined.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05096468. Registered on October 27, 2021.

Opioid-induced short-term consciousness improvement in patients with disorders of consciousness

Introduction

Effective treatment to facilitate recovery from prolonged disorders of consciousness is a complex topic for the medical community. In clinical practice, we have found that a subset of patients has a short-term improvement of consciousness after general anesthesia.

Methods

To determine the clinical factors responsible for the consciousness improvement, we enrolled 50 patients with disorders of consciousness who underwent surgery from October 2021 to June 2022. Their states of consciousness were evaluated before surgery, within 48 h after surgery, and 3 months after surgery. Clinical-related factors and intraoperative anesthetic drug doses were collected and compared between patients with and without consciousness improvement. Independent associations between selected factors and postoperative improvement were assessed using multivariate logistical regression analyses.

Results

Postoperative short-term consciousness improvement was found in 44% (22/50) of patients, with significantly increased scores of auditory and visual subscales. Patients with traumatic etiology, a preoperative diagnosis of minimally conscious state, and higher scores in the auditory, visual, and motor subscales were more likely to have postoperative improvement. This short-term increase in consciousness after surgery correlated with patients' abilities to communicate in the long term. Furthermore, the amount of opioid analgesic used was significantly different between the improved and non-improved groups. Finally, analgesic dose, etiology, and preoperative diagnosis were independently associated with postoperative consciousness improvement.

Discussion

In conclusion, postoperative consciousness improvement is related to the residual consciousness of the patient and can be used to evaluate prognosis. Administration of opioids may be responsible for this short-term improvement in consciousness, providing a potential therapeutic approach for disorders of consciousness.

Valgus-varus deformity induced abnormal tissue metabolism, inflammatory damage and apoptosis in broilers

1. This study explored the tissue metabolic status and the relationship with inflammation in valgus-valgus deformity (VVD) broilers with increasing age.2. Tissue and blood from VVD and healthy broilers were collected at two, four and five weeks old. A fully automated biochemical analyser, real-time PCR, HE staining and enzyme-linked immunosorbent assay were used to detect tissue metabolic indexes, mRNA levels of inflammation and apoptosis cytokines in immune organs, histological changes and serum inflammation and immune-related protein contents in VVD broilers.3. The results showed that VVD increased the levels of total protein, albumin, alanine aminotransferase at five weeks of age, aspartate aminotransferase, urea and creatine kinase in blood at two weeks of age. It upregulated the gene expression of inflammatory factors IL-1β, IL-6, IL-8, TNF-α, NF-κB and TGF-β and apoptotic factors FAS, Bcl-2, caspase-3 and 9 in immune organs; increased levels of serum proteins TNF-α, IL-1β and IL-6 and decreased levels of serum immunoglobulins IgY and CD3⁺.4. In addition, with increasing age, IL-10 gene expression gradually increased in the BF and decreased in the spleen.5. In conclusion, VVD broilers have disorders of liver and kidney metabolism, inflammation and apoptosis of immune organs and increased levels of serum inflammatory factor proteins.

Brain relaxation using desflurane anesthesia and total intravenous anesthesia in patients undergoing craniotomy for supratentorial tumors: a randomized controlled study

BACKGROUND

Satisfactory brain relaxation is essential in neurosurgery. Desflurane anesthesia and propofol-based total intravenous anesthesia (TIVA) have different effects on cerebral hemodynamics, potentially contributing to discrepant brain relaxation. The purpose of this study was to compare the effects of desflurane and TIVA on brain relaxation in patients undergoing craniotomy for supratentorial tumors.

METHODS

In this randomized, controlled study, we enrolled patients aged 18-60 years, with ASA I-III, who were scheduled to undergo elective craniotomy for supratentorial tumors. Patients were randomly assigned in a 1:1 ratio to receive desflurane anesthesia or TIVA. The primary outcome was the proportion of satisfactory brain relaxation. Secondary outcomes included emergence and extubation times, recovery of cognitive function and postoperative complications.

RESULTS

Of 369 patients who were assessed for eligibility, 111 were randomized and 110 were included in the modified intention-to-treat analysis (55 in the desflurane group and 55 in the TIVA group). The proportion of satisfactory brain relaxation was similar between the two groups: 69% in the desflurane group and 73% in the TIVA group (RR: 0.950, 95% CI: 0.748-1.207; P = 0.675). Patients assigned to the desflurane group had shorter emergence (10 [8-13] min vs. 13 [10-20] min, P < 0.001) and extubation times (13 [10-18] min vs. 17 [13-23] min, P < 0.001), and better recovery of cognitive function at 15 min after extubation (16 [0-24] vs. 0 [0-20], P = 0.003), but experienced increased postoperative nausea and vomiting (PONV) (16 [29%] vs. 6 [11%] P = 0.017) and tachycardia (22 [40%] vs. 9 [16%], P = 0.006) during recovery.

CONCLUSIONS

Desflurane anesthesia and TIVA provide similar brain relaxation in patients without intracranial hypertension undergoing elective craniotomy. Desflurane accelerates the recovery from anesthesia but is associated with increased PONV and tachycardia during the recovery period.

TRIAL REGISTRATION

Clinicaltrial.gov (NCT04691128). Date of registration: December 31, 2020.

General Anesthesia vs Conscious Sedation for Endovascular Treatment in Patients With Posterior Circulation Acute Ischemic Stroke: An Exploratory Randomized Clinical Trial

Importance

No definitive conclusion can be made on the best choice of anesthesia for people with acute posterior circulation stroke during endovascular treatment. Only a few observational studies have focused on this topic in recent years, and they have differing conclusions.

Objective

To examine whether conscious sedation (CS) is a feasible alternative to general anesthesia (GA) during endovascular treatment in patients with acute posterior circulation stroke.

Design, Setting, and Participants

A randomized parallel-group exploratory trial with blinded end point evaluation (Choice of Anesthesia for Endovascular Treatment of Acute Ischemic Stroke [CANVAS II]) enrolled adult patients from March 2018 to June 2021 at 2 comprehensive care hospitals in China. Patients with acute posterior circulation stroke were enrolled, randomized, and monitored for 3 months. Of 210 patients admitted with acute ischemic posterior circulation stroke, 93 were recruited and 87 were included in the intention-to-treat (ITT) analysis after exclusions, 43 were assigned to GA and 44 to CS. All analyses were unadjusted or adjusted with the ITT principle.

Interventions

Participants were randomly assigned to CS or GA in a 1:1 ratio.

Main Outcomes and Measures

The primary end point was functional independence at 90 days evaluated with the modified Rankin Scale (mRS).

Results

A total of 87 participants were included in the ITT study (mean [SD] age, 62 [12] years; 16 [18.4%] female and 71 [81.6%] male). Of these, 43 were in the GA group and 44 in the CS group. The overall baseline median (IQR) National Institute of Health Stroke Scale (NIHSS) score was 15 (12-17). In the CS group, 13 people (29.5%) were ultimately transferred to GA. The CS group had a higher incidence of functional independence; however, no significant difference was found between the 2 groups (48.8% vs 54.5%; risk ratio, 0.89; 95% CI, 0.58-1.38; adjusted odds ratio [OR], 0.91; 95% CI, 0.37-2.22). However, GA performed better in successful reperfusion (mTICI 2b-3) under ITT analysis (95.3% vs 77.3%; adjusted OR, 5.86; 95% CI, 1.16-29.53).

Conclusion and Relevance

The findings in this study suggest that CS was not better than GA for the primary outcome of functional recovery and was perhaps worse for the secondary outcome of successful reperfusion.

Trial Registration

ClinicalTrials.gov Identifier: NCT03317535.

Comparison of As(III) Adsorption by Nanomagnetic Fe3O4, Activated Carbon and Modified Activated Carbon

As a kind of new material, nanomagnetic Fe3O4 (NMF) has many advantages in water and wastewater treatment. In this paper, the adsorption characteristic for arsenic(III) (As) by NMF was studied, and the adsorption was compared with the traditional adsorbent of activated carbon (AC) and modified activated carbon (MAC). The results showed that the NMF had high adsorption performance for As, and the adsorption performance of modified activated carbon and activated carbon were far lower than that of magnetic nanomagnetic Fe3O4. The adsorption capacity for As with NMF, MAC, and AC was 0.189 mg.g-1, 0.023 mg.g-1 and 0.013 mg.g-1 in 0.25 mg.L-1 As solution, respectively. The adsorption rate for As was different from the three adsorbents. For NMF, it needs only 10 minutes to reach an adsorption balance, while the time to balance was 20 minutes for MAC and more than 120 minutes for AC. The adsorption for As by the three adsorbents all conform to Langmuir adsorption isotherm, and the adsorption kinetics for As by the three adsorbents were in accordance with the pseudo-second-order kinetics model. The adsorption efficiency of MAC and AC was lower than nanomagnetic Fe3O4. The nanomagnetic Fe3O4 was an effective adsorbent for arsenic.

Effect of early stellate ganglion block in cerebral vasospasm after aneurysmal subarachnoid hemorrhage (BLOCK-CVS): study protocol for a randomized controlled trial

Introduction

Stellate ganglion block has been reported to expand cerebral vessels and alleviate vasospasm after aneurysmal subarachnoid hemorrhage. However, the causal relationship between early stellate ganglion block and cerebral vasospasm prevention has not yet been established. The purpose of this study was to explore the effectiveness and safety of early stellate ganglion block as a preventive treatment for cerebral vasospasm and delayed cerebral ischemia.

Methods/design

This is a single-center, prospective, randomized, controlled, blinded endpoint assessment superiority trial. A total of 228 patients will be randomized within 48 h of aneurysmal subarachnoid hemorrhage onset in a 1:1 ratio into two groups, one group receiving an additional e-SGB and the other group receiving only a camouflaging action before anesthesia induction in the operating room. The primary outcome is the incidence of symptomatic vasospasm within 14 days after aSAH. Further safety and efficacy parameters include the incidence of radiographic vasospasm, new cerebral infarction, postoperative delirium, and complications up to 90 days after surgery; postoperative cerebral hemodynamics; Mini-Mental State Examination score; modified Rankin scale score; and all-cause mortality up to 90 days after surgery.

Discussion

This is a randomized controlled trial to explore the effectiveness and safety of early stellate ganglion block as a preventive treatment to reduce cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. If the results are positive, it may provide a new direction for the prevention and treatment of cerebral vasospasm and delayed cerebral ischemia.

Trial registration

The study was registered on Clincaltrials.gov on December 13, 2020 (NCT04691271).

Factors associated with artificial airway retention after skull base chordoma resection: A retrospective cohort study

Background

Chordoma is a malignant bone and soft tissue tumor derived from embryonic notochord remnants, and skull base chordoma accounts for ~1/3 of all chordoma cases. Skull base chordoma is closely related to the brainstem and cranial nerves and has a high recurrence rate. The purpose of this study was to investigate the influence of the timing of tracheal extubation on perioperative pulmonary complications. We also aimed to explore predictors of postoperative artificial airway (AA) retention in patients with skull base chordoma.

Methods

This was a single-center, retrospective cohort study. The study population included all skull base chordoma patients undergoing surgical treatment between January 2019 and December 2021 at Beijing Tiantan Hospital. The primary outcome was the incidence of postoperative pulmonary complications. Several patient characteristics were evaluated for potential associations with AA retention.

Results

A total of 310 patients with skull base chordoma were enrolled. The frequency of AA retention after surgery for skull base chordoma was 30.97%. The incidence of postoperative pulmonary complications was much lower in those without AA retention (3.74 vs. 39.58%, P &lt; 0.001). Factors with the highest point estimates for the odds of AA retention included body mass index, cranial nerve involvement, maximum tumor diameter, operative method, hemorrhage volume, operative duration and intraoperative mechanical ventilation duration.

Conclusions

In this retrospective cohort study, most of the factors associated with postoperative airway retention were closely related to the patient's tumor characteristics. These data demonstrate that respiratory management in patients with skull base chordoma remains an ongoing concern.

Effect of Sufentanil Combined with Gabapentin on Acute Postoperative Pain in Patients Undergoing Intraspinal Tumor Resection: Study Protocol for a Randomized Controlled Trial

Purpose

Patients undergoing intraspinal tumor resection usually experience severe postoperative pain. Inadequate postoperative analgesia usually leads to severe postsurgical pain, which could cause patients to suffer from many other related complications. Recently, an increasing number of studies have found that gabapentin can relieve hyperalgesia, postoperative pain, and postoperative inflammation. However, there have been no reports on the use of gabapentin combined with sufentanil preoperatively for acute pain following intraspinal tumor resection.

Study Design and Methods

This is a protocol for a randomized, placebo-controlled, and double-blinded trial. One-hundred and sixty-eight participants with chronic pain related to the intraspinal tumor will be randomized into the gabapentin and placebo groups in a 1:1 ratio. In the gabapentin group, patients will be given 300 mg gabapentin orally 36 h, 24 h, and 12 h before surgery; the placebo group will receive a placebo orally at the same time points preoperatively. To estimate the efficacy and safety endpoints, all the researchers and patients will be blinded until the completion of this study. The primary outcome will be the consumption of sufentanil within 48 h postoperatively. The secondary outcomes include the visual analog scale pain score and Von Frey mechanical pain threshold 36 h and 24 h before and 24 h and 48 h after surgery, the incidence of postoperative nausea, vomiting, and drowsiness, the length of hospital stay and medical expenses.

Discussion

This trial is to evaluate the efficacy and safety of gabapentin combined with sufentanil for postoperative analgesia in patients who complain of pain before intraspinal tumor resection. The findings will provide a new strategy for multimode perioperative analgesia management in these patients.

[Establishment of a culture system for human nasal mucosa organoids with controllable differentiation]

OBJECTIVE

To establish a culture system for human nasal mucosal organoids with controllable differentiation to reproduce the structure and function of the source tissue through staged expansion-differentiation culture.

METHODS

Fresh samples of surgically resected middle turbinate and nasal polyp tissues were collected, from which the nasal mucosa epithelial cells were isolated by enzymatic digestion and filtration for continuous culture at the air-liquid interface for expansion (EO group) or staged culture for expansion and differentiation (DO group). Immunohistochemical staining was used to characterize the structure, cellular composition and ciliary function of nasal mucosal organoids in the two groups. The secretion function of the differentiated nasal mucosal organoids in DO group was evaluated using PAS staining.

RESULTS

Both of the two organoid culture systems yielded vacuolar or solid spherical 3D organoids, and their diameters increased progressively with time. On day 16 of culture, more vacuolar organoids occurred in DO group, while more solid spherical organoids were seen in EO group, and the proportion of vacuoles was significantly greater in DO group than in EO group [(54.67±13.26)% vs (21.67±8.57)%, P < 0.05]. Short tandem repeat (STR) test of the nasal mucosal organoids and the source tissue showed a 100% match between them. On day 21 of culture, scanning and transmission electron microscopy of the nasal mucosal organoids identified ultrastructure of cilia in DO group and short villi structure in most of the organoids in EO group. Immunohistochemical staining showed positivity for P63 (basal cells), β-tubulin (ciliated columnar cells), and MUC5AC (goblet cells) in the organoids. Compared with those in EO group, the organoids in DO group showed significantly greater percentages of ciliated cells [(7.95±1.81)% vs (27.04±5.91)%, P < 0.05] and goblet cells [(14.46±0.93)% vs (39.85±5.43)%, P < 0.05) with a similar percentage of basal cells [(56.91±14.12)% vs (53.42±15.77)%, P > 0.05]. The differentiated nasal mucosal organoids in DO group were positively stained for glycogen.

CONCLUSION

The staged expansion-differentiation culture method allows more stable and prolonged growth of the cultured cells in vitro to produce organoids with controllable differentiation closely resembling the morphological structure and functions (ciliary function and secretory function) of the source tissue.

Joint synthesis and registration network for deformable MR-CBCT image registration for neurosurgical guidance

Objective.The accuracy of navigation in minimally invasive neurosurgery is often challenged by deep brain deformations (up to 10 mm due to egress of cerebrospinal fluid during neuroendoscopic approach). We propose a deep learning-based deformable registration method to address such deformations between preoperative MR and intraoperative CBCT.Approach.The registration method uses a joint image synthesis and registration network (denoted JSR) to simultaneously synthesize MR and CBCT images to the CT domain and perform CT domain registration using a multi-resolution pyramid. JSR was first trained using a simulated dataset (simulated CBCT and simulated deformations) and then refined on real clinical images via transfer learning. The performance of the multi-resolution JSR was compared to a single-resolution architecture as well as a series of alternative registration methods (symmetric normalization (SyN), VoxelMorph, and image synthesis-based registration methods).Main results.JSR achieved median Dice coefficient (DSC) of 0.69 in deep brain structures and median target registration error (TRE) of 1.94 mm in the simulation dataset, with improvement from single-resolution architecture (median DSC = 0.68 and median TRE = 2.14 mm). Additionally, JSR achieved superior registration compared to alternative methods-e.g. SyN (median DSC = 0.54, median TRE = 2.77 mm), VoxelMorph (median DSC = 0.52, median TRE = 2.66 mm) and provided registration runtime of less than 3 s. Similarly in the clinical dataset, JSR achieved median DSC = 0.72 and median TRE = 2.05 mm.Significance.The multi-resolution JSR network resolved deep brain deformations between MR and CBCT images with performance superior to other state-of-the-art methods. The accuracy and runtime support translation of the method to further clinical studies in high-precision neurosurgery.

Safety and efficacy of intravenous or topical tranexamic acid administration in surgery: a protocol for a systematic review and network meta-analysis

INTRODUCTION

Tranexamic acid (TXA) has become a widely used antifibrinolytic drug for reducing bleeding in surgery. However, adverse events, such as seizures, pulmonary embolism and deep vein thrombosis, limit its application. To date, insufficient attention has been devoted to determining the optimal dosage and administration route of TXA in the field of surgery. Thus, this study uses the network meta-analysis method, relying on its characteristics of combining direct comparison and indirect comparison, to analyse the safety and efficacy of different doses (high, medium, low) of intravenous injection or of topical application of TXA.

METHODS AND ANALYSIS

We will search the PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science and China National Knowledge Internet databases using a strategy that combines the terms TXA, randomised controlled trials and embolism (or haemorrhage, blood transfusion, seizure, mortality). Two reviewers will independently screen all identified abstracts for eligibility and evaluate the risk-of-bias of the included studies using the Cochrane risk of bias tool for randomised controlled studies. We will conduct a systematic review and network meta-analysis. We plan to investigate heterogeneity by performing subgroup analysis and sensitivity analysis, and we will also consider the dose-response relationship between the optimal dose and a better routine. We will assess the overall certainty of the evidence for each outcome using the Grading Recommendations Assessment, Development and Evaluation approach ETHICS AND DISSEMINATION: No ethics approval will be sought, as no original data will be collected for this review. Findings will be disseminated through peer-reviewed publications and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42021281206.

Effect of intraoperative muscle relaxation reversal on the success rate of motor-evoked potential recording in patients undergoing spinal surgery: study protocol for a randomised controlled trial

INTRODUCTION

Transcranial motor-evoked potentials (TceMEPs) is conventionally performed without neuromuscular blockade (NMB) because of its potential interference with neuromuscular junction and signal interpretation. Sugammadex is the first highly selective antagonist that binds to rocuronium and can rapidly and effectively reverse NMB. This study aims to evaluate the success rate of intraoperative muscle relax reversal by sugammadex on intraoperative TceMEP recording.

METHODS AND ANALYSIS

We will conduct a single-centre randomised controlled study. In total, 162 patients undergoing thoracic or lumbar spinal surgery will be randomly divided into the sugammadex group or control group at a ratio of 1:1. Total intravenous anaesthesia by propofol and remifentanil will be performed in both groups. In the sugammadex group, patients will receive continuous infusion of rocuronium to produce a blockade maintained for at least two twitches in train-of-four, rocuronium infusion will be discontinued and 2 mg/kg sugammadex will be given while performing TceMEPs monitoring. In the control group, rocuronium infusion will be discontinued and the same volume of saline will be infused while performing TceMEPs monitoring. The primary aim of this study is to evaluate the success rate of TceMEPs recording between two groups.

ETHICS AND DISSEMINATION

The approval for the study was certificated by the Ethical Committee of Beijing Tiantan Hospital, Capital Medical University on, 16 July 2021 (KY2021-082-02). The study was registered on clincaltrials.gov on 25 October 2020. Our study might guide neuromuscular blockade plans in TceMEPs monitoring undergoing spinal surgery. The findings of the study will be published in peer-reviewed journals and will be presented at national or international conference.

TRIAL REGISTRATION NUMBER

NCT04608682.

Effect of esketamine on perioperative depressive symptoms in major surgery patients (PASSION II): study protocol for a randomised controlled trial

INTRODUCTION

Depressive symptoms are common for patients undergoing major surgery and may worsen their mental health and lead to poor clinical outcomes. It is essential to seek a safe rapid-acting treatment for relieving moderate-to-severe depressive symptoms in patients undergoing major surgery.

METHODS AND ANALYSIS

This study is a randomised, placebo-controlled and double-blinded trial aiming to determine the effect of esketamine on moderate-to-severe depressive symptoms in patients undergoing major surgery. Five hundred and sixty-four participants, aged 18-65 years old, undergoing major surgery will be randomly allocated into the esketamine and placebo groups at a 1:1 ratio. Esketamine or placebo will be given intravenously at the same speed on suturing the incision by anaesthesiologists in charge who are blinded to the randomisation. In the esketamine group, the total dosage of esketamine will be 0.2 mg/kg body weight. To estimate the efficacy and safety endpoints, blinded evaluation by trained researchers will be completed at 3 days, 5 days, 1 month, 3 months and 6 months after surgery. The primary outcome is the remission rate at the third postoperative day. The secondary outcomes include depression-related scores, severe pain events and safety-related endpoints such as psychotic symptoms, manic symptoms and dissociative symptoms.

ETHICS AND DISSEMINATION

This study was approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University, Beijing, China on 30 October 2020 (KY-2020-058-02). This trial is designed to explore whether the administration of esketamine could improve the mental health of patients with depressive symptoms undergoing major surgery. The conclusions of this study will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT04425473.

Deformable MR-CT image registration using an unsupervised, dual-channel network for neurosurgical guidance

PURPOSE

The accuracy of minimally invasive, intracranial neurosurgery can be challenged by deformation of brain tissue - e.g., up to 10 mm due to egress of cerebrospinal fluid during neuroendoscopic approach. We report an unsupervised, deep learning-based registration framework to resolve such deformations between preoperative MR and intraoperative CT with fast runtime for neurosurgical guidance.

METHOD

The framework incorporates subnetworks for MR and CT image synthesis with a dual-channel registration subnetwork (with synthesis uncertainty providing spatially varying weights on the dual-channel loss) to estimate a diffeomorphic deformation field from both the MR and CT channels. An end-to-end training is proposed that jointly optimizes both the synthesis and registration subnetworks. The proposed framework was investigated using three datasets: (1) paired MR/CT with simulated deformations; (2) paired MR/CT with real deformations; and (3) a neurosurgery dataset with real deformation. Two state-of-the-art methods (Symmetric Normalization and VoxelMorph) were implemented as a basis of comparison, and variations in the proposed dual-channel network were investigated, including single-channel registration, fusion without uncertainty weighting, and conventional sequential training of the synthesis and registration subnetworks.

RESULTS

The proposed method achieved: (1) Dice coefficient = 0.82±0.07 and TRE = 1.2 ± 0.6 mm on paired MR/CT with simulated deformations; (2) Dice coefficient = 0.83 ± 0.07 and TRE = 1.4 ± 0.7 mm on paired MR/CT with real deformations; and (3) Dice = 0.79 ± 0.13 and TRE = 1.6 ± 1.0 mm on the neurosurgery dataset with real deformations. The dual-channel registration with uncertainty weighting demonstrated superior performance (e.g., TRE = 1.2 ± 0.6 mm) compared to single-channel registration (TRE = 1.6 ± 1.0 mm, p < 0.05 for CT channel and TRE = 1.3 ± 0.7 mm for MR channel) and dual-channel registration without uncertainty weighting (TRE = 1.4 ± 0.8 mm, p < 0.05). End-to-end training of the synthesis and registration subnetworks also improved performance compared to the conventional sequential training strategy (TRE = 1.3 ± 0.6 mm). Registration runtime with the proposed network was ∼3 s.

CONCLUSION

The deformable registration framework based on dual-channel MR/CT registration with spatially varying weights and end-to-end training achieved geometric accuracy and runtime that was superior to state-of-the-art baseline methods and various ablations of the proposed network. The accuracy and runtime of the method may be compatible with the requirements of high-precision neurosurgery.

Ketamine Alleviates Depressive Symptoms in Patients Undergoing Intracranial Tumor Resection: A Randomized Controlled Trial

BACKGROUND

Depressive symptoms occur in over 40% of neurosurgical patients during the perioperative period. However, no measure has been suggested to have a rapid effect on depressive surgical patients during increasingly shorter stays in the hospital. This study aimed to determine whether ketamine could improve depressive symptoms rapidly and safely during the hospital stay.

METHODS

This was a randomized, placebo-controlled, and double-blinded trial. Patients with moderate-to-severe depressive symptoms undergoing elective supratentorial brain tumor resection were randomized to intravenously receive either (1) 0.5 mg·kg-1 ketamine for 40 minutes or (2) an identical volume of normal saline. The primary outcome was treatment response on postoperative day 3, defined as a ≥50% reduction from the baseline depressive score. The secondary outcomes included the rate of remission and safety outcomes. The Montgomery-Åsberg Depression Rating Scale was applied by trained psychiatrists to evaluate depressive symptoms.

RESULTS

A total of 84 neurosurgical patients were enrolled in the trial. The response rate was increased by the administration of ketamine (41.5% [17/41] vs 16.3% [7/43]; relative risk [RR]: 2.51, 95% confidence interval [CI], 1.18-5.50) relative to the administration of placebo at 3 days. Furthermore, the remission rate at discharge (29.3% [12/41] vs 7.0% [3/43]; RR: 4.20, 95% CI, 1.28-13.80) was also improved by ketamine. No psychotic symptoms or adverse events were reported to be substantially higher in the ketamine group.

CONCLUSIONS

The trial indicates that the intraoperative administration of ketamine could alleviate moderate-to-severe depressive symptoms in neurosurgical patients without worsening safety.

Deformable 3D-2D registration for high-precision guidance and verification of neuroelectrode placement

Purpose.Accurate neuroelectrode placement is essential to effective monitoring or stimulation of neurosurgery targets. This work presents and evaluates a method that combines deep learning and model-based deformable 3D-2D registration to guide and verify neuroelectrode placement using intraoperative imaging.Methods.The registration method consists of three stages: (1) detection of neuroelectrodes in a pair of fluoroscopy images using a deep learning approach; (2) determination of correspondence and initial 3D localization among neuroelectrode detections in the two projection images; and (3) deformable 3D-2D registration of neuroelectrodes according to a physical device model. The method was evaluated in phantom, cadaver, and clinical studies in terms of (a) the accuracy of neuroelectrode registration and (b) the quality of metal artifact reduction (MAR) in cone-beam CT (CBCT) in which the deformably registered neuroelectrode models are taken as input to the MAR.Results.The combined deep learning and model-based deformable 3D-2D registration approach achieved 0.2 ± 0.1 mm accuracy in cadaver studies and 0.6 ± 0.3 mm accuracy in clinical studies. The detection network and 3D correspondence provided initialization of 3D-2D registration within 2 mm, which facilitated end-to-end registration runtime within 10 s. Metal artifacts, quantified as the standard deviation in voxel values in tissue adjacent to neuroelectrodes, were reduced by 72% in phantom studies and by 60% in first clinical studies.Conclusions.The method combines the speed and generalizability of deep learning (for initialization) with the precision and reliability of physical model-based registration to achieve accurate deformable 3D-2D registration and MAR in functional neurosurgery. Accurate 3D-2D guidance from fluoroscopy could overcome limitations associated with deformation in conventional navigation, and improved MAR could improve CBCT verification of neuroelectrode placement.

Continuation versus discontinuation of aspirin-based antiplatelet therapy for perioperative bleeding and ischaemic events in adults undergoing neurosurgery: protocol for a systematic review and meta-analysis

INTRODUCTION

Antiplatelet therapy is commonly used in primary or secondary prevention of atherosclerotic and thrombotic diseases, such as coronary artery disease, transient ischaemic attack or stroke. Recent studies noted that antiplatelet therapy should be continued perioperatively in patients at high risk of thrombosis and low bleeding risk in orthopaedic, spinal or urological surgery. However, evidence in neurosurgery is lacking. Thus, we aim to conduct a systematic review and meta-analysis to assess whether the continuous use of antiplatelet drugs in neurosurgery increases the risk of perioperative bleeding.

METHODS AND ANALYSIS

We will search PubMed, Cochrane Central Register of Controlled Trials and Embase using a strategy that combines the terms aspirin, bleeding/ischaemic and neurosurgery. Two reviewers will independently screen all identified abstracts for eligibility and evaluate the risk of bias of the included studies using the Cochrane risk of bias tool for randomised controlled studies and the Newcastle-Ottawa Scale for observational studies (including cohort studies, case-control studies, case series). Discrepancies will be resolved by consultation with a third researcher. We will conduct a systematic review and meta-analysis. If evidence suggests moderate statistical or clinical heterogeneity, we plan to investigate this heterogeneity by performing subgroup analyses and sensitivity analysis.

ETHICS AND DISSEMINATION

No ethics approval will be sought as no original data will be collected for this review. Findings will be disseminated through peer-reviewed publication and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42020202590.

Effects of Sevoflurane-Propofol-Balanced Anesthesia on Flash Visual Evoked Potential Monitoring in Spine Surgery: A Randomized Noninferiority Trial

BACKGROUND

Intraoperative flash visual evoked potential (FVEP) can be used to monitor visual function during spine surgery. However, it is limited due to the previous perception of its sensitivity to inhalation anesthesia. We conducted this trial to test the noninferiority of sevoflurane-propofol-balanced anesthesia (BA) versus popular propofol-based total intravenous anesthesia (TIVA) on the amplitude of FVEP during spine surgery.

METHODS

A total of 60 patients undergoing spine surgery were randomized to receive either sevoflurane-propofol-balanced anesthesia (BA group) or propofol-based total intravenous anesthesia (TIVA group) for anesthesia maintenance. We titrated the propofol plasma concentration to keep the bispectral index (BIS) values between 40 and 50. The primary outcome was the P100-N145 amplitudes of FVEP at 120 minutes after induction of anesthesia. The noninferiority margin (δ) was defined as 10% of the P100-N145 amplitude at 120 minutes after induction in the TIVA group. If the confidence interval (CI) for mean differences of P100-N145 amplitude at 120 minutes after induction between BA and TIVA groups lied above the lower limit of -δ with P < .025, we defined BA group was noninferior to TIVA group.

RESULTS

Fifty-nine patients were included in the final analysis. The amplitude of P100-N145 at 120 minutes after anesthesia induction in group BA was noninferior to group TIVA (3.8 [1.3] µV vs 3.2 [1.6] µV, -δ = -0.32, mean difference, 0.57, 95% CI, -0.18 to 1.33, P for noninferiority = .015).

CONCLUSIONS

The effect of 0.5 minimum alveolar concentration (MAC) of sevoflurane-propofol-balanced anesthesia on the P100-N145 amplitude of FVEP was noninferior to that of propofol-based TIVA under comparable BIS range.

[Prevalence and influencing factors of deciduous dental caries among preschool children in Qingdao city in 2019]

In 2019, the rate of primary tooth caries rate among 1 598 preschool children in Shinan District and Shibei District of Qingdao was 59.4%. The multivariate logistic regression model showed that compared with children ≤ 2 years old with history of iron deficiency anemia (IDA), suffering IDA, breastfeeding to 2 years old and no tooth melanin, children ≤ 2 years old without history of IDA, not suffering IDA, breastfeeding to less than 2 years old and heavy tooth melanin had a lower risk of primary tooth caries, with OR (95%CI) values about 0.328 (0.197-0.549), 0.354 (0.208-0.603), 0.636 (0.437-0.926) and 0.301 (0.143-0.635), respectively.

Anaesthetic depth and delirium after major surgery: a randomised clinical trial

BACKGROUND

Postoperative delirium is a serious complication of surgery associated with prolonged hospitalisation, long-term cognitive decline, and mortality. This study aimed to determine whether targeting bispectral index (BIS) readings of 50 (light anaesthesia) was associated with a lower incidence of POD than targeting BIS readings of 35 (deep anaesthesia).

METHODS

This multicentre randomised clinical trial of 655 at-risk patients undergoing major surgery from eight centres in three countries assessed delirium for 5 days postoperatively using the 3 min confusion assessment method (3D-CAM) or CAM-ICU, and cognitive screening using the Mini-Mental State Examination at baseline and discharge and the Abbreviated Mental Test score (AMTS) at 30 days and 1 yr. Patients were assigned to light or deep anaesthesia. The primary outcome was the presence of postoperative delirium on any of the first 5 postoperative days. Secondary outcomes included mortality at 1 yr, cognitive decline at discharge, cognitive impairment at 30 days and 1 yr, unplanned ICU admission, length of stay, and time in electroencephalographic burst suppression.

RESULTS

The incidence of postoperative delirium in the BIS 50 group was 19% and in the BIS 35 group was 28% (odds ratio 0.58 [95% confidence interval: 0.38-0.88]; P=0.010). At 1 yr, those in the BIS 50 group demonstrated significantly better cognitive function than those in the BIS 35 group (9% with AMTS ≤6 vs 20%; P<0.001).

CONCLUSIONS

Among patients undergoing major surgery, targeting light anaesthesia reduced the risk of postoperative delirium and cognitive impairment at 1 yr.

CLINICAL TRIAL REGISTRATION

ACTRN12612000632897.

Management of Endovascular Treatment for Acute Ischemic Stroke During the COVID-19 Pandemic at a Single Institution in Beijing, China: A Brief Report

BACKGROUND

The coronavirus disease (COVID-19) pandemic is currently a major challenge for health care systems around the world. For a time-sensitive emergency such as acute ischemic stroke (AIS), streamlined workflow times are essential to ensure good clinical outcomes.

METHODS

The aim of this single-center, retrospective, observational study was to describe changes in stroke workflow patterns and clinical care during the COVID-19 pandemic. Data from AIS patients undergoing emergent endovascular treatment (EVT) between 23 January and 8 April 2020 were retrospectively collected and compared with data from patients admitted during a similar period in 2019. The primary outcome was difference in time from symptom onset to recanalization. Secondary outcomes included workflow times, clinical management, discharge outcomes, and health-economic data.

RESULTS

In all, 21 AIS patients were admitted for emergent EVT during the 77-day study period, compared with 42 cases in 2019. Median time from symptom onset to recanalization was 132 minutes longer during the pandemic compared with the previous year (672 vs. 540 min, P=0.049). Patients admitted during the pandemic had a higher likelihood of endotracheal intubation (84.6% vs. 42.4%, P<0.05) and a higher incidence of delayed extubation after EVT (69.2% vs. 45.5%, P<0.05). National Institutes of Health Stroke Scale at hospital discharge was similar in the 2 cohorts, whereas neurointensive care unit stay was longer in patients admitted during the pandemic (10 vs. 7 days, P=0.013) and hospitalization costs were higher (123.9 vs. 95.2 thousand Chinese Yuan, P=0.052).

CONCLUSION

Disruptions to medical services during the COVID-19 pandemic has particularly impacted AIS patients undergoing emergent EVT, resulting in increased workflow times. A structured and multidisciplinary protocol should be implemented to minimize treatment delays and maximize patient outcomes.

Fast Estimation of Møller-Plesset Correlation Energies Based on Atomic Contributions

Dynamic correlation plays an important role in the accurate calculation of chemical compounds such as the description of equilibrium structures in chemical systems. A model for the fast estimation of dynamic correlation energy is introduced in this work. This model is based on the idea of decomposition of the contribution of dynamic correlation energy calculated by nth order Møller-Plesset perturbation (MPn) theory with respect to atomic regions. Multiple levels of theory, including MP2, MP2.5, and MP4, are used as the reference, and the corresponding correlation energy densities are calculated. The proposed model is concise, fast, and promising for practical use, such as the prediction of reaction energies. It can also work as a baseline model or pretrained model for follow-up studies of machine learning.