Angiopoietin-2 (Ang2) is a key proangiogenic factor, but its role in surgery-induced angiogenesis, a possible cause of cancer recurrence, is still elusive. We measured the plasma Ang2 levels in healthy controls (n = 42) and stage I–IV perioperative nonsmall cell lung cancer (NSCLC) patients (n = 227) with enzyme-linked immunosorbent assay, and examined the impact of Ang2 in the plasmas on in vitro angiogenesis and proliferation of human umbilical vein endothelial cells and human microvascular endothelial cells. Ang2 plasma levels are significantly increased in untreated NSCLC patients (2697 ± 1354 pg/mL) compared to control (1473 ± 560.6 pg/mL) and positively associated with disease stage but not with histology. Ang2 plasma levels in stage I–IIIA NSCLC patients (n = 154) are elevated after the standard open thoracic surgery, following an approximate pattern to increase quickly in the 1st postoperative days (PODs, from preoperative 2342 ± 1084 to POD1: 4485 ± 1617 and POD3: 5370 ± 1879 pg/mL), reach the peak about 2 weeks later (POD14: 6099 ± 2280 pg/mL), drop slowly thereafter (POD28: 3877 ± 1388 and POD42: 3365 ± 1189 pg/mL), and remain significantly higher than preoperative 8 weeks after the procedure (POD56: 2937 ± 943.3 pg/mL). The postoperative plasmas enhance in vitro angiogenesis and Ang2 removal from the plasmas can counteract the effect. The postoperative plasmas stimulate endothelial proliferation independently of Ang2. These results suggest that plasma Ang2 increases after NSCLC surgery and contributes to the proangiogenic property of the postoperative plasmas, thus supporting the possible administration of anti-Ang2 therapy for NSCLC in postoperative adjuvant setting.

Background: Acute Achilles tendon rupture (AATR) is common among young individuals. There are various management options available, including conservative treatment, open surgical repair, and minimally invasive treatments. However, the optimal treatment approach remains controversial.Purpose: In this study, we conducted a thorough analysis of the existing literature to compare the clinical outcomes of surgical and nonoperative treatments for patients with AATR by conducting a meta-analysis of randomized controlled trials.Study design: Meta analysis; Level of evidence, 1.Methods: Eligible trials randomly assigned adults with AATR to surgical or conservative treatment and assessed by three independent reviewers. We searched in PubMed, Embase, and The Cochrane Library. The assessment of risk of bias was conducted by entering the data from each included study into the Revman computer program. Extracted data were meta-analyzed. Heterogeneity was evaluated using the I2 test. Pooled results were expressed as odds ratios, risk ratios (OR), and mean differences (MD).Results: The meta-analysis included a total of 14 studies and 1,399 patients, with 696 patients receiving surgical intervention and 703 patients undergoing non-surgical treatment. The follow- up duration ranged from 12 to 30 months. The surgical group was found to have a significantly lower re-rupture rate (OR: 0.30, 95% CI: 0.18–0.54; P < 0.00001), but also had a higher risk of other complications (OR: 3.28, 95% CI: 1.56–6.93, P = 0.002). The surgical group also had significantly abnormal calf (OR: 0.45, 95% CI: 0.26–0.76, P = 0.03). There was no statistically significant difference between the two groups in terms of returning to sports, ATRS, abnormal motion of foot and ankle, unable heel-rise, and torque for plantar flexion.Conclusion: The meta-analysis results indicate that surgical intervention for AATR is associated with a lower re-rupture rate, but a higher risk of other complications. Our assessment of life-quality and functional outcomes also suggests that surgery leads to significantly better outcomes in terms of sick leave, abnormal calf, and torque for plantar flexion. Based on these findings, we recommend that surgery is a preferable option for patients who have a higher risk of re-rupture and require a quick rehabilitation.

Although the pediatric perioperative pain management has been improved in recent years, the valid and reliable pain assessment tool in perioperative period of children remains a challenging task. Pediatric perioperative pain management is intractable not only because children cannot express their emotions accurately and objectively due to their inability to describe physiological characteristics of feeling which are different from those of adults, but also because there is a lack of effective and specific assessment tool for children. In addition, exposure to repeated painful stimuli early in life is known to have short and long-term adverse sequelae. The short-term sequelae can induce a series of neurological, endocrine, cardiovascular system stress related to psychological trauma, while long-term sequelae may alter brain maturation process, which can lead to impair neurodevelopmental, behavioral, and cognitive function. Children’s facial expressions largely reflect the degree of pain, which has led to the developing of a number of pain scoring tools that will help improve the quality of pain management in children if they are continually studied in depth. The artificial intelligence (AI) technology represented by machine learning has reached an unprecedented level in image processing of deep facial models through deep convolutional neural networks, which can effectively identify and systematically analyze various subtle features of children’s facial expressions. Based on the construction of a large database of images of facial expressions in children with perioperative pain, this study proposes to develop and apply automatic facial pain expression recognition software using AI technology. The study aims to improve the postoperative pain management for pediatric population and the short-term and long-term quality of life for pediatric patients after operational event.

Background: Despite the long-lasting notion about the substantial contribution of intraoperative un-stabilization of homeostasis factors on the incidence on acute kidney injury (AKI), the possible influence of intraoperative glucose or lactate management, as a modifiable factor, on the development of AKI remains inconclusive.Objectives: To investigated the relationship between intraoperative hyperglycemia, hyperlactatemia, and postoperative AKI in cardiac surgery.Methods: A retrospective cohort study was conducted among 4,435 adult patients who underwent on-pump cardiac surgery from July 2019 to March 2022. Intraoperative hyperglycemia and hyperlactatemia were defined as blood glucose levels >10 mmol/L and lactate levels >2 mmol/L, respectively. The primary outcome was the incidence of AKI. All statistical analyses, including t tests, Wilcoxon rank sum tests, chi-square tests, Fisher's exact test, Kolmogorov-Smirnov test, logistic regression models, subgroup analyses, collinearity analysis, and receiver operating characteristic analysis, were performed using the statistical software program R version 4.1.1.Results: Among the 4,435 patients in the final analysis, a total of 734 (16.55%) patients developed AKI after on-pump cardiac surgery. All studied intraoperative metabolic disorders was associated with increased AKI risk, with most pronounced odds ratio (OR) noted for both hyperglycemia and hyperlactatemia were present intraoperatively [adjusted OR 3.69, 95% confidence intervals (CI) 2.68–5.13, p < 0.001]. Even when hyperglycemia or hyperlactatemia was present alone, the risk of postoperative AKI remained elevated (adjusted OR 1.97, 95% CI 1.50–2.60, p < 0.001).Conclusion: The presence of intraoperative hyperglycemia and hyperlactatemia may be associated with postoperative acute kidney injury (AKI) in patients undergoing on-pump cardiac surgery. Proper and timely interventions for these metabolic disorders are crucially important in mitigating the risk of AKI.