Background: Systemic inflammation is one of the underlying mechanisms of cognitive impairment. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a systemic inflammation indicator. This meta-analysis aimed to evaluate the association between high NLR and cognitive impairment (CI) risk.Method: A comprehensive systematic search was conducted to identify eligible studies published until May 30, 2023. The reference group comprised patients with the lowest NLR level, whereas the exposure group comprised those with the highest NLR level. The main outcome was to examine the relationship between NLR and CI risk. The secondary outcome included the association between patient characteristics or comorbidities and CI risk.Results: This meta-analysis included 11 studies published between 2018 and 2023, involving 10,357 patients. Patients with CI had a higher NLR than those without (mean difference=0.35, 95% confidence interval [CI]: 0.26–0.44, p < 00001, I^{2 =} 86%). Consistently, pooled results revealed an association between high NLR and CI risk (odds ratio [OR]=2.53, 95% CI:1.67–3.82, p<0.0001, I^{2 =} 84%). Furthermore, aging (mean difference =4.31 years, 95% CI:2.83–5.8, p < 0.00001, I^{2 =} 92%), diabetes (OR=1.59, 95% CI:1.35–1.88, p < 0.00001, I^{2 =} 66%), and hypertension (OR=1.36, 95% CI:1.19–1.57, p < 0.00001, I^{2 =} 0%) were significant risk factors for CI. However, no significant associations were observed between CI and male gender (OR = 0.84, 95% CI:0.64–1.11, p = 0.22, I^{2 =} 81%), body mass index (mean = −0.32 kg/m², 95% CI: −0.82, 0.18, p = 0.2, I^{2 =} 82%), alcohol consumption (OR = 1.11, 95% CI:0.95−1.3, p = 1.35, I^{2 =} 0%), and smoking (OR = 0.99, 95% CI:0.87–1.13, p = 0.86, I^{2 =} 0%). Meta-regression found that diabetes and hypertension, but not age, significantly moderated the association between NLR and CI.Conclusion: This meta-analysis showed a significant association between high NLR and increased CI risk. Moreover, meta-regression identified diabetes and hypertension, but not age, as significant moderating factors in the relationship between NLR and CI. To validate and strengthen these findings, further large-scale studies are required.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023430384, identifier CRD42023430384.

Background: This meta-analysis aimed to evaluate the efficacy and safety of electroacupuncture (EA) in improving postoperative ileus after colorectal surgery. Methods: Electronic databases (e.g. Medline) were screened to identify randomized controlled trials that focused on the association between EA and postoperative ileus. Time to first flatus served as the primary outcome, while the secondary outcomes included time required for the recovery of other gastrointestinal functions (e.g. bowel sound recovery), time to tolerability of liquid/solid food, postoperative pain scores, risk of overall complications, and hospital length of stay. Results: Our meta-analysis focusing on 16 studies with a total of 1562 patients demonstrated positive associations of EA with shorter times to the first flatus [mean difference (MD): −10.1 h, P<0.00001, n=1562], first defecation (MD: −11.77 h, P<0.00001, n=1231), bowel sound recovery (MD: −10.76 h, P<0.00001, n=670), tolerability of liquid (MD: −16.44 h, P=0.0002, n=243), and solid food (MD: −17.21 h, P=0.005, n=582) than those who received standard care. The use of EA was also correlated with a lower risk of overall complications (risk ratio:0.71, P=0.04, n=1011), shorter hospital length of stay (MD: −1.22 days, P=0.0001, n=988), and a lower pain score on postoperative days two (standardized MD: −0.87, P=0.009, n=665) and three (standardized MD: −0.45, P<0.00001, n=795), without a difference in time to first ambulation. Conclusion: Our findings showed an association between EA and enhanced gastrointestinal functional recovery and reduced pain severity following colorectal surgery, highlighting the potential benefits of incorporating EA into perioperative care to enhance recovery outcomes in this setting.

Perioperative neurocognitive disorders (POND) are common in older adults and are associated with adverse outcomes. This meta-analysis aimed to evaluate the efficacy and safety of esketamine for the prophylaxis of POND. Electronic databases were comprehensively searched from inception to April 1, 2024, to identify randomized controlled trials (RCTs) exploring the impact of perioperative esketamine on POND in adult patients. The primary outcomes were the incidence of POND and the level of postoperative cognitive function. The secondary outcomes included recovery characteristics (i.e., respiratory depression, extubation time, agitation, hallucinations, and nightmares) and inflammatory markers. Subgroup and meta-regression analyses were conducted to investigate the heterogeneity and effect of esketamine dosage. A total of 24 RCTs (n = 2,130 patients), all conducted in China with relatively short follow-up periods (≤ 3 months), were included. Esketamine was found to significantly reduce the risk of POND (risk ratio:0.53, 95%confidence interval [CI]: 0.43–0.67) and improved cognitive function on postoperative day 1 (standardized mean difference [SMD]:1.22, 95%CI:0.85–1.59) and day 3 (SMD:0.94, 95%CI: 0.46–1.43) compared with controls, without impacting recovery characteristics. Furthermore, esketamine was associated with lower pain scores, reduced risk of postoperative nausea/vomiting, and decreased levels of inflammatory markers (IL-6, TNF-α, and S100β). Subgroup and meta-regression analyses revealed that age, quality of studies, type of esketamine administration, and esketamine dosage did not have a significant impact on cognitive outcomes. The evidence showed moderate certainty for POND risk, low certainty for POD 1 cognitive function and several complications (agitation, hallucinations, PONV, respiratory issues, nightmares) and biomarkers (TNF-α, s100β), and very low certainty for POD 3 cognition, extubation time, pain, and IL-6 levels. Perioperative esketamine is potentially effective in reducing the risk of POND and improving cognitive function in adult patients, regardless of age and dosage. Nevertheless, the certainty of evidence was low to very low for several outcomes (e.g., cognitive function on POD 3). Given that all included studies were conducted in China with relatively short follow-up periods, further high-quality RCTs with diverse populations and longer follow-up are warranted to validate these findings.

Background: Vitamin D deficiency (VDD) has emerged as a potential contributor to diabetic complications. This study aimed to investigate the association between VDD at the time of type 2 diabetes mellitus (T2DM) diagnosis and subsequent risk of developing diabetic retinopathy (DR).Methods: This retrospective cohort study used data from the TriNetX Research Network to analyze adult patients newly diagnosed with T2DM between January 2020 and December 2022. The patients were classified as vitamin D-deficient (<20 ng/mL) or sufficient (≥30 ng/mL). After 1:1 propensity score matching, 10,651 patients were included in each group. The primary outcome was the risk of DR within 3 years of T2DM diagnosis. The secondary outcomes included hospitalization, emergency department visits, pneumonia, and all-cause mortality. An exploratory analysis was also conducted to examine outcomes in patients with vitamin D insufficiency (20–30 ng/mL) compared to the sufficient group.Results: At the 3-year follow-up, VDD was significantly associated with an increased risk of DR [hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.17–1.80, p < 0.001], hospitalization (HR 1.23, 95% CI 1.17–1.29, p < 0.001), emergency department visits (HR 1.17, 95% CI 1.11–1.24, p < 0.001), pneumonia (HR 1.18, 95% CI 1.07–1.31, p = 0.001), and mortality (HR 1.51, 95% CI 1.36–1.67, p < 0.001). Sex-stratified analysis revealed that the association between VDD and DR was significant among female patients (HR 1.41, 95% CI 1.07–1.86, p = 0.015) but not among males. Exploratory analysis showed that vitamin D insufficiency (20–30 ng/mL) was not associated with increased DR risk, suggesting a threshold effect.Conclusion: In newly diagnosed T2DM patients, VDD was independently associated with increased risks of DR and other adverse outcomes, particularly in females. The observed threshold effect suggests that maintaining vitamin D levels above the deficiency threshold may be sufficient to mitigate DR risk. Assessment of vitamin D status may be valuable for risk stratification in newly diagnosed T2DM, and addressing VDD may represent a modifiable risk factor for improving outcomes.