Background: Painless gastrointestinal endoscopy under intravenous propofol anesthesia is widely applied in the clinical scenario. Despite the good sedation and elimination of anxiety that propofol provides, low SpO₂ may also result. Doxapram is a respiratory stimulant with a short half-life. The primary aim of this study was to investigate the effects of doxapram on alleviating low SpO₂ induced by the combination of propofol and fentanyl during painless gastrointestinal endoscopy. Methods: In this prospective study, patients scheduled for painless gastrointestinal endoscopy were randomly assigned to group D or S with 55 patients per group. Initially, both groups received a combination of propofol and fentanyl. Patients in group D received 50 mg doxapram after propofol injection, while patients in group S received an equal volume of saline. Vital signs of the patients, propofol dose, examination duration, and incidences of low SpO₂ were recorded. Results: There were no statistical differences in propofol consumption and examination duration between the two groups. Twenty-six patients in group S experienced low SpO₂ versus 10 in group D (P = 0.001). Nineteen patients in group S underwent oxygenation with a face mask in contrast to 8 in group D (P = 0.015). Eighteen patients in group S were treated with jaw lifting compared to 5 in group D (P = 0.002). Four patients in group S underwent assisted respiration compared to 2 in group D (without statistical difference). The average oxygen saturation in group S was significantly lower than that in group D at 1, 2 and 3 min after propofol injection (P < 0.001, P = 0.001 and P = 0.020, respectively). There were no statistical differences in oxygen saturation at other time points. There were no statistical differences in MAP and HR (except for the time point of 1 min after the induction) between the two groups. Conclusions: Low dose of doxapram can effectively alleviate low SpO₂ in painless gastrointestinal endoscopy with intravenous propofol, without affecting propofol consumption, examination duration, MAP, or HR. Trail registration: The study was approved by the Institutional Ethics Committee of Clinical and New Technology of Wuxi People’s Hospital on 20th July, 2018 (KYLLH2018029) and registered in the Chinese Clinical Trial Register on 16th August, 2018 (ChiCTR1800017832).

Background: Intestinal obstruction can result in inflammatory injury to distant organs, especially the lungs. Stellate ganglion block (SGB) provides sympathetic nervous homeostasis and inhibits the systemic inflammatory response. This study aimed to investigate whether SGB can alleviate acute lung injury by inhibiting phospholipase A₂ expression in rats. Methods: Thirty healthy male Sprague–Dawley rats were divided into three groups: C group (sham-operated); CLP group (cecal ligation and puncture with intestinal obstruction), and cervical sympathetic trunk transection (CSTT) group (transection of the cervical sympathetic trunk following CLP).Arterial blood samples were obtained to determine the ratio of partial arterial pressure of oxygen (PaO₂) to fraction of oxygen in inspired air (FiO₂). Venous blood samples were used to evaluate the serum concentrations of chemokines, tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 using enzyme-linked immunosorbent assays. Following euthanasia, the lungs were isolated to estimate the wet/dry lung weight (W/D) ratio, evaluate the pathological damage to lung tissues on microscopy, and determine secretory-type phospholipase A₂ (sPLA₂) expression using western blotting. Results: Rats in the CLP group showed increased fatigue, decreased activity levels, and coarse, gray hair. The levels of chemokines, TNF-α, and IL-6 in the CLP and CSTT groups were higher than those in the C group. However, the levels were lower in the CSTT group than those in the CLP group. IL-10 levels in the CLP group were higher and lower than those in the C and CSTT groups, respectively. W/D ratios and PaO₂/FiO₂ in the CLP and CSTT groups were higher than those in the C group, whereas these ratios in the CSTT group were lower than those in the CLP group. No lung injury was noted in group C, and the lung injury scores were lower in the CSTT group than those in the CLP group. sPLA₂ expression levels in the CLP group were higher than those in the C group, whereas these levels in the CSTT group were lower than those in the CLP group. Conclusions: sPLA₂ overexpression in the lungs may be a pathogenic factor in acute lung injury. CSTT alleviated acute lung injury by inhibiting sPLA₂ expression.

In patients with severe pulmonary hypertension, nebulized nitroglycerin inhalation combined with subarachnoid anesthesia is a safe anesthetic option for cesarean section. It maintains stable hemodynamics and, by decreasing pulmonary artery pressure, prevents right heart failure.

Background: Patients with painful diabetic peripheral neuropathy (PDPN) increasingly use generative artificial intelligence chatbots for information on symptoms, treatment, foot care, and when to seek professional help. Their usefulness depends on safety, accuracy, guideline concordance, actionability, and readability. Objective: To compare five publicly accessible generative AI chatbots in answering standardized patient-oriented questions about PDPN. Methods: Sixty standardized English-language questions covering eight clinical domains were submitted once to ChatGPT, Gemini, Microsoft Copilot, DeepSeek, and Doubao in separate single-turn conversations, yielding 300 responses. Five reviewers independently assessed safety, accuracy, guideline concordance, and actionability using predefined criteria. Guideline concordance was scored against six mapped elements per question and converted to a percentage. Actionability was assessed using seven binary criteria with prespecified question-level applicability. Readability was evaluated using six established indices. Paired comparisons used Cochran’s Q test for safety and Friedman tests for non-binary outcomes, followed by multiplicity-adjusted pairwise analyses. Results: All 300 responses were analyzed. Inter-rater agreement was high for safety (Fleiss’ κ = 0.874), accuracy [ICC (2,1) = 0.881], guideline concordance [ICC (2,1) = 0.874], and actionability [ICC (2,1) = 0.877]. Twenty-eight responses (9.3%) were classified as unsafe or potentially unsafe. Unsafe-response rates ranged from 5.0 to 15.0%, with no detected overall between-model difference (Cochran’s Q = 4.462, p = 0.347). Accuracy, guideline concordance, and actionability differed across models (all p < 0.001; Kendall’s W = 0.683, 0.730, and 0.556, respectively). ChatGPT generally achieved higher content-related scores, whereas Doubao scored lower. All readability indices also differed across models (all p < 0.001), with ChatGPT and Doubao producing less complex text and DeepSeek showing greater reading difficulty. Conclusion: The five chatbots showed distinct performance patterns across content quality and readability. Although no overall safety difference was detected, every system generated at least one response with a plausible pathway to inappropriate self-management, delayed assessment, medication or product misuse, or preventable injury. Chatbots may support general patient education, but medication decisions, foot-risk assessment, and urgent-care triage require professional verification.