Although ampullary neoplasia is a rare entity and represents 0.6%-0.8% of gastrointestinal cancers, the incidence among young adults has risen over the past 20 years. Most ampullary tumors are sporadic, but a few genetic syndromes substantially increase the risk of ampullary neoplasia. Compared with other neoplastic pancreaticobiliary entities, there is a relative lack of guidance on best practices for management of ampullary lesions. Ampullary cancer is associated with a 5-year survival rate ranging from 20% to 75%, depending on the stage of diagnosis. Ensuring high-quality endoscopic assessment and treatment with complete resection will decrease recurrence risk and identify patients at an earlier stage.

Accurate and efficient detection of catecholamines (CAs) is of great importance for the diagnosis and treatment of neuroendocrine-related diseases. However, developing convenient sensing platforms that combine high sensitivity, high selectivity, and multi-mode validation capabilities still faces challenges. To address this issue, an irregular octahedral cobalt-iron bimetallic organic framework (io-CoFe-MIL) nanozyme with excellent peroxidase-like activity was synthesized via a solvothermal method. The nanozyme can efficiently catalyze the oxidation of substrate 3,3',5,5'-tetramethylbenzidine (TMB), generating blue oxidized TMB (TMBox). The inhibitory effect of CAs on such TMB catalytic oxidation process leads to changes in both solution color and system temperature. Thus, a colorimetric/photothermal dual-mode sensing platform was constructed for catecholamines detection, as epinephrine (EP), dopamine (DA), and norepinephrine (NE). The colorimetric sensor exhibited sensitive responses toward various CAs with limit of detection (LOD) of 0.03 µM for EP, 0.055 µM for DA, and 0.08 µM for NE. While in the photothermal mode, the LODs for EP, DA, and NE were 0.027 µM, 0.74 µM and 1.2 µM, respectively. The presented dual-mode methods can be well used for sensitive detection of EP, DA, and NE in actual porcine serum samples, that are in consistent with those obtained from the instrument of HPLC, demonstrating the reliability and practical applicability of the method. This work provides a promising strategy for highly sensitive and multi-mode detections of CAs based on the synergistic integration of colorimetric and photothermal dual-signal responses.

Single-injection peripheral nerve blocks (PNBs) provide excellent perioperative analgesia in children but are limited by finite duration. Pediatric populations were excluded from the major adult adjunct reviews. This narrative review synthesizes the evidence for adjuncts added to local anesthetics for single-injection PNBs and caudal blocks in patients aged 0 to 18 years, including dexamethasone, dexmedetomidine, clonidine, conventional opioids, buprenorphine, magnesium sulfate, midazolam, ketamine, neostigmine, tramadol, nalbuphine, and epinephrine.

The trigeminocardiac reflex (TCR) is clinically defined as the sudden onset of increased parasympathetic activity resulting from stimulation of the trigeminal nerve. This reflex increases parasympathetic tone and can lead to significant bradycardia and hypotension. We report the case of severe bradycardia and hypotension that occurred under general anesthesia during insertion of a cotton swab into the nasal cavity. A 57-year-old woman was scheduled for nasotracheal intubation for oral surgery, and following loss of consciousness, intubation was initiated using cotton swabs soaked in a solution of 2% lidocaine and 1:100,000 epinephrine that were inserted through the left nostril. The patient immediately developed severe bradycardia and hypotension which were managed with intravenous ephedrine after removing the cotton swabs rather than atropine due to concerns related to closed-angle glaucoma. The patient responded promptly to the ephedrine bolus, and no further complications occurred. It was assumed that the ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve were stimulated by the cotton swabs being inserted into the nasal cavity, triggering the TCR. Anesthesiologists need to be aware of the risks associated with administering mydriatic drugs such as ephedrine and epinephrine, which are relatively contraindicated, as well as atropine to patients with closed-angle glaucoma.

Mild bleeding disorders are the most common inherited bleeding disorders, often leading to perioperative haemorrhages. Preoperative screening for mild bleeding disorders remains challenging due to the limitations of existing screening tools, resulting in a substantial proportion of patients being referred for preoperative investigations. The aim of this study was to develop, externally validate, and implement an easy-to-use, explainable machine learning-based decision support tool for the prediction of mild bleeding disorders.