Propofol-based total intravenous anesthesia (TIVA) with remifentanil is widely used for general anesthesia but is frequently associated with hypotension and bradycardia. Remimazolam, an ultra-short-acting benzodiazepine, provides rapid onset and offset, with the additional advantage of reversal by flumazenil, and may result in less hemodynamic depression. Previous randomized studies have largely focused on the induction phase or the incidence of hypotension, with limited data on continuous intraoperative hemodynamic changes during laparoscopic gynecologic surgery. The study is designed to compare prospectively the intraoperative hemodynamic profiles of remimazolam-based versus propofol-based TIVA in patients undergoing robotic gynecologic surgery in the Trendelenburg position.

Myxedema coma is a rare endocrine emergency with high mortality that is typically associated with severe biochemical hypothyroidism. However, profound clinical decompensation may occur despite only modest abnormalities in thyroid function tests, making diagnosis challenging. We report the case of an 87-year-old woman with long-standing hypothyroidism, primary adrenal insufficiency, pituitary pathology, and ischemic heart disease who presented with an Escherichia coli urinary tract infection and subsequently developed profound hypothermia, severe bradycardia, hypotension, reduced consciousness, and gastrointestinal hypomotility despite appropriate antimicrobial therapy. Thyroid function tests demonstrated only mildly elevated thyroid-stimulating hormone with near-normal free thyroxine concentrations. Repeat clinical assessment revealed delayed relaxation of the ankle reflexes. Retrospective application of the Popoveniuc diagnostic scoring system gave a score of 105, providing strong support for the diagnosis of myxedema coma. The end-of-life care pathway was reversed, and treatment with intravenous hydrocortisone, intravenous levothyroxine, active warming, and supportive care resulted in marked clinical recovery. This case highlights the importance of recognizing myxedema coma as a clinical diagnosis, maintaining a high index of suspicion despite relatively mild biochemical abnormalities, and undertaking repeated clinical reassessments in elderly patients with impaired endocrine reserve.

Chronic low energy availability (LEA) describes inadequate energy intake relative to expenditure and underlies Relative Energy Deficiency in Sport (REDs), impairing physiological health and athletic performance. This study examined relationships between both anthropometry and body composition, cardiovascular function, and sleep quality in collegiate athletes with LEA-associated symptoms. A total of 109 collegiate athletes (Males = 43, females = 66) underwent anthropometric analysis (BOD POD), resting cardiovascular assessment, and Pittsburgh Sleep Quality Index (PSQI) questionnaire. Mann-Whitney U-tests assessed sex differences in cardiovascular function, anthropometry, and sleep quality. Spearman rank correlations (ρ) evaluated associations between anthropometric indices and cardiovascular and sleep outcomes. Males exhibited greater anthropometric measures (p < 0.01) and blood pressure (p < 0.001) than females. Global PSQI scores indicated poor sleep quality in both sexes (males: 5.9 ± 2.7; females: 5.7 ± 2.4), with no significant sex differences. In females, anthropometry was positively correlated with blood pressure (p < 0.01). In males, greater anthropometric measures were positively associated with blood pressure and resting heart rate (p < 0.05). Of the population studied, 19% of males and 29% of females presented with a clinically low %BF; 49% of males and 47% of females had bradycardia; 16% of males and 55% of females had hypotension; and 67% of males and 62% of females had poor sleep quality. Symptoms associated with LEA are prevalent in male and female collegiate athletes and suggest the need for closer monitoring to ensure athletes optimal health and performance.

Physiological adaptation to exercise results in a series of electrical, structural, and functional cardiac changes, broadly named 'athlete's heart'. Symmetrical enlargement of all cardiac chambers and mild increase in wall thickness are common findings in highly trained athletes. Typical electrocardiogram (ECG) features include sinus bradycardia, first-degree atrioventricular (AV) block, isolated voltage criteria for right and left ventricular hypertrophy and early repolarisation. Cardiac remodelling may be marked in some athletes, and it may be challenging to distinguish physiological adaptation from cardiac conditions at risk of sudden cardiac death (SCD), such as cardiomyopathies. Differential diagnosis often requires a comprehensive assessment starting from a detailed personal and family history to baseline tests, such as ECG and echocardiogram. In some cases, second-line tests, such as prolonged ambulatory ECG monitoring, exercise tolerance test and cardiovascular magnetic resonance are required. In this narrative review, we will explore the key features of physiological cardiac adaptation to exercise, and we will focus on differential diagnosis between 'athlete's heart' and cardiomyopathies.

Cold seawater immersion is a critical lethal risk in maritime accidents and military operations, frequently inducing fatal myocardial dysfunction. However, the mechanisms underlying this seawater immersion hypothermia-induced cardiac injury remain poorly defined. This study aimed to elucidate the pathological progression and underlying mechanisms of myocardial injury induced by cold seawater immersion. A male SD rat model was immersed in 15 °C seawater for 2 h. Echocardiography, transmission electron microscopy, transcriptomics, and Western blot were performed to assess cardiac function, mitochondrial ultrastructure, and molecular mechanisms. Cold stress triggered progressive bradycardia (~480 to ~100 bpm) with initial Frank-Starling compensation, followed by decompensation with reduced cardiac output and impaired diastolic function. Mitochondrial ultrastructural damage preceded histological lesions and was accompanied by elevated cardiac injury markers (cTnT, CK-MB, BNP). Cardiac tissue exhibited upregulated TNF-α, IL-1β, and IL-6, while transcriptomic analysis revealed enrichment of inflammatory pathways (TNF, NF-κB) and coordinated upregulation of pattern recognition receptors including scavenger receptor, Toll-like receptor, and NOD-like receptor families. The Western blot confirmed NF-κB activation, NLRP3 inflammasome assembly, and the N-terminal fragment of gasdermin D (GSDMD-NT) accumulation, indicating pyroptotic cell death. These findings demonstrate that cold seawater stress disrupts mitochondrial homeostasis and activates the NF-κB/NLRP3/pyroptosis cascade, contributing to inflammatory cardiomyocyte death and cardiac decompensation. This mechanistic insight may inform therapeutic strategies for seawater immersion hypothermia.

Background Caudal epidural analgesia is a widely used and effective regional anesthetic technique for pediatric infraumbilical surgeries. Although bupivacaine provides reliable analgesia, its relatively short duration has prompted the use of adjuvants to prolong postoperative pain relief. Dexmedetomidine, a selective α2-adrenergic agonist, and tramadol, a centrally acting analgesic, are commonly employed caudal adjuvants; however, their comparative effects when combined with bupivacaine remain incompletely defined. Methods This prospective, randomized, double-blind study included 60 pediatric patients aged two to eight years undergoing elective infraumbilical surgeries under general anesthesia. All patients received a caudal block with 0.25% bupivacaine (1 mL/kg) and were randomized into two groups: Group D received dexmedetomidine 0.5 µg/kg (n = 30), and Group T received tramadol 1 mg/kg (n = 30). Hemodynamic parameters, including heart rate (HR) and mean arterial pressure (MAP), were recorded intraoperatively and at extubation. The primary outcome was time to first rescue analgesia, defined as the time from skin closure to a Face, Legs, Activity, Cry, Consolability (FLACC) score >4. Data were analyzed using appropriate parametric tests, with p < 0.05 considered statistically significant. Results Demographic characteristics and duration of surgery were comparable between the groups. Mean age was 4.19 ± 1.91 years in Group D and 4.55 ± 2.10 years in Group T (p = 0.49), while mean body weight was 14.15 ± 4.00 kg and 15.16 ± 4.24 kg, respectively (p = 0.35). The duration of postoperative analgesia was significantly longer in the dexmedetomidine group compared with the tramadol group (812.70 ± 46.15 minutes vs. 605.53 ± 45.12 minutes; p < 0.0001). HR and MAP decreased gradually in both groups following induction, with lower values observed in the dexmedetomidine group; however, differences in HR at all measured time points were not statistically significant. MAP after extubation was significantly lower in Group D compared with Group T (66.73 ± 5.96 mmHg vs. 70.17 ± 6.86 mmHg; p = 0.04). No episodes of bradycardia or hypotension requiring intervention occurred in either group. Conclusion Dexmedetomidine (0.5 µg/kg) as an adjuvant to caudal bupivacaine provided significantly prolonged postoperative analgesia compared with tramadol (1 mg/kg) in pediatric infraumbilical surgeries. Both agents maintained stable perioperative hemodynamics without clinically significant adverse effects; however, dexmedetomidine demonstrated better attenuation of hemodynamic responses, particularly after extubation. Low-dose dexmedetomidine appears to be an effective and safe caudal adjuvant in pediatric patients undergoing infraumbilical surgical procedures.

This report describes a rare case of severe cerebral injury secondary to an air embolism following endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction. Through meticulous analysis of this complication, we aim to elucidate the potential mechanisms responsible for inadvertent gas entry during therapeutic procedures, evaluate strategies for early detection, and discuss precautionary measures to enhance procedural safety in biliary interventions. This study provides valuable insights into understanding and potentially reducing such adverse iatrogenic outcomes in interventional endoscopy practice.

Sodium 2-mercaptobenzothiazole (MBTNa) is a water-soluble benzothiazole compound widely used in industrial applications, yet its potential vascular developmental toxicity remains insufficiently understood. In this study, zebrafish embryos were used to evaluate the cardiovascular and vascular developmental effects of MBTNa and to explore the possible molecular mechanisms involved. Embryos were exposed to 0.001-1 μM MBTNa from 4 to 72 hpf, and cardiovascular morphology, vascular development, apoptosis-related signals, network toxicology prediction, molecular docking, Western blot analysis, and PTK787-based rescue experiments were performed. MBTNa exposure induced selective cardiovascular and vascular defects, including pericardial edema, bradycardia, impaired intersegmental vessel development, common cardinal vein dilation, and ectopic subintestinal vessel sprouting. Network toxicology and molecular docking identified Kdr/PI3K/Akt-associated signaling as a potential pathway involved in MBTNa-induced vascular abnormalities. RT-qPCR analysis showed altered expression of PI3K/Akt/GSK3β-related and apoptosis-related genes, and Western blot analysis further showed increased relative levels of p-AKT and p-GSK3β after MBTNa exposure. In addition, PTK787 co-treatment partially attenuated MBTNa-induced vascular abnormalities and reversed selected transcriptional alterations. These findings suggest that Kdr/PI3K/Akt-associated signaling is involved in MBTNa-induced vascular developmental toxicity and highlight the need to include vascular endpoints in the risk assessment of benzothiazole-related contaminants.