UNASSIGNED: Ciprofol is a recently developed short-acting gamma-aminobutyric acid receptor agonist with a higher potency than that of propofol. As a new sedative drug, there are few clinical studies on ciprofol. We sought to examine the safety and efficacy of ciprofol use for general anesthesia in neurosurgical individuals undergoing neurosurgical surgery with intraoperative neurophysiological monitoring (IONM).
UNASSIGNED: This single-center, non-inferiority, single-blind, randomized controlled trial was conducted from September 13, 2022 to September 22, 2023. 120 patients undergoing elective microvascular decompression surgery (MVD) with IONM were randomly assigned to receive either ciprofol or propofol. The primary outcome of this study was the amplitude of intraoperative compound muscle action potential decline, and the secondary outcome included the indexes related to neurophysiological monitoring and anesthesia outcomes.
UNASSIGNED: The mean values of the primary outcome in the ciprofol group and the propofol group were 64.7±44.1 and 53.4±35.4, respectively. Furthermore, the 95% confidence interval of the difference was -25.78 to 3.12, with the upper limit of the difference being lower than the non-inferiority boundary of 6.6. Ciprofol could achieve non-inferior effectiveness in comparison with propofol in IONM of MVD. The result during anesthesia induction showed that the magnitude of the blood pressure drop and the incidence of injection pain in the ciprofol group were significantly lower than those in the propofol group (P<0.05). The sedative drug and norepinephrine consumption in the ciprofol group was significantly lower than that in the propofol group (P<0.05).
UNASSIGNED: Ciprofol is not inferior to propofol in the effectiveness and safety of IONM and the surgical outcome. Concurrently, ciprofol is more conducive to reducing injection pain and improving hemodynamic stability, which may be more suitable for IONM-related surgery, and has a broad application prospect.

BACKGROUND: The lips are one crucial determinant of facial attractiveness. Current studies investigating lip attractiveness were mostly conducted in Caucasians, and the results could not directly apply to Asians. Aside from lip proportions, lip contours play an important role in attractiveness but it is unclear how people perceive different lip contours. The aim of this study was to investigate the aesthetic perception of various lip shapes by Chinese to identify the most attractive lip morphology for women and men, respectively.
METHODS: 303 Chinese participants were invited to rate the attractiveness of identical lip images with different contours and proportions in a young female and a young male. Stratified analyses were performed to assess the effect of gender, age and occupation on the preference of lip shapes.
RESULTS: The lips that were rated to be most attractive had a flat upper vermilion border, an M-shaped oral fissure and a U-shaped lower vermilion border in both genders. Most respondents considered an upper-to-lower vermilion proportion of 1:1 to be more attractive, regardless of the gender of the lip models, and the lip thickness-to-width proportions of 1:2 and 1:2.5 were perceived most attractive for female and male, respectively.
CONCLUSIONS: This study adds to our understanding of how lip contours contribute to attractiveness and that Chinese have distinctive aesthetic preferences for lip morphology, which possibly stem from racial characteristics and cultural differences. With such knowledge, practitioners may better tailor the treatment strategy when performing lip rejuvenation procedures.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND: Quantitative evaluation of facial aesthetics is an important but also time-consuming procedure in orthognathic surgery, while existing 2D beauty-scoring models are mainly used for entertainment with less clinical impact.
METHODS: A deep-learning-based 3D evaluation model DeepBeauty3D was designed and trained using 133 patients\' CT images. The customised image preprocessing module extracted the skeleton, soft tissue, and personal physical information from raw DICOM data, and the predicting network module employed 3-input-2-output convolution neural networks (CNN) to receive the aforementioned data and output aesthetic scores automatically.
RESULTS: Experiment results showed that this model predicted the skeleton and soft tissue score with 0.231 ± 0.218 (4.62%) and 0.100 ± 0.344 (2.00%) accuracy in 11.203 ± 2.824 s from raw CT images.
CONCLUSIONS: This study provided an end-to-end solution using real clinical data based on 3D CNN to quantitatively evaluate facial aesthetics by considering three anatomical factors simultaneously, showing promising potential in reducing workload and bridging the surgeon-patient aesthetics perspective gap.

BACKGROUND: Anesthetic drugs may alter exosomal microRNA (miRNA) contents and mediate cancer progression and tumor microenvironment remodeling. Our study aims to explore how the anesthetics (sevoflurane and propofol) impact the miRNA makeup within exosomes in hepatocellular carcinoma (HCC), alongside the interconnected signaling pathways linked to the tumor immune microenvironment.
METHODS: In this prospective study, we collected plasma exosomes from two groups of HCC patients (n = 5 each) treated with either propofol or sevoflurane, both before anesthesia and after hepatectomy. Exosomal miRNA profiles were assessed using next-generation sequencing (NGS). Furthermore, the expression data from The Cancer Genome Atlas-Liver Hepatocellular Carcinoma (TCGA-LIHC) was used to pinpoint the differentially expressed exosomal miRNAs (DEmiRNAs) attributed to the influence of propofol or sevoflurane in the context of HCC. Gene set enrichment analysis (GSEA) and gene set variation analysis (GSVA) were used to dissect the signaling pathways and biological activities associated with the identified DEmiRNAs and their corresponding target genes.
RESULTS: A total of 35 distinct DEmiRNAs were exclusively regulated by either propofol (n = 9) or sevoflurane (n = 26). Through TCGA-LIHC database analysis, 8 DEmiRNAs were associated with HCC. These included propofol-triggered miR-452-5p and let-7c-5p, as well as sevoflurane-induced miR-24-1-5p, miR-122-5p, miR-200a-3p, miR-4686, miR-214-3p, and miR-511-5p. Analyses revealed that among these 8 DEmiRNAs, the upregulation of miR-24-1-5p consistently demonstrated a significant association with lower histological grades (p < 0.0001), early-stage tumors (p < 0.05) and higher survival (p = 0.029). Further analyses using GSEA and GSVA indicated that miR-24-1-5p, along with its target genes, were involved in governing the tumor immune microenvironment and potentially inhibiting tumor progression in HCC.
CONCLUSIONS: This study provided bioinformatics evidence suggesting that sevoflurane-induced plasma exosomal miRNAs may have a potential impact on the immune microenvironment of HCC. These findings established a foundation for future research into mechanistic outcomes in cancer patients.

Objective: To measure and analyze upper lip morphology variation before and after the cross-arch fixed restoration of the maxillary implant-supported prostheses using cone- beam CT (CBCT) to provide an esthetic objective reference for maxillary edentulous patients. Methods: There were 32 maxillary edentulous patients selected in the Department of Dental Implantology, The Affiliated Stomatological Hospital of Nanjing Medical University from January 2010 to December 2023. The CBCT data of patients with maxillary full-arch implant-supported fixed prostheses were retrospectively collected before implantation (T0), at the time of radio-guide insertion (T1), and after final repair (T2). The length and thickness of the upper lip were measured and analyzed at each time point, and the correlation between the upper lip contour data and facial esthetic parameters was analyzed. Results: After the final prosthodontic treatment, the length of the upper lip was significantly increased from (21.72±2.84) mm to (24.98±2.93) mm (t=-8.13, P<0.001) compared with that before implant treatment. The widths of the middle and vermilion of the upper lip (Sm-Hm/Ls-UP), were reduced from (13.24±1.41), (12.81±1.67) mm to (11.36±1.67), (10.21±1.69) mm, with significant differences (t=7.79, P<0001; t=9.37, P<0.001). The lower face height (Sn-Gn) was increased from (54.52±4.95) mm to (58.70±4.42) mm, with significant differences (t=-11.05, P<0.001). However, the nasolabial angle reduced significantly from 95.35°± 7.70°to 90.53°±7.28°(t=7.68, P<0.001). The width of the middle of the upper lip with a radiation guide was (10.94±1.24) mm, and it increased significantly compared with that after the final prosthesis treatment (t=-0.76, P<0.05). The proportion of straight upper lip profiles accounted for 59% (19/32), and the proportion of concave upper lip profiles accounted for 41% (13/32) after the final prosthesis treatment. In addition, the results of correlation analysis showed that the nasolabial angle variation was weak and negatively correlated with residual bone height (r=-0.37, P=0.490). Conclusions: After the treatment of the maxillary full-arch implant-supported fixed prosthesis, the length of the upper lip increases, and the thickness of the upper lip becomes significantly thin. The maxillary full-arch implant-supported fixed prostheses support upper lips to improve the patients\' side appearances.
目的： 分析评估上颌全牙列种植固定修复对锥形束CT上唇轮廓的影响，为上颌牙列缺失患者种植修复美学治疗提供参考。 方法： 回顾性收集2010年1月至2023年12月于南京医科大学附属口腔医院口腔种植科行上颌全牙列种植固定修复的32例上颌牙列缺失患者的种植治疗前（T0）、戴入放射导板时（T1）及最终修复后（T2）锥形束CT资料。对患者各时间点上唇长度和厚度等指标进行测量分析，对上唇轮廓数据及面部美学参数进行相关性分析。 结果： 与种植治疗前相比，最终修复后上唇总长度由（21.72±2.84）mm增加至（24.98±2.93）mm（t=-8.13，P<0.001）；上唇中部厚度和上唇唇红厚度分别由（13.24±1.41）和（12.81±1.67）mm下降至（11.36±1.67）和（10.21±1.69）mm（t=7.79，P<0001；t=9.37，P<0.001），患者面下部高度从（54.52±4.95）mm增加至（58.70±4.42）mm（t=-11.05，P<0.001）；而鼻唇角则由（95.35°±7.70°）减小至（90.53°±7.28°）（t=7.68，P<0.001）。最终修复后上唇中部厚度比戴入放射导板时［（10.94±1.24）mm］显著增加（t=-0.76，P<0.05）。最终修复后上唇侧面轮廓形态分类为直形（19例；59%）和凹形（13例；41%）。相关性分析显示，治疗前后鼻唇角变化量与剩余牙槽嵴高度占前鼻棘点至上中切牙切点距离的比例呈中等弱相关（r=-0.37，P=0.049）。 结论： 上颌全牙列种植固定修复后患者上唇长度增长、厚度变薄，上颌全牙列种植固定义齿能恢复上唇支撑，改善患者侧貌。.

BACKGROUND: Ketamine, as an anesthetic, has been considered for terminating status epilepticus (SE); however, due to the urgency and severity of the condition, there are currently no randomized controlled trials internationally assessing the efficacy of ketamine for treating super-refractory status epilepticus. Similarly, there appears to be a lack of systematic reviews addressing this topic in the literature. Therefore, this systematic review aims to explore the effectiveness and safety of ketamine for terminating super-refractory status epilepticus.
METHODS: We conducted a systematic search on PubMed, EMBASE, and Web of Science databases. Manuscripts unrelated to the research on super-refractory status epilepticus were excluded, as were manuscripts published in non-English languages. The quality assessment and risk of bias were evaluated using the MINORS criteria. Data extraction was limited to qualitative synthesis due to the unsuitability of the data for meta-analysis.
RESULTS: Out of 782 studies retrieved from electronic databases, 11 met the inclusion criteria. Among them, 10 studies were retrospective, and 1 study was prospective. Patient data for inclusion were sourced from the case registries of the researchers\' respective hospitals. Across all included studies, the administration of ketamine significantly reduced the duration of status epilepticus and demonstrated higher safety compared to patients not receiving ketamine treatment for super-refractory status epilepticus. Additionally, early administration of ketamine correlated with improved treatment outcomes. The risk of bias across all studies was deemed low.
CONCLUSIONS: This systematic review suggests that ketamine may be a feasible treatment option for super-refractory status epilepticus. However, given the critical nature of super-refractory status epilepticus, clinicians should prioritize its termination over evaluating the efficacy of specific medications, ensuring patient safety remains paramount. If feasible in real-world medical settings, future research should focus on designing randomized controlled trials to observe the specific efficacy and mechanisms of ketamine. Careful validation is necessary before considering ketamine as a first-line treatment for super-refractory status epilepticus.

BACKGROUND: High mobile glandular ptotic breasts present the greatest challenge for implant breast augmentation with suboptimal outcomes occurring frequently. Here, we describe and evaluate an innovative approach for breast augmentation in this breast type. By widely disrupting and redefining the parenchyma-muscle interface, this technique offers opportunities to restore the takeoff point of the breast and improve the fullness of the upper pole, thus producing a \"perkier\" breast appearance.
METHODS: A retrospective review was performed, and 68 patients who underwent breast augmentation with either type III dual-plane or the new approach between January 2015 and January 2021 were included. The patients were divided into two groups. The aesthetic outcome and patient satisfaction were evaluated using different 10-point rating forms. Data on demographic information, surgical details, and relative complication rates were recorded and compared.
RESULTS: Upon comparing the aesthetic outcomes and satisfaction, the test group demonstrated better breast shape, nipple-areola position, upper pole contour outcome, and upper pole satisfaction. No post-operative hematoma, seroma, or infection occurred in either groups. No double-bubble deformity occurred in the test group, whereas it occurred in two patients in the control group. The rates of capsular contracture were 1.4% and 1.6%, in the test and control groups, respectively.
CONCLUSIONS: The new approach is a safe surgical method with good aesthetic outcome, high patient satisfaction, and long-lasting result. This approach is a supplement to the dual-plane techniques, to realize the benefits of mastopexy and type III dual-plane breast augmentation.

In landscape appreciation, what tourists directly perceive is the atmosphere of the landscape. This paper introduces the concept of \"Ecological Structure\" from Gernot Böhme\'s theory of atmospheric aesthetics into the assessment of landscapes, utilizing atmosphere as a bridge between horticultural ecology, aesthetics, and culture. It examines the relationship between the objective environment and subjective perception. This study conducted a field survey of Xingqing Palace Park and selected the waterside plant landscape that directly reflects the atmosphere of the royal garden as the research object. In the first stage of this study, Scenic Beauty Estimation was used to evaluate the overall beauty of 32 landscape units; in the second stage, the Delphi method and Analytic Hierarchy Process were used to evaluate the ecological structures that affect the garden landscape atmosphere; in the third stage, the two evaluation results of the Kendall\'s W concord coefficient test Analytic Hierarchy Process and Scenic Beauty Estimation have high consistency, which shows that the atmosphere is great value to the beauty of the landscape. This study provides designers with a means to create a garden atmosphere using ecological structures and provides new ideas for landscape design.

OBJECTIVE: The aim of this retrospective clinical study was to compare the 5-year radiological and clinical outcomes of patients undergoing immediate implantation with or without the modified socket-shield technique.
METHODS: Patients who underwent anterior tooth replacement via the modified socket-shield technique (MSST) or the conventional immediate implantation technique (CIIT) between 2016 and 2017 were included. The labial bone thickness was assessed at different measurement levels (0, 2, 4 and 6 mm apical to the implant shoulder (IS)) postoperatively (T1), 6 months postoperatively (T2) and 5 years postoperatively (T3). The pink aesthetic score (PES) was evaluated before surgery (T0) and at T2 and T3. Implant success, complications and patient satisfaction were evaluated at every visit.
RESULTS: Thirty-six patients (18 in the MSST group) underwent follow-up for 5 years, with no cases of implant failure. Two cases of exposure were detected in the MSST group, but there were no significant effects on hard or soft tissue. Patients in the MSST group showed less and more stable bone resorption than did those in the CIIT group at any measurement level and any time. A higher PES was achieved in the MSST group. Patient satisfaction was similar in both groups.
CONCLUSIONS: The MSST is a reliable immediate implantation method because of its ability to preserve the alveolar bone and provide superior recovery of aesthetics.

BACKGROUND: Each year, tens of thousands of people worldwide choose to undergo cosmetic surgery in order to alter their appearance. In recent years, young people have gradually emerged to comprise the main driving force behind the increasing demand for cosmetic surgery. Previous studies have found that sexism may motivate young people to undergo such surgeries. However, few studies have been conducted to determine if this psychological mechanism influences the acceptance of cosmetic surgery among Chinese university students.
METHODS: A total of 579 Chinese university students (280 girls and 299 boys, 17-20 years) volunteered to participate in the online survey. They completed a questionnaire containing the Ambivalent Sexism Inventory, the 12-item General Health Questionnaire, the Gender-Role Attitudes Questionnaire and the Acceptance of Cosmetic Surgery Scale. We firstly evaluated the underlying factor structure of the Acceptance of Cosmetic Surgery Scale using exploratory and confirmatory factor analyses, and exploring pattern of associations between the constructs was analyzed via path analysis.
RESULTS: According to the findings, hostile sexism was associated with greater levels of acceptance toward cosmetic surgery. Moreover, gender-role attitudes mediated the link between hostile sexism and the acceptance of cosmetic surgery, and this mediation was positively influenced by general mental health.
CONCLUSIONS: Our study contributes to a deeper understanding of Chinese university students\' attitudes toward cosmetic surgery, hostile sexism may contribute to normalizing traditional gender stereotypes and encourage cosmetic surgery acceptability among Chinese university students.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .