In a double-blind randomized trial, 82 frail elderly patients undergoing thoracoscopic radical resection of lung cancer received either intravenous esketamine or a placebo (normal saline) during surgery. Those given esketamine had significantly lower depression scores (HAMD-17) at 7 and 30 days after surgery, indicating less postoperative depression. They also reported better sleep quality in the first week and showed higher scores on a cognitive function test (MMSE) in the first month. Esketamine was associated with higher levels of serum BDNF and 5-HT, lower levels of S100β and NSE, reduced use of anesthetic drugs, fewer side effects like nausea and hyperalgesia, and shorter stays in the recovery room and hospital. Esketamine appears to improve postoperative depressive state, sleep, and cognitive function in this vulnerable group.
Consciousness is linked to how neural activity shifts along a unimodal-transmodal cortical axis, a simple signature that is abnormally elevated under psychedelics and in psychosis. This hierarchical dynamic reflects changes in global brain integration and connectome diversity. Quasi-periodic patterns show hierarchical heterogeneity as spatiotemporally propagating waves tied to arousal, a pattern also seen in macaques. The spatial distribution of the principal cortical gradient aligns with genetic transcription of the histaminergic system and functional connectome mapping of the tuberomammillary nucleus, which promotes wakefulness. Combining behavioral, neuroimaging, electrophysiological, and transcriptomic evidence, the authors propose that global consciousness is supported by efficient hierarchical processing along a low-dimensional macroscale gradient.