Objective To observe the effect of esketamine on intraoperative analgesic management of burn patients.Methods A prospective randomized controlled study was conducted in which 104 patients with scab grafting under general anesthesia in the Fourth Medical Center of the PLA General Hospital from December 2023 to September 2024 were selected as the study subjects.The patients were divided into esketamine group and sufentanil group according to random number table method,with 52 cases in each group.Basic data,laboratory examination indicators,perioperative circulation of patients[including mean arterial pressure(MAP),heart rate(HR)],perioperative anxiety and pain scales[including self-rating anxiety scale(SAS),visual analog scale for anxiety(VAS-A),visual analog scale for pain(VAS-P),numerical rating scale(NRS),and the occurrence of postoperative adverse reactions.Results After excluding 6 patients who withdrew and 3 who required changes in anesthesia,95 patients completed the study(47 in the esketamine group and 48 in the sufentanil group).Compared with sufentanil group,patients in the two groups had stable intraoperative circulation,esketamine group had higher MAP at 2 minutes after anesthesia intubation(T3),at intraoperative skin removal(T4),at intraoperative skin grafting(T5),and at exit room(T6),HR was faster at T3-T5(P<0.05),and the time from surgery to extubation was extended[minutes:7.0(5.0,11.0)vs.5.0(3.8,8.3),P<0.05],the first exhaust time was significantly shortened[hours:3.8(1.5,7.3)vs.6.2(3.4,10.5),P<0.05],the proportion of increased secretion during recovery period was significantly higher[36.2%(17/47)vs.16.7%(8/48),P<0.05],and the VAS-P score at rest 24 hours after surgery[0.0(0.0,1.0)vs.0.5(0.0,1.0),P<0.05]and VAS-P score during exercise[1.5(1.0,2.0)vs.2.0(1.0,3.0),P<0.05]were significantly lower.There were no significant differences in anesthesia drug consumption and postoperative adverse reactions between the two groups.Conclusion Esketamine is safe and feasible for intraoperative analgesia management of burn patients,and it is a potential drug for perioperative frugal opioid anesthesia management.

Objective To observe the effect of esketamine on intraoperative analgesic management of burn patients.Methods A prospective randomized controlled study was conducted in which 104 patients with scab grafting under general anesthesia in the Fourth Medical Center of the PLA General Hospital from December 2023 to September 2024 were selected as the study subjects.The patients were divided into esketamine group and sufentanil group according to random number table method,with 52 cases in each group.Basic data,laboratory examination indicators,perioperative circulation of patients[including mean arterial pressure(MAP),heart rate(HR)],perioperative anxiety and pain scales[including self-rating anxiety scale(SAS),visual analog scale for anxiety(VAS-A),visual analog scale for pain(VAS-P),numerical rating scale(NRS),and the occurrence of postoperative adverse reactions.Results After excluding 6 patients who withdrew and 3 who required changes in anesthesia,95 patients completed the study(47 in the esketamine group and 48 in the sufentanil group).Compared with sufentanil group,patients in the two groups had stable intraoperative circulation,esketamine group had higher MAP at 2 minutes after anesthesia intubation(T3),at intraoperative skin removal(T4),at intraoperative skin grafting(T5),and at exit room(T6),HR was faster at T3-T5(P<0.05),and the time from surgery to extubation was extended[minutes:7.0(5.0,11.0)vs.5.0(3.8,8.3),P<0.05],the first exhaust time was significantly shortened[hours:3.8(1.5,7.3)vs.6.2(3.4,10.5),P<0.05],the proportion of increased secretion during recovery period was significantly higher[36.2%(17/47)vs.16.7%(8/48),P<0.05],and the VAS-P score at rest 24 hours after surgery[0.0(0.0,1.0)vs.0.5(0.0,1.0),P<0.05]and VAS-P score during exercise[1.5(1.0,2.0)vs.2.0(1.0,3.0),P<0.05]were significantly lower.There were no significant differences in anesthesia drug consumption and postoperative adverse reactions between the two groups.Conclusion Esketamine is safe and feasible for intraoperative analgesia management of burn patients,and it is a potential drug for perioperative frugal opioid anesthesia management.

BACKGROUND: The hemoglobin glycation index (HGI) was developed to quantify glucose metabolism and individual differences and proved to be a robust measure of individual glycosylated hemoglobin (HbA1c) bias. Here, we aimed to explore the relationship between different HGIs and the risk of 5-year major adverse cardiovascular events (MACEs) by performing a large multicenter cohort study in China. METHODS: A total of 9791 subjects from the Risk Evaluation of Cancers in Chinese Diabetic Individuals: a Longitudinal Study (the REACTION study) were divided into five subgroups (Q1-Q5) with the HGI quantiles (≤5th, >5th and ≤33.3th, >33.3th and ≤66.7th, >66.7th and ≤95th, and >95th percentile). A multivariate logistic regression model constructed by the restricted cubic spline method was used to evaluate the relationship between the HGI and the 5-year MACE risk. Subgroup analysis between the HGI and covariates were explored to detect differences among the five subgroups. RESULTS: The total 5-year MACE rate in the nationwide cohort was 6.87% (673/9791). Restricted cubic spline analysis suggested a U-shaped correlation between the HGI values and MACE risk after adjustment for cardiovascular risk factors ( χ2 = 29.5, P <0.001). After adjustment for potential confounders, subjects with HGIs ≤-0.75 or >0.82 showed odds ratios (ORs) for MACE of 1.471 (95% confidence interval [CI], 1.027-2.069) and 2.222 (95% CI, 1.641-3.026) compared to subjects with HGIs of >-0.75 and ≤-0.20. In the subgroup with non-coronary heart disease, the risk of MACE was significantly higher in subjects with HGIs ≤-0.75 (OR, 1.540 [1.039-2.234]; P = 0.027) and >0.82 (OR, 2.022 [1.392-2.890]; P <0.001) compared to those with HGIs of ≤-0.75 or >0.82 after adjustment for potential confounders. CONCLUSIONS We found a U-shaped correlation between the HGI values and the risk of 5-year MACE. Both low and high HGIs were associated with an increased risk of MACE. Therefore, the HGI may predict the 5-year MACE risk.
Humans ; Cohort Studies ; Longitudinal Studies ; Diabetes Mellitus, Type 2/diagnosis* ; Maillard Reaction ; Glycated Hemoglobin ; Cardiovascular Diseases

Objective To evaluate the diagnostic value of related contrast material(Rel.CM)of the dual-energy CT (DECT) virtual noncalcium (VNCa) for detecting acute traumatic bone marrow edema in knee joint.Methods A total of 17 patients(18 knees)with definite trauma history and knee joint disorders were prospectively enrolled. Conventional CT, VNCa and MRI images were obtained by MRI and DECT scan. Each knee was divided into 12 regions, respectively, to observe the performance of MRI and VNCa images. The diagnostic efficacy of different Rel. CM values (1.25, 1.45, 1.75) was analyzed for the knee traumatic bone marrow edema,select the best Rel.CM value.And the CT values of bone marrow and bone marrow damage were measured on VNCa of the optimal Rel. CM parameters. Using ROC to evaluate the efficacy of VNCa in different Rel.CM values for diagnosing traumatic bone marrow edema,the difference of CT value between bone marrow lesion and bone marrow in normal region of bone marrow was obtained by using rank sum test. Results DECT and MRI were performed in 17 patients (18 knees). Eighteen knees were divided into 216 areas.MRI showed 94 areas of bone marrow edema,including 35 in distal portion of femur, 59 in proximal tibia. Rel.CM values of 1.25, 1.45, 1.75 of the VNCa map were used to diagnose traumatic bone marrow edema in the knee with the area under the ROC curve of 0.643, 0.871, 0.656, respectively. Rel.CM with 1.45 VNCa diagram was the most accurate. The CT values of the bone marrow edema region and the normal region were -64.3(-20.6 to-90.8)HU,-93.4(-70.5 to-120.7)HU, respectively, on the VNCa graph with the optimal Rel.CM parameters (1.45) (Z=-8.270, P<0.05). Conclusions The VNCa image with a Rel.CM value of 1.45 has a better diagnostic performance for traumatic bone marrow edema in knee joint. CT value measurement in VNCa image can be used for quantitative analysis of traumatic bone marrow edema.

Objective To explore the MR features of granulomatous mastitis and to improve the diagnosis of the disease.Methods MR findings of 1 1 patients with granulomatous mastitis confirmed by pathology were retrospectively reviewed.Results Nine (81.82%)lesions showed regional or diffused hyperintensity on T2 WI with heterogeneous gridding features.2 (18.18%)lesions showed mass-like enhancement and 9 lesions showed non-mass-like enhancement.Of 9 (81.82%)lesions with non-mass-like en-hancement,the enhancement patterns included diffused in 2 (18.18%)cases,regional in 4 (36.36%)cases,multiple-regional in 2 (18.18%)cases,and focal in 1 (9.09%)case,respectively.All the lesions showed early heterogeneous enhancement,and clumped-ring enhancement was seen in 6 lesions.The signal intensity of the lesions was increased and more uniform in the later stage.The time-signal intensity curve was type I in 7(63.64%)cases,type II in 3 (27.27%)cases and type III in 1 (9.09%)case.The mean ADC value was (1.82±0.1 7)×10 -3 mm2/s,and there was no significant difference between lesions and normal regions (t=1.766, P >0.05).Concomitant signs included barymastia,thickening of skin,edema surrounding the lesions,and axillary lymph node en-largement.The BI-RADS category was 3 degree in 1 (9.09%)case,4a degree in 5 (45.45%)cases,4b degree in 2 (18.18%)ca-ses,4c degree in 2 (18.18%)cases and 5 degree in 1 (9.09%)case.The misdiagnosis ratio was 54.55%.Conclusion Granuloma-tous mastitis has certain characteristic MR features.The misdiagnosis ratio of granulomatous mastitis is high.Therefore,clinical data should be referred when making diagnosis.