BACKGROUND: Parkinson's disease (PD) is a leading cause of death and disability worldwide, and is associated with a significant Global Burden of Disease (GBD). We analyzed the trends in PD incidence, mortality, and disability-adjusted life year (DALY) burden in China, and compared them with global data. METHODS: Estimates and 95% uncertainty intervals (UIs) for incidence, mortality, DALYs, years lived with disability (YLDs), and years of life lost (YLLs) for PD were extracted from the GBD, Injuries, and Risk Factors Study 2021. We describe the epidemiology of PD at global and Chinese levels, analyze trends in incidence and mortality from 1990 to 2021 by joinpoint regression models, and decompose PD burden according to population size, age structure, and epidemiological changes. RESULTS: GBD 2021 estimated 508,378 (95% UI: 430,499-592,748) incident cases of PD, 92,035 (95% UI: 75,908-108,133) deaths, and 2,159,514 (95% UI: 1,826,196-2,521,344) DALYs in China, with the higher age-standardized rate (ASR) in incidence, mortality and DALYs than the global levels. The DALY burden of PD in China increased slightly from 1990 to 2021, consistent with the global upward trend. Joinpoint regression analysis indicated that the ASR of incidence in China increased faster than the global average, while the ASR of mortality decreased, with the fastest decline in 2004-2014. Decomposition analysis revealed that men and the middle sociodemographic index (SDI) quintile (32.82%) were responsible for the most significant DALYs, whose changes were primarily driven by population growth and aging. CONCLUSIONS The burden of PD showed an overall increasing trend from 1990 to 2021, which was primarily driven by population growth and aging. This study highlights the significant challenges in controlling and managing PD, including the increase in cases and gender differences, which may provide guidance for comprehensive strategies to address the changing profiles of PD in China.
Humans ; Parkinson Disease/mortality* ; China/epidemiology* ; Global Burden of Disease ; Male ; Incidence ; Female ; Disability-Adjusted Life Years ; Middle Aged ; Aged ; Adult ; Quality-Adjusted Life Years ; Aged, 80 and over ; Cost of Illness ; Adolescent ; Pattern Analysis, Machine

Objective To investigate the predictive value of preoperative plasma total cholesterol levels for postoperative delirium(POD)following esophagectomy and to analyze its associated risk factors.Methods The complete perioperative electronic medical records of 187 patients with POD who underwent esophagectomy at the 960 Hospital of the People's Liberation Army between January 2019 and December 2023 were retrospectively analyzed.According to the occurrence of POD within one week postoperatively,the patients were categorized into a delirium group and a non-delirium group.The preoperative plasma total cholesterol levels were used to construct a receiver operating characteristic(ROC)curve for predicting delirium after esophagectomy.The area under the curve(AUC)and its 95%confidence interval(CI)were calculated.Additionally,the plasma total cholesterol level corresponding to the maximum Youden index(sensitivity+specificity-1)was determined as the optimal critical value.Results POD occurred in 24 of 187 patients who underwent esophageal cancer resection,with an incidence rate of 12.83%.Compared to the non-delirium group,the delirium group exhibited older age,lower intraoperative blood pressure,lower plasma total cholesterol and low-density lipoprotein levels,longer anesthesia duration,and a higher preva-lence of coronary heart disease,which was identified as a risk factor for POD.Dexmedetomidine administration was associated with a reduced occurrence of POD.The AUC,95%CI,cut-off value,sensitivity,and specificity of preop-erative plasma total cholesterol level for predicting POD were 0.761,0.657～0.865,≤4.11 mmol/L,70.8%,and 77.3%,respectively.Conclusions Among non-hyperlipidemic patients,low preoperative plasma total cholesterol levels and intraoperative hypotension are identified as independent risk factors for POD following esophageal cancer resection.Preoperative plasma total cholesterol levels exhibit moderate predictive value for the occurrence of POD.

Objective To investigate the predictive value of preoperative plasma total cholesterol levels for postoperative delirium(POD)following esophagectomy and to analyze its associated risk factors.Methods The complete perioperative electronic medical records of 187 patients with POD who underwent esophagectomy at the 960 Hospital of the People's Liberation Army between January 2019 and December 2023 were retrospectively analyzed.According to the occurrence of POD within one week postoperatively,the patients were categorized into a delirium group and a non-delirium group.The preoperative plasma total cholesterol levels were used to construct a receiver operating characteristic(ROC)curve for predicting delirium after esophagectomy.The area under the curve(AUC)and its 95%confidence interval(CI)were calculated.Additionally,the plasma total cholesterol level corresponding to the maximum Youden index(sensitivity+specificity-1)was determined as the optimal critical value.Results POD occurred in 24 of 187 patients who underwent esophageal cancer resection,with an incidence rate of 12.83%.Compared to the non-delirium group,the delirium group exhibited older age,lower intraoperative blood pressure,lower plasma total cholesterol and low-density lipoprotein levels,longer anesthesia duration,and a higher preva-lence of coronary heart disease,which was identified as a risk factor for POD.Dexmedetomidine administration was associated with a reduced occurrence of POD.The AUC,95%CI,cut-off value,sensitivity,and specificity of preop-erative plasma total cholesterol level for predicting POD were 0.761,0.657～0.865,≤4.11 mmol/L,70.8%,and 77.3%,respectively.Conclusions Among non-hyperlipidemic patients,low preoperative plasma total cholesterol levels and intraoperative hypotension are identified as independent risk factors for POD following esophageal cancer resection.Preoperative plasma total cholesterol levels exhibit moderate predictive value for the occurrence of POD.

Objective:To evaluate the efficacy of visualized precise lung expansion for determining the intersegmental plane in thoracoscopic segmentectomy.Methods:Sixty-four American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, regardless of gender, aged 33-77 yr, with body mass index of 16-34 kg/m 2, undergoing elective thoracoscopic segmentectomy under general anesthesia, were included. They were preoperatively reconstructed with 3D CT bronchovascularization to reconstruct the pulmonary vasculature, bronchus, and the virtual intersegmental planes of the lungs. The patients were divided into 2 groups ( n=32 each) using a random number table method: visualized precise lung expansion group (group V) and modified expansion and atrophy group (group E). Group V used visualized precision lung expansion to determine the intersegmental planes, and group E used the modified expansion and atrophy method to determine the intersegmental planes. The intraoperative intersegmental plane determination time, target segmental bronchus identification and treatment time, anesthesia time, operation time, postoperative air leakage, pulmonary atelectasis, fever, occurrence of lung infection, postoperative 24 h drainage volume, drain removal time and hospitalization time were recorded in the two groups. Results:Compared with group E, the intersegmental plane determination time, target segment bronchial identification and treatment time, anesthesia time and operation time were significantly shortened in group V( P<0.05).There were no significant differences between groups in the 24 h postoperative drainage volume, drain removal time, hospitalization time or incidence of postoperative pulmonary complications ( P>0.05). Conclusions:Compared with the modified expansion and atrophy method, visualized precise lung expansion can effectively shorten the intersegmental plane determination time in thoracoscopic segmentectomy.

Genicular nerve block is usually used for the treatment of chronic pain of knee osteoar-thritis,which can effectively relieve knee pain and preservemotor function.With the rapid development of ultrasound technology,ultrasound-guided genicular nerve block can improve the accuracy of nerve block and reduce block-related complications.This article reviews the research progress of ultrasound-guided genicular nerve block in three aspects:anatomy,operation methods and clinical application.

Objective To investigate the postoperative complications of ex vivo liver resection combined with autologous liver transplantation in the treatment of end-stage hepatic alveolar echinococcosis at high altitude and related prevention and treatment strategies. Methods Surgical data and follow-up data were collected from 11 patients with end-stage hepatic alveolar echinococcosis who underwent autologous liver transplantation in Qinghai People's Hospital from January 2013 to March 2019, and intraoperative and postoperative conditions were analyzed. Results All 11 patients underwent autologous liver transplantation successfully, without intraoperative death, among whom 2(18.18%) underwent hemi-extracorporeal hepatectomy and 9 (81.82%) underwent total extracorporeal hepatectomy. For the reconstruction of the retrohepatic inferior vena cava, 2 patients (18.18%) underwent reconstruction with the autologous great saphenous vein, 4 patients (36.36%) underwent reconstruction with artificial vessels, and the autologous retrohepatic inferior vena cava was preserved in 5 patients (45.45%). For biliary reconstruction, 8 patients (72.73%) underwent choledochoenterostomy and 3 (27.27%) underwent choledochocholedochostomy. The main postoperative complications of the 11 patients included bleeding in 2 patients (18.18%), bile leakage and abdominal infection in 4 patients (36.36%), bilioenteric anastomotic stenosis in 1 patient (9.09%), thrombus in 2 patients (18.18%), pulmonary infection and pleural effusion in 2 patients (18.18%), and echinococcosis recurrence in 1 patient (9.09%). Of all 11 patients, 2 (18.18%) died during the perioperative period, and the other 9 patients (81.82%) were improved and discharged. Conclusion Bleeding, biliary complications, and infection are the main causes of death in patients undergoing autologous liver transplantation at high altitude. An accurate understanding of surgical indication, careful multidisciplinary evaluation before surgery, superb operation during surgery, standardized surgical procedures, and fine perioperative management are the key to reducing perioperative mortality, avoiding and reducing postoperative complications, and achieving good long-term survival in patients undergoing autologous liver transplantation.

With the development of ultrasound technology, the needle position and local anesthetic diffusion can be observed in real time, and therefore, the accuracy and success rate of nerve block have been significantly improved. Ultrasound-guided fascial space block, such as transversus abdominis plane block and quadratus psoas block, has been widely used in postoperative analgesia in delivery woman. This paper reviews the application of ultrasound-guided fascial space block in postoperative analgesia of cesarean section in recent years, in order to provide reference for further clinical application.

Postoperative delirium (POD) is one of the common complications of central nervous system after operation. Severe POD can even develop into dementia, which seriously reduces the quality of life. Neuroinflammation and sleep disorder play important roles in the pathogenesis of POD. Dexmedetomidine (DEX) is a commonly used anesthetic in clinic, which is often used in the sedation of ICU patients and clinical anesthesia. DEX can reduce perioperative inflammatory response, improve patient's sleep, and reduce the incidence of POD. In this paper, the effects of DEX on neuroinflammation and sleep are discussed in order to provide evidence for clinical prevention and treatment of POD.

COVID-19 is the latest and most severe epidemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Besides the respiratory system, the effects of SARS-CoV-2 on central and peripheral nervous systems have been recognized by more and more people. Clinically, patients with COVID-19 have been reported from mild anosmia and hypoesthesia to acute necrotizing hemorrhagic encephalopathy and Guillain-Barre syndrome. In order to facilitate clinicians to recognize the nerve injury of COVID-19 patients and give timely treatment to these patients, this paper reviews the latest research progress on the possible pathways of nerve injury, clinical manifestations and pathogenesis of COVID-19 patients.

OBJECTIVE: To analyze clinical manifestations, diagnosis and treatment of annular pancreas in neonates. METHODS: Clinical data of 114 neonates with annular pancreas admitted in the Children's Hospital of Zhejiang University from January 2009 to December 2018 were reviewed. The demographic parameters (gestational age, birth weight), clinical manifestations, onset time, results of antenatal examination, associated anomalies, radiological findings, operations, postoperative complications were analyzed. RESULTS: One hundred and two cases were examined by abdominal echography, in which 68 cases showed duodenal obstruction, 4 cases showed annular pancreas. Plain abdomen X-ray examination performed in 113 cases before operation, 76 cases presented double-bubble sign, 12 cases presented single-bubble sign and 5 cases had high-position intestinal obstruction. Upper gastrointestinal radiography (UGI) was performed in 103 cases, which suggested duodenal obstruction in 102 cases. Operations were performed in all cases, of which 69 cases were operated under laparoscopy including 1 case converted to open laparotomy. The mean fasting time after surgery was (7.8±2.7) d, and the mean length of hospital stay was (16.9±10.1) d. Five patients had postoperative complications. The incidence of postoperative complications in antenatal abnormal group was lower than that in the antenatal non-abnormal group (<0.05); the average fasting time in laparoendscopic surgery group was shorter than that in traditional laparotomy group (<0.05). CONCLUSIONS Neonates with recurrent vomiting early after birth should be highly suspected to have annular pancreas. The fetal chromosome examination should be performed with abnormal antenatal screening. Surgery is the only effective way to diagnose and treat annular pancreas, and laparoscopic surgery could be the first choice for experienced doctors.
Duodenal Obstruction ; diagnostic imaging ; surgery ; Humans ; Infant, Newborn ; Laparoscopy ; Pancreas ; abnormalities ; diagnostic imaging ; pathology ; surgery ; Pancreatic Diseases ; diagnostic imaging ; pathology ; surgery ; Retrospective Studies