Objective:To evaluate the effect of low-dose esketamine on intraoperative electroencephalogram (EEG) burst suppression under general anesthesia in elderly patients.Methods:In this prospective randomized controlled trial, 86 elderly patients of either sex, scheduled for elective lumbar fusion surgery at Anhui No. 2 Provincial People′s Hospital from March 15 to June 1, 2024, aged 60-85 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification ⅡorⅢ, were divided into 2 groups ( n=43 each) using a random number table method: esketamine group (group S) and control group (group C). In group S, esketamine at a dose of 0.25 mg/kg was intravenously injected after anesthesia induction, while the equal volume of normal saline was intravenously injected in group C. The occurrence of EEG burst suppression and frequency of the characteristic density spectral array were recorded using the Masimo Sedline cerebral function monitor. The patient state index was recorded before esketamine administration and at 5, 10, 30 and 60 min after administration and at 5 min before the end of the surgery. Delirium was assessed using the Confusion Assessment Method at 1 and 3 days after operation. The total pressing times of patient-controlled analgesia within 48 h after operation, requirement for rescue analgesia and occurrence of adverse reactions (nausea and vomiting, delayed emergence from anesthesia, agitation, headache) were recorded. The consumption of ephedrine, phenylephrine, sufentanil and remifentanil during operation, emergence time, time of tracheal extubation, length of stay in the post-anesthesia care unit, and length of postoperative hospital stay were also recorded. Results:Compared with group C, the incidence of EEG burst suppression and frequency of the characteristic density spectral array were significantly decreased, the patient state index values were increased at each time point after administration and 5 min before the end of surgery, the consumption of ephedrine, phenylephrine, sufentanil and remifentanil during operation was reduced, the effective pressing times of patient-controlled analgesia, rate of rescue analgesia, and incidence of postoperative delirium within 3 days after operation were decreased, and the length of postoperative hospital stay was shortened in group S ( P<0.05). Conclusions:Low-dose esketamine can reduce intraoperative EEG burst suppression and decrease the development of postoperative delirium under general anesthesia in elderly patients.

OBJECTIVE: To observe the effect of perioperative transcutaneous electrical acupoint stimulation (TEAS) on postoperative fatigue syndrome (POFS) in elderly patients undergoing laparoscopic radical gastrectomy. METHODS: A total of 80 elderly patients scheduled for laparoscopic radical gastrectomy were randomized into a TEAS group and a sham TEAS group, 40 cases in each one. In the TEAS group, TEAS intervention was applied at bilateral Hegu (LI4), Neiguan (PC6), Zusanli (ST36) and Sanyinjiao (SP6) from 30 min before anesthesia induction until surgery completion, and at 18:00 on 1st, 2nd and 3rd days after surgery, once a day, 30 min a time. In the sham TEAS group, the same acupoints were selected and connected to the electroacupuncture device at the same time, without electrical stimulation. One day before surgery and 1, 3, 7 days after surgery, the 10-item short form of identity consequence fatigue scale (ICFS-10) score was observed, and the POFS incidence rate of 1, 3, 7 days after surgery was assessed in the two groups. One day before surgery, surgery completion, and 1, 3 days after surgery, the serum levels of superoxide dismutase (SOD), β-endorphin (β-EP) were detected; 1 day before surgery and 1, 3, 7 days after surgery, the serum level of tumor necrosis factor-α (TNF-α) was detected in the two groups. The pain visual analog scale (VAS) score was observed at 24, 48 and 72 h after surgery; the intraoperative dosage of propofol and remifentanil, and the incidence rate of postoperative nausea and vomiting, itching, respiratory depression were recorded in the two groups. RESULTS: In the TEAS group, on 1, 3, 7 days after surgery, except for the scores of item 8-10, the item scores and the total scores of ICFS-10 were lower than those in the sham TEAS group (P<0.001); on 3 and 7 days after surgery, the POFS incidence rates were lower than those in the sham TEAS group (P<0.05). In the TEAS group, on 1 and 3 days after surgery, the serum levels of SOD were higher than those in the sham TEAS group (P<0.05, P<0.01); at surgery completion, and on 1, 3 days after surgery, the serum levels of β-EP were higher than those in the sham TEAS group (P<0.001, P<0.01); on 1, 3, 7 days after surgery, the serum levels of TNF-α were lower than those in the sham TEAS group (P<0.01, P<0.001). In the TEAS group, at 24, 48 and 72 h after surgery, the pain VAS scores were lower than those in the sham TEAS group (P<0.001, P<0.01, P<0.05); the intraoperative dosage of remifentanil was lower than that in the sham TEAS group (P<0.001); the incidence rate of postoperative nausea and vomiting was lower than that in the sham TEAS group (P<0.01). CONCLUSION Perioperative TEAS intervention can effectively reduce the incidence rate of POFS, improve fatigue symptom and mental state in elderly patients undergoing laparoscopic radical gastrectomy, its mechanism may related to enhancing endogenous β-EP release, inhibiting inflammatory response, and reducing central oxidative stress, thereby promoting postoperative recovery.
Humans ; Acupuncture Points ; Male ; Female ; Aged ; Transcutaneous Electric Nerve Stimulation ; Postoperative Complications/therapy* ; Middle Aged ; Fatigue/etiology* ; Gastrectomy/adverse effects* ; beta-Endorphin/blood* ; Tumor Necrosis Factor-alpha/blood*

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To analyze the trend of infertility disease burden from 1990 to 2019 and predict the age-standardized prevalence rate (ASPR) and age-standardized disability-adjusted life-year (DALY) rate of male and female infertility for 2020—2029, providing a certain reference for the prevention and treatment of infertility diseases.Methods:Based on the Global Burden of Disease 2019, prevalence, ASPR, DALY rate, and age-standardized DALY rate were used to evaluate the global burden of infertility comprehensively. The estimated annual percentage change was used to describe trends in the disease burden of infertility in 21 regions worldwide. The Bayesian age period cohort model was used to predict the ASPR and age-standardized DALY rate for male and female infertility in 204 countries and regions from 2020 to 2029. Sensitivity analysis was performed using the autoregressive integrated moving average model.Results:The prevalence, DALY rate, ASPR and age-standardized DALY rate of global male infertility increased from 319.52 per 100 000,1.82 per 100 000, 2 856.53 per 100 000, and 16.19 per 100 000 in 1990 to 565.30 per 100 000, 3.22 per 100 000, 3 398.53 per 100 000, and 19.36 per 100 000 in 2019, respectively. The prevalence, DALY rate, ASPR, and age-standardized DALY rate of global female infertility increased from 656.67 per 100 000, 3.53 per 100 000, 6 036.36 per 100 000, and 32.27 per 100 000 in 1990 to 1 223.78 per 100 000, 6.59 per 10 000, 7 483.12 per 100 000, and 40.33 per 100 000 in 2019, respectively. The burden of infertility disease was the highest in men and women aged 30-34 years, and the ASPR and age-standardized DALY rates were 4 407.47 per 100 000, 25.08 per 100 000, 10 270.55 per 100 000 and 55.65 per 100 000, respectively. Only in 45-49 years of age, the prevalence of infertility (11.31 per 100 000) and DALY rate (0.06 per 100 000) in women were lower than those in men (15.68 per 100 000 and 0.08 per 100 000). In addition, the burden of infertility was the lowest in high socio-demographic index regions. Cameroon had the highest ASPR (7 652.40 per 100 000) and age-standardized DALY rate (43.94 per 100 000) for male infertility. Chinese women had the highest ASPR (20 402.30 per 100 000) and age-standardized DALY rate (106.16 per 100 000) of infertility. The forecast results show that the burden of male and female infertility diseases will increase in 204 countries and regions from 2020 to 2029.Conclusion:The burden of infertility diseases in men and women increased in 204 countries and regions from 1990 to 2019, and it is predicted that the global burden of infertility diseases will continue to rise in 2020—2029. Preliminary screening of infertility should be carried out as soon as possible, health education should be strengthened and effective prevention and treatment strategies should be formulated.

Objective:To analyze the trend of infertility disease burden from 1990 to 2019 and predict the age-standardized prevalence rate (ASPR) and age-standardized disability-adjusted life-year (DALY) rate of male and female infertility for 2020—2029, providing a certain reference for the prevention and treatment of infertility diseases.Methods:Based on the Global Burden of Disease 2019, prevalence, ASPR, DALY rate, and age-standardized DALY rate were used to evaluate the global burden of infertility comprehensively. The estimated annual percentage change was used to describe trends in the disease burden of infertility in 21 regions worldwide. The Bayesian age period cohort model was used to predict the ASPR and age-standardized DALY rate for male and female infertility in 204 countries and regions from 2020 to 2029. Sensitivity analysis was performed using the autoregressive integrated moving average model.Results:The prevalence, DALY rate, ASPR and age-standardized DALY rate of global male infertility increased from 319.52 per 100 000,1.82 per 100 000, 2 856.53 per 100 000, and 16.19 per 100 000 in 1990 to 565.30 per 100 000, 3.22 per 100 000, 3 398.53 per 100 000, and 19.36 per 100 000 in 2019, respectively. The prevalence, DALY rate, ASPR, and age-standardized DALY rate of global female infertility increased from 656.67 per 100 000, 3.53 per 100 000, 6 036.36 per 100 000, and 32.27 per 100 000 in 1990 to 1 223.78 per 100 000, 6.59 per 10 000, 7 483.12 per 100 000, and 40.33 per 100 000 in 2019, respectively. The burden of infertility disease was the highest in men and women aged 30-34 years, and the ASPR and age-standardized DALY rates were 4 407.47 per 100 000, 25.08 per 100 000, 10 270.55 per 100 000 and 55.65 per 100 000, respectively. Only in 45-49 years of age, the prevalence of infertility (11.31 per 100 000) and DALY rate (0.06 per 100 000) in women were lower than those in men (15.68 per 100 000 and 0.08 per 100 000). In addition, the burden of infertility was the lowest in high socio-demographic index regions. Cameroon had the highest ASPR (7 652.40 per 100 000) and age-standardized DALY rate (43.94 per 100 000) for male infertility. Chinese women had the highest ASPR (20 402.30 per 100 000) and age-standardized DALY rate (106.16 per 100 000) of infertility. The forecast results show that the burden of male and female infertility diseases will increase in 204 countries and regions from 2020 to 2029.Conclusion:The burden of infertility diseases in men and women increased in 204 countries and regions from 1990 to 2019, and it is predicted that the global burden of infertility diseases will continue to rise in 2020—2029. Preliminary screening of infertility should be carried out as soon as possible, health education should be strengthened and effective prevention and treatment strategies should be formulated.

Objective:To evaluate the effect of low-dose esketamine on intraoperative electroencephalogram (EEG) burst suppression under general anesthesia in elderly patients.Methods:In this prospective randomized controlled trial, 86 elderly patients of either sex, scheduled for elective lumbar fusion surgery at Anhui No. 2 Provincial People′s Hospital from March 15 to June 1, 2024, aged 60-85 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification ⅡorⅢ, were divided into 2 groups ( n=43 each) using a random number table method: esketamine group (group S) and control group (group C). In group S, esketamine at a dose of 0.25 mg/kg was intravenously injected after anesthesia induction, while the equal volume of normal saline was intravenously injected in group C. The occurrence of EEG burst suppression and frequency of the characteristic density spectral array were recorded using the Masimo Sedline cerebral function monitor. The patient state index was recorded before esketamine administration and at 5, 10, 30 and 60 min after administration and at 5 min before the end of the surgery. Delirium was assessed using the Confusion Assessment Method at 1 and 3 days after operation. The total pressing times of patient-controlled analgesia within 48 h after operation, requirement for rescue analgesia and occurrence of adverse reactions (nausea and vomiting, delayed emergence from anesthesia, agitation, headache) were recorded. The consumption of ephedrine, phenylephrine, sufentanil and remifentanil during operation, emergence time, time of tracheal extubation, length of stay in the post-anesthesia care unit, and length of postoperative hospital stay were also recorded. Results:Compared with group C, the incidence of EEG burst suppression and frequency of the characteristic density spectral array were significantly decreased, the patient state index values were increased at each time point after administration and 5 min before the end of surgery, the consumption of ephedrine, phenylephrine, sufentanil and remifentanil during operation was reduced, the effective pressing times of patient-controlled analgesia, rate of rescue analgesia, and incidence of postoperative delirium within 3 days after operation were decreased, and the length of postoperative hospital stay was shortened in group S ( P<0.05). Conclusions:Low-dose esketamine can reduce intraoperative EEG burst suppression and decrease the development of postoperative delirium under general anesthesia in elderly patients.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Osteosarcoma is a kind of primary malignant tumor of bone originated from mesenchymal tissue, which mainly occurs in children and adolescents, and presents the characteristics of high malignancy, rapid growth, early metastasis and poor prognosis. Currently, most of the studies at home and abroad mainly focused on therapeutic procedures. However, reliable predictors are essential for monitoring disease changes, guiding treatment and evaluating prognosis. In recent years, the research on prognosis related genes of osteosarcoma has become a new hotspot. Its abnormal expression affects the progress, invasion and metastasis of osteosarcoma cells, and plays an important role in drug resistance and chemotherapy of osteosarcoma. This paper briefly summarizes the abnormal expression of genes related to the prognosis of osteosarcoma: miRNAs, Incrna, CircRNA, ErbB gene family and the imbalance of oncogenes and immune related genes, and fully understands their characteristics, in order to provide a new direction and possible new drug treatment target for the early diagnosis and treatment of osteosarcoma patients, so as to improve the prognosis of osteosarcoma patients.

Objective To evaluate how functional endoscopic sinus surgery(FESS)modifies patients symptom profiles and the quality of life and analyze the influential factors.Methods During 2010 to 2012,90 cases were investigated to evaluate the quality of life of different age groups to use SNOT-20.Results The quality of life after the surgery of different age groups were significantly higher than it before the surgery(P<0.05).The juvenile group:first dimension(nasal congestion,70%),the second dimension (memory,30%),the third dimension(worried about the condition,30%)and the fourth dimension(social influence,40%).The young aged group:first dimension(nasal congestion,73.3%),the fourth dimension(social influence,43.3%),second dimension (quality of sleep,20.0%)and the third dimension(irritability,16.7%).The middle and old aged group:first dimension(nasal con-gestion,66.7%),the third dimension(trepidation,20%),the second dimension(quality of sleep,20.0%)and the fourth dimension (financial burden,40.0%).Preoperative QOL related factors:complications,age,gender,disease duration and urban-rural;Postop-erative QOL related factors:complications,disease duration,age,perioperative management,gender and urban-rural.Conclusion The quality of life of different ages after FESS is improved in different aspects.To increase the level of perioperative compliance can improve the quality of life.

ObjectiveTo investigate the predisposing factors and pathogenic fungal species of Malassezia folliculitis in different geographical areas and body sites.MethodsTotally,241 patients diagnosed with Malassezia folliculitis were asked to complete a questionnaire.The content of hair follicles was obtained and subjected to fungal smear and culture examination.Fungal species were identified according to morphological,physiological and biochemical features.Results Of the 241 patients with Malassezia folliculitis,204 (84.65％) were positive for smear examination.A total of 259 specimens were collected from these patients,and fungal culture grew 213(82.24％) strains,of which,209 belonged to Malassezia species,4(1.54％) to Candida species.Among the 209 Malassezia strains,186 were activated and subjected to species identification which resulted in 6 species,including M.furfur (111 strains,59.68％ ),M.sloofiae (43 strains,23.12％ ),M.sympodialis (17 strains,9.14％),M.globosa (9 strains,4.84％),M.pachydermatis (4 strains,2.15％),and M.obtuse(2 strains,1.08％ ).Of the pathogenic fungi of Malassezia folliculitis,M.furfur predominated in the chest,back,abdomen,face and neck,M.sloofiae in the upper limbs,shoulders and vertex,M.globosa in the lower limbs.There were obvious differences in the distribution of pathogenic fungal species at different body sites in a same host,and M.furfur with M.sloofiae or M.sympodialis appeared to be the most common pathogens.ConclusionsIn this study,6 Malassezia species are identified in patients with Malassezia folliculitis in Nantong and Nanjing area,M.furfur and M.sloofiae appear to be the dominant pathogens.