Shoulin Chen

Objectives: To compare the effects of preoperative pericapsular nerve group (PENG) block versus femoral nerve block (FNB) on pain in patients with hip fractures. Methods: Sixty eligible patients were randomized (1:1) to receive a PENG block or FNB. The primary endpoint was postblock pain assessed through the visual analog scale (VAS). Secondary endpoints included time to optimal ultrasound imaging, procedure duration, time to first rescue analgesic, 24-hour rescue analgesic consumption, postoperative recovery quality, vital signs, and adverse events. Results: At 30 minutes postblock, both resting VAS scores (0.0 [0.0, 1.2] vs. 1.1 [0.6, 1.8], P =0.020) and passive movement VAS scores (2.9 [1.7, 3.6] vs. 3.4 [2.7, 4.7], P =0.027) were significantly lower in the PENG group compared with the FNB group. At 12 hours postblock, resting VAS (3.0 [2.1, 4.0] vs. 2.3 [1.7, 2.6], P =0.006) and passive movement VAS (6.8 [5.1, 7.3] vs. 4.9 [4.1, 5.8], P =0.002) were higher in the PENG group. The PENG group achieved optimal ultrasound imaging faster, had an earlier time to first rescue analgesic, and required a greater total dose of rescue analgesics within 24 hours (all P <0.001). Procedure duration, vital signs, and recovery quality did not differ significantly. Discussion: PENG blocks outperform FNB in imaging speed and early pain control but yield a shorter block duration, thereby increasing 24-hour rescue analgesic demands.

Perioperative neurocognitive disorders (PND) are common in elderly patients, with emerging evidence linking their pathogenesis to abnormal cell death. PANoptosis is a newly identified inflammatory form of programmed cell death, but its role in PND remains unknown. Here, we employed animal behavioral tests, single-cell sequencing (scRNA-seq), methylated RNA immunoprecipitation-sequencing (meRIP-seq), RNA sequencing (RNA-seq), immunofluorescence, and TUNEL staining to investigate the role and underlying mechanisms of PANoptosis in PND. Y-maze and open-field experiments confirmed cognitive and locomotor deficits in a PND mouse model. scRNA-seq revealed altered cellular composition and neuronal heterogeneity in PND brain tissues, with elevated PANoptosis-related gene expression and scores in PND neurons. In vivo and in vitro assays confirmed increased expression of PANoptosis markers (ASC, AIM2, Pyrin) and neuronal apoptosis in PND. Based on the differentially expression gene (DEG) analysis conducted using scRNA-seq, we identified NSUN6 as a key gene that was significantly downregulated in neurons of the PND group, and overexpression of NSUN6 suppressed isoflurane-induced neuronal PANoptosis. RNA-seq and meRIP-seq further revealed that NSUN6 promoted m5C modifications enriched in CDSs and 3' UTRs, with pathway analysis implicating PANoptosis-associated signaling. OAS2 was identified as a direct substrate of NSUN6-mediated m5C modification, with NSUN6 overexpression enhancing both its m5C enrichment and expression. Collectively, our findings suggest that NSUN6 may be involved in OAS2-associated m5C modification and neuronal PANoptosis, supporting a potential role for the NSUN6/OAS2 axis in the pathogenesis of PND.

Autism Spectrum Disorders (ASD) represent a range of neurodevelopmental conditions characterized by abnormal behavioral patterns. ASD is frequently comorbid with other neurodevelopmental disorders. However, there remains a gap in research on the burden of ASD in East and Southeast Asia. We stratified the analysis by region, country, age, and sex; used the Sociodemographic Index (SDI) as a pivot to examine the relationship between the burden of autism and SDI through frontier analysis and health inequality analysis; and finally projected global, sex-specific trends in ASD disease burden from 2022 to 2050. The global burden of ASD, including in East and Southeast Asia, has exhibited a generally increasing trend over recent decades. Japan demonstrated a relatively high ASD burden. The analysis revealed that females tend to experience a higher burden than males, and ASD is more prevalent among younger age groups. A positive correlation was observed between SDI and ASD burden, with higher SDI levels associated with greater burden. Health inequality analyses indicated that while ASD prevalence and Years Lived with Disability (YLDs) are predominantly concentrated in high-SDI countries, incidence rates are higher in low-SDI regions. Finally, the global burden of ASD among both males and females is projected to continue rising through the year 2050. The burden of ASD in East and Southeast Asia continues to increase year by year. High-SDI countries tend to report a greater disease burden. From 1990 to 2021, nearly all countries in the region experienced a continuous rise in ASD burden. Although there is a growing trend of ASD incidence shifting toward low-SDI countries, prevalence and years lived with disability (YLDs) remain predominantly concentrated in high-SDI countries. Finally, the global burden of ASD among both males and females is projected to continue rising through 2050.

The disease burden of dementia in the elderly is predicted to rise, and dementia among older adults has become a crucial issue for public health. Quantifying the disease burden of dementia in the elderly can provide relevant areas and countries with scientific data to help them adjust their healthcare strategies. We analyzed the disease burden of Alzheimer’s disease and other dementias among individuals aged 65 and older from 1990 to 2021; the relationship between mortality rates and disability-adjusted life years (DALYs) with socio-demographic index (SDI); conducted a frontier analysis of the disease burden across 204 countries; and quantified inequalities in age-standardized DALYs for Alzheimer’s disease and other dementias using the slope inequality index and concentration index. Globally, age-standardized DALYs and mortality rates for individuals aged 65 and older have declined over time. We find that the disease burden of dementia is significantly associated with SDI. High SDI countries have 169% higher baseline levels of dementia burden compared to low SDI countries, as estimated based on their current level of social development. Finally, our health inequality analyses reveal that while the overall trend of DALYs for dementia increases with SDI, the burden is primarily concentrated in populations with lower SDI, as non-developed countries account for the majority of the population. The global population aged 65 and older experiences a significant reduction in healthy life expectancy due to dementia. The burden of disease in most countries is higher than the minimum disease burden associated with SDI in those countries. The burden of disease in low and middle SDI countries has been showing an increasing trend. The gap in disease burden among regions with different SDI levels is also continuously narrowing.

Background: Avoiding postoperative delirium (POD) can have a significant detrimental effect on the rehabilitation and prognosis of elderly urological patients. It is necessary to explore the risk factors associated with POD in elderly urology to provide a basis for clinical recognition of delirium. Methods: For relevant studies, we comprehensively searched Embase, MEDLINE, Ovid, PubMed, Scopus, The Cochrane Library, and Web of Science. The search deadline was September 2021. Results: We identified 2046 studies, 8 of which were included in the ultimate analysis. A total of 8 articles, including 356 cases in the delirium group and 1813 cases in the non-delirium group, were included in the relevant literature. The 2 groups mentioned above differed significantly in the following factors: history of delirium (odds ratio [OR] = 6.98, 95% confidence interval [CI]: 1.63–29.86, P = .009); Preoperative use of psychotropic drugs (OR = 1.97, 95% CI: 1.11–3.52, P = .02); age (OR = 3.10, 95% CI: 2.08–4.12, P < .0001). The meta-analysis demonstrated that smoking, alcohol consumption, gender (male), mode of anesthesia (general anesthesia) and being unmarried did not have a significant effect on POD in elderly urological patients. Conclusion: The risk factors for POD in elderly urological patients include history of delirium, preoperative use of psychotropic drugs, and age. The present study provides guidance for taking targeted preventive measures to reduce risks.