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Objective To investigate the effect of appropriate dosage of remimazolam in combination with remifentanil on stress response and cognitive function in elderly patients gastrointestinal endoscopy.Methods Elderly patients undergoing gastrointestinal endoscopy in the Department of Anesthesiology and Pain of the First People's Hospital of Yongkang from June 2021 to June 2023 were selected as the study subjects and were divided into group A(0.15 mg·kg-1),group B(0.20 mg·kg-1)and group C(0.25 mg·kg-1)according to the different doses of remimazolam.Modified alertness/sedation(MOAA/S)scores,anesthesia-related indexes(first sedation success,gastrointestinal endoscopy time awakening time,and discharge time),stress-related indexes[cortisol(COR),epinephrine(ADR)and adrenocorticotropic hormone(ACTH)],mini-mental status examination(MMSE)scores and anesthesia-related adverse reactions were compared among the three groups.Results A total of 186 patients were included in the study,with 62 patients in each group.The MOAA/S scores of groups B and C were significantly lower than those in group A(P<0.05)immediately after gastrointestinal endoscopy,3 min and 6 min for gastroenteroscopy.The success rate of first sedation in groups B and C was significantly higher than that in group A,while the time of gastrointestinal endoscopy was significantly lower than that in group A,and the time of awakening and leaving the room were significantly longer than those in group A(P<0.05).The levels of COR,ADR and ACTH immediately after gastrointestinal endoscopy in groups B and C were significantly lower than those in group A(P<0.05).The MMSE scores of groups B and C at 10 min and 30 min after wake were significantly higher than those in group A(P<0.05).The total incidence of adverse reactions in group B was significantly lower than that in groups A and C(P<0.05).Conclusion 0.20 mg·kg-1 and 0.25 mg·kg-1 remimazolam for geriatric gastrointestinal endoscopy have better sedative effect,can reduce the degree of stress response,and have less impact on cognitive function,but the dose of 0.25 mg·kg-1 can lead to an increase in the incidence of hypotension and hypoxemia,and the recommended dose of remimazolam in geriatric gastrointestinal endoscopy is 0.20 mg·kg-1.
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Objective·To detect the effects of propofol on rat hippocampal astrocytes and clarify its mechanism.Methods·According to the time after propofol injection,twenty-four SD rats were randomly divided into three groups,i.e.0 min,45 min and 90 min group.Rats were administrated intraperitoneally with propofol (10 mg/mL,100 mg/kg body weight).The levels of glial fibrillary acidic protein (GFAP) and S100β mRNA in rat hippocampus were evaluated by realtime PCR.And cell viabilities and levels of GFAP mRNA were examined in primary cultured hippocampal astrocytes induced by 10 μmol/L propofol with or without 10 μmol/L extracellular signal-regulated kinase (ERK) inhibitor PD98059 pretreatment.Results·The mRNA levels of GFAP in the hippocampal tissue were (1.32±0.12) times (P=0.000) and (1.12±0.09) times (P=0.012) that in 0 min group,respectively,45 min and 90 min after injection of propofol.The mRNA levels of S100β in the hippocampal tissue were (1.14±0.11) times (P=0.005) and (1.05±0.10)times (P=0.284) that in 0 min group,respectively,45 min and 90 min after injection of propofol.The mRNA levels of GFAP and S100β were timedependently altered,first increasing,and then decreasing.In vitro,the cell viabilities (P=0.041) and levels of GFAP mRNA (P=0.026) in primary cultured hippocampal astrocytes were significantly elevated after propofol treatment,and these effects of propofol were reversed by ERK inhibitor PD98059.Conclusion·Propofol time-dependently upregulated the expression of GFAP and S100β via ERK signaling pathway in rat hippocampal astrocytes,so as to activate astrocytes.
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Objective·To detect the effects of propofol sedation on cognitive function in rats and its mechanism. Methods?·?Forty-eight SD rats were randomly divided into three groups, i.e. control group, 100?mg/kg group and 300?mg/kg group. Rats were administrated intraperitoneally with propofol (10?mg/mL, 100?mg/kg or 300?mg/kg). The mRNA levels of brain derived neurotropic factor (BDNF)-TrkB/p75 signal molecules in rat hippocampus were evaluated by realtime PCR 45 min after propofol treatment. Learning and memory ability was examined by inhibitory avoidance (IA) test after propofol treatment. Results?·?The mRNA levels of BDNF in the hippocampal tissue were (1.20±0.13) fold (P=0.002) and (88±12) % (P=0.044) of that in control group, respectively, in 100?mg/kg group and 300?mg/kg group after injection of propofol. The mRNA levels of TrkB were (1.01±0.11) fold ( P=0.982) and (86±11) % (P=0.018) of that in control group, respectively, in 100?mg/kg group and 300?mg/kg group. The mRNA levels of p75 were (1.02±0.10) fold (P=0.778) and (1.59±0.18) fold (P=0.000) of that in control group, respectively, in 100?mg/kg group and 300?mg/kg group. There was no significant difference of the 24 h IA memory retention latency between 100?mg/kg group and control group. The 24 h IA memory retention latency in 300?mg/kg group was significantly decreased compared with control group (P=0.028) and 100?mg/kg group (P=0.020). Conclusion?·?Propofol dose-dependently regulates the expression of BDNF-TrkB/p75 signal molecules, and high dose propofol may reduce cognitive function via BDNF-TrkB/p75 signal.
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<p><b>OBJECTIVE</b>To investigate the biomechanical effect of anterior screw fixation on the type II fractured odontoid process.</p><p><b>METHODS</b>Twenty fresh human C1-C2 vertebrae specimens were harvested and randomly divided into three groups. The angle of type II fracture line was 0 degree in group I (n=6), 17 degrees in group II (n=8) and 25 degrees in group III (n=6). The fractures were treated by anterior screw fixation. Insertion torque,maximal axial pullout force and stiffness of the bone-screw were tested.</p><p><b>RESULTS</b>There was no significant difference of screw insertion torque and the pull-out strength between each group. The displacement of the odontoid fragment had an association to the angle of the fracture line,the displacement of the small angle was significantly higher than that of the large one (P < 0.5). No significant difference of structure stiffness of the bone-screw was found between each group.</p><p><b>CONCLUSION</b>Anterior screw fixation is feasible for type II odontoid fracture with certain fracture line extends from anteroinferior to posterosuperior.</p>