Effects of different doses of remimazolam on hemodynamics during general anesthesia in patients with septic shock.

OBJECTIVE: The stability of hemodynamics plays a vital role in the process of anesthesia induction for patients with septic shock. As a new-type benzodiazepine, remimazolam has numerous advantages, including rapid induction, rapid recovery, stable hemodynamics, and mild respiratory depression. Nevertheless, reports about the effects of remimazolam on hemodynamics in patients with septic shock are still limited. The study aimed to evaluate the effects that different doses of remimazolam have on hemodynamics in inducing general anesthesia in patients with septic shock. PATIENTS AND METHODS: Admitted to the intensive care unit of our hospital from January 2023 to June 2023, 75 patients with septic shock caused by acute appendicitis-induced sepsis were selected as observation subjects. They were randomly assigned to receive low-dose [0.2 mg/(kg·h)], medium-dose [0.3 mg/(kg·h)], and high-dose [0.4 mg/(kg·h)] remimazolam by using a random number table, with 25 patients in each group. Their intraoperative conditions were recorded, including operation duration, intraoperative hemorrhage volume, intraoperative transfusion volume, and decannulation time. Hemodynamic parameters, including mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), and stoke volume index (SVI) were collected at seven-time points (T0: before induction; T1: before intubation; T2: after intubation; T3: the start of operation; T4: 15 min after operation; T5: 30 min after operation; T6: the end of operation). We also compared hepatic and renal function indexes, including blood urea nitrogen (BUN), serum creatinine (sCr), procalcitonin (PCT), white blood cells (WBC), tumor necrosis factor-α2 (TNF-α2), and Interleukin-6 (IL-6), of the three groups of patients before operation and 1, 3, 5, 7 days after operation. In addition, the incidence of adverse reactions in the three groups was recorded and compared. RESULTS: During remimazolam induction, the number of patients with intraoperative need for rescue remimazolam in the medium-dose and high-dose groups was significantly lower than in the low-dose group (p < 0.05). In terms of hemodynamic indexes, MAP in the high-dose group at T2 was lower than that at T0 (p < 0.05), and MAP at T2 was significantly lower in the high-dose group than that in the medium-dose group (p < 0.05). Furthermore, MAP at T4 in the medium-dose and high-dose groups declined compared with the low-dose group (p < 0.05). There were no significant differences in HR, CI, and SVI at different time points among the three groups (p > 0.05), but levels of HR and SVI decreased and CI increased after anesthesia compared with those before operation. Additionally, in comparison with the levels before operation, levels of sCR, BUN, PCT, WBC, TNF-α, and IL-6 were higher on postoperative days 1, 3 (p < 0.05) and lower on postoperative day 7 (p < 0.05). After the operation, both levels of BUN and sCR in the medium-dose and high-dose groups were lower than those in the low-dose group (p < 0.05). CONCLUSIONS: Remimazolam is safe and effective for inducing general anesthesia in patients with septic shock. Low, medium, and high doses of remimazolam can maintain a stable hemodynamic state, and the recovery of hepatic and renal function is certain to depend on the dose.

The value of right ventricular ultrasound assessment and cardiac biomarkers in the prognosis of sepsis.

OBJECTIVE: The aim of this study was to explore the risk factors affecting the prognosis of patients with sepsis using a prospective design. PATIENTS AND METHODS: From January 2022 to March 2023, a prospective study was conducted in the Intensive Care Unit (ICU) of Cangzhou Central Hospital, including 58 patients who met the diagnostic criteria for sepsis. Patients were divided into a survival group (39 cases) and a death group (19 cases) based on outcome. Within 24 hours, the following indicators were collected: gender, age, underlying diseases, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, cardiac troponin I (cTnI), B-type natriuretic peptide (BNP), lactate, procalcitonin, ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), systolic velocity (S'), and global longitudinal strain/strain rate (GLS/GLSr) and global circumferential strain/strain rate (GCS/GCSr) by speckle tracking. Logistic regression analysis was used to evaluate the risk factors for mortality in septic patients, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of various risk factors for sepsis-related death. RESULTS: There was no significant difference in gender, age, underlying diseases, BNP, procalcitonin, EF, TAPSE, S', GLSr, GCS, or GCSr between the two groups (p>0.05). There were statistically significant differences in APACHE II score, SOFA score, cTnI, lactate, and GLS between the two groups (p<0.05). Logistic regression analysis showed that SOFA score (OR=2.32, 95% CI: 1.067-5.289, p<0.05), cTnI (OR=1.19, 95% CI: 1.001-1.312, p<0.05), and GLS (OR=1.58, 95% CI: 1.012-2.721, p<0.05) were risk factors for sepsis-related death (p<0.05). The areas under the ROC curves for SOFA score, cTnI, and GLS were 0.769, 0.757, and 0.846, respectively. CONCLUSIONS: SOFA score, cTnI, and GLS are independent risk factors for mortality in patients with sepsis. Among these factors, GLS has the highest predictive value for patient prognosis. Therefore, when predicting the prognosis of patients with sepsis, the assessment of right ventricular ultrasound can be used in clinical practice.

Correlation between Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Disease before and after Metabolic Bariatric Surgery.

BACKGROUND: Emerging evidence has revealed that obstructive sleep apnea (OSA) is associated with non-alcoholic fatty liver disease (NAFLD). However, the impact of OSA on NAFLD among obese patients undergoing metabolic and bariatric surgery (MBS), especially during follow-up period, remains unclear. OBJECTIVE: To analyze the correlation based on preoperative characteristics and postoperative conditions among bariatric patients with comorbid OSA and NAFLD. METHODS: Clinical data of patients who underwent MBS in our institution between January 2016 and June 2019 were reviewed retrospectively. Correlation analysis and linear regressions were used to identify how OSA links with NAFLD before and after treatment of MBS. RESULTS: Of 308 patients, 181 were diagnosed with OSA and enrolled in the present study, and 127 completed follow-up visits at 6 months. The proportion of NAFLD in the mild-moderate OSA and severe OSA groups was 75.0% and 96.0%, respectively. MBS was effective at improving sleep apnea and nocturnal hypoxia, as well as liver steatosis and fibrosis (P < 0.05). And we also found that there were significant correlations not only between OSA- and NAFLD-related characteristics at baseline but also between their improvements after surgery, eventually leading to similar prognosis of NAFLD for both groups (P < 0.05), no matter what presurgical differences existed. In addition, the results of the univariate and multivariate linear regression analyses supported preoperative liver/spleen Hounsfield units ratio (LSR) by computerized tomography (CT) as an independent predictor of the effect of MBS on liver steatosis. CONCLUSION: In conclusion, MBS plays a pivotal role in the control of medical conditions in obese patients with OSA and NAFLD. Given the correlation between OSA and NAFLD in the present study, in the case of both the severity at baseline as well as the improvement after surgery, OSA may pose an impact on the prognosis of NAFLD in bariatric patients.

[The levels of interleukin 8 in gingival crevicular fluids of chronic periodontitis].

OBJECTIVE: To study the changes of IL-8 levels in chronic periodontitis progress and correlation with clinical parameters. METHODS: The concentrations and total amounts of IL-8 cytokine in gingival crevicular fluids by double antibody sandwich ABC ELISA in chronic periodontitis (before and after treatment) and healthy control group were determined. Clinical parameters were measured and analysed. RESULTS: In the chronic periodontitis, IL-8 cytokine was detected,significantly higher than the healthy group. The total amounts of IL-8 and GCF had significant differences between the diseased and healthy groups, as well as between the groups before and after treatment (P<0.01, P<0.05, respectively), but no significant difference was found between these groups in the concentration of IL-8 (P>0.05). There was positive correlation between the total amounts of IL-8 and clinical parameters, between GCF volume and clinical parameters (P<0.01). CONCLUSION: These data indicated that the total amounts of IL-8 exhibited dynamic changes upon progress of chronic periodontitis. The levels of IL-8 in GCF are valuable in judging the degree of chronic periodontitis and in guiding clinical treatment.

[Morphologic survey of temporomandibular joint an autopsy investigation].

OBJECTIVES: Understanding the functional structure of temporomandibular joint (TMJ) will be advantageous for us to study the relationship between the occlusal movement and its morphology, and it also will be beneficial for operators of arthroscopy to grasp the relationship between the scope of operation and adjacent landmarks. METHODS: We dissected and measured the TMJ of seven cadavers to study the sizes of condyle and fossa, the oblique angles of their bevel faces and the oblique angles of bevel face of condyle with disc, the distances from midpoint of posterior tragus and cartilage of external auditory canal to the anterior and posterior recess walls. RESULTS: The parameters of the anatomic relationship between condyle, disc, fossa, superior joint space of TMJ and adjacent landmarks were recorded. CONCLUSION: (1) Articular disc coordinates condyle and articular fossa, and increases the condyle anterior bevel's slope which makes them more stable; (2) Transverse ridge of condyle contacts with fossa on point and plane which make lateral motion of condyle more agile; (3) It is important parameter for an operator of arthroscopy to control the depth and range of puncture that measured the distances between anterior and posterior recess walls of upper space in TMJ, the distances from anterior and posterior recess walls to midpoint of posterior tragus and cartilage of external auditory canal, and the size of fossa; Morphology of TMJ is changing with age.

[Exploration of the dental peri-implantitis therapy]

OBJECTIVE:Our study is try to establish the treatment mehtod for periimplantitis from clinical aspect,so as to treat failing implant effectively.METHODS:Peri-implantitis was treated using four methods:(1)essential treatment,(2)gingivectomy,(3)flap operation,(4)guided bone regeneration(GBR).Clinical peri-implant assessments included probing depth (PD),gingival index(GI),mibility (MOB),data analysis was carried out using singed-rank test.RESULTS:27 cases were successfully treated,and the rate was 71.05%,11 implants were extracted,the parameters before and after treatment have significant difference.CONCLUSION:It is essential to maintain good oral hygiene,determine the standard of diagnosis of peri-implantitis and successful treatment.

[Detection of the causes of clinical failure of bioactive glass titanium alloy core implant]

Total number of 252 implants made of titanium alloy coated with a suitable bioactive glass were applied in clinic from October,1988 to July,1994.The success rate is 90,47%,24 implants failed with failed rate of 9.53%,The authors have also discussed the cruxes of success,causes of clinical failed,implantitis and complication of prosthesis,and given the new conception of re-implanting.

[Observation of clinical effect of bioactive glass titanium alloy core implant]

A novel kind of implant made of titanium alloy spray coated with a suitable bioactive glass was investigated.49 implantation were done in clinical patients from Oct 1988 to 1992.42 implantation functioned well up to the time.7 implantation failed. The success rate is 85.71%.The authors have also discussed the indications,method of implantation and other related things on the paper.