Effect of Intravenous Injection of Remazolam on Stress Response and Analgesic Effect in Patients with Transurethral Resection of the Prostate: A Single-Centre Study

Background: The reasonable selection of anaesthesia methods and drugs is the key to ensuring the perioperative safety of patientswith the transurethral resection of the prostate (TURP). The effect of intravenous remazolam injection on stress response andanalgesic effect in patients with transurethral prostate cancer electrotomy were explored.Methods: The medical records of 160 patients with prostatic hyperplasia who underwent TURP in Tianjin hospital from November2020 to November 2022 were selected for retrospective analysis. Five patients who did not meet the study conditions wereexcluded, and 155 patients were finally included. According to anaesthesia schemes, the patients were divided into the observationgroup (OBG, n = 76, routine surgical anaesthesia and intravenous remazolam injection) and control group (COG, n = 79,routine surgical anaesthesia). Postoperative eye-opening times were recorded for both groups. The groups were compared interms of anaesthetic effects, stress indexes, haemodynamic indexes, and use of postoperative analgesic drugs at different times,and adverse reactions were observed.Results: The anaesthesia onset time and eye-opening time in the OBG were shorter than those in the COG (p < 0.001). The heartrate and mean arterial pressure of the OBG during anaesthesia induction were higher than those in the COG (p < 0.001). TheOBG showed significantly lower noradrenaline and cortisol levels than the COG 1, 12 and 24 h after surgery (p < 0.001). Thetime of first pressing in the analgesic pump in the OBG was later than that in the COG, and the total consumption of sufentanil was less than that in the COG (p < 0.001). The total incidence of adverse reactions in the OBG was lower than that in the COG(p < 0.05). (AU)

Wearable, Biodegradable, and Antibacterial Multifunctional Ti3C2Tx MXene/Cellulose Paper for Electromagnetic Interference Shielding and Passive and Active Dual-Thermal Management.

An energy-saving scheme that can simultaneously realize electromagnetic interference (EMI) shielding, passive solar radiative heating, and active Joule heating in a single wearable device is still a huge challenge. Here, by combining the unique properties of Ti3C2Tx MXene and biocompatible cellulose nanofibers (CNFs), a flexible, degradable, and antibacterial multifunctional Ti3C2Tx/CNF paper (∼0.6 Ω/sq) is constructed through a facile vacuum filtration strategy. The resultant device not only exhibits an admirable EMI shielding effectiveness of ∼48.5 dB at the X-band and a superior heating property including dual-driven electrothermal and photothermal conversion without energy but also possesses wide temperature range regulation and long-time stability. More impressively, both high antibacterial efficiency (toward both gram-positive and gram-negative bacteria) and good degradability with low-concentration hydrogen peroxide solution can also be achieved in Ti3C2Tx/CNF papers. This study provides a promising platform for practical applications of multifunctional Ti3C2Tx/CNFs in EMI shielding, thermotherapy, heat preservation, and antibacterial protection in harsh environments, satisfying the demands for energy-saving, environmentally friendly, and sustainable development.

Effect of dexmedetomidine on tourniquet-induced skeletal muscle injury.

OBJECTIVE: The aim of this study was to investigate whether dexmedetomidine could reduce tourniquet-induced skeletal muscle injury. METHODS: C57BL6 male mice were randomly assigned to sham, ischemia/reperfusion, and dexmedetomidine groups. Mice in the ischemia/reperfusion and dexmedetomidine groups received normal saline solution and dexmedetomidine intraperitoneally, respectively. The sham group underwent the same procedure as the ischemia/reperfusion group, with the exception of tourniquet application. Subsequently, the ultrastructure of the gastrocnemius muscle was observed, and its contractile force was examined. In addition, Toll-like receptor 4 and nuclear factor-κB expression within muscles was detected by Western blot. RESULTS: Dexmedetomidine alleviated myocyte damage and increased the contractility of skeletal muscles. Moreover, dexmedetomidine significantly inhibited the expression of Toll-like receptor 4/nuclear factor-κB in the gastrocnemius muscle. CONCLUSION: Taken together, these results demonstrate that dexmedetomidine administration attenuated tourniquet-induced structural and functional impairment of the skeletal muscle, partly through inactivation of the Toll-like receptor 4/nuclear factor-κB pathway.

Effect of dexmedetomidine on tourniquet-induced skeletal muscle injury

SUMMARY OBJECTIVE: The aim of this study was to investigate whether dexmedetomidine could reduce tourniquet-induced skeletal muscle injury. METHODS: C57BL6 male mice were randomly assigned to sham, ischemia/reperfusion, and dexmedetomidine groups. Mice in the ischemia/reperfusion and dexmedetomidine groups received normal saline solution and dexmedetomidine intraperitoneally, respectively. The sham group underwent the same procedure as the ischemia/reperfusion group, with the exception of tourniquet application. Subsequently, the ultrastructure of the gastrocnemius muscle was observed, and its contractile force was examined. In addition, Toll-like receptor 4 and nuclear factor-κB expression within muscles was detected by Western blot. RESULTS: Dexmedetomidine alleviated myocyte damage and increased the contractility of skeletal muscles. Moreover, dexmedetomidine significantly inhibited the expression of Toll-like receptor 4/nuclear factor-κB in the gastrocnemius muscle. CONCLUSION: Taken together, these results demonstrate that dexmedetomidine administration attenuated tourniquet-induced structural and functional impairment of the skeletal muscle, partly through inactivation of the Toll-like receptor 4/nuclear factor-κB pathway.

Effect of Intravenous Injection of Remazolam on Stress Response and Analgesic Effect in Patients with Transurethral Resection of the Prostate: A Single-Centre Study.

BACKGROUND: The reasonable selection of anaesthesia methods and drugs is the key to ensuring the perioperative safety of patients with the transurethral resection of the prostate (TURP). The effect of intravenous remazolam injection on stress response and analgesic effect in patients with transurethral prostate cancer electrotomy were explored. METHODS: The medical records of 160 patients with prostatic hyperplasia who underwent TURP in Tianjin hospital from November 2020 to November 2022 were selected for retrospective analysis. Five patients who did not meet the study conditions were excluded, and 155 patients were finally included. According to anaesthesia schemes, the patients were divided into the observation group (OBG, n = 76, routine surgical anaesthesia and intravenous remazolam injection) and control group (COG, n = 79, routine surgical anaesthesia). Postoperative eye-opening times were recorded for both groups. The groups were compared in terms of anaesthetic effects, stress indexes, haemodynamic indexes, and use of postoperative analgesic drugs at different times, and adverse reactions were observed. RESULTS: The anaesthesia onset time and eye-opening time in the OBG were shorter than those in the COG (p < 0.001). The heart rate and mean arterial pressure of the OBG during anaesthesia induction were higher than those in the COG (p < 0.001). The OBG showed significantly lower noradrenaline and cortisol levels than the COG 1, 12 and 24 h after surgery (p < 0.001). The time of first pressing in the analgesic pump in the OBG was later than that in the COG, and the total consumption of sufentanil was less than that in the COG (p < 0.001). The total incidence of adverse reactions in the OBG was lower than that in the COG (p < 0.05). CONCLUSIONS: Intravenous remazolam injection provides safe and effective sedation and analgesia for patients on TURP and reduces the occurrence of stress responses and adverse reactions. However, cases involved in this study were all from a single centre, and multi-centre research and verification are needed.

Effects of Lumbar Plexus Block Combined with Infiltration Anesthesia on Anesthesia Comfort Scores and Stress Responses in Elderly Patients Undergoing Hip Replacement.

Objective: To investigate the effects of lumbar plexus block combined with infiltration anesthesia on anesthesia comfort scores and stress responses in elderly patients undergoing hip replacement. Methods: The materials of 100 elderly patients undergoing hip replacement who were treated in our hospital (January 2020-January 2021) were retrospectively analyzed, and they were equalized into the experimental group (n = 50) and control group (n = 50) according to the anesthesia methods. The experimental group received lumbar plexus block combined with infiltration anesthesia, and the control group received combined spinal-epidural anesthesia combined with infiltration anesthesia. The patients' anesthesia comfort scores, stress responses, and postoperative pain indexes were compared between the two groups. Results: Compared with the control group, the experimental group achieved much lower scores of mood change, shivering response, and traction reaction (P < 0.001), indicating that the anesthesia comfort in the experimental group was higher. Compared with the control group, the experimental group had much better perioperative stress response indexes (P < 0.05) and eminently lower pain scores at 12 and 24 hours after surgery (P < 0.05). Conclusion: Lumbar plexus block combined with infiltration anesthesia can relieve the stress responses and postoperative pain of elderly patients undergoing hip replacement and increase their anesthesia comfort. Therefore, this anesthesia method is translational in clinic.

Effects of Three Anesthesia Methods on Inflammation, Oxidative Stress, Analgesia and Cognition in Elderly Patients Receiving Hip Replacement.

The study aimed to investigate the effects of different anesthesia methods on the analgesia, inflammation and oxidative stress levels and cognitive function in elderly patients undergoing hip replacement. 100 elderly patients requiring hip replacement and admitted to Tianjin Hospital from March 2017 to March 2019 were enrolled and divided into group A (n=35, general anesthesia with endotracheal intubation), group B (n=35, epidural anesthesia) and group C (n=30, general anesthesia with endotracheal intubation + epidural anesthesia). The basic vital signs, inflammatory factors, stress response indicators and cognitive function changes were compared among three groups. Additionally, the effects of three different anesthesia methods were analyzed based on the differences in postoperative analgesic effect, extubation time and recovery time. The vital signs [systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR)] were lower in group C than those in group A and group B after surgery (p<0.05). The VAS score at 12 h and 24 h after surgery was lower than that at 3 h after surgery (p<0.05). Group A and B had increased levels of these inflammatory factors after surgery compared with those before surgery. Postoperative extubation time, eye-opening time upon calling and recovery time were significantly shorter in group C than those in groups A and B (p<0.05). The oxidative stress indexes in group C were remarkably lower than those in groups A and B (p<0.05). The MMSE score was decreased in groups A and B after surgery compared with that before surgery (p<0.05). General anesthesia combined with epidural anesthesia applied in elderly patients undergoing hip replacement achieves a good anesthetic effect and is able to stabilize the vital signs and stress levels of patients and improve postoperative analgesic effect and cognitive function, which is worthy of popularization in clinical practice.

Clinical Application of Perioperative Anaesthesia Management Based on Enhanced Recovery after Surgery Concept to Elderly Patients Undergoing Total Knee Replacement.

Objective: To explore the clinical application effect of perioperative anesthesia management based on enhanced recovery after surgery (ERAS) concept to elderly patients undergoing total knee replacement (TKR). Methods: By means of retrospective analysis, the medical data of elderly patients undergoing TKR treated in our hospital (02, 2019-02, 2020) were analyzed, and 100 patients were selected as the study objects according to the inclusion and exclusion criteria and divided into the study group (SG) and reference group (RG) according to their admission order, with 50 cases each. Patients in SG received perioperative anesthesia management based on ERAS concept, and those in RG accepted routine perioperative anesthesia management, so as to compare the perioperative inflammatory factors levels, postoperative recovery indicators, and postoperative Numeric Rating Scale (NRS) scores between the two groups. Results: Compared with RG after surgery, SG obtained significantly lower inflammatory factors levels (P < 0.001) and significantly better recovery indicators (P < 0.05), and the pain scores at postoperative 12 h and 24 h of SG were, respectively (1.46 ± 0.67) points and (2.00 ± 0.45) points, which were significantly lower than those of RG (P < 0.05). Conclusion: Perioperative anesthesia management based on EARS concept can improve the perioperative indicators of elderly patients undergoing TKR, result in less postoperative pain, and obtain a more desirable recovery.

Application of Different Doses of Dexmedetomidine Combined with General Anesthesia in Anesthesia of Patients with Traumatic Tibiofibular Fractures and Its Effect on the Incidence of Adverse Reactions.

Objective: To explore the application of different doses of dexmedetomidine combined with general anesthesia in patients with traumatic tibiofibular fractures. Methods: A total of 120 patients with traumatic tibiofibular fractures treated in our hospital (January 2018-January 2021) were selected as the research subjects and equally grouped into group A, group B, group C, and group D according to the dosage of dexmedetomidine. Group B, group C, and group D were pumped with 0.3 µg/kg, 0.5 µg/kg, and 0.8 µg/kg load doses of dexmedetomidine before anesthesia induction, with the same doses for maintenance during surgery. Group A was intravenously pumped with the same amount of normal saline and received tracheal intubation after anesthesia induction, with propofol and remifentanil to maintain general anesthesia during surgery. Results: No notable differences in general data were observed among the groups (P > 0.05). Ramsay sedation scores of all groups showed a downward trend after drug withdrawal. At 10 min, 30 min, and 60 min, the scores of groups C and D were markedly higher than those of groups A and B (P < 0.05), and the scores were higher in group D than those in group C (P < 0.05). The HR changes at each period were close between groups A and B (P > 0.05). The HRs at T1 and T2 in group C were slightly lower than those in group D (P > 0.05), and the HRs at T1 in groups A and B were remarkably higher than those in groups C and D, and were higher than those at T0 and T2 (P < 0.05). The SBP levels of all groups began to rise at T0, peaked at T1, and decreased to a lower level at T2 than that at T0. Moreover, the SBP levels of groups C and D at T1 and T2 were notably lower compared with groups A and B (P < 0.05). With a lower DBP level in group C than the other three groups at T1, the DBP levels were notably lower in groups C and D than those in groups A and B at T2 (P < 0.05). With no statistical difference in the MAP levels at T0 among the four groups (P > 0.05), the MAP levels in group A at T1 and T2 were obviously higher compared with groups C and D (P < 0.05). The extubation time in group A was notably longer than that that in groups B, C, and D (P < 0.05), with longer extubation time in group B than that in groups C and D (P < 0.05). The orientation recovery time in group D was markedly shorter than that in groups A, B, and C (P < 0.05). The incidence of cognitive dysfunction, chills, and restlessness in groups C and D was notably lower compared with groups A and B (P < 0.05), with a higher incidence of chills, intraoperative hypotension, and delayed awakening in group D than in group C (P < 0.05). Conclusion: Dexmedetomidine at doses of 0.5 µg/kg and 0.8 µg/kg has a better effect in the maintenance of general anesthesia for patients with traumatic tibiofibular fractures, with faster orientation recovery, better recovery of postoperative cognitive function, and a lower incidence of adverse reactions. Dexmedetomidine at 0.5 µg/kg is recommended in view of the increased risk of excessive sedation, chills, restlessness, and intraoperative hypotension in patients at 0.8 µg/kg.

Etomidate ameliorated advanced glycation end-products (AGEs)-induced reduction of extracellular matrix genes expression in chondrocytes.

Osteoarthritis (OA) is a rheumatic disease common in the elderly. AGEs are the end products of glycation reactions and play an important role in the development of OA. Etomidate is a general anesthesia-inducing agent recently reported to exert significant anti-inflammatory effects. The present study aims to explore the protective effect of Etomidate against advanced glycation end-products (AGEs)-induced reduction of extracellular matrix gene expression in chondrocytes. In the present study, we found that AGEs significantly reduced the expression of Collagen II (COL2A1) and Aggrecan (ACAN) at the gene level. Furthermore, AGEs inhibited the expression of SRY-related high mobility group-box gene 9 (SOX-9), promoting the expression of COL2A1 and ACAN. COL2A1, ACAN, and SOX-9 in chondrocytes were significantly elevated by treatment with Etomidate alone. Consistently, Etomidate ameliorated AGEs-induced downregulation of COL2A1, ACAN, and SOX-9 in a dose-dependent manner. Importantly, we found that knockdown of SOX-9 eliminated the beneficial effects of Etomidate against AGEs-induced decrease in COL2A1 and ACAN genes. Based on these findings, we demonstrated that Etomidate could ameliorate AGEs-induced reduction of extracellular matrix gene expression in chondrocytes by upregulating SOX-9.

Realizing Ultralong-Term Cyclicability of 5 Volt-Cathode-Material Graphite Flakes by Uniformly Comodified TiO2/Carbon Layer Inducing Stable Cathode-Electrolyte Interphase.

A common issue the high-voltage cathode materials of secondary batteries suffered from is oxidative electrolyte decomposition inducing rapid capacity fading with discharge/charge cycling. Herein, a highly efficient strategy realizing stable cathode-electrolyte interphase (CEI) and ultralong-term cyclicability of 5 volt-cathode-material graphite flakes (GFs) for dual-ion batteries is demonstrated. The TiO2/carbon-comodified GF (TO/GF) cathode material with uniform distribution and tight bonding of the nanosized TiO2/carbon layer on the GF surface is synthesized, in which the GF surface is partitioned into nanodomains by the uniformly distributed TiO2 nanoparticles. Meanwhile, the amorphous carbon layer acts as a gummed tape bonding tightly the TiO2 nanoparticles on the graphite flake surface. Serial electrochemical impedance spectroscopy and structural/chemical analyses demonstrate that these unique structural characteristics of the TiO2/carbon comodification endow the TO/GF cathode material with a stable CEI layer coupled with much reduced electrolyte decomposition. Consequently, extremely high cyclicability of 10,000 stable discharge/charge cycles with an extremely low capacity fading rate of 0.0021% for anion PF6- storage is realized. This efficient strategy has a potential to be extended to other high-voltage cathode materials and further scaled to the industrial level.

Difference Between Posterior Monteggia Fractures and Posterior Fracture-Dislocation of Proximal Ulna in Adults.

OBJECTIVE: To figure out the difference between patients with posterior Monteggia fractures which were concomitant with proximal radioulnar joint (PRUJ) dislocation and posterior fracture-dislocation of the proximal ulna that were not concomitant with PRUJ. METHODS: From January 2016 to January 2019, 37 consecutive adult patients who had posterior fracture-dislocation of proximal ulna (no PRUJ dislocation, n = 16) and posterior Monteggia fractures (PRUJ dislocation, n = 21) were included. All patients had intraoperative fluoroscopy, computed tomography (CT) scans, and standard radiography (anteroposterior view and lateral view). The mechanism of injury, the cases with open fracture, sustained multiple injuries and classification of fracture was recorded. The clinical details of the patients such as the final range of motion (ROM) and the Broberg-Morrey scores were described. RESULTS: Patients with PRUJ dislocation (ten type A, five type B, and six type D) and those without concomitant PRUJ dislocation (fifteen type A and one type C) exhibited an obvious difference according to the classifications of Jupiter et al. (P = 0.010). Ninety-five percent of patients who had PRUJ dislocation were accompanied by a metaphyseal fracture, while only 50% of the patients who did not have PRUJ dislocation were accompanied by a metaphyseal fracture (P = 0.002). Meanwhile, 16 of 20 metaphyseal fractures had more than one fragment in the group of dislocations, but five of eight metaphyseal fractures were comminuted in the control group. The two groups exhibited an obvious difference (P = 0.009). The 21 patients who sustained a radioulnar dislocation had less mean arc of flexion, pronation, and Broberg-Morrey scores were significantly less than the patients of the control group (flexion: 117.38 ± 14.46 vs 127.50 ± 13.416, P = 0.035; pronation: 59.76 ± 11.88 vs 67.50 ± 6.58, P = 0.017; Broberg-Morrey: 80.48 ± 12.17 vs 88.19 ± 10.28, P = 0.040). CONCLUSIONS: Patients suffering posterior Monteggia fractures had more metaphyseal fractures, more comminuted fractures of the metaphysis, and worse ultimate ulnohumeral motion than patients of posterior fracture-dislocation of proximal ulna.

Overexpression of microRNA-141 relieves chronic constriction injury-induced neuropathic pain via targeting high-mobility group box 1.

The function of microRNAs (miRNAs or miRs) in regulating neuropathic pain has attracted increasing attention in recent years. However, the precise mechanism of miRNAs in neuropathic pain remains largely unknown. In the present study, an important role of miR­141 and its putative target gene, high­mobility group box­1 (HMGB1), was demonstrated in a rat model of neuropathic pain induced by chronic constriction injury (CCI). The expression of miR­141 was significantly downregulated in the dorsal root ganglion of rats following CCI surgery. Overexpression of miR­141 by intrathecal injection of miR­141 precursor mediated by a lentivirus­derived gene transfer significantly inhibited mechanical allodynia, thermal hyperalgesia and proinflammatory cytokine release in CCI rats. Using a dual luciferase reporter assay, a direct interaction between miR­141 and the 3'­untranslated region of HMGB1 was verified. Overexpression of miR­141 significantly suppressed the expression of HMGB1 in vitro and in vivo. Furthermore, overexpression of HMGB1 apparently abrogated the beneficial effect of miR­141 on inhibiting neuropathic pain. Taken together, the data suggest that overexpression of miR­141 alleviates neuropathic pain development via targeting and inhibiting HMGB1, implying that blocking HMGB1 by miR­141 could be a useful therapeutic strategy for the treatment of neuropathic pain.