Objective:To investigate the effects of remimazolam besylate and midazolam on postoperative cognitive function of patients undergoing gynecologic laparoscopic surgery under general anesthesia.Methods:From May 2019 to January 2021, 120 patients with gynecological laparoscopic surgery under general anesthesia in Haikou Maternal and Child Health Hospital were selected and divided into control group (60 cases) and observation group (60 cases) by random number table. The control group was given 0.05 mg/kg midazolam and 0.50 μg/kg sufentanil and 0.15 mg/kg vecuronium bromide were used for anesthesia induction. Patients in the observation group were given 0.3 mg/kg remimazolam besylate and 0.50 μg /kg sufentanil and 0.15 mg/kg vecuronium were used for anesthesia induction. The levels of hemodynamic indexes before anesthesia (T 0), during anesthesia (T 1), and after intubation (T 2) as well as the levels of postoperative anesthesia recovery indexes were compared between the two groups. The Visual Analogue Scale (VAS) score and Mini-Mental State Examination (MMSE) scores were recorded and compared before surgery, 24 h, 72 h after surgery. The total incidence of adverse reactions after surgery was recorded and compared between the two groups. Results:The heart rate (HR) at T 1 and T 2 in the two groups was higher than that at T 0, the oxygen saturation (SpO 2) at T 1 and T 2 was lower than that at T 0, the mean arterial pressure (MAP) at T 1 was lower than that at T 0, and the MAP at T 2 was higher than that at T 0, with statistically significant difference (all P<0.05); The HR and MAP at T 1 and T 2 in the observation group were lower than those in the control group, and SpO 2 was higher than those in the control group (all P<0.05); The recovery time of spontaneous respiration, eye opening time and extubation time in the observation group were significantly shorter than those in the control group (all P<0.05); The MMSE score at 24 h and 72 h after operation was lower than that before operation, and the VAS score at 24 h was higher than that before operation in both groups (all P<0.05); The MMSE scores in the observation group at 24 h and 72 h after operation were significantly higher than those in the control group (all P<0.05), and there was no significant difference in the VAS scores at 24 h and 72 h after operation between the two groups ( P>0.05); There was no significant difference in the total incidence of adverse reactions between the two groups (all P>0.05). Conclusions:Remimazolam besylate has little effect on cognitive function of patients undergoing gynecologic laparoscopic surgery under general anesthesia, with fast recovery and high safety, which is worthy of clinical promotion.

Objective:To observe the changes of lactate clearance rate (LCR) and serum polyligandosan-1 (SDC-1) in patients with septic shock complicated with acute respiratory distress syndrome (ARDS) and to evaluate its prognostic value.Methods:Patients with septic shock and ARDS who were admitted to the Respiratory Intensive Care Unit (RICU) of Zhengzhou Central Hospital Affiliated to Zhengzhou University from February 2021 to April 2022 were selected as subjects. The patients were divided into the survival group and death group according to their 28-day survival status. General clinical data and related indicators of patients in the two groups were collected and compared. The related factors influencing the 28-day death of patients with septic shock and ARDS were screened, and receiver operating characteristic (ROC) curve was drawn to evaluate the individual and combined forecast value of LCR and SDC-1 for the prognosis of patients with septic shock and ARDS.Results:Compared with the survival group, sequential organ failure score (SOFA) and acute physiology and chronic health status score Ⅱ(APACHE Ⅱ) at admission to RICU, the levels of 24 h Lac, 6 h SDC-1, 24 h SDC-1 and 72 h SDC-1 in the death group increased significantly (all P< 0.05), and the levels of 6 h LCR, 24 h LCR, 6 h OI, 24 h OI and 72 h OI significantly decreased (all P<0.05). Spearman correlation analysis showed that SDC-1 at 6 h, 24 h and 72 h was significantly negatively correlated with OI at corresponding time points (all P<0.05), and LCR at 6 h and 24 h was significantly positively correlated with OI at corresponding time points (all P<0.05). Multivariate Logistic regression analysis showed that SOFA score, 24 h LCR, 24 h SDC-1 and 72 h SDC-1 were the risk factors of 28-d death in patients with septic shock and ARDS (all P<0.05). The areas under ROC curve of each related factor were SOFA score, 24 h LCR, 24 h SDC-1 and 72 h SDC-1, which could predict the prognosis (all P<0.05). 24 h LCR combined with 24 h SDC-1 had the maximum area under the curve (AUC=0.805, 95% CI: 0.691-0.920, with a sensitivity of 75.0% and a specificity of 74.4%). Conclusions:24 h LCR, 24 h SDC-1 and 72 h SDC-1 are the risk factors of the 28-day death of patients with septic shock and ARDS. 24 h LCR combined with 24 h SDC-1 can improve the test efficiency compared with the single indicator.

Susceptibility-weighted imaging (SWI) is a high resolution, three-dimensional gradient echo T 2* sequence magnetic resonance technique. It uses the different susceptibilities between tissues to display the susceptibility image, which is extremely sensitive to paramagnetic substance such as deoxyhemoglobin and blood breakdown substances. In the acute stage of ischemic stroke, SWI can effectively evaluate the severity of the disease, guide the treatment plan, and predict the clinical outcome. This article reviews the research progress of SWI in the acute phase of ischemic stroke.

Objective To analyze the efficacy of ponatinib as salvage therapy in relapse chronic myeloid leukemia with T315I mutation (CML-T315D after allogeneic stem cell transplantation (allo-HSCT).Methods Twelve patients with CML-T315I (10 cases of T315I mutation before transplantation and 2 cases of T315I mutation at the time of relapse after transplantation) were included in this retrospective analysis.Ponatinib was used as single agent or combined with chemotherapy and/or donor lymphocyte infusion.The samples obtained for RTQ-PCR were also analyzed for the BCR ABL1 mutation by direct sequencing.Scanning of the ABL KD (amino acids 219-506) for the presence of mutations was sequenced by Sanger.Results In 12 patients with relapse after transplantation,2 patients with molecular relapse were treated with only single-agent ponatinib,and among 10 patients with hematologic relapse,1 patient was treated with single-agent ponatinib and 3 patients were given ponatinib combined with donor lymphocyte infusion (DLI),the remaining 6 patients were treated with ponatinib combined with chemotherapy and DLI.After the treatment with ponatinib,11 patients had a good response,10 patients obtained complete hematologic remission (CHR),1 patient obtained partial hematologic remission (PHR) and 1 patient had no response (NR).For cytogenetic response,10 patients obtained complete cytogenetic response (CCyR),1 patient obtained partial cytogenetic response (PCyR) and one patient had no cytogenetic response.For the molecular biological response,9 patients obtained complete molecular response (CMR),1 patient obtained majore molecular response (MMR) and 2 patients had no molecular biological response.The median time to obtain CHR was 36 days (29-96 days),the median time to obtain CCyR was 63 days (32-127 days),and the median time to obtain CMR was 89 days (27-152 days).The median follow-up time after treatment with ponatinib was 598 (range,93-1470) days,9 patients survived and 3 died.Causes of deaths included leukemia relapse (n =2)and ineffective treatment (n =1).The 2-year overall and disease-free survival rate after relapse in 12 patients was 75.0％ ± 12.5％ and 31.7％ ± 14.9％,respectively.Conclusion This small sample data suggested that ponatinib as salvage therapy had a good response to the relapse CML-T315I after allo-HSCT.

Objective To evaluate the feasibility of secondary transplantation for patients with acute leukemia after failure of the first haploidentical hematopoietic stem cell transplantation. Methods Two acute leukemia patients underwent the first haploidentical hematopoietic stem cell transplantation from two donors with thalassemia, and the number of collected CD34⁺ cells was 2.57×10⁶/kg and 1.99×10⁶/kg per donor, respectively. The first haploidentical hematopoietic stem cell transplantation failed. Secondary transplantation was performed from two non-thalassemia donors, and the number of collected CD34⁺ cells was 4.28×10⁶/kg and 5.75×10⁶/kg per donor, respectively. A reduced-intensity conditioning regimen consisting of fludarabine (Flu), busulfan (Bu) and antithymocyte globulin (ATG) was adopted for the secondary transplantation. Results For two recipients, the time of secondary transplantation of neutrophil and platelet was +12 d and +10 d, +10 d and +10 d, respectively. Up to the final follow-up (+1 062 d and +265 d after secondary transplantation), the primary diseases of both two recipients have been completely relieved without evident post-transplantation complications. Conclusions Secondary transplantation with reduced-intensity conditioning regimen may successfully treat acute leukemia after failure of the first haploidentical hematopoietic stem cell transplantation.

Vascular recanalization is an important treatment method for acute ischemic stroke. Antiplatelet drugs combined with intravenous thrombolysis and endovascular therapy have become the research hotspots in recent years. Platelet glycoprotein Ⅱb/Ⅲa receptor antagonist is a new class of antiplatelet drugs that work by inhibiting the last common pathway in the platelet aggregation process. Its safety and effectiveness in the treatment of acute coronary syndrome have been proven, but its application in patients with acute ischemic stroke is still in the exploratory stage. This article reviews the application of tirofiban in the treatment of acute ischemic stroke reperfusion.