Remimazolam is a new,ultra-short-acting benzodiazepine sedative narcotic drug that acts on γ-aminobutyric acid type A receptor(GABAAR).Benzodiazepine receptors on the α subunit of GABAAR have sedative,hypnotic and anxiolytic effects with mild cardiopulmonary effects.The clinical roles of remimazolam in painless endoscopy and general anesthesia have been gradually discovered.Organ protection is the focus of perioperative process,which has a profound impact on postoperative recovery and prognosis.Remimazolam has a protective effect on the nervous system,heart,lung,liver,gastrointestinal tract and other important organs,and its mechanism may be related to anti-inflammation,anti-apoptosis,and stress reduction.This article reviews the organ and systemprotective effect and mechanism of remimazolam,so as to provide some reference for its clinical application.

Objective:To evaluate the effect of small-dose esketamine on the learning and memory ability of chronic sleep-deprived rats and the role of hippocampal amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors (AMPARs).Methods:Forty healthy male Sprague-Dawley rats, aged 4 months, weighing 200-280 g, were divided into 4 groups ( n=10 each) using a random number table method: normal control group (N group), chronic sleep deprivation group (SD group), chronic sleep deprivation+ esketamine group (SDK group) and chronic sleep deprivation + esketamine + AMPAR antagonist CNQX group (SDKI group). The sleep deprivation model was prepared by the modified multi-platform water environment method. For 3 consecutive days after developing the model, ketamine 10 mg/kg was intraperitoneally injected in SDK group, and SDKI group received intraperitoneal injection of CNQX 1 mg/kg followed by ketamine 10 mg/kg. Morris water maze test was used to detect spatial learning and memory ability after the end of sleep deprivation or after administration. After the water maze test, rats were sacrificed, and the hippocampal tissue was obtained to detect the expression of hippocampal Homer1a mRNA (by quantitative polymerase chain reaction), Homer1a, metabotropic glutamate receptor 5 (mGluR5) and AMPAR (by Western blot). The density of dendritic spines in hippocampal CA1 region was determined by Golgi staining. Results:Compared with N group, the escape latency was significantly prolonged, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were decreased, the expression of Homer1a protein and mRNA and mGluR5 was up-regulated, the expression of AMPAR was down-regulated, and the density of dendritic spines in hippocampal CA1 region was decreased in SD group ( P<0.05). Compared with SD group, the escape latency was significantly shortened, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were increased, the expression of AMPAR was up-regulated, and the density of dendritic spines in hippocampal CA1 region was increased in SDK group ( P<0.05). Compared with SDK group, the escape latency was significantly prolonged, the percentage of time spent in the target quadrant and the number of times the animals crossing the platform were decreased, the expression of AMPAR was down-regulated, and the density of dendritic spines in hippocampal CA1 region was decreased in SDKI group ( P<0.05). There was no significant difference in the expression of Homer1a protein and mRNA and mGluR5 among SD group, SDK group and SDKI group ( P>0.05). Conclusions:Small-dose esketamine can improve the learning and memory ability of chronic sleep-deprived rats, and the mechanism may be related to up-regulation of the expression of hippocampal AMPARs.

Objective:To evaluate the effects of propofol, dexmedetomidine and ketamine on oncentrations of β-amyloid peptide (Aβ) and tau in cerebrospinal fluid (CSF) of sleep-deprived rats.Methods:Forty SPF healthy male Sprague-Dawley rats, aged 3-4 months, weighing 230-280 g, were divided into 5 groups ( n=8 each) using a random number table method: control group (group C), sleep deprivation group (SD), propofol group (group P), dexmedetomidine group (group D) and ketamine group (group K). The sleep deprivation was induced using the improved multi-platform sleep deprivation model.Propofol 100 mg/kg, dexmedetomidine 100 mg/kg and ketamine 80 mg/kg were intraperitoneally injected at 72 h of sleep deprivation to maintain anesthesia for 3 h in P, D and K groups, respectively.Group C entered the large platform for 72 h free activity.The CSF was collected at 3 h of anesthesia for measurement of concentrations of Aβ and tau protein by enzyme-linked immunosorbent assay. Results:The concentrations of Aβ and tau protein in CSF were significantly higher in SD, P, K and D groups than in group C ( P<0.05). Compared with group SD, the concentrations of Aβ and tau protein in CSF were significantly increased in P and K groups, and the concentrations of Aβ and tau protein in CSF were significantly decreased in group D ( P<0.05). Conclusion:Dexmedetomidine can decrease the the concentrations of Aβ and tau protein in CSF of sleep deprived rats, while propofol and ketamine lead to the opposite effect.

Objective:To construct the intelligent medical cloud management platform of diabetes education clinic in ClassⅢ general hospital and observe the clinical effects.Methods:A total of 260 young and middle-aged patients with type 2 diabetes mellitus (T2DM) who were admitted to Department of Endocrinology in the First Affiliated Hospital of Henan University from June to December 2019 were selected by convenience sampling method. They were divided into the control group and the experimental group by the random number table method, with 130 cases in each group. Patients in the control group were given routine diabetes outpatient follow-up, while the experimental group was given group education, case management, behavioral intervention, condition supervision and online follow-up intervention based on the intelligent medical cloud management platform of the diabetes education clinic. The blood glucose control status and the self-management ability of the two groups before and after 3 months of intervention were compared.Results:After intervention for 3 months, fasting plasma glucose (FPG) , 2h plasma glucose of 75g oral glucose tolerance test (OGTT 2h PG) and hemoglobin A1c (HbA1c) of patients in two groups were reduced than those before intervention, and FPG, OGTT 2h PG and HbA1c levels in the experimental group were lower than those in the control group. The differences were statistically significant ( P<0.05) . The mean blood glucose (MBG) and mean amplitude of plasma glucose excursions (MAGE) in the experimental group were lower than those in the control group, and the difference was statistically significant ( P<0.05) . After 3 months of intervention, blood glucose was monitored 6 833 times in the control group and 7 279 times in the experimental group. The incidence of hypoglycemia in the experimental group was lower than that in the control group [0.77% (56/7 279) vs. 2.82% (193/6 833) , χ 2=85.885, P<0.05]. After 3 months of intervention, the scores of diet, exercise, blood glucose monitoring, prevention of complications and medical compliance in the two groups were all higher than those before intervention, and the scores of diet, exercise, blood glucose monitoring and medical compliance in the experimental group were higher than those in the control group. The differences were statistically significant ( P<0.01) . Conclusions:The construction and application of intelligent medical cloud management platform of diabetes education clinic can better improve blood glucose control and improve self-management ability of patients.

Objective To explore the feasibility of FloTrac/Vigileo System in hemodynamic monitoring during the surgery of single-lung ventilation patients.Methods Twenty-five patients with thoracoscopic lobectomy under general anesthesia,aged 35-65 years,ASA physical status Ⅰ or Ⅱ, preoperative showed no application taboo of FloTrac/Vigileo system or transesophageal echocardio-graphy (TEE).The radial artery puncture catheter was inserted after getting into the operating room, then connect the FloTrac/Vigileo system,after that the TEE was inserted following the induction of general anesthesia.Using the FloTrac/Vigileo system to record the stroke volume (SVF),cardiac output (COF),stroke volume variation (SVV),at the moment of after turning over (T0),opening chest and single-lung ventilation(T1),single-lung ventilation for 15 minutes (T2),single-lung venti-lation for 30 minutes (T3),single-lung ventilation for 45 minutes (T4)single-lung ventilation for 60 minutes (T5).Using TEE to monitor the index and record the the stroke volume (SVT)cardiac out-put(COT)and inferior vena cava collapse index(cIVC)of the same patient at same time as Group F. Results There was no statistically significant different between SVFand SVTat T0-T5in both groups,Overall correlation analysis,r=0.84,P<0.01.There is no statistically significant different between COFand COTat T0-T5in both groups,Overall correlation analysis,r=0.92,P<0.01. Correlation analysis of SVV of group F and cIVC of group T,the results were positively correlate,r=0.80,P<0.01.Conclusion FloTrac/Vigileo system can be used as a monitoring method for mo-nitoring hemodynamics in thoracic surgery.

Objective: To discuss the clinical results of three-stage functional ear reconstruction for microtia with congenital aural stenosis (CAS). Methods: From September 2007 to June 2017, 53 cases of microtia with CAS underwent all three-stage functional ear reconstruction, and 445 cases of microtia underwent two stage ear reconstruction without meatoplasty at the same periods. First-stage of three-stage functional ear reconstruction: it was similar to Nagata technique. The crus of helix could not be too long, since we needed the space for the next meatoplasty. Second-stage: it was a modified meatoplasty with endoaural-conchal incision, in which two local rotation flaps and a transposition split-thickness scalp flap were used to widen the stenotic external auditory canal (EAC) and reconstructed the tympanic membrane. Third-stage: it was a modified technique for firm elevation of the reconstructed auricle by using the retro-auricular fascial flap wrapping a porous polyethylene (Medpor) wedge or stored cartilage as the strut. If the patient showed EAC cholesteatoma or infection, we could do the meatoplasty at the first stage. If the patient had completed ear reconstruction, meatoplasty could be done at the third stage. Results: 53 cases underwent all three-stage functional ear reconstruction. There were 41 cases (77.4%) obtaining serviceable hearing. The complication rate of meatoplasty was 1.89% and the complication rate of ear reconstruction was 5.66%. Among the 445 cases of microtia treated with two stage ear reconstruction without meatoplasty, the complication rate of ear reconstruction was 9.43%. There was no significant difference between the two groups (P>0.05). Conclusions Our novel three-stage functional ear reconstruction is a feasible strategy for microtia with CAS. The patients can obtain satisfactory auricle and serviceable hearing. The results are stable and can improve the life quality in both aesthetics and hearing function.

The application of transesophageal echocardiography (TEE) in perioperative monitoring was introduced,and its involvement in non-cardiac surgery was described.The advantages and disadvantages of TEE were analyzed when applied to cardiac and non-cardiac operations for congenital heart disease,coronary disease,vascular heart disease,aorta disease and etc.The abuse of vasoactive drug or fluid is avoided due to subjective evaluation on cardiac function and volume load.TEE facilitates the anesthetist in diagnosis and evaluation of the patient with heart diseases,and the surgeon in immediate assessment of the operation,which can be used for real-time monitoring of cardiac function and hemodynamics.

Objective To evaluate the effect of dexmedetomidine on the damage to intestinal mu-cous membrane of rats with obstructive jaundice. Methods Thirty pathogen-free healthy male Sprague-Dawley rats, aged 4-6 months, weighing 200-250 g, were divided into 3 groups(n=10 each)using a random number table: control group(group C), obstructive jaundice group(group OJ)and dexmedeto-midine group(group D). Obstructive jaundice was induced by double ligation of common bile duct in anes-thetized rats. In group D, dexmedetomidine was intraperitoneally injected in a loading dose of 100 μg∕kg at 3 days after establishment of the model, followed by intraperitoneal infusion of 50 μg·kg-1·h-1for 5 h. The equal volume of normal saline was given instead in C and OJ groups. At 5 h after administration of dexmedetomidine, blood samples were collected from the heart for determination of serum concentrations of diamine oxidase(DAO)and tumor necrosis factor-alpha(TNF-α)by enzyme-linked immunosorbent as-say. Then the rats were sacrificed and colon tissues were removed for microscopic examination of the patho-logical changes. Results Compared with group C, the serum DAO and TNF-α concentrations were signifi-cantly increased in OJ and D groups(P<0.05).Compared with group OJ, the serum DAO and TNF-α concentrations were significantly decreased in group D(P<0.05).The pathological changes were signifi-cantly attenuated in group D when compared with group OJ. Conclusion Dexmedetomidine can reduce the damage to intestinal mucous membrane of rats with obstructive jaundice.

Objective To investigate the effects of combined general and epidural anesthesia on intestinal barrier function in patients with obstructive jaundice after surgery.Methods Forty patients with obstructive jaundice,male 1 5 cases,female 25 cases,aged 26-65 years,of ASA Ⅰ-Ⅲ,with TBIL >100 μmol/L were randomly divided into two groups (n =20):the general intravenous anes-thesia group (group GA)and the combined general and epidural anesthesia group (group GE).Pa-tients of group GA with oxygen mask rapid intubate induction of endotracheal after general anesthesia. Patients of group GE take left side line of T8~9 or T9 ~1 0 segmental epidural puncture and insert cathe-ter,after changing the hypothesis to be 2% lidocaine 5 ml for test quantity,confirm without anesthe-sia complications and other abnormalities after general anesthesia 5 minutes later.Peripheral venous blood was sampled when entering the operating room (T1 ),and at the end of operation (T2 ),24 hours after operation(T3 )and 48 hours after operation (T4 ).The concentration of D-lactate (D-LA) was measured using ELISA method.Also polymerase chain reaction (PCR)was performed for quali-tative detection of Escherichia coli specific beta galactosidase gene BG.Results Compared with T1 , Plasma D-LA level in two groups at T2-T4 were increased gradually and it was significantly higher in group GA than in group GE at T2-T4 with significant difference (P <0.05).The Escherichia coli DNA test was negative at T1 ,the positive rate of Escherichia coli DNA gradually increased,and it was significantly higher in group GA than in group GE at T4 with significant difference(P <0.05).Conclusion Compared with the general intravenous anesthesia, general anesthesia combined with epidural anesthesia may relieve the intestinal barrier injury in patients with obstructive jaundice after surgery.

Objective To evaluate the effect of dexmedetomidine on liver injury in the rats with ob?structive jaundice. Methods Forty?five healthy male Sprague Dawley rats, weighing 250-300 g, aged 8-9 weeks, were divided into 3 groups ( n=15 each) using a random number table: sham operation group ( S group) , obstructive jaundice group ( OJ group) and dexmedetomidine group ( D group) . Obstructive jaun?dice was induced in rats by division and double ligation of the common bile duct in OJ and D groups. Dexmedetomidine 100 μg∕kg was injected intraperitoneally at 72 h after establishment of the model in group D. At 3, 5 and 24 h after administration, blood samples were collected from hearts for determination of the plasma alanine aminotransferase (ALT) and C?reactive protein (CRP) levels. After blood sampling at each time point, the specimens from the external right lobe of the liver were obtained for detection of the expres?sion of Toll?like receptor 4 ( TLR4) mRNA ( by real?time polymerase chain reaction) and TLR4 content ( by enzyme?linked immunosorbent assay) in liver tissues and for pathological examination of liver tissues ( with light microscope) . Results Compared with group S, the plasma ALT and CRP levels were significantly increased at each time point after administration, and the expression of TLR4 mRNA in liver tissues was significantly up?regulated, and TLR4 content in liver tissues was significantly increased in OJ and D groups ( P<0?05) . Compared with group OJ, the plasma ALT and CRP levels were significantly decreased at each time point after administration, and the expression of TLR4 mRNA in liver tissues was significantly down?regulated, and TLR4 content in liver tissues was significantly decreased in group D ( P<0?05) . The degree of damage to liver tissues was significantly attenuated in group D compared with group OJ, and was aggrava?ted in group D compared with group S. Conclusion Dexmedetomidine can reduce liver injury in the rats with obstructive jaundice.