AIM:To observe the effect of opioid-free anesthesia with esketamine on delirium after hip replacement surgery in elderly patients.METH-ODS:One hundred and fourteen elderly patients who underwent hip replacement were randomly di-vided into two groups:opioid-free anesthesia(OFA)group and opioid anesthesia(OA)group(n=57).During anesthesia induction and maintenance,es-ketamine was administered in OFA group,and that fentanyl and remifentanil were administered in OA group.Delirium was mainly recorded within 3 days after the surgeries,and the patients'delirium sta-tus was evaluated using the Chinese Revised Deliri-um Diagnostic Scale(CAM-CR).RESULTS:The pa-tients in OFA group had lower CAM-CR scores and delirium incidence compared to those in the OA group at 2 days after surgery.CONCLUSION:Opioid-free anesthesia based on esketamine can effective-ly reduce delirium after hip replacement in elderly patients.

AIM:To observe the effect of opioid-free anesthesia with esketamine on delirium after hip replacement surgery in elderly patients.METH-ODS:One hundred and fourteen elderly patients who underwent hip replacement were randomly di-vided into two groups:opioid-free anesthesia(OFA)group and opioid anesthesia(OA)group(n=57).During anesthesia induction and maintenance,es-ketamine was administered in OFA group,and that fentanyl and remifentanil were administered in OA group.Delirium was mainly recorded within 3 days after the surgeries,and the patients'delirium sta-tus was evaluated using the Chinese Revised Deliri-um Diagnostic Scale(CAM-CR).RESULTS:The pa-tients in OFA group had lower CAM-CR scores and delirium incidence compared to those in the OA group at 2 days after surgery.CONCLUSION:Opioid-free anesthesia based on esketamine can effective-ly reduce delirium after hip replacement in elderly patients.

Cognitive dysfunction has become a pivotal factor affecting the quality of life of elderly patients. The existing literatures can not explain the factors causing cognitive decline. Many researchers believe that anesthetics and analgesics may play important roles in cognitive dysfunction. This review will discuss the effects of different anesthetics and analgesics on cognitive function and briefly describe their mechanisms, so as to provide reference for the rational choice of medications in clinical practice.

OBJECTIVE：To overview t he s ystematic revi ews on JAK inhibitors in the treatment of rheumatoid arthritis （RA）， and to provide evidence-based basis for the treatment of RA with these drugs. METHODS ：The Cochrane Library ，PubMed， Embase，CNKI，Wanfang database and VIP were electronically searched to collect systematic reviews of JAK inhibitors in the treatment of RA from inception to Dec. 2020. After data extraction of included systematic review ，PRISMA statement ，AMSTAR2 scale and GRADE were used to evaluate the report quality ，methodological quality and the level of evidence for outcome indicators. RESULTS ：A total of 12 systematic reviews involving 103 outcomes were included. PRISMA score of systematic reviews was between 17.5 and 22.5，and the reported quality defects were mainly reflected in scheme ，registration and other aspects. AMSTAR 2 evaluation results showed that there were 6 studies of low quality and 6 studies of very low quality ，without high-quality study and medium-quality study. GRADE assessment results for outcome indicators showed low to medium quality of evidence. The summary of evidence showed that compared to placebo ，JAK inhibitor could alleviate various indicators of RA ； compared to adalimumab ，the advantage was not obvious. JAK inhibitors did not increase the incidence of serious adverse events ， but the systematic reviews were inconsistent in their effects on the incidence of total adverse events and liver injury. CONCLUSIONS：The efficacy of JAK inhibitors in the treatment of RA has certain advantages over placebo ，but more studies are needed to demonstrate the efficacy of JAK inhibitors in the treatment of RA compared to other drugs ；the advantage of safety is uncertain.

Objective:To observe the clinical efficacy of Qingfei-Xiaoyan Decoction combined with conventional western medicine in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods:Eighty-two patients with acute exacerbation of COPD were selected in Bozhou People's Hospital from January 2017 to June 2018 and randomly divided into a control group and a treatment group (41 in each group) using randomized number table method. Patients in the control group were treated with conventional western medicine and those in the treatment group with Qingfei-Xiaoyan Decoction on the basis of the control group for 2 weeks. Dyspnea of patients was evaluated with the modified British Medical Research Council dyspnea questionnaire (mMRC). Impact of the disease was measured with the COPD Assessment Test (CAT). The serum levels of C-reactive protein (CRP) and procalcitonin (PCT) were measured by ELISA. Results:The total efficacy rate in trementat group 95.1% (39/41) was significantly higher than that in the control group 73.2% (30/41) ( χ2=4.999, P=0.025). After the treatment, the scores of mMRC (0.63 ± 0.07 vs. 0.95 ± 0.12; t=7.921, P<0.01) and CAT (9.18 ± 0.12 vs. 14.01 ± 1.56; t=11.359, P<0.01) in the treatment group were significantly lower than those in the control group. After the treatment, the forced expiratory volume in one second (FEV1) percentage predicted (51.05% ± 5.63% vs. 45.77% ± 5.31%; t=10.453, P<0.01) and FEV1/forced vital capacity (FVC) (59.15 ± 6.44 vs. 54.24 ± 6.02; t=5.621, P<0.01) in the treatment group were significantly higher than those in the control group. After the treatment, the serum levels of CRP (8.06 ± 0.87 mg/L vs. 10.55 ± 1.21 mg/L; t=10.216, P<0.01) and PCT (4.20 ± 0.48 μg/L vs. 6.33 ± 0.69 μg/L; t=7.004, P<0.01) in the treatment group were significantly lower than those in the control group. Conclusions:Qingfei-Xiaoyan Decoction can inhibite inflammation, improve symptoms and lung function, increase the efficacy in patients with acute exacerbation of COPD.