Objective:To evaluate the effect of heavy smoking on the dose-effect relationship of ciprofol for painless gastroscopy when combined with alfentanil.Methods:This was a prospective study. American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ male patients, aged 18-64 yr, with body mass index of 18-28 kg/m 2, undergoing elective painless gastroscopy from October 2023 to February 2024 in Baoding First Central Hospital, were divided into non-smoking group and heavy smoking group (smoking index>400) according to the status of smoking. Alfentanil 5 μg/kg and ciprofol were intravenously injected, and gastroscopy was performed after the patient′s eyelash reflex disappeared and the jaw was relaxed. The study was performed by the Dixon′s up-and-down method, and the initial dose of ciprofol was 0.4 mg/kg. The dose of ciprofol increased or decreased by 0.04 mg/kg each time based on the positive or negative response of the previous patient. A positive response was defined as the Modified Observer′s Assessment of Alertness/Sedation Scale score being greater than 1 point at 3 min after ciprofol injection or the occurrence of coughing, swallowing, body movement, or other responses that affected the operation during the insertion of the endoscope. The median effective dose (ED 50) and 95% confidence interval of propofol for painless gastroscopy were determined by the probit analysis. Results:Twenty-five patients were finally included in non-smoking group and 23 patients in heavy smoking group. The ED 50 (95% confidence interval) of ciprofol when combined with alfentanil was 0.205 (0.159, 0.244) mg/kg in non-smoking group and 0.252 (0.184, 0.295) mg/kg in heavy smoking group. The ED 50 was significantly higher in heavy smoking group than in non-smoking group ( u=390, P=0.009). Conclusions:Heavy smoking can weaken the sedative potency of propofol for sedation when used for painless gastroscopy when combined with alfentanil.

Objective:To evaluate the effect of age on the sedative potency of remimazolam.Methods:This was a prospective study. Patients of either sex, aged 40-80 yr, with body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective surgery with general anesthesia, were divided into middle age group (40-64 yr) and elderly group (65-80 yr) based on the age of the patients. The test was performed by the Dixon′s up-and-down method. The initial dose of remimazolam was 0.3 mg/kg. The Modified Observer′s Assessment of Alertness/Sedation Scale score ≤1 and bispectral index value≤60 within 3 min after administration were considered as an effective sedation. The dose of remimazolam was increased/decreased by 0.03 mg/kg based on the sedative efficacy in the previous patient. The 50% effective dose (ED 50) and 95% confidence interval ( CI) of remimazolam were calculated by the probit method. The time to the loss of consciousness was recorded. Results:The ED 50 (95% CI) of remimazolam was 0.345 (0.306-0.384) mg/kg in middle age group, while the ED 50 (95% CI) of remimazolam was 0.322 (0.303-0.339) mg/kg in elderly group. The ED 50 was significantly higher in middle age group than in elderly group ( u=417.00, P=0.022). The time to loss of consciousness was significantly longer in elderly group than in middle age group ( t=-2.96, P=0.008). Conclusions:For middle-aged and elderly patients aged 40-80 yr, the sedative potency of remimazolam increases with age.

Objective:To compare the anesthetic potency of ciprofol combined with alfentanil in patients with different body mass indexes (BMIs) during gastroscopy.Methods:American Society of Anesthesiologists Physical Status classification I or Ⅱ patients, aged 18-64 yr, with a BMI of 18-36 kg/m 2, undergoing elective painless gastroscopy at Baoding First Central Hospital from October to December 2023, were divided into 3 groups: normal group (18 kg/m 2≤BMI<24 kg/m 2), overweight group (24 kg/m 2≤BMI<28 kg/m 2) and obesity group (BMI≥28 kg/m 2). The 95% effective dose (ED 95) of ciprofol during painless gastroscopy was determined by the biased coin design. Alfentanyl 5 μg/kg and ciprofol were intravenously injected for anesthesia induction. Gastroscopy was performed after the patient′s eyelash reflex disappeared, the jaw muscle was relaxed and the Modified Observer′s Assessment of Alertness/Sedation Scale score ≤ 1. The initial dose of ciprofol was 0.2 mg/kg with a dose gradient of 0.04 mg/kg. The positive response were defined as the Modified Observer′s Assessment of Alertness/Sedation Scale score still> 1 after 3 min of ciprofol injection or any other responses affecting the procedure, such as body movement, bucking, or swallowing during insertion of the endoscope. If the response was positive, the next patient received a higher dose of ciprofol, or conversely if negative, the next patient received the same dose (95% probability) or a lower dose (5% probability). Each group was completed with 40 cases. Results:The ED 95 and 95% confidence intervals of ciprofol in normal, overweight and obese groups were 0.266 (0.246, 0.285) mg/kg, 0.218 (0.189, 0.244) mg/kg, 0.191 (0.156, 0.220) mg/kg, respectively. The ED 95 of ciprofol was significantly lower in overweight and obese groups than in normal group ( P<0.05). Conclusions:Overweight and obesity can increase the anesthetic potency of ciprofol in patients undergoing gastroscopy.

Objective To observe the effect of ultrasound-guided iliopsoas plane block(IPB)on the quality of postoperative recovery in patients undergoing hip arthroplasty.Methods Sixty patients who underwent hip arthroplasty were selected,37 males and 23 females,aged 40-79 years,BMI 18-30 kg/m2,ASA physical status Ⅰ-Ⅲ.The patients were divided into two groups by random number table method:the iliopsoas plane block group(group IPB)and the femoral nerve block(FNB)group(group FNB),30 pa-tients in each group.Before anesthesia induction,IPB was performed with 0.5%ropivacaine 10 ml and lat-eral femoral cutaneous nerve block was performed with 0.5%ropivacaine 5 ml in group IPB.And FNB was performed with 0.5%ropivacaine 10 ml and lateral femoral cutaneous nerve block was performed with 0.5%ropivacaine 5 ml in group FNB.The dosages of propofol,remifentanil,and cis-atracurium during operation were recorded.The quality of recovery-15(QoR-15)scale was evaluated preoperatively and postoperatively 1 day,2 and 3 days.The max VAS(VASmax)pain score and manual muscle test(MMT)score of quadri-ceps muscle were recorded 12,24,and 48 hours after surgery.The time of getting out of bed for the first time,opioid dosage,and patient satisfaction were recorded.The incidence of nerve injury,vascular injury,puncture site infection,and local anesthetic poisoning were recorded.The postoperative complications of diz-ziness,nausea and vomiting,deep vein thromboses,and elirium were also recorded.Results There was no significant difference in the dosage of propofol,remifentanil,and cis-atracurium between the two groups.Compared with group FNB,the QoR-15 scale score in group IPB was significantly higher 1 day,2 and 3 days after operation(P＜0.05).Compared with group FNB,the MMT scores of quadriceps muscle was sig-nificantly higher in group IPB 12 and 24 hours after surgery(P＜0.05),and the first time of getting out of bed was shortened in group IPB(P＜0.05).However,there were no significant differences in the VASmax pain score,MMT score of quadriceps muscle 48 hours after surgery,opioid dosage,and patient satisfaction between the two groups.No nerve block related complications were found in both groups.There were no sig-nificant differences in postoperative complications between the two groups.Conclusion The iliopsoas plane block can improve the quality of postoperative recovery and accelerate the recovery of patients with hip re-placement,and the effect is better than that of femoral nerve block.

To construct and validate a deep learning-based bone age prediction model for children living in both plain and highland regions.

Bone age, the most commonly used and effective indicator for understanding children's growth and development, plays an important role in the diagnosis and efficacy evaluation of various growth and development disorders. Clinically, X-rays of the left hand and wrist are mostly taken for bone age assessment, but there is a certain radiation risk. Ultrasound can clearly display the epiphysis and secondary ossification center, and conveniently perform multi-site scanning and dynamic measurement without radiation. In recent years, great progress has been made in the research and clinical application of ultrasound in bone age assessment. This article, by reviewing the latest literature, discusses the value of musculoskeletal ultrasound and quantitative ultrasound in bone age assessment, raises the problems in the study of ultrasound assessment of bone age, and suggests direction for improvement.

Preliminary exploration of using ultrasound to quantitatively evaluate the development of epiphyseal cartilage and analyze its correlation with bone age, based on the ultrasound findings of the long bone joint end.

To research on area ossification ratio (AOR), a novel parameter for quantitatively assessing adolescent bone age by conventional ultrasonography, and evaluate the correlation between AOR and radiographic bone age.

To construct and validate a deep learning-based bone age prediction model for children living in both plain and highland regions.

Objective:To compare the anesthetic potency of ciprofol combined with alfentanil in patients with different body mass indexes (BMIs) during gastroscopy.Methods:American Society of Anesthesiologists Physical Status classification I or Ⅱ patients, aged 18-64 yr, with a BMI of 18-36 kg/m 2, undergoing elective painless gastroscopy at Baoding First Central Hospital from October to December 2023, were divided into 3 groups: normal group (18 kg/m 2≤BMI<24 kg/m 2), overweight group (24 kg/m 2≤BMI<28 kg/m 2) and obesity group (BMI≥28 kg/m 2). The 95% effective dose (ED 95) of ciprofol during painless gastroscopy was determined by the biased coin design. Alfentanyl 5 μg/kg and ciprofol were intravenously injected for anesthesia induction. Gastroscopy was performed after the patient′s eyelash reflex disappeared, the jaw muscle was relaxed and the Modified Observer′s Assessment of Alertness/Sedation Scale score ≤ 1. The initial dose of ciprofol was 0.2 mg/kg with a dose gradient of 0.04 mg/kg. The positive response were defined as the Modified Observer′s Assessment of Alertness/Sedation Scale score still> 1 after 3 min of ciprofol injection or any other responses affecting the procedure, such as body movement, bucking, or swallowing during insertion of the endoscope. If the response was positive, the next patient received a higher dose of ciprofol, or conversely if negative, the next patient received the same dose (95% probability) or a lower dose (5% probability). Each group was completed with 40 cases. Results:The ED 95 and 95% confidence intervals of ciprofol in normal, overweight and obese groups were 0.266 (0.246, 0.285) mg/kg, 0.218 (0.189, 0.244) mg/kg, 0.191 (0.156, 0.220) mg/kg, respectively. The ED 95 of ciprofol was significantly lower in overweight and obese groups than in normal group ( P<0.05). Conclusions:Overweight and obesity can increase the anesthetic potency of ciprofol in patients undergoing gastroscopy.