Objective:To evaluate the effect of remimazolam tosilate on postoperative delirium (POD) in elderly patients undergoing urological surgery.Methods:In this randomized controlled trial, 220 American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ elderly patients of either sex, aged≥65 yr, with body mass index of 18-28 kg/m 2, scheduled for elective urological surgery under general anesthesia, were divided into 2 groups ( n=110 each) using a random number table method: propofol group (group P) and remimazolam tosilate group (group R). Group P received propofol 1.0-1.5 mg/kg for induction and propofol 2-6 mg·kg -1·h -1 for maintenance, while group R received remimazolam tosilate 0.2-0.3 mg/kg for induction and remimazolam tosilate 0.5-1.2 mg·kg -1·h -1 for maintenance. The other drugs for induction and maintenance were the same in the two groups. POD was assessed using the Chinese version of the 3-minute diagnostic interview for Confusion Assessment Method within 3 days after surgery in the two groups. The intraoperative consumption of remifentanil and usage of vasoactive drugs, extubation time, 15-item Quality-of-Recovery scale scores at 24 h after operation, requirement for rescue analgesia within 24 h after operation, and postoperative adverse effects were recorded. Results:There were no significant differences in the incidence of POD within 3 days after operation, 15-item Quality-of-Recovery scale scores at 24 h after operation, or rate of rescue analgesia within 24 h after operation between two groups ( P>0.05). Compared with group P, the requirement for intraoperative vasoactive drugs was significantly reduced, the extubation time was shortened, and the incidence of hypoxemia was decreased within 24 h after operation in group R ( P<0.05 or 0.001). Conclusions:Remimazolam tosilate has no marked effect on the occurrence of POD in elderly patients undergoing urological surgery.

In the pathogenesis of many neurological diseases such as epilepsy,immune responses and neuroinflammation play a key role and provide new directions for treatment.In the era of personalized medicine,with the reduction of anti-epileptic treatment resources,there is an increasing focus on the application of neuroimmunomodulators or anti-inflammatory treatments in epilepsy patients.Therefore,this article reviews the latest progress in the epileptogenic mechanisms related to immune activation or neuroin-flammation,with particular attention to current and potential new treatments for epilepsy in the future.Neuroinflammation can lead to various types of epilepsy,including structural,infectious,post-traumatic,autoimmune and hereditary epilepsy.In recent years,some emerging studies have identified multiple major molecular pathways in the neuroinflammatory process,which may become future thera-peutic targets for epilepsy.A variety of drugs that are currently known or under development have been proven to have the ability to inhibit or regulate immune or neuroinflammatory molecules in epilepsy,and some of these drugs are expected to become new options for antiepileptic treatment.

Objective:To evaluate the effect of remimazolam tosilate on postoperative delirium (POD) in elderly patients undergoing urological surgery.Methods:In this randomized controlled trial, 220 American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ elderly patients of either sex, aged≥65 yr, with body mass index of 18-28 kg/m 2, scheduled for elective urological surgery under general anesthesia, were divided into 2 groups ( n=110 each) using a random number table method: propofol group (group P) and remimazolam tosilate group (group R). Group P received propofol 1.0-1.5 mg/kg for induction and propofol 2-6 mg·kg -1·h -1 for maintenance, while group R received remimazolam tosilate 0.2-0.3 mg/kg for induction and remimazolam tosilate 0.5-1.2 mg·kg -1·h -1 for maintenance. The other drugs for induction and maintenance were the same in the two groups. POD was assessed using the Chinese version of the 3-minute diagnostic interview for Confusion Assessment Method within 3 days after surgery in the two groups. The intraoperative consumption of remifentanil and usage of vasoactive drugs, extubation time, 15-item Quality-of-Recovery scale scores at 24 h after operation, requirement for rescue analgesia within 24 h after operation, and postoperative adverse effects were recorded. Results:There were no significant differences in the incidence of POD within 3 days after operation, 15-item Quality-of-Recovery scale scores at 24 h after operation, or rate of rescue analgesia within 24 h after operation between two groups ( P>0.05). Compared with group P, the requirement for intraoperative vasoactive drugs was significantly reduced, the extubation time was shortened, and the incidence of hypoxemia was decreased within 24 h after operation in group R ( P<0.05 or 0.001). Conclusions:Remimazolam tosilate has no marked effect on the occurrence of POD in elderly patients undergoing urological surgery.

Objective To explore the effect of the ratio of high-density lipoprotein cholesterol(HDL-C)/total cholesterol(TC)on no-reflow after percutaneous coronary intervention(PCI)in elderly patients with acute coronary syndrome(ACS)complicated with diabetes mellitus(DM).Methods A retrospective analysis was conducted on 206 elderly ACS patients complicated with DM undergoing PCI in our hospital from January 2018 to August 2024.The HDL-C and TC levels were detected by cholesterol oxidase test,and the HDL-C/TC ratio was calculated.Coronary angi-ography(CAG)was applied to evaluate no-reflow phenomenon after PCI,and according to the re-sults,the patients were divided into a non-reflow group(41 cases)and a normal reflow group(165 cases).ROC curve was plotted to evaluate the predictive performance of HDL-C/TC ratio for no-reflow after PCI in patients with ACS complicated DM.Results The no-reflow group had signifi-cantly higher TC and glycated hemoglobin A1c(HbA1c)levels and more balloon dilatations,but lower HDL-C level and HDL-C/TC ratio than the normal flow group(P＜0.01).Multivariate lo-gistic regression analysis showed that HbA1c(OR=3.196,95％CI:1.619-6.310,P=0.001),number of balloon dilatations(OR=3.504,95％CI:1.807-6.797,P=0.000),and HDL-C/TC ra-tio(OR=3.927,95％CI:2.0 73-7.441,P=0.000)were influencing factors of no-reflow after PCI in patients with ACS and DM.The AUC value of HDLC,TC,and HDL-C/TC ratio in predicting no-reflow after PCI was 0.842,0.726,and 0.922,respectively.Conclusion HDL-C/TC ratio is an influencing factor for no-reflow in patients with ACS and DM after PCI.The ratio at a cut-off val-ue of ≤0.21 has a certain predictive value for no-reflow after PCI in these elderly patients.

Hypertension is a major factor leading to cardiovascular events and death, and accurate blood pressure measurement is a fundamental means of evaluating blood pressure levels, achieving hypertension diagnosis, and observing antihypertensive efficacy. Compared to traditional brachial pressure, central aortic pressure (CAP) exhibits a stronger correlation with cardiovascular events. However, its non-invasive detection technology has not yet been widely adopted in clinical practice. In order to promote the clinical application of CAP and optimize blood pressure management, this article systematically summarizes the research progress of CAP estimation algorithms. These algorithms were categorized into three types: direct substitution methods, generalized model-based methods and personalized estimation methods. The characteristics and clinical adaptability of each algorithm were analyzed. The findings highlight that CAP estimation algorithms are moving towards personalization and non-linearity.
Algorithms ; Humans ; Blood Pressure Determination/methods* ; Hypertension/physiopathology* ; Arterial Pressure/physiology* ; Blood Pressure/physiology* ; Aorta/physiology*

In the pathogenesis of many neurological diseases such as epilepsy,immune responses and neuroinflammation play a key role and provide new directions for treatment.In the era of personalized medicine,with the reduction of anti-epileptic treatment resources,there is an increasing focus on the application of neuroimmunomodulators or anti-inflammatory treatments in epilepsy patients.Therefore,this article reviews the latest progress in the epileptogenic mechanisms related to immune activation or neuroin-flammation,with particular attention to current and potential new treatments for epilepsy in the future.Neuroinflammation can lead to various types of epilepsy,including structural,infectious,post-traumatic,autoimmune and hereditary epilepsy.In recent years,some emerging studies have identified multiple major molecular pathways in the neuroinflammatory process,which may become future thera-peutic targets for epilepsy.A variety of drugs that are currently known or under development have been proven to have the ability to inhibit or regulate immune or neuroinflammatory molecules in epilepsy,and some of these drugs are expected to become new options for antiepileptic treatment.

Objective To explore the effect of the ratio of high-density lipoprotein cholesterol(HDL-C)/total cholesterol(TC)on no-reflow after percutaneous coronary intervention(PCI)in elderly patients with acute coronary syndrome(ACS)complicated with diabetes mellitus(DM).Methods A retrospective analysis was conducted on 206 elderly ACS patients complicated with DM undergoing PCI in our hospital from January 2018 to August 2024.The HDL-C and TC levels were detected by cholesterol oxidase test,and the HDL-C/TC ratio was calculated.Coronary angi-ography(CAG)was applied to evaluate no-reflow phenomenon after PCI,and according to the re-sults,the patients were divided into a non-reflow group(41 cases)and a normal reflow group(165 cases).ROC curve was plotted to evaluate the predictive performance of HDL-C/TC ratio for no-reflow after PCI in patients with ACS complicated DM.Results The no-reflow group had signifi-cantly higher TC and glycated hemoglobin A1c(HbA1c)levels and more balloon dilatations,but lower HDL-C level and HDL-C/TC ratio than the normal flow group(P＜0.01).Multivariate lo-gistic regression analysis showed that HbA1c(OR=3.196,95％CI:1.619-6.310,P=0.001),number of balloon dilatations(OR=3.504,95％CI:1.807-6.797,P=0.000),and HDL-C/TC ra-tio(OR=3.927,95％CI:2.0 73-7.441,P=0.000)were influencing factors of no-reflow after PCI in patients with ACS and DM.The AUC value of HDLC,TC,and HDL-C/TC ratio in predicting no-reflow after PCI was 0.842,0.726,and 0.922,respectively.Conclusion HDL-C/TC ratio is an influencing factor for no-reflow in patients with ACS and DM after PCI.The ratio at a cut-off val-ue of ≤0.21 has a certain predictive value for no-reflow after PCI in these elderly patients.

Abstract: Objective To express Mycobacterium tuberculosis Rv2626c protein in Escherichia coli (E. coli) and study the antigenicity of the purified recombinant Rv2626c protein. Methods The amino acid sequence of Rv2626c protein from Mycobacterium tuberculosis H37Rv strain (accession number: CCP45424.1) in GenBank was retrieved and converted into the corresponding DNA sequence according to the codon preference of E. coli. This DNA sequence was synthesized and cloned into pET24a(+) plasmid to construct pET24a(+)-Rv2626c recombinant plasmid. This plasmid was transformed into E. coli BL21(DE3) cells, and the expression of Rv2626c protein was induced under various conditions of isopropyl β-D-thiogalactopyranoside (IPTG) concentrations, temperature, and period. The recombinant Rv2626c protein was identified by SDS-PAGE and Western Blot. The recombinant Rv2626c protein was purified by nickel chelate affinity chromatography and used to immunize violet blue rabbits to prepare anti-Rv2626c anti-serum. The specificity and titer of the serum were respectively detected by Western Blot and enzyme-linked immunosorbent assay (ELISA). Results The recombinant plasmid pET24a(+)-Rv2626c was successfully constructed. SDS-PAGE analysis showed that recombinant Rv2626c was expressed in the recombinant plasmid transformed E. coli with IPTG induction, with a molecular weight of about 14 500, and the size was consistent with the expectation. The optimal expression condition for recombinant Rv2626c protein was at 31 ℃ with 1.0 mmol/L IPTG for 6 hours. The target protein was mainly present in a soluble form, which was consistent with the results of Western blot. The hyperimmunized serum with recombinant Rv2626c protein vaccination showed good specificity, with a titer of 1∶ 256 000 detected by ELISA. Conclusions Mycobacterium tuberculosis Rv2626c protein is successfully expressed in E. coli, and the purified protein has good purity and antigenic activity, laying the foundation for further reveals of its biological functions.

Objective To investigate the effects of nalbuphine combined with dexmedetomidine on postop-erative recovery quality and pain in patients who undergoing laparoscopic bariatric surgery.Methods A total of 169 patients who underwent laparoscopic bariatric surgery at our hospital were included and divided into control group(group C),nalbuphine group(group N),dexmedetomidine group(group D),and nalbuphine combined with dexme-detomidine group(group ND)using randomised numerical table method.Group C received intravenous injection of saline,group N and group ND received intravenous injection of nalbuphine before the end of the surgery,and group D and group ND received pumping of dexmedetomidine before anesthesia induction and during surgery.Compare the postoperative recovery quality score(QoR-40),hemodynamics at different time points,visual analogue scale score(VAS),sedation-agitation scale(SAS),first time out of bed activity and exhaust time,and incidence of nausea and vomiting among four groups.Results The postoperative QoR-40 scores of patients in group ND were better than those in group C and group N(P<0.05),and the QoR-40 scores in group D were better than those in group C(P<0.05).MAP and HR were more stable during the awakening period in group ND and group D(P<0.05).Compared with group C,patients in all three groups had lower VAS scores and SAS scores(P<0.05)and consumed less remedial analgesic medication(P<0.05).In terms of adverse reactions,the incidence of postoperative nausea,vomiting and coughing in the group ND was lower than that in the group C(P<0.05).Conclusion The combination of nalbuphine and dexmedetomidine could improve the quality of postoperative recovery and pain in patients under-going laparoscopic bariatric surgery,reduce hemodynamic fluctuations during the patients′ recovery period,reduce the incidence of nausea and vomiting,and improve the patients′ prognosis.

Critical care medicine-related treatment is an interdisciplinary and multi-professional process,often leading to secondary or concomitant mental disorders in clinical practice.Currently,there is no consensus on the pharmacological treatment of related mental illnesses in China.The Chinese Society of Psychosomatic Medicine collaborated with the Critical Care Medicine expert group to form a consensus writing expert group.After a systematic review of relevant literature,summarizing published domestic and foreign literature,and extensive discussions,the consensus was developed.The consensus elaborates on the principles and processes of the standardized use of psychotropic drugs in critical care medicine,as well as the clinical indications,precautions,and specific drug selection of various psychiatric medications,providing feasible suggestions and guidance for the clinical application of psychiatric medications in the intensive care unit.