Objective To investigate the impact of recent rhythmic interventions on the depth of sedation during anesthesia induction in patients undergoing general anesthesia with remazolam toluene sulfonate.Methods Patients aged 18～65 years who underwent elective surgery under general anesthesia were selected and divided into a day group(7:00～19:00)and a night group(19:00～7:00 the following day)based on the start time of anesthesia induction.Each group comprised 70 patients,further subdivided into five equal dose groups of remazolam toluene sulfonate at 0.11,0.13,0.16,0.18,and 0.22 mg/kg,with 14 patients in each subgroup.The Modified Observer's Assessment of Alertness/Sedation(MOAA/S)score and Bispectral Index(BIS)value were recorded 3 minutes post-administration,and the correlation coefficient between these two parameters was calculated.The induction dose and unit body weight dose of remazolam toluene sulfonate were documented when the MOAA/S score was≤1.Addition-ally,the induction dose of remazolam for both day and night groups as well as for patients of different genders was recorded.The half effective dose(ED50),95％effective dose(ED95),and 95％confidence interval(CI)for both the day and night groups were also calculated.Results When MOAA/S≤1,the induced dose of remazolam in the night group(12.34±3.51)mg was significantly lower than that in the day group(13.98±4.21)mg.Additionally,the dose per unit body weight of remazolam in the night group(0.20±0.049)mg/kg was also significantly lower than that in the day group(0.22±0.056)mg/kg.Statistically significant differences were observed in the ED50 and ED95 values of remazolam between the day and night groups(P<0.05).The correlation coefficient between BIS and MOAA/S was 0.902(95％CI:0.876～0.925)in the day group and 0.905(95％CI:0.879～0.929)in the night group,indicating a strong correlation between MOAA/S and BIS in both groups.However,there was no significant difference in the correlation coefficients between the two groups(P>0.05).The correlation coefficients between BIS and MOAA/S were 0.763(95％CI:0.726～0.799)in the daytime group and 0.777(95％CI:0.739～0.808)in the nighttime group.In a separate analysis,the correlation coefficients were 0.768(95％CI:0.723～0.804)for the day-time group and 0.771(95％CI:0.723～0.811)for the nighttime group.A strong correlation was observed between MOAA/S and BIS in both male and female patients during both day and night,with no significant difference in corre-lation coefficients between groups(P>0.05).However,BIS values were significantly lower in the nighttime group compared to the daytime group(P<0.05).Additionally,male patients required a higher total induced dose of rem-azolam than female patients during both day and night,with this difference being statistically significant(P<0.05).Furthermore,female patients exhibited a significant decrease in BIS values at night(P<0.05).Conclusions Recent studies have shown that circadian rhythm significantly influences anesthesia-induced sedation in patients undergoing general anesthesia with remazolam toluenesulfonate.Specifically,the sedation effect is more pronounced in nighttime procedures,and there is a notable gender difference,with female patients exhibiting better sedation outcomes during nighttime surgeries.

Objective To investigate the impact of recent rhythmic interventions on the depth of sedation during anesthesia induction in patients undergoing general anesthesia with remazolam toluene sulfonate.Methods Patients aged 18～65 years who underwent elective surgery under general anesthesia were selected and divided into a day group(7:00～19:00)and a night group(19:00～7:00 the following day)based on the start time of anesthesia induction.Each group comprised 70 patients,further subdivided into five equal dose groups of remazolam toluene sulfonate at 0.11,0.13,0.16,0.18,and 0.22 mg/kg,with 14 patients in each subgroup.The Modified Observer's Assessment of Alertness/Sedation(MOAA/S)score and Bispectral Index(BIS)value were recorded 3 minutes post-administration,and the correlation coefficient between these two parameters was calculated.The induction dose and unit body weight dose of remazolam toluene sulfonate were documented when the MOAA/S score was≤1.Addition-ally,the induction dose of remazolam for both day and night groups as well as for patients of different genders was recorded.The half effective dose(ED50),95％effective dose(ED95),and 95％confidence interval(CI)for both the day and night groups were also calculated.Results When MOAA/S≤1,the induced dose of remazolam in the night group(12.34±3.51)mg was significantly lower than that in the day group(13.98±4.21)mg.Additionally,the dose per unit body weight of remazolam in the night group(0.20±0.049)mg/kg was also significantly lower than that in the day group(0.22±0.056)mg/kg.Statistically significant differences were observed in the ED50 and ED95 values of remazolam between the day and night groups(P<0.05).The correlation coefficient between BIS and MOAA/S was 0.902(95％CI:0.876～0.925)in the day group and 0.905(95％CI:0.879～0.929)in the night group,indicating a strong correlation between MOAA/S and BIS in both groups.However,there was no significant difference in the correlation coefficients between the two groups(P>0.05).The correlation coefficients between BIS and MOAA/S were 0.763(95％CI:0.726～0.799)in the daytime group and 0.777(95％CI:0.739～0.808)in the nighttime group.In a separate analysis,the correlation coefficients were 0.768(95％CI:0.723～0.804)for the day-time group and 0.771(95％CI:0.723～0.811)for the nighttime group.A strong correlation was observed between MOAA/S and BIS in both male and female patients during both day and night,with no significant difference in corre-lation coefficients between groups(P>0.05).However,BIS values were significantly lower in the nighttime group compared to the daytime group(P<0.05).Additionally,male patients required a higher total induced dose of rem-azolam than female patients during both day and night,with this difference being statistically significant(P<0.05).Furthermore,female patients exhibited a significant decrease in BIS values at night(P<0.05).Conclusions Recent studies have shown that circadian rhythm significantly influences anesthesia-induced sedation in patients undergoing general anesthesia with remazolam toluenesulfonate.Specifically,the sedation effect is more pronounced in nighttime procedures,and there is a notable gender difference,with female patients exhibiting better sedation outcomes during nighttime surgeries.

Objective:To summarize the characteristics of oral contrast ultrasound in patients with esophageal hiatal hernia (EHH), to screen the diagnostic criteria for EHH diagnosis by oral contrast ultrasound and to evaluate their diagnostic values.Methods:Sixty-one patients who visited the Hernia and Abdominal Wall Surgery Department of the Sixth Affiliated Hospital of Sun Yat-sen University from June 2023 to December 2023 for symptoms of acid reflux, heartburn, belching, recurrent epigastric pain, chest pain, and cough, and who were clinically suspected of EHH and underwent oral contrast ultrasound were retrospectively collected. The internal diameter of the esophageal hiatus, the length of the intraabdominal esophagus (IAEL), the angle of His, the supradiaphragmatic hernia sac, the sign of gastric wall sliding, and the sign of esophageal-gastric ring uplift were recorded by oral contrast ultrasound. All ultrasonographic data were retrospectively analyzed, and the diagnosis of EHH by surgery or with the simultaneous diagnosis of EHH by barium meal examination and gastroscopy were used as the gold standard. The diagnostic criteria of oral contrast ultrasound for EHH were obtained and their diagnostic values were evaluated by ROC curve analysis.Results:The indicators of EHH diagnosed by oral contrast ultrasound were analyzed according to ROC curves as follows: internal diameter of esophageal hiatus >15 mm (AUC=0.913), IAEL≤33 mm (AUC=0.776), angle of His > 90° (AUC=0.735), supradiaphragmatic hernia sac (AUC=0.913), gastric wall sliding sign (AUC=0.827), upward displacement of the esophagogastric ring (AUC=0.721). The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value, AUC, and 95% CI of the diagnosis of EHH using the internal diameter of the esophageal hiatus >15 mm or the presence of a supradiaphragmatic hernia sac as the diagnostic criterion for the diagnosis of EHH by oral contrast ultrasound were 86.5%, 100%, 88.5%, 100%, 56.3%, 0.933, and 0.838-0.981, respectively. Conclusions:The optimal diagnostic criterion for EHH diagnosis by oral contrast ultrasound is esophageal hiatal internal diameter >15 mm or the presence of supradiaphragmatic hernia sac, which has 100% specificity and positive predictive value. It is recommended to be widely used as a screening test for EHH in the clinic.

Cystatin, a cysteine protease inhibitor found in many parasites, plays important roles in immune evasion. This study analyzed the molecular characteristics of a cystatin from Fasciola hepatica (FhCystatin) and expressed recombinant FhCystatin (rFhcystatin) to investigate the immune modulatory effects on lipopolysaccharide-induced proliferation, migration, cytokine secretion, nitric oxide (NO) production, and apoptosis in mouse macrophages. The FhCystatin gene encoded 116 amino acids and contained a conserved cystatin-like domain. rFhCystatin significantly inhibited the activity of cathepsin B. rFhCystatin bound to the surface of mouse RAW264.7 cells, significantly inhibited cell proliferation and promoted apoptosis. Moreover, rFhCystatin inhibited the expression of cellular nitric oxide, interleukin-6, and tumor necrosis factor-α, and promoted the expression of transforming growth factor-β and interleukin-10. These results showed that FhCystatin played an important role in regulating the activity of mouse macrophages. Our findings provide new insights into mechanisms underlying the immune evasion and contribute to the exploration of potential targets for the development of new drug to control F. hepatica infection.

Background: Bovine papillomatosis is a type of proliferative tumor disease of skin and mucosae caused by bovine papillomavirus (BPV). As a transboundary and emerging disease in cattle, it poses a potential threat to the dairy industry. Objectives: The aim of this study is to detect and clarify the genetic diversity of BPV circulating in dairy cows in Xinjiang, China. Methods: 122 papilloma skin lesions from 8 intensive dairy farms located in different regions of Xinjiang, China were detected by polymerase chain reaction. The genetic evolution relationships of various types of BPVs were analyzed by examining this phylogenetic tree. Results: Ten genotypes of BPV (BPV1, BPV2, BPV3, BPV6, BPV7, BPV8, BPV10, BPV11, BPV13, and BPV14) were detected and identified in dairy cows. These were the first reported detections of BPV13 and BPV14 in Xinjiang, Mixed infections were detected, and there were geographical differences in the distribution of the BPV genotypes. Notably, the BPV infection rate among young cattle (< 1-year-old) developed from the same supply of frozen sperm was higher than that of the other young cows naturally raised under the same environmental conditions. Conclusions Genotyping based on the L1 gene of BPV showed that BPVs circulating in Xinjiang China displayed substantial genetic diversity. This study provided valuable data at the molecular epidemiology level, which is conducive to developing deep insights into the genetic diversity and pathogenic characteristics of BPVs in dairy cows.

Background: Bovine papillomatosis is a type of proliferative tumor disease of skin and mucosae caused by bovine papillomavirus (BPV). As a transboundary and emerging disease in cattle, it poses a potential threat to the dairy industry. Objectives: The aim of this study is to detect and clarify the genetic diversity of BPV circulating in dairy cows in Xinjiang, China. Methods: 122 papilloma skin lesions from 8 intensive dairy farms located in different regions of Xinjiang, China were detected by polymerase chain reaction. The genetic evolution relationships of various types of BPVs were analyzed by examining this phylogenetic tree. Results: Ten genotypes of BPV (BPV1, BPV2, BPV3, BPV6, BPV7, BPV8, BPV10, BPV11, BPV13, and BPV14) were detected and identified in dairy cows. These were the first reported detections of BPV13 and BPV14 in Xinjiang, Mixed infections were detected, and there were geographical differences in the distribution of the BPV genotypes. Notably, the BPV infection rate among young cattle (< 1-year-old) developed from the same supply of frozen sperm was higher than that of the other young cows naturally raised under the same environmental conditions. Conclusions Genotyping based on the L1 gene of BPV showed that BPVs circulating in Xinjiang China displayed substantial genetic diversity. This study provided valuable data at the molecular epidemiology level, which is conducive to developing deep insights into the genetic diversity and pathogenic characteristics of BPVs in dairy cows.

Objective To investigate the abnormal cerebral perfusion of unilateral ICA and VBA sclerotic stenosis by CT perfusion and DSA image.Methods Among 219 patients with ICS,the imaging (CTP,DSA) and clinical data from 120 patients with unilateral ICA sclerotic stenos(67 patients)and VBA sclerotic stenosis 53 patients were analyzed retrospectively.The degree of ICA sclerotic stenosis and collateral circulation were determined according to DSA results.Univariate analysis was used to explore the effects of stenosis degree of ICA and VBA sclerosis,establishment of collateral circulation and stroke risk factors on cerebral perfusion.Results The degree of unilateral ICA and VBA sclerosis stenosis has a low-degree positive correlation with cerebral perfusion (r=0.249,P=0.042,P=0.025;r=0.381,P=0.005,P=0.007),which is statistically significant.The collateral circulation of unilateral ICA stenosis (13 cases of normal perfusion and 12 cases of hypoperfusion) was significantly different from cerebral perfusion (P=0.041).There was no statistical significance between abnormal CTP perfusion and stroke factors (P>0.05).Fifty three cases of VBA sclerosis stenosis (19 cases of low perfusion include VBA severe stenosis 5 and occlusion 14;34 cases of normal perfusion group include 22 cases of severe stenosis and 12 cases of occlusion).There was no statistical significance between the establishment of collateral circulation (23 cases in the normal perfusion group and 8 cases in the low perfusion group) and the influencing factors of stroke (P>0.05).Conclusion There was a low positive correlation between the degree of sclerotic stenosis of ICA and VBA and cerebral perfusion.The establishment of collateral circulation can improve the state of cerebral blood flow to a certain extent.

Fluid therapy is a crucial treatment for patients with extensive burn, which affects patients′prognosis directly. Accurate urine output measurement plays an irreplaceable role in guiding fluid resuscitation in clinic. As one of the best indexes in traditional burn resuscitation, urine output comprehensively reflects systemic circulation. However, it doesn′t fully reflect all the specific chapters of microcirculation and systemic circulation and deficient cellular oxygen metabolism exactly. We need to use urine output combined with other shock parameters to ensure adequate fluid replacement. Currently, the most common way of urine output monitoring is manual measurement. The article reviews the application of urine output monitoring in guiding fluid resuscitation of burn shock.