Objective:To evaluate the effect of the remimazolam-flumazenil regimen on the emergence of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).Methods:Eighty-four American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients, regardless of gender, aged 18-78 yr, with body mass index of 18-30 kg/m 2, undergoing elective ERCP under general anesthesia, were allocated into 2 groups ( n=42 each) using a random number table method: remimazolam-flumazenil group (RF group) and propofol group (P group). Anesthesia was induced as follows: Remimazolam 0.2 mg/kg and remifentanil 2 μg/kg were intravenously injected in RF group, and propofol 1.5 mg/kg and remifentanil 2 μg/kg were intravenously injected in P group. Anesthesia was maintained as follows: Remimazolam was intravenously infused at a rate of 0.5-2.0 mg·kg -1·h -1 and remifentanil at a rate of 0.1-0.2 μg·kg -1·min -1 in RF group, and propofol was intravenously infused at a rate of 2-8 mg·kg -1·h -1 and remifentanil at a rate of 0.1-0.2 μg·kg -1·min -1 in P group, maintaining a bispectral index value of 40-60. At the end of procedure, RF group received an intravenous injection of flumazenil at 0.2 mg, while P group received an equal volume of normal saline. The emergence time, laryngeal mask removal time, duration of post-anesthesia care unit stay, development of adverse events during the emergence period, patients′ satisfaction scores, endoscopists′ satisfaction scores, and 15-item Quality of Recovery scale scores at 24 h after operation were recorded. Results:Compared to P group, the emergence time, laryngeal mask removal time and duration of post-anesthesia care unit stay were significantly shortened, and the incidence of euphoria was decreased in RF group ( P<0.05). There were no statistically significant differences between the two groups in the incidence of agitation, dizziness, nausea/vomiting, and re-sedation, patients′ satisfaction scores, endoscopists′ satisfaction scores, and 15-item Quality of Recovery scale scores at 24 h after operation ( P>0.05). Conclusions:Compared to propofol, the remimazolam-flumazenil regimen can shorten the emergence time and improve the quality of recovery when used for ERCP procedures.

Objective:To evaluate the effect of remimazolam on hemodynamics when used for anesthesia induction in patients undergoing coronary artery bypass grafting (CABG).Methods:Sixty patients of either sex, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ-Ⅲ, with ejection fraction>35%, cardiac index (CI) >2.0 L·min -1·m -2 and body mass index <28 kg/m 2, undergoing CABG under general anesthesia, were divided into 2 groups ( n=30 each)using a random number table method: remazolam group (group R) and midazolam group (group M). Group R received intravenous remimazolam 0.08 mg/kg, and group M received intravenous midazolam 0.05 mg/kg, and both groups used sufentanil, etomidate, and rocuronium bromide for anesthesia induction to maintain the BIS value at 40-65. Before anesthesia induction, at 1-2 min after intravenous injection of remimazolam/midazolam-sufantanil-etomidate, immediately before tracheal incubation, at 30 s-15 min after tracheal intubation, and immediately before skin incision, blood pressure, heart rate, mean arterial pressure, CI, stroke volume index, systemic vascular resistance index, and left heart systolic index were measured, and vasoactive drugs were used to maintain the stability of vital signs and to record the cardiovascular events. Results:Compared with group M, the incidence of hypotension and usage rate of vasoactive drugs were significantly decreased, and the incidence of decrease in CI and stroke volume index by more than 20% and changes in left heart systolic index were decreased in group R( P<0.05). Conclusions:Remimazolam can reduce the disturbance of hemodynamics to a certain extent when used for anesthesia induction as compared with midazolam in patients undergoing CABG.

Objective::The purpose of this study was to determine the relationship between remnant-like particle cholesterol (RLP-C) and major adverse cardiovascular events (MACEs) in patients with different levels of proprotein convertase subtilisin/kexin 9 (PCSK9).Methods::From September 2007 to January 2009, 1,859 subjects in Pingguoyuan communities in Beijing were initially screened. After excluding those with bedridden status, mental illness, severe systemic diseases, and missing data, 1,680 subjects were recruited for follow up. All recruited subjects were followed up from February 2013 to September 2013 (181 subjects were lost to follow-up) and from June 2017 to September 2018 (174 subjects were lost to follow up). Finally, 1,325 subjects were included in the study. General demographic characteristics, lifestyle and behaviors, disease history and use of medication was collected. Levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fast blood glucose, RLP-C, low-density lipoprotein triglycerides and PCSK9 were measured. The levels of RLP-C (low: RLP-C ≤ 157 mg/L; high: RLP-C > 157 mg/L) and PCSK9 (low: PCSK9 ≤ 135.87 μg/L; high: PCSK9 > 135.87 μg/L) were represented using quartiles. Subjects were categorized into 4 groups according to their RLP-C and PCSK9 levels: Q4, high levels of RLP-C with high levels of PCSK9; Q3, high levels of RLP-C with low levels of PCSK9; Q2, low levels of RLP-C with high levels of PCSK9; and Q1, low levels of RLP-C with low levels of PCSK9. The association of RLP-C with MACEs in subjects with different PCSK9 levels was evaluated.Results::After a median follow-up of 9.5 years, 1,325 subjects were included in the study and a total of 191 MACEs had occurred. The incidence of MACEs was higher in the RLP-C > 157 mg/L group than the RLP-C ≤ 157 mg/L group (18.40% vs. 10.42%). Cox proportional hazards regression model analysis showed that increased RLP-C levels were associated with an increased risk of MACEs (hazard ratio: 1.405; 95% confidence interval: 1.005-1.964; P < 0.005). The incidence of MACEs was higher in the high RLP-C/PCSK9 group vs. the low RLP-C/PCSK9 group (20.68% vs. 8.76%). Cox proportional hazards regression model analysis showed that RLP-C was associated with an increased risk of MACEs in subjects with high PCSK9 levels independent of traditional risk factors (hazard ratio: 1.791; 95% confidence interval: 1.168-2.825; P = 0.001), but not in those with low PCSK9 levels. Conclusions::RLP-C was identified as a risk factor for MACEs, particularly in subjects with high PCSK9 levels. Lowering PCSK9 levels may reduce residual risk in subjects with elevated plasma RLP-C levels.

Objective::The purpose of this study was to determine the relationship between remnant-like particle cholesterol (RLP-C) and major adverse cardiovascular events (MACEs) in patients with different levels of proprotein convertase subtilisin/kexin 9 (PCSK9).Methods::From September 2007 to January 2009, 1,859 subjects in Pingguoyuan communities in Beijing were initially screened. After excluding those with bedridden status, mental illness, severe systemic diseases, and missing data, 1,680 subjects were recruited for follow up. All recruited subjects were followed up from February 2013 to September 2013 (181 subjects were lost to follow-up) and from June 2017 to September 2018 (174 subjects were lost to follow up). Finally, 1,325 subjects were included in the study. General demographic characteristics, lifestyle and behaviors, disease history and use of medication was collected. Levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fast blood glucose, RLP-C, low-density lipoprotein triglycerides and PCSK9 were measured. The levels of RLP-C (low: RLP-C ≤ 157 mg/L; high: RLP-C > 157 mg/L) and PCSK9 (low: PCSK9 ≤ 135.87 μg/L; high: PCSK9 > 135.87 μg/L) were represented using quartiles. Subjects were categorized into 4 groups according to their RLP-C and PCSK9 levels: Q4, high levels of RLP-C with high levels of PCSK9; Q3, high levels of RLP-C with low levels of PCSK9; Q2, low levels of RLP-C with high levels of PCSK9; and Q1, low levels of RLP-C with low levels of PCSK9. The association of RLP-C with MACEs in subjects with different PCSK9 levels was evaluated.Results::After a median follow-up of 9.5 years, 1,325 subjects were included in the study and a total of 191 MACEs had occurred. The incidence of MACEs was higher in the RLP-C > 157 mg/L group than the RLP-C ≤ 157 mg/L group (18.40% vs. 10.42%). Cox proportional hazards regression model analysis showed that increased RLP-C levels were associated with an increased risk of MACEs (hazard ratio: 1.405; 95% confidence interval: 1.005-1.964; P < 0.005). The incidence of MACEs was higher in the high RLP-C/PCSK9 group vs. the low RLP-C/PCSK9 group (20.68% vs. 8.76%). Cox proportional hazards regression model analysis showed that RLP-C was associated with an increased risk of MACEs in subjects with high PCSK9 levels independent of traditional risk factors (hazard ratio: 1.791; 95% confidence interval: 1.168-2.825; P = 0.001), but not in those with low PCSK9 levels. Conclusions::RLP-C was identified as a risk factor for MACEs, particularly in subjects with high PCSK9 levels. Lowering PCSK9 levels may reduce residual risk in subjects with elevated plasma RLP-C levels.

Objective:To evaluate the effect of long-chain non-coding RNA MEG3(LncRNA MEG3) on the radiosensitivity of cervical cancer cells, and to explore its underlying mechanism.Methods:The expression of LncRNA MEG3 in cervical cancer cells was detected by qRT-PCR. In the overexpression control group (transfected with pcDNA 3.1), LncRNA MEG3 overexpression group (transfected with pcDNA 3.1-LncRNA MEG3), miR-NC inhibition group (transfected with anti-miR-NC), miR-181a-5p inhibition group (transfected with anti-miR-181a-5p), LncRNA MEG3+ miR-NC overexpression group (co-transfected with pcDNA3.1-LncRNA MEG3 and anti-miR-NC), LncRNA MEG3+ miR-181a-5p overexpression group (co-transfected with pcDNA 3.1-LncRNA MEG3 and anti-miR-181a-5p), all plasmids were transfected into SiHa cells by liposome method. The cell survival fraction was assessed by colony formation assay. The cell apoptosis rate was evaluated by flow cytometry. The cell fluorescence activity was assessed by dual luciferase reporter assay. The expression levels of PTEN, p-Akt and Akt proteins were detected by Western blot.Results:Compared with the radiosensitive group, the expression of LncRNA MEG3 was significantly down-regulated in radiation-resistant cervical cancer tissues ( P<0.05), and its expression level was positively correlated with the sensitivity of cervical cancer cells. Overexpression of LncRNA MEG3 or inhibition of miR-181a-5p could significantly enhance the irradiation sensitivity and promote the apoptosis of cervical cancer cell line SiHa (both P<0.05). The fluorescence activity of wild-type LncRNA MEG3 cells was inhibited by miR-181a-5p. Overexpression of miR-181a-5p reversed the irradiation sensitization and pro-apoptosis effect of LncRNA MEG3 and the regulation of the PTEN/Akt signaling pathway on cervical cancer cell. Conclusion:LncRNA MEG3 can enhance the sensitivity of cervical cancer cells to radiation exposure, probably by targeting the miR-181a-5p and regulating the PTEN/Akt signaling pathway, which will provide a new direction for improving clinical prognosis of cervical cancer patients.

Objective To analyze and explore the clinical value of CYP2C19 genetic polymorphism in the treatment of refractory gastroesophageal reflux disease.Methods The CYP2C19 genetic polymorphism was detected and analyzed in 198 RGERD patients.According to genotyping,the patients were divided into extensive metabolism and poor metabolism.Each patient was filled in RDQ and LA Classification(from A to D) by endoscopy before and after 8 weeks of PPI treatment.Results There were 160 cases in EM group,mean age 53.23-± 14.52 years old.There were 38 cases in PM group,mean age 52.11 ± 12.13 years old.And all patients were treated with omeprazole 20 mg (twice daily).The mean score of RDQ in the PM group was significantly decreased after 8 weeks,and the esophageal mucosal lesion was significantly improved by endoscopy(P ＜ 0.05),but there was no significant difference in EM group with RDQ and LA (P ＞ 0.05).Conclusion The RGERD patients with poor metabolism group of CYP2C19 using proton pump inhibitors can achieve better efficacy.Theoretically,increasing the PPI dose can achieve the desired effect in the patients of EM group.So the clinician can be based on metabolic typing to achieve individualized medication and rationalization of medication.

Objective To study the influence of hierarchical psychological nursing on anxiety, depression, 5-hydroxytryptamine (5-HT) and Galanin (GAL) of patients with gastroesophageal reflux disease. Methods A total of 238 gastroesophageal reflux disease patients were divided into study group( n=119) and control group( n=119) by random number table. Two groups of patients were given the same routine care. Based on this, patients in the control group were given conventional psychological nursing, the study group were given hierarchical psychological nursing. SAS and SDS were used to evaluate the two group patients mental status before and after different mental care. Enzyme linked immunosorbent assay ( ELISA) was used to evaluate the contents of 5-HT and GAL of the two groups.Results After 4 weeks of hierarchical psychological nursing, SAS and SDS scores of the study group were (41.47±9.37) and (42.13±12.36). Those scores of the control group were (45.68±14.81) and (48.15±14.21). The differences were significant (t=2.62,3.49;P<0.05). After 4 weeks of hierarchical psychological nursing, 5-HT and GAL contents of the study group were (166.05±63.66) ng/ml and (23.18±8.74)pg/ml. Those contents of the control group were (146.30±63.75)ng/ml and (25.45± 9.03)pg/ml. The differences were significant (t=2.39,1.97;P<0.05).Conclusions Hierarchical psychological nursing can decrease anxiety and depression of patients with gastroesophageal reflux disease and help the contents of GAL and 5-HT return to normal level gradually. It is worthy of clinical promotion and popularization.

Objective： To study the changes of water molecular diffusion in the ischemic region by using MR dephase technique and discuss the potential mechanism of the diffusion changes at early stage. Methods: Totally 43 cases were studied retrospectively. There were 10 cases whose MRI examinations were performed within 6 hours，12 cases from 7－24 hours，7 cases from 2－7 days, 8 cases from 8－14 days, 6 cases from 15 days to 2 months. The apparent diffusion coefficients in the ischemic region were calculated. Results: The ADCav in the grey matter was 8.61×10－4mm2*s－1. The ADCav decreased to (4.72×10－4±1.51×10－4) mm2*s－1 in ischemic region at superacute stage, ADCav ratio to contralateral corresponding region was 0.55±0.18, and ADCav increased to (5.68×10－4±1.22×10－4) mm2*s－1 during the time range of 2-7 days, （9.22×10－4±2.07×10－4） during the time range of 8－14 days, and approaching （26.42×10－4+9.65×10－4） mm2*s－1 during the time range of 2 months. The pearson product- moment correlation between the changes of diffusion value and time was sighificent (r=0.95, P<0.001). ADCv increased at superacute stage and decreased over time. Conclusion: The diffusion of water molecules in ischemic region decreased at superacute stage, and the ADC increased over time. The anisotropy increased at superacute stage and decreased as the course developed. DWI could detect ischemic lesion much earlier than CT and routine MR examination. DWI has great value in the diagnosis of superacute stroke. The mechanism of the diffusion changes at early stage may be the intracellular toxicity edema.

Objective To summarize the clinical characters, diagnostic and therapeutic strategy of the cured patient with human H5N1 avian influenza pneumonia in mainland of China,and to provide effective experiences for the physicians to diagnose human avian influenza infection.Methods The clinical data of the cured patient with H5N1 avian influenza infection in China was analyzed.Results The patient was treated with short-term symmetrel and ribavirin for antiviral therapy companied with the lowdosage and long-term(4 weeks) glucocorticoid therapy.The CPAP assistant ventilation was used and the airway was kept unobstructed.The antibiotic was used to prevent and control the followed infection.The supportive treatment was applied to protect the organ′s function of the patient.The pathogenetic condition of the patient became better with the hemogram risen and the lungs pathological changes absorbed gradually.The chest CT reexamined at the 7th day of the hospitalized-term suggested that the left lung fibrosis started to be absorbed and it was obviously absorbed at the 16th day.The breath function and all the internal organs functions became better.The patient convalesced and left hospital at the 46th day.Conclusion In the human avian influenza infection,the pathogenetic condition may progress quickly after the pneumonia appears.The lung injury and lung fibrosis as well as the multi-organs dysfunction were emerged in the patient rapidly.The progression of disease can be controlled and the prognosis can be improved by the prompt and correct treatment.