Objective To explore the influence of different doses of remimazolam for general anesthesia induction on tracheal intubation stress response and hemodynamics in patients undergoing radical resection of colon cancer.Methods From August 2020 to August 2023,75 patients undergoing radical resection of colon cancer were induced by general anesthesia using remazolam.According to the random number table method,they were divided into group A(25 cases,0.2 mg/kg of remimazolam),group B(25 cases,0.3 mg/kg of remimazolam)and group C(25 cases,0.4 mg/kg of remimazolam).The stress response status[cortisol(Cor),epinephrine(E),norepinephrine(NE)]and hemodynamics[heart rate(HR),mean arterial pressure(MAP)]before anesthesia(T0),at tracheal intubation(T1),at 30 min after intubation(T2)and at 10 min after extubation(T3),anesthesia recovery status and total incidence rate of adverse anesthesia reactions were compared among the three groups.Results At T0,there were no obvious differences in the levels of Cor,E,NE,HR,SVI and MAP among the three groups(P＞0.05).At T1-T3,the levels of Cor,E and NE in group A[T1:(181.76±12.49)pg/ml,(67.94±2.66)ng/ml,(355.12±19.82)ng/ml;(231.90±15.82)pg/ml,(72.15±2.83)ng/ml,(379.86±20.31)ng/ml;T3:(300.65±17.43)pg/ml,(77.82±2.85)ng/ml,(405.31±24.36)ng/ml]were higher than those in group B[T1:(172.31±12.07)pg/ml,(66.22±2.73)ng/ml,(326.47±19.24)ng/ml;T2:(214.75±14.88)pg/ml,(70.34±2.79)ng/ml,(354.18±20.66)ng/ml;T3:(279.08±16.62)pg/ml,(75.03±2.81)ng/ml,(387.05±22.82)ng/ml]and group C[T1:(165.44±11.74)pg/ml,(64.01±2.75)ng/ml,(300.66±19.50)ng/ml;T2:(200.42±14.35)pg/ml,(67.59±2.80)ng/ml,(330.18±21.05)ng/ml;T3:(251.33±16.08)pg/ml,(72.44±2.70)ng/ml,(354.11±22.07)ng/ml](P＜0.05).At T1-T2,the HR and MAP were higher in group A[T1:(79.49±4.05)beats/min,(96.09±1.77)mmHg;T2:(76.55±3.83)beats/min,(94.88±1.55)mmHg]than those in group B[T1:(76.22±3.89)beats/min,(95.01±1.63)mmHg;T2:(74.23±3.76)beats/min,(93.89±1.51)mmHg]and group C[T1:(73.65±3.81)beats/min,(94.02±1.61)mmHg;T2:(71.55±3.61)beats/min,(92.97±1.46)mmHg](P＜0.05).There were no significant differences in HR and MAP among the three groups at T3(P＞0.05).The time of breathing recovery,open eye and extubation in group C was significantly longer compared with that in group A and group B(P＜0.05).There were no significant difference in total incidence rate of anesthesia adverse reactions between group B and group A,group C(P＞0.05).Conclusion 0.3 mg/kg remimazolam in patients undergoing radical resection of colon cancer has an ideal sedative effect,and it has small impact on stress response and hemodynamics,and has fast postoperative recovery and high safety.

Objective To explore the influence of different doses of remimazolam for general anesthesia induction on tracheal intubation stress response and hemodynamics in patients undergoing radical resection of colon cancer.Methods From August 2020 to August 2023,75 patients undergoing radical resection of colon cancer were induced by general anesthesia using remazolam.According to the random number table method,they were divided into group A(25 cases,0.2 mg/kg of remimazolam),group B(25 cases,0.3 mg/kg of remimazolam)and group C(25 cases,0.4 mg/kg of remimazolam).The stress response status[cortisol(Cor),epinephrine(E),norepinephrine(NE)]and hemodynamics[heart rate(HR),mean arterial pressure(MAP)]before anesthesia(T0),at tracheal intubation(T1),at 30 min after intubation(T2)and at 10 min after extubation(T3),anesthesia recovery status and total incidence rate of adverse anesthesia reactions were compared among the three groups.Results At T0,there were no obvious differences in the levels of Cor,E,NE,HR,SVI and MAP among the three groups(P＞0.05).At T1-T3,the levels of Cor,E and NE in group A[T1:(181.76±12.49)pg/ml,(67.94±2.66)ng/ml,(355.12±19.82)ng/ml;(231.90±15.82)pg/ml,(72.15±2.83)ng/ml,(379.86±20.31)ng/ml;T3:(300.65±17.43)pg/ml,(77.82±2.85)ng/ml,(405.31±24.36)ng/ml]were higher than those in group B[T1:(172.31±12.07)pg/ml,(66.22±2.73)ng/ml,(326.47±19.24)ng/ml;T2:(214.75±14.88)pg/ml,(70.34±2.79)ng/ml,(354.18±20.66)ng/ml;T3:(279.08±16.62)pg/ml,(75.03±2.81)ng/ml,(387.05±22.82)ng/ml]and group C[T1:(165.44±11.74)pg/ml,(64.01±2.75)ng/ml,(300.66±19.50)ng/ml;T2:(200.42±14.35)pg/ml,(67.59±2.80)ng/ml,(330.18±21.05)ng/ml;T3:(251.33±16.08)pg/ml,(72.44±2.70)ng/ml,(354.11±22.07)ng/ml](P＜0.05).At T1-T2,the HR and MAP were higher in group A[T1:(79.49±4.05)beats/min,(96.09±1.77)mmHg;T2:(76.55±3.83)beats/min,(94.88±1.55)mmHg]than those in group B[T1:(76.22±3.89)beats/min,(95.01±1.63)mmHg;T2:(74.23±3.76)beats/min,(93.89±1.51)mmHg]and group C[T1:(73.65±3.81)beats/min,(94.02±1.61)mmHg;T2:(71.55±3.61)beats/min,(92.97±1.46)mmHg](P＜0.05).There were no significant differences in HR and MAP among the three groups at T3(P＞0.05).The time of breathing recovery,open eye and extubation in group C was significantly longer compared with that in group A and group B(P＜0.05).There were no significant difference in total incidence rate of anesthesia adverse reactions between group B and group A,group C(P＞0.05).Conclusion 0.3 mg/kg remimazolam in patients undergoing radical resection of colon cancer has an ideal sedative effect,and it has small impact on stress response and hemodynamics,and has fast postoperative recovery and high safety.

Objective To investigate the correlation between the total CSVD burden and fundus vasculopathy,and evaluate significance of fundus vasculopathy for cognitive impairment in CSVD patients.Methods A total of 290 inpatients who taking physical examination in our department from May 2021 to August 2022 were consecutively recruited,and according to their score of CSVD,they were divided into group 0(129 cases),group 1(51 case),group 2(42 cases),group 3(44 cases),and group 4(24 cases).All the subjects underwent brain magnetic resonance imaging,fundus fluorescein angiography,and cognitive function assessment.The total CSVD burden and fundus vasculopathy were evaluated.The general clinical data,results of laboratory tests,fundus vascularization,and cognitive function were compared among the groups with different CSVD burden scores.Spearman correlation analysis and linear correlation analysis were used to explore the correlation between total CSVD burden score and fundus vascular disease.Results Significant differences were observed in terms of age,years of education,cerebral infarction/TIA,total cho-lesterol,LDL-C,creatinine,MoC A and MMSE scores,positive results of connectivity test,digit-symbol conversion test,Stroop colour-word interference test and verbal fluency test,values of CRAE,CRVE,AVR,Scheie grade,DWMH and PVWMH,enlarged perivascular space in the basal ganglia(BG-EPVS),lacunar infarct and cerebral microbleeds(CMB)in different CSVD total bur-den groups(P＜0.05,P＜0.01).Spearman correlation analysis showed that total CSVD burden was negatively correlated with CRAE and AVR(r=-0.655,P=0.000;r=-0.679,P=0.000),and positively with CRVE and Scheie grade(r=0.560,P=0.000;r=0.685,P=0.000).Multivari-ate linear analysis showed that the total CSVD burden after adjusting for relevant risk factors was significantly correlated with CRAE,CRVE,AVR and Scheie grades(P＜0.01).Conclusion Fun-dus vasculopathy is strongly associated with increased total CSVD burden,and it can be regarded as a valid predictor of CSVD-related cognitive impairment.

Objective To investigate the incidence of motoric cognitive risk(MCR)syndrome and declines in both motor and cognitive functions in elderly patients with enlarged perivascular spaces(EPVS).Methods A total of 113 patients(≥60 years old)with EPVS identified by head MRI admitted to our department from March 1 to November 30,2023 were consecutively recrui-ted,and according to having MCR syndrome or not,they were divided into MCR group(44 cases)and non-MCR group(69 cases).Cognitive function and motor function were assessed with aid of Montreal Cognitive Scale(MoCA),Simple Mental State Examination Scale(MMSE),trail making test,and motor function assessments,including Tinetti Balance and Gait Scale,Short Physical Performance Battery(SPPB),8-meter walk,Timed up and Go test(TUGT),walking and contin-uous subtraction task(WSS),walking and semantic fluency task(WSF),and TUGT and serial subtraction task(TUGSS).The motor and cognitive functions were compared between the two groups,and the risk factors related to MCR syndrome in EPVS patients were analyzed by multi-variate logistic regression.Results Compared with the non-MCR group,the MCR group had low-er MoCA score,total SPPB score,8-meter walk speed,and longer times of TMT-A,TMT-B,WSS,WSF and TUGSS(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that in Model 1(including variables with differences in univariate analysis),MoCA score,8-meter walk speed,and TUGSS time were independent risk factors for MCR syndrome in EPVS patients(P＜0.05,P＜0.01);in Model 2(adjusting for age,sex,education level,and comorbidities),MoCA score(OR=0.621,95％CI:0.432-0.929,P=0.010),8-meter walk speed(OR=1.332,95％CI:1.115-1.591,P=0.002),and TUGSS time(OR=0.393,95％CI:0.232-0.665,P=0.001)re-mained independent risk factors for MCR syndrome in EPVS patients.Conclusion Among elderly EPVS patients,those with MCR syndrome show significantly worse cognitive and motor function compared to those without.MoCA score,8-meter walk speed,and TUGSS time are related factors for MCR occurrence in EPVS patients.

Objective:The aim of this study was to design and perform "Tap-hammer"system that can be used to elicit vestibular evoked myogenic potentials (VEMP) in normal adults and to report the preliminary results of this system.Methods:A triggered Tap-hammer was designed, made and connected with an electric recording system, to form as a system for Tap-VEMP recording. Twenty healthy adult volunteers (7 males and 13 females, aged 20 to 37 years, 40 ears in total) were recruited for air-conducted sound VEMP (ACS-VEMP) and Tap-VEMP examinations. Waveforms and parameters of both VEMPs were recorded and analyzed. SPSS 22.0 software was used for statistical analysis.Results:The response rates of ACS-, Tap-ocular VEMP (oVEMP) and ACS-, Tap-cervical VEMP (cVEMP) were both 100% (40/40). The mean±SD n1 latency, p1 latency, n1-p1 interval, amplitude, and asymmetry ratio (AR%) of Tap-oVEMP were (9.80±2.51)ms, (13.90±3.26)ms, (4.09±1.43)ms, (16.43±9.61)μV, (22.68±17.35)% respectively. The mean±SD p1 latency, n1 latency, p1-n1 interval, amplitude, and asymmetry ratio (AR%) of Tap-cVEMP were (13.26±2.07)ms, (21.84±2.89)ms, (8.58±2.10)ms, (457.65±274.94)μV, (20.42±13.46)% respectively. Both n1 latency and p1 latency of Tap-VEMPs were shorter than those in ACS-VEMPs ( P<0.05). No statistical difference could be found between the two stimulation methods in the parameters of n1-p1 interval, amplitude, and asymmetry ratio( P>0.05). Conclusion:The Tap-hammer system can elicit VEMP responses in healthy young people. This system can be used as an alternative stimulation method for bone conduction VEMP.

Objective To construct and explore the in vivo and in vitro D-galactose induced cognitive impairment models and evaluate the application value of the combined models in the study of cognitive impairments.Methods The cognitive impairment mice model induced by D-gal was prepared by continuous intraperitoneal injection of D-gal saline solution for 8weeks, followed by detection of learning and memory functions with Morris water maze.The related molecular markers in the brain tissue were assayed to evaluate the effect and application value.D-gal cell model was prepared by adding D-gal in different concentrations into the cell cultural medium of neurons harvested from the hippocampus of young mice.The effect and application value were evaluated by detecting the molecular markers related to the level of cell injury.Results The Morris water maze on the D-gal model showed that the learning and memory functions of mice in the model group were significantly lower than those in the control group.Meanwhile, the levels of apoptosis and oxidative stress in the model group were significantly higher than those in the control group.In the hippocampal neuron model of D-gal, the neurons showed a dose-dependent morphologic and functional change with the increase of D-gal dose and the levels of apoptosis and oxidative stress were significantly higher than those in the negative control.Conclusion D-galactose can be successfully used to induce cognitive impairment models both in vivo and in vitro through the decrease of the learning and memory functions of mice and induction of apoptosis and oxidative stress in neurons.Combined application of the two models of D-gal can be one of effective and promising tools for the study of cognitive impairment and pharmacodynamic evaluation.

Objective To investigate the protective effects of N-acetyl-L-tryptophan (L-NAT) on intestinal damage after rat hepatic ischemia reperfusion.Methods Twenty-four healthy adult rats were divided into the sham operation group (Sham),ischemia reperfusion group (IR),ischemia reperfusion and N-acetyl-L-tryptophan group(IR+L-NAT).The hepatic ischemia reperfusion model was established by occluding the afferent vessels of the left and middle lobes.The morphological structures of the small intestine were observed by hematoxylin-eosin (HE) staining.The expressions of active caspase-3,Bax and Bcl-2 were detected by immunohistochemistry staining.Results (1) In the IR group,the structure of intestinal villis was destroyed,the intestinal mucosa showed congestion and exfoliation,the epithelial cells had degeneration and necrosis,and infiltration of inflammatory cells appeared;which could be alleviated by L-NAT.(2)The immunohistochemistry showed that compared with the Sham group,the expression of active caspase-3,Bcl-2 and Bax in the IR group was increased,after L-NAT intervention,the Bax and caspase-3 expression was decreased,while the Bcl-2 expression was further increased.Conclusion L-NAT could inhibit the apoptosis of small intestinal epithelial cells caused by liver ischemic reperfusion and attenuates intestinal epithelial damage.

The hydroa vacciniforme -like lymphoma is clinically manifested by rash ,fever,hepatospleno-megaly and lymphadenectasis .Pathological character showed that lymphocytes infiltrated into dermis and there were some heterocysts.Immunohistochemistory showed that Bcl -6,Bcl -2,CD3,CD8,TIA,CD4,granzyme, EBER were positive,CD56,CD20 all tested negative.The rearrangement of TCR of bone marrow cell was positive . The hydroa vacciniforme-like lymphoma is uncommon clinically ,and it is easy to misdiagnosed .The effect of tra-ditional therapy is poor ,while the allogeneic hematopoietic stem cell transplantation followed by lymphocyte and donor-derived EBV-specific cytotoxic T -lymphocyte immunotherapy is effective ,which may offer an curable therapy for HVLL.