Objective To explore the impacts of remimazolam on intraoperative intracranial pressure(ICP)and cerebral oxygenation in patients undergoing laparoscopic lower abdominal and pelvic surgery under CO2 pneumoperitoneum combined with Trendelenburg position.Methods Eighty-eight patients scheduled to undergo laparoscopic lower abdominal and pelvic surgery were randomly assigned to the remimazolam group(n=44)and the sevoflurane group(n=44).In the remimazolam group,continuous infusion of remimazolam at a rate of 1 mg/(kg·h)was administered for anesthesia maintenance.In contrast,the sevoflurane group inhaled 2％sevoflurane.Heart rate(HR),mean arterial pressure(MAP),peak airway pressure(Peak),plateau airway pressure(Plat),end-tidal CO2(PETCO2),regional cerebral oxygen saturation(rSO2),and optic nerve sheath diameter(ONSD)of both eyes were measured and recorded at the following time points:prior to anesthesia induction(T0),5 minutes after induction(T1),10 minutes(T2),30 minutes(T3),and 60 minutes(T4)after the establishment of pneumo-peritoneum in Trendelenburg position,as well as 30 minutes after deflation in the supine position(T5).Results No significant intergroup differences were detected in HR,MAP,Peak,Plat,or PETCO2 at any time point(P>0.05).In both groups,Peak and Plat values were significantly higher at T2-T4 compared to T1(P<0.05).Regard-ing the ONSD)no intergroup differences were noted at T0 and T1(P>0.05).From T2 to T5,ONSD in both groups increased significantly relative to T0..It gradually rose with the prolongation of pneumoperitoneum and Trendelen-burg positioning and showed a slight decrease at T5(P<0.05).Specifically,at T3 and T4,the remimazolam group exhibited significantly smaller ONSD values than the sevoflurane group(P<0.05).Throughout the study,no inter-group differences in rSO2 were observed(P>0.05).Conclusion In laparoscopic lower abdominal and pelvic surgeries performed in the Trendelenburg position,intravenous anesthesia with remimazolam may be more effective in mitigating the elevation of intracranial pressure compared to sevoflurane inhalation.

Objective:To evaluate the relationship between the mechanism of buprenorphine in attenuating neuroinflammation in microglia and the MAM domain-containing glycosylphosphatidylinositol anchor gene 1 ( MDGA1). Methods:The human microglial cell line HMC-3 was cultured in vitro and divided into 4 groups ( n=6 each) using a table of random numbers: control group (Con group), lipopolysaccharide(LPS)group, buprenorphine + LPS group (Bup+ LPS group) and buprenorphine + LPS + MDGA1 knockdown group (Bup+ LPS+ shMDGA1 group). LPS group was incubated with LPS at a final concentration of 1 μg/ml for 4 h. Bup+ LPS group was incubated with buprenorphine at a final concentration of 100 ng/ml for 1 h, followed by incubation with LPS at a final concentration of 1 μg/ml for 4 h. Bup+ LPS+ shMDGA1 group was transfected with MDGA1-specific shorthairpin RNA for knockdown, and the remaining treatment was similar to those previously described in Bup+ LPS group. The expression of MDGA1 in microglia was detected using real-time quantitative polymerase chain reaction, and the concentrations of interleukin (IL)-6, IL-1β, tumor necrosis factor-α (TNF-α), and inducible nitric oxide synthase (iNOS) in the supernatant were measured using enzyme-linked immunosorbent assay. Results:Compared with Con group, the concentrations of IL-6, IL-1β, TNF-α and iNOS in the supernatant were significantly increased, and the expression of MDGA1 in microglia was down-regulated in LPS group ( P<0.05). Compared with LPS group, the concentrations of IL-6, IL-1β, TNF-α and iNOS in the supernatant were significantly decreased, and the expression of MDGA1 in microglia was up-regulated in Bup+ LPS group ( P<0.05). Compared with Bup+ LPS group, the concentrations of IL-6, IL-1β, TNF-α and iNOS in the supernatant were significantly increased, and the expression of MDGA1 in microglia was down-regulated in Bup+ LPS+ sh MDGA1 group ( P<0.05). Conclusions:The mechanism by which buprenorphine alleviates neuroinflammation in microglia may be related to the up-regulation of the expression of MDGA1.

Schizophrenia (SZ) stands as a severe psychiatric disorder. This study applied diffusion tensor imaging (DTI) data in conjunction with graph neural networks to distinguish SZ patients from normal controls (NCs) and showcases the superior performance of a graph neural network integrating combined fractional anisotropy and fiber number brain network features, achieving an accuracy of 73.79% in distinguishing SZ patients from NCs. Beyond mere discrimination, our study delved deeper into the advantages of utilizing white matter brain network features for identifying SZ patients through interpretable model analysis and gene expression analysis. These analyses uncovered intricate interrelationships between brain imaging markers and genetic biomarkers, providing novel insights into the neuropathological basis of SZ. In summary, our findings underscore the potential of graph neural networks applied to multimodal DTI data for enhancing SZ detection through an integrated analysis of neuroimaging and genetic features.
Humans ; Schizophrenia/pathology* ; Diffusion Tensor Imaging/methods* ; Male ; Female ; Adult ; Brain/metabolism* ; Young Adult ; Middle Aged ; White Matter/pathology* ; Gene Expression ; Nerve Net/diagnostic imaging* ; Graph Neural Networks

Objective:To evaluate the relationship between the mechanism of buprenorphine in attenuating neuroinflammation in microglia and the MAM domain-containing glycosylphosphatidylinositol anchor gene 1 ( MDGA1). Methods:The human microglial cell line HMC-3 was cultured in vitro and divided into 4 groups ( n=6 each) using a table of random numbers: control group (Con group), lipopolysaccharide(LPS)group, buprenorphine + LPS group (Bup+ LPS group) and buprenorphine + LPS + MDGA1 knockdown group (Bup+ LPS+ shMDGA1 group). LPS group was incubated with LPS at a final concentration of 1 μg/ml for 4 h. Bup+ LPS group was incubated with buprenorphine at a final concentration of 100 ng/ml for 1 h, followed by incubation with LPS at a final concentration of 1 μg/ml for 4 h. Bup+ LPS+ shMDGA1 group was transfected with MDGA1-specific shorthairpin RNA for knockdown, and the remaining treatment was similar to those previously described in Bup+ LPS group. The expression of MDGA1 in microglia was detected using real-time quantitative polymerase chain reaction, and the concentrations of interleukin (IL)-6, IL-1β, tumor necrosis factor-α (TNF-α), and inducible nitric oxide synthase (iNOS) in the supernatant were measured using enzyme-linked immunosorbent assay. Results:Compared with Con group, the concentrations of IL-6, IL-1β, TNF-α and iNOS in the supernatant were significantly increased, and the expression of MDGA1 in microglia was down-regulated in LPS group ( P<0.05). Compared with LPS group, the concentrations of IL-6, IL-1β, TNF-α and iNOS in the supernatant were significantly decreased, and the expression of MDGA1 in microglia was up-regulated in Bup+ LPS group ( P<0.05). Compared with Bup+ LPS group, the concentrations of IL-6, IL-1β, TNF-α and iNOS in the supernatant were significantly increased, and the expression of MDGA1 in microglia was down-regulated in Bup+ LPS+ sh MDGA1 group ( P<0.05). Conclusions:The mechanism by which buprenorphine alleviates neuroinflammation in microglia may be related to the up-regulation of the expression of MDGA1.

Objective To explore the impacts of remimazolam on intraoperative intracranial pressure(ICP)and cerebral oxygenation in patients undergoing laparoscopic lower abdominal and pelvic surgery under CO2 pneumoperitoneum combined with Trendelenburg position.Methods Eighty-eight patients scheduled to undergo laparoscopic lower abdominal and pelvic surgery were randomly assigned to the remimazolam group(n=44)and the sevoflurane group(n=44).In the remimazolam group,continuous infusion of remimazolam at a rate of 1 mg/(kg·h)was administered for anesthesia maintenance.In contrast,the sevoflurane group inhaled 2％sevoflurane.Heart rate(HR),mean arterial pressure(MAP),peak airway pressure(Peak),plateau airway pressure(Plat),end-tidal CO2(PETCO2),regional cerebral oxygen saturation(rSO2),and optic nerve sheath diameter(ONSD)of both eyes were measured and recorded at the following time points:prior to anesthesia induction(T0),5 minutes after induction(T1),10 minutes(T2),30 minutes(T3),and 60 minutes(T4)after the establishment of pneumo-peritoneum in Trendelenburg position,as well as 30 minutes after deflation in the supine position(T5).Results No significant intergroup differences were detected in HR,MAP,Peak,Plat,or PETCO2 at any time point(P>0.05).In both groups,Peak and Plat values were significantly higher at T2-T4 compared to T1(P<0.05).Regard-ing the ONSD)no intergroup differences were noted at T0 and T1(P>0.05).From T2 to T5,ONSD in both groups increased significantly relative to T0..It gradually rose with the prolongation of pneumoperitoneum and Trendelen-burg positioning and showed a slight decrease at T5(P<0.05).Specifically,at T3 and T4,the remimazolam group exhibited significantly smaller ONSD values than the sevoflurane group(P<0.05).Throughout the study,no inter-group differences in rSO2 were observed(P>0.05).Conclusion In laparoscopic lower abdominal and pelvic surgeries performed in the Trendelenburg position,intravenous anesthesia with remimazolam may be more effective in mitigating the elevation of intracranial pressure compared to sevoflurane inhalation.

Objective To explore the effects of dexmedetomidine combined with desflurane anesthesia on cerebral oxygen metabolism,sedation depth and cerebral function in liver cancer patients undergoing partial hepatic lobectomy.Methods A total of 30 liver cancer patients undergoing partial hepatic lobectomy at the Affiliated Cancer Hospital of Zhengzhou University from March to September 2022 were selected as the research subjects,they were divided into control group(n=15)and observation group(n=15)according to different anesthesia methods.Patients in both groups underwent partial open hepatectomy,and they were given the same anesthesia induction method.The patients in the control group received desflurane for anesthesia mainte-nance,while patients in the observation group received dexmedetomidine combined with desflurane for anesthesia maintenance.The anesthesia recovery indexes including the postoperative recovery time,recovery time of spontaneous breathing,eye-opening time of patients between the two groups were compared.The arterial oxygen saturation(SaO2),cervical vein oxygen saturation(SjvO2),arterial partial pressure of oxygen(PaO2)and partial pressure of venous oxygen of patients were detected by blood gas analyzer before anesthesia induction(T0),at the completion of anesthesia induction(T,),at 10 minutes after hepatic portal occlusion(T2),after hepatic lobectomy(T3)and after surgery(T4),and arterio-venous oxygen content difference(AVDO2)and cerebral oxygen extraction rate(CEO2)were calculated.The sedation depth of patients was evaluated by bispectral index(BIS)and patient state index(PSI)at T0,T1,T2,T3 and T4.The cerebral function of patients was evaluated by the Glasgow-Pittsburgh cerebral performance category scale at 3 months after surgery.The incidence of postoperative adverse reactions of patients between the two groups was compared.Results The postoperative recovery time,recovery time of sponta-neous breathing and eye-opening time of patients in the observation group were significantly shorter than those in the control group(P＜0.05).There was no significant difference in SaO2 of patients between the two groups at different time points(P＞0.05).At T2 and T3,SjvO2,AVDO2 and CEO2 of patients in the observation group were significantly lower than those in the control group(P＜0.05),but there was no significant difference in SjvO2,AVDO2 and CEO2 of patients between the two groups at the other time points(P＞0.05).At T2,T3 and T4,BIS and PSI of patients in the observation group were significantly lower than those in the control group(P＜0.05),but there was no significant difference in BIS and PSI of patients between the two groups at T0 and T1(P＞0.05).In the control group,there were 11 patients with postoperative brain function in grade 1,3 patients in grade Ⅱ and 1 patient in grade Ⅲ;in the observation group,there were 12 patients in grade Ⅰ and 3 patients in gradeⅡ.There was no significant difference in postoperative grading of brain function between the two groups(x2=1.044,P＞0.05).There was no significant difference in the total incidence of postoperative adverse reactions between the control group and observation group[20.00％(3/15)vs 26.67％(4/15),x2=0.186,P＞0.05].Conclusion Dexmedetomidine combined with desflurane anesthesia can shorten anesthesia recovery time,improve anesthesia depth and reduce cerebral oxygen metabolism in patients undergoing liver cancer surgery,which has no effect on cerebral function,showing good safety.

Objective:To evaluate the efficacy of oliceridine for analgesia in the patients undergoing radical thyroidectomy for thyroid cancer.Methods:In this prospective, randomized, double-blind, single-center, positive-control study, 84 patients of either sex, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, weighing 50-70 kg, with a body mass index of 18-28 kg/m 2, education years ≥ 6 yr, and expected surgery time>1 h, with thyroid cancer undergoing radical surgery under general anesthesia at the Affiliated Cancer Hospital of Zhengzhou University from August to October 2024, were divided into 2 groups using a random number table method: sufentanil group (S group, n=41) and oliceridine group (O group, n=43). During anesthesia induction: Group S received intravenous injection of sufentanil 15 μg, while group O received intravenous injection of oliceridine 3 mg; If the increase in mean arterial pressure or heart rate exceeded 20% of the baseline value within 3 min after tracheal intubation, an additional 5 μg of sufentanil (S group) or 1 mg of oliceridine (O group) was added. At 2 min before skin incision, sufentanil 15 μg was intravenously injected in group S, and oliceridine 3 mg was intravenously injected in group O. Effectiveness evaluation indicators: The visual analog scale scores were recorded at 5 min after tracheal extubation, immediately upon exiting the post-anesthesia care unit, and at 24 and 48 h postoperatively; Ramsay sedation scores were recorded at 5, 10, 20 and 30 min after tracheal extubation. The safety evaluation indicators: The use of vasoactive drugs during surgery and occurrence of adverse reactions within 48 h after surgery were recorded. Results:Compared with group S, no significant change was found in visual analog scale scores at different time points after surgery and Ramsay sedation scores at different time points after tracheal extubation ( P>0.05), and the usage rate of atropine during surgery and incidence of postoperative nausea and vomiting were significantly decreased in group O ( P<0.05). Conclusions:Oliceridine can produce postoperative analgesic efficacy comparable to sufentanil in the patients undergoing radical thyroidectomy for thyroid cancer, with smoother intraoperative hemodynamics and lower incidence of postoperative nausea and vomiting.

Objective:To evaluate the efficacy of oliceridine for postoperative analgesia in patients undergoing breast-conserving surgery for breast cancer.Methods:In this prospective, randomized, double-blind, single-center, positive-control clinical study, 123 patients with breast cancer, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classification I or Ⅱ, with a body mass index of 18-28 kg/m 2, undergoing breast-conserving surgery under general anesthesia at the Affiliated Cancer Hospital of Zhengzhou University from May to August 2024, were divided into 2 groups using a random number table method: sufentanil group (group S, n=62) and oliceridine group (group O, n=61). During anesthesia induction, sufentanil 15 μg was intravenously injected in group S, and oliceridine 3 mg was intravenously injected in group O. At 2 min before skin incision, sufentanil 10 μg was intravenously injected in group S, and oliceridine 2 mg was intravenously injected in group O. Postoperative patient-controlled intravenous analgesia was performed, with group S receiving sufentanil 50 μg and group O receiving oliceridine 10 mg, each diluted with normal saline to 100 ml. The pain visual analog scale scores at rest and during activity were recorded at 6, 12, 24 and 48 h postoperatively. The time of the first pressing of the postoperative analgesic pump, effective pressing times of patient-controlled analgesia and requirement for rescue analgesia within 24 h after surgery were recorded. The Ramsay sedation scores were recorded at 5, 15 and 30 min after tracheal extubation. The postoperative recovery quality was measured using the 15-item quality of recovery questionnaire at 24 h before surgery and at 24 and 48 h after surgery. The adverse reactions were recorded within 48 h after surgery. Results:Compared with group S, no significant change was found in visual analog scale scores at rest and during activity at different time points, the time of the first pressing of the postoperative analgesic pump, effective pressing times of patient-controlled analgesia and requirement for rescue analgesia within 24 h after operation, or the Ramsay sedation scores at 5, 15 and 30 min after tracheal extubation ( P>0.05), and 15-item quality of recovery scores were significantly increased at 24 and 48 h after surgery, and the incidence of postoperative nausea and vomiting was decreased in group O ( P<0.05). Conclusions:Oliceridine produces postoperative analgesic effects comparable to sufentanil without affecting patient awakening and reduces postoperative nausea and vomiting, which is helpful for early postoperative recovery when used in the patients undergoing breast-conserving surgery for breast cancer.

Objective:To evaluate the efficacy of oliceridine for patient-controlled intravenous analgesia (PCIA) after bone tumor resection.Methods:In this prospective randomized controlled study, 72 patients of either sex, aged 18-64 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, who underwent elective bone tumor resection under general anesthesia, were selected and divided into 2 groups ( n=36 each) by the random number table method: sufentanil group (group S) and oliceridine group (group O). Combined intravenous-inhalational anesthesia was used in both groups. PCIA was performed from the end of surgery until 48 h after surgery. PCIA solution contained sufentanil 2 μg/kg in normal saline 100 ml in group S and oliceridine 0.4 mg/kg in normal saline 100 ml in group O. The background infusion rate was 2 ml/h, the bolus dose was 2 ml, the lockout interval was 15 min, and the maximum dose per hour was 10 ml in both groups. Flurbiprofen ester 50 mg was intravenously injected as rescue analgesic after operation when numerical rating scale score at rest≥4 or numerical rating scale score during activity≥7. The number of effective pressing times of patient-controlled analgesia (PCA), total pressing times of PCA, consumption of analgesics and requirement for rescue analgesia were recorded within 48 h after operation. Ramsay sedation scores were recorded at 2, 6, 12, 24 and 48 h after surgery. The occurrence of adverse reactions and requirement for rescue antiemetic within 48 h after surgery were recorded.The 15-item quality of recovery scale scores were assessed at 24 h before surgery and 24 and 48 h after surgery. The patient satisfaction score and satisfaction rate were recorded. Results:Compared with group S, the number of effective pressing times of PCA, total pressing times of PCA and consumption of analgesics were significantly reduced within 48 h after operation, the Ramsay sedation score was significantly increased at 12 h after surgery, the incidence of nausea and vomiting and rescue antiemetic rate were decreased, and the 15-item quality of recovery scale scores, satisfaction score and satisfaction rate were increased in group O ( P<0.05). There were no significant differences in the rate of rescue analgesia and incidence of respiratory depression, dizziness, pruritus and urinary retention within 48 h after operation ( P>0.05). Conclusions:Oliceridine has similar effect to sufentanil for postoperative PCIA, reduces the development of postoperative nausea and vomiting, improves satisfaction, and promotes early postoperative recovery when used in the patients undergoing bone tumor resection.

Objective To investigate the influence of sodium bicarbonate Ringer's solution and compound Ringer's solution on patients'acid-base balance and liver and kidney function during controlled low central venous pressure(CLCVP)hepatectomy.Methods A total of 60 patients with primary liver cancer who underwent CLCVP hepatectomy in the Affiliated Cancer Hospital of Zhengzhou University from June 2020 to June 2022 were selected and randomly divided into the sodium bicarbonate Ringer's solution group and compound Ringer's solution group,with 30 patients in each group.Patients in the sodium bicarbonate Ringer's solution group were infused with sodium bicarbonate Ringer's solution,while patients in the compound Ringer's solution group were infused with compound Ringer's solution after anesthesia induction and before liver parenchymal disconnection.The pH value,base excess(BE)and blood lactic acid(Lac)levels were detected using the blood gas analyzer in the two groups before anesthesia induction(T,),at the beginning of surgery(T2),2 h during surgery(T3),4 h during surgery(T4),and at the end of surgery(T5),respectively.The levels of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood urea nitrogen(BUN),and serum creatinine(Scr)were detected using the automatic biochemical analyzer 24 h before and 24 h after surgery,respectively.The body mass,surgical time,intraoperative infusion volume,urine volume,changes in body acid-base balance during surgery,and changes in liver and kidney function before and after surgery between the two groups were compared.Results There was no statistically significant difference in body mass,surgical time,intraoperative infusion volume,and urine volume between the two groups of patients(P＞0.05).At T,,there was no statistically significant difference in pH value,BE and Lac levels between the two groups of patients(P＞0.05).Compared to T,,the pH value in the compound Ringer's solution group increased at T2 and decreased at T3,T4 and T5,while BE and Lac levels from T2 to T5 showed an increasing trend(P＜0.05);compared to T,,the pH value in the sodium bicarbonate Ringer's solution group increased at T2 and decreased at T3,BE and Lac levels increased at T2 and T3(P＜0.05),and there was no statistically significant difference in pH value,BE and Lac levels at T4 and T5 compared to T1(P＞0.05).At T5,the pH value in the sodium bicarbonate Ringer's solution group was significantly higher than that in the compound Ringer's solution group,while the BE and Lac levels were significantly lower than those in the compound Ringer's solution group(P＜0.05).There was no statisti-cally significant difference in the levels of ALT,AST,BUN and Scr 24 hours before surgery between the two groups of patients(P＞0.05);compared to 24 hours before surgery,there was no significant change in the levels of ALT,AST,BUN and Scr 24 hours after surgery(P＞0.05);there was no statistically significant difference in the levels of ALT,AST,BUN and Scr 24 hours after surgery between the two groups(P＞0.05).Conclusion Compared to compound Ringer's solution,sodium bicarbonate Ringer's solution has a smaller impact on the internal environment of the body during the CLCVP hepatectomy and can effectively maintain the stability of the body's acid-base balance.Both the two solutions have no significant impact on the patient's liver and kidney function.