Objective:To explore the effects of remimazolam versus dexmedetomidine combined with spinal-epidural anesthesia in elderly patients undergoing hip replacement.Methods:A total of 100 elderly patients who needed total hip replacement in the Nanjing Lishui People′s Hospital from March 2021 to March 2023 were selected and divided into two groups by dynamic randomization, with 50 cases in each group. Both groups underwent surgery under combined spinal-epidural anesthesia. The control group was given dexmedetomidine for anesthesia, and the observation group was given remimazolam for anesthesia. The depth of sedation [eye-opening time, post anesthesia care unit (PACU) stay time, awakening time], cognitive function at different time periods [Mini-Mental State Examination (MMSE) score], inflammatory factor indexes [interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], and hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP)] were compared between the two groups.Results:The eye-opening time and PACU stay time in the observation group were shorter than those in the control group (all P<0.05), and there was no significant difference in awakening time between the two groups ( P>0.05). The MAP of both groups at post-skin incision (T 1) and completion of internal fixation (T 2) was higher than that after anesthesia induction (T 0), and decreased at the end of surgery (T 3); the HR of both groups at T 1 was lower than that at T 0, but increased at T 2, and then decreased at T 3. There were no significant differences in MAP and HR between the two groups at each time point (all P>0.05). The MMSE scores of the observation group at 1, 4, and 7 days after surgery were significantly higher than those of the control group (all P<0.05). The serum levels of IL-1β, IL-6, and TNF-α in both groups at post-anesthesia (t 1), end of surgery (t 2), and post-surgery (t 3) were significantly higher than those at 1 day before surgery (t 0), and the serum levels of IL-1β, IL-6, and TNF-α in the observation group at t 1, t 2, and t 3 were lower than those in the control group (all P<0.05). Conclusions:Both remimazolam and dexmedetomidine can effectively maintain hemodynamic stability in elderly patients undergoing hip replacement surgery, while remimazolam can more effectively shorten the time to reach the required depth of sedation, reduce the occurrence of cognitive dysfunction, and decrease the secretion of inflammatory factors.

Objective To elucidate the mechanisms of trauma-induced coagulopathy(TIC),clarify the specific pathogenic factors and pathophysiological processes,and discover the effective diagnostic indicators and therapeutic targets.Methods Transcriptomic data of traumatic hemorrhagic shock patients were obtained from the Gene Expression Omnibus(GEO)to identify differentially expressed genes(DEGs).Coagulation-related genes(CRGs)from the Kyoto Encyclopedia of Genes and Genomes(KEGG)were intersected with DEGs.Machine learning algorithms,including least absolute shrinkage and selection operator(LASSO)and random forest(RF),were applied to identify key genes.The CIBERSORT algorithm was used to analyze the correlation between key genes and immune cell infiltration.Through consensus clustering,subtype analysis was conducted on trauma patients to compare the infiltration of immune cells.A rat model of traumatic hemorrhagic shock was established to validate coagulation function and the expression of key genes.Results The dataset included samples from 17 healthy controls and 478 patients with traumatic hemorrhagic shock.A total of 6 315 DEGs were identified under the screening criterion of corrected P<0.05.Gene set enrichment analysis(GSEA)showed that the up-regulated DEGs were significantly enriched in the glucose metabolism pathway,while the down-regulated DEGs were enriched in the immune reaction-related pathways.Through cross-analysis of DEGs and CRGs,a total of 65 differentially expressed coagulation-related genes(DE-CRGs)were screened out.GO functional enrichment showed that these genes were mainly located in secreting granular membranes and platelet α-granules,and were involved in physiological processes such as blood coagulation,regulation of body fluid levels,and wound healing.KEGG pathway analysis revealed that these genes were significantly enriched in pathways such as platelet activation,complement and coagulation cascade reactions,Rap1 signaling pathway,and human cytomegalovirus infection.Six key DE-CRGs were identified through machine learning.Receiver operating characteristic(ROC)curve analysis indicated that these genes had good diagnostic efficacy.CIBERSORT analysis revealed a significant correlation between key genes and immune cell infiltration.Patients were classified into two subtypes based on the six key genes:subtype A was rich in CD8+T cells and activated NK cells,presented an immune-active state;subtype B was mainly composed of monocytes and resting NK cells,with insufficient activation of immune pathways.Animal experiments on rats showed that hemorrhagic shock can lead to coagulation dysfunction.The results of qRT-PCR further confirmed that the expression trend of key genes was consistent with the results of bioinformatics analysis.Conclusion In this study,through transcriptomics and machine learning methods,six key genes closely related to TIC were systematically screened out,namely GNA13,PIK3R3,ITGAM,MAPK14,PPP1CC and LYN,and their close connections with coagulation function and immune infiltration were revealed.Animal experiments have further verified the value of these genes as potential diagnostic and therapeutic targets.

Objective:To evaluate the immunogenicity and immune persistence of human rabies vaccine (Vero cell) in healthy people aged 10-17 years and compare it with a group of adults aged 18-60 years.Methods:This study was conducted between July 2021 and November 2022 with Shangyu district and Shengzhou city of Shaoxing city, Zhejiang Province selected as the research sites. Zagreb regimen (2-1-1 schedule) and Essen regimen (1-1-1-1-1 schedule) were used for rabies vaccine administration. Serum samples were collected at different time points before and after immunization to compare the differences in seropositivity rates and geometric mean concentrations (GMC) between the 10-17 age group and the 18-60 age group.Results:A total of 1 200 healthy participants aged 10-60 were included, with 157 individuals (13.1%) in the 10-17 age group and 1 043 individuals (86.9%) in the 18-60 age group. Both groups displayed a nearly 100% seropositivity rate at 3, 6 and 12 months, and the participants in the same age group had similar antibody levels. The GMC of antibodies gradually increased after vaccination and peaked on 14 d. The 10-17 age group showed higher GMC of antibodies than the 18-60 age group at 14 d after the first dose (Zagreb regimen: 81.85 IU/ml vs 63.15 IU/ml, t=2.411, P=0.018; Essen regimen: 86.61 IU/ml vs 69.24 IU/ml, t=3.906, P<0.001). Similar differences were observed in the GMC of antibodies at 14 d and 3 months after the full vaccination course, but these differences gradually decreased and disappeared at 6 and 12 months after vaccination. Conclusions:Human rabies vaccine (Vero cell) has lasting immune protection in all participants within one year after vaccination, with no significant differences between the two vaccination regimens. Participants aged 10-17 have higher antibody levels compared to adults aged 18-60, but there is no significant difference in immune persistence between the two age groups.

Objective To evaluate the effect of different doses of esketamine combined with propofol medium and long chain fat emulsion in painless gastroenteroscopy.Methods 144 patients who were scheduled to receive painless gastroenteroscopy from January 2022 to December 2023 were randomly divided into four groups with 36 cases in each group.The load dose of esketamine in group A,group B and group C was 0.2,0.3 and 0.4 mg/kg respectively,and group D was treated with equivalent normal saline instead of esketamine as the control.All the patients were administrated with propofol medium and long chain fat emulsion during the examination.Heart rate(HR),mean arterial pressure(MAP)and percutaneous arterial oxygen saturation(SpO2)were recorded immediately after electrocardiograph monitoring was established(T0),immediately before examination(T1),immediately after gastroscopy placement(T2),immediately before colonoscopy(T3),immediately after colonoscopy implantation(T4)and immediately after examination(T5).The dosage of propofol medium and long chain fat emulsion,recovery time and discharge time were compared among the four groups.Patients were assessed with quality of recovery-40 questionnaire(QoR-40)at T0 and at wake time(T6).The adverse reactions of the four groups were compared.Results There were statistically significant differences in the temporal effects of HR,MAP and SpO2 among the 4 groups(F=3.91,21.65,6.17,P＜0.05);There were statistically significant differences in the intergroup effects of HR,MAP and SpO2 among the 4 groups(F=14.57,7.14,30.34,P＜0.05).The variation trend of SpO2 in groups A,B,C and D was statistically significant(F=2.88,P＜0.05).The first and total dosage of propofol medium and long chain fat emulsion,and the recovery time of the four groups were statistically significant(P＜0.05).The initial dosage and total dosage of propofol medium and long chain fat emulsion in group A,group B and group C were significantly lower than those in group D(P＜0.05),and group B and group C were significantly lower than group A(P＜0.05),but there was no significant difference between group B and group C(P＞0.05).The recovery time of group A and group B were significantly shorter than that of group C and group D(P＜0.05),and group C was significantly longer than that of group D(P＜0.05),and there was no significant difference between group A and group B(P＞0.05).There was no significant difference in the time of get discharged from the hospital among the four groups(P＞0.05).The total scores of QoR-40 in four group at T6 were significantly lower than those at T0 respectively(P＜0.05).T6 QoR-40 total score:group B was significantly higher than group A,Group C and group D(P＜0.05),group A and group C were significantly higher than group D(P＜0.05),and there was no significant difference between group A and group C(P＞0.05).There were significant differences in the incidence of hypoxemia,hypotension,bradycardia,tachycardia,body movement and dizziness among the four groups(P＜0.05).The incidence of hypoxemia,hypotension and bradycardia in group B and group C was significantly lower than that in group D(P＜0.083),and the incidence of dizziness in group C was significantly higher than that in group D(P＜0.0083).Among them,1 case in group A and 3 cases in group D needed mask pressure ventilation due to hypoxemia.There was no significant difference in the incidence of nausea and vomiting among the four groups(P＞0.05).Conclusion During painless gastroenteroscopy,the application of 0.3 mg/kg esketamine combined with propofol medium and long chain fat emulsion can help maintain the hemodynamic stability,alleviate the respiratory and circulatory inhibition caused by propofol medium and long chain fat emulsion,accelerate recovery,and reduce adverse reactions in patients.

Objective To elucidate the mechanisms of trauma-induced coagulopathy(TIC),clarify the specific pathogenic factors and pathophysiological processes,and discover the effective diagnostic indicators and therapeutic targets.Methods Transcriptomic data of traumatic hemorrhagic shock patients were obtained from the Gene Expression Omnibus(GEO)to identify differentially expressed genes(DEGs).Coagulation-related genes(CRGs)from the Kyoto Encyclopedia of Genes and Genomes(KEGG)were intersected with DEGs.Machine learning algorithms,including least absolute shrinkage and selection operator(LASSO)and random forest(RF),were applied to identify key genes.The CIBERSORT algorithm was used to analyze the correlation between key genes and immune cell infiltration.Through consensus clustering,subtype analysis was conducted on trauma patients to compare the infiltration of immune cells.A rat model of traumatic hemorrhagic shock was established to validate coagulation function and the expression of key genes.Results The dataset included samples from 17 healthy controls and 478 patients with traumatic hemorrhagic shock.A total of 6 315 DEGs were identified under the screening criterion of corrected P<0.05.Gene set enrichment analysis(GSEA)showed that the up-regulated DEGs were significantly enriched in the glucose metabolism pathway,while the down-regulated DEGs were enriched in the immune reaction-related pathways.Through cross-analysis of DEGs and CRGs,a total of 65 differentially expressed coagulation-related genes(DE-CRGs)were screened out.GO functional enrichment showed that these genes were mainly located in secreting granular membranes and platelet α-granules,and were involved in physiological processes such as blood coagulation,regulation of body fluid levels,and wound healing.KEGG pathway analysis revealed that these genes were significantly enriched in pathways such as platelet activation,complement and coagulation cascade reactions,Rap1 signaling pathway,and human cytomegalovirus infection.Six key DE-CRGs were identified through machine learning.Receiver operating characteristic(ROC)curve analysis indicated that these genes had good diagnostic efficacy.CIBERSORT analysis revealed a significant correlation between key genes and immune cell infiltration.Patients were classified into two subtypes based on the six key genes:subtype A was rich in CD8+T cells and activated NK cells,presented an immune-active state;subtype B was mainly composed of monocytes and resting NK cells,with insufficient activation of immune pathways.Animal experiments on rats showed that hemorrhagic shock can lead to coagulation dysfunction.The results of qRT-PCR further confirmed that the expression trend of key genes was consistent with the results of bioinformatics analysis.Conclusion In this study,through transcriptomics and machine learning methods,six key genes closely related to TIC were systematically screened out,namely GNA13,PIK3R3,ITGAM,MAPK14,PPP1CC and LYN,and their close connections with coagulation function and immune infiltration were revealed.Animal experiments have further verified the value of these genes as potential diagnostic and therapeutic targets.

Objective:To explore the effects of remimazolam versus dexmedetomidine combined with spinal-epidural anesthesia in elderly patients undergoing hip replacement.Methods:A total of 100 elderly patients who needed total hip replacement in the Nanjing Lishui People′s Hospital from March 2021 to March 2023 were selected and divided into two groups by dynamic randomization, with 50 cases in each group. Both groups underwent surgery under combined spinal-epidural anesthesia. The control group was given dexmedetomidine for anesthesia, and the observation group was given remimazolam for anesthesia. The depth of sedation [eye-opening time, post anesthesia care unit (PACU) stay time, awakening time], cognitive function at different time periods [Mini-Mental State Examination (MMSE) score], inflammatory factor indexes [interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], and hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP)] were compared between the two groups.Results:The eye-opening time and PACU stay time in the observation group were shorter than those in the control group (all P<0.05), and there was no significant difference in awakening time between the two groups ( P>0.05). The MAP of both groups at post-skin incision (T 1) and completion of internal fixation (T 2) was higher than that after anesthesia induction (T 0), and decreased at the end of surgery (T 3); the HR of both groups at T 1 was lower than that at T 0, but increased at T 2, and then decreased at T 3. There were no significant differences in MAP and HR between the two groups at each time point (all P>0.05). The MMSE scores of the observation group at 1, 4, and 7 days after surgery were significantly higher than those of the control group (all P<0.05). The serum levels of IL-1β, IL-6, and TNF-α in both groups at post-anesthesia (t 1), end of surgery (t 2), and post-surgery (t 3) were significantly higher than those at 1 day before surgery (t 0), and the serum levels of IL-1β, IL-6, and TNF-α in the observation group at t 1, t 2, and t 3 were lower than those in the control group (all P<0.05). Conclusions:Both remimazolam and dexmedetomidine can effectively maintain hemodynamic stability in elderly patients undergoing hip replacement surgery, while remimazolam can more effectively shorten the time to reach the required depth of sedation, reduce the occurrence of cognitive dysfunction, and decrease the secretion of inflammatory factors.

Objective To evaluate the effect of different doses of esketamine combined with propofol medium and long chain fat emulsion in painless gastroenteroscopy.Methods 144 patients who were scheduled to receive painless gastroenteroscopy from January 2022 to December 2023 were randomly divided into four groups with 36 cases in each group.The load dose of esketamine in group A,group B and group C was 0.2,0.3 and 0.4 mg/kg respectively,and group D was treated with equivalent normal saline instead of esketamine as the control.All the patients were administrated with propofol medium and long chain fat emulsion during the examination.Heart rate(HR),mean arterial pressure(MAP)and percutaneous arterial oxygen saturation(SpO2)were recorded immediately after electrocardiograph monitoring was established(T0),immediately before examination(T1),immediately after gastroscopy placement(T2),immediately before colonoscopy(T3),immediately after colonoscopy implantation(T4)and immediately after examination(T5).The dosage of propofol medium and long chain fat emulsion,recovery time and discharge time were compared among the four groups.Patients were assessed with quality of recovery-40 questionnaire(QoR-40)at T0 and at wake time(T6).The adverse reactions of the four groups were compared.Results There were statistically significant differences in the temporal effects of HR,MAP and SpO2 among the 4 groups(F=3.91,21.65,6.17,P＜0.05);There were statistically significant differences in the intergroup effects of HR,MAP and SpO2 among the 4 groups(F=14.57,7.14,30.34,P＜0.05).The variation trend of SpO2 in groups A,B,C and D was statistically significant(F=2.88,P＜0.05).The first and total dosage of propofol medium and long chain fat emulsion,and the recovery time of the four groups were statistically significant(P＜0.05).The initial dosage and total dosage of propofol medium and long chain fat emulsion in group A,group B and group C were significantly lower than those in group D(P＜0.05),and group B and group C were significantly lower than group A(P＜0.05),but there was no significant difference between group B and group C(P＞0.05).The recovery time of group A and group B were significantly shorter than that of group C and group D(P＜0.05),and group C was significantly longer than that of group D(P＜0.05),and there was no significant difference between group A and group B(P＞0.05).There was no significant difference in the time of get discharged from the hospital among the four groups(P＞0.05).The total scores of QoR-40 in four group at T6 were significantly lower than those at T0 respectively(P＜0.05).T6 QoR-40 total score:group B was significantly higher than group A,Group C and group D(P＜0.05),group A and group C were significantly higher than group D(P＜0.05),and there was no significant difference between group A and group C(P＞0.05).There were significant differences in the incidence of hypoxemia,hypotension,bradycardia,tachycardia,body movement and dizziness among the four groups(P＜0.05).The incidence of hypoxemia,hypotension and bradycardia in group B and group C was significantly lower than that in group D(P＜0.083),and the incidence of dizziness in group C was significantly higher than that in group D(P＜0.0083).Among them,1 case in group A and 3 cases in group D needed mask pressure ventilation due to hypoxemia.There was no significant difference in the incidence of nausea and vomiting among the four groups(P＞0.05).Conclusion During painless gastroenteroscopy,the application of 0.3 mg/kg esketamine combined with propofol medium and long chain fat emulsion can help maintain the hemodynamic stability,alleviate the respiratory and circulatory inhibition caused by propofol medium and long chain fat emulsion,accelerate recovery,and reduce adverse reactions in patients.

Objective:To evaluate the immunogenicity and immune persistence of human rabies vaccine (Vero cell) in healthy people aged 10-17 years and compare it with a group of adults aged 18-60 years.Methods:This study was conducted between July 2021 and November 2022 with Shangyu district and Shengzhou city of Shaoxing city, Zhejiang Province selected as the research sites. Zagreb regimen (2-1-1 schedule) and Essen regimen (1-1-1-1-1 schedule) were used for rabies vaccine administration. Serum samples were collected at different time points before and after immunization to compare the differences in seropositivity rates and geometric mean concentrations (GMC) between the 10-17 age group and the 18-60 age group.Results:A total of 1 200 healthy participants aged 10-60 were included, with 157 individuals (13.1%) in the 10-17 age group and 1 043 individuals (86.9%) in the 18-60 age group. Both groups displayed a nearly 100% seropositivity rate at 3, 6 and 12 months, and the participants in the same age group had similar antibody levels. The GMC of antibodies gradually increased after vaccination and peaked on 14 d. The 10-17 age group showed higher GMC of antibodies than the 18-60 age group at 14 d after the first dose (Zagreb regimen: 81.85 IU/ml vs 63.15 IU/ml, t=2.411, P=0.018; Essen regimen: 86.61 IU/ml vs 69.24 IU/ml, t=3.906, P<0.001). Similar differences were observed in the GMC of antibodies at 14 d and 3 months after the full vaccination course, but these differences gradually decreased and disappeared at 6 and 12 months after vaccination. Conclusions:Human rabies vaccine (Vero cell) has lasting immune protection in all participants within one year after vaccination, with no significant differences between the two vaccination regimens. Participants aged 10-17 have higher antibody levels compared to adults aged 18-60, but there is no significant difference in immune persistence between the two age groups.

Objective To observe the clinical and symptomatic improvement three months after uterine artery embolization(UAE),and to analyze the value of apparent diffusion coefficient(ADC)in MR diffusion weighted imaging(DWI)in assessing the response of fibroids volume after UAE.Methods A total of 40 patients with uterine fibroids were included.The volume changes of fibroids,clinical and symptomatic improvement before and after treatment were recorded,and the efficacy of UAE was comprehensively analyzed.All patients underwent MR DWI before UAE and were evaluated at three months postoperatively by outpatient MR follow-up,with fibroids vol-ume and ADC quantitative measurements were performed to compare the changes in ADC values of fibroids preoperatively and post-operatively at each b value.Pearson correlation analysis was performed to analyze the correlation between baseline ADC values and postoperative fibroids volume reduction.Regression analysis was performed to assess the relationship between ADC and fibroids volume reduction after UAE.And the receiver operating characteristic(ROC)curve were plotted to analyze the predictive value of ADC values for evaluating fibroids volume reduction of more than 30％after UAE.Results The patients'clinical symptoms was improved in the three months after surgery,the volume of fibroids was significantly reduced,and the life quality was improved,the difference was sta-tistically significant(P＜0.05).There was no significant effect on ovarian function,hormone levels did not change significantly com-pared to before surgery,with no statistical significance(P＞0.05).When b=50,1 000 s/mm2,the changes in ADC values before and after uterine fibroids treatment were not significant,with no statistical significance(P＞0.05).However,the changes in ADC values before and after uterine fibroids treatment were significant when b=800 s/mm2 and the difference was statistically significant(P＜0.05).Under the condition of b=800 s/mm2,Pearson correlation analysis showed ADC value had a positive correlation with postoperative uterine fibroids volume reduction rate(r=0.45,P＜0.05),and the area under the curve(AUC)for ADC value to predict the reduction rate of uterine fibroids volume by more than 30％after UAE was 0.787.The cut-off value was 1.143 × 10-3 mm2/s,with sensitivity and specificity of 0.793 and 0.818,respectively.Conclusion UAE is more effective in treating uterine fibroids.The baseline ADC value of uterine fibroids correlated significantly with the volume reduction after UAE.The ADC value can be used to assess the volume response after UAE.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.