Intravenous sedation is commonly used in routine dental procedures, however, existing agents are associated with limitations in recovery profiles and postoperative complications. Remimazolam has emerged as a promising alternative to address these clinical challenges. This study aimed to establish the non-inferiority of titrated remimazolam compared to midazolam concerning both efficacy and safety endpoints in dental extraction procedures. This randomized, single-blind, parallel-controlled, non-inferiority study was conducted across 13 centers in China from September 2021 to July 2023. A total of 612 eligible patients scheduled for dental extraction were randomized to receive either remimazolam (group R, initial dose of 0.1 mg/kg with 2 mg top-ups; n = 307) or midazolam (group M, initial dose of 0.05 mg/kg with 1 mg top-ups; n = 305). The primary endpoint was the sedation success rate, with a predefined non-inferiority margin of 6 https://www.chictr.org.cn/showproj.html?proj=133251 , Principal investigator: Hui Zhang, date of registration: September 4, 2021).

Reactive oxygen species (ROS) are closely associated with the initiation and progression of osteoarthritis (OA). Scavenging ROS within inflamed chondrocytes represents an effective strategy to treat OA. In this study, mimicking natural Mn-SOD, we successfully constructed a nanozyme with Mn3O4 as the core and polydopamine (PDA) as the outer modification. Density Functional Theory (DFT) calculations combined with Electron Spin Resonance (ESR) detection revealed that the nanozyme demonstrates high enzyme-like activity. Furthermore, cytotoxicity assays confirmed its excellent biocompatibility. Within inflamed chondrocytes, Mn3O4@PDA nanozyme had been demonstrated to regulate the oxidative stress microenvironment, thereby inhibiting inflammatory responses. Moreover, injecting Mn3O4@PDA into the joints of rats with osteoarthritis could effectively alleviate the inflammatory response and relieve the degeneration of articular cartilage, reducing the OARSCI score by 85.25% at 8 weeks. Therefore, this study demonstrated that Mn3O4@PDA with high enzymelike activity and good biocompatibility could efficiently scavenge ROS, reduce inflammatory responses, and promote cartilage regeneration, thereby achieving the treatment of OA.

Background: Remimazolam is a novel ultra-short-acting benzodiazepine sedative that has the potential to be an alternative for procedural sedation due to its rapid sedation and recovery, no accumulation effect, stable hemodynamics, minimal respiratory depression, anterograde amnesia effect, and specific antagonist. Here, we aimed to compare the safety and efficacy of remimazolam with dexmedetomidine for awake tracheal intubation by flexible bronchoscopy (ATI-FB). Methods: Ninety patients scheduled for ATI-FB were randomly divided into three groups, each consisting of 30 cases: dexmedetomidine 0.6 mg/kg + sufentanil (group DS), remimazolam 0.073 mg/kg + sufentanil (group R1S), or remimazolam 0.093 mg/kg + sufentanil (group R2S). The primary outcome was the success rate of sedation. Secondary outcomes were MOAA/S scores, hemodynamic and respiratory parameters, intubation conditions, intubation time, tracheal intubation amnesia, and adverse events. Results: The success rates of sedation in groups R2S and DS were higher than that in group R1S (93.3%, 86.7%, respectively, vs 58.6%; P = 0.002), and intubation conditions were better than those in group R1S (P < 0.05). Group R2S had shorter intubation times than groups R1S and DS (P = 0.003), and a higher incidence of tracheal intubation amnesia than group DS (P = 0.006). No patient in the three groups developed hypoxemia or hypotension, and there were no significant differences in oligopnea, PetCO(2), or bradycardia Conclusion: In conclusion, both DS and R2S had higher success rates of sedation, better intubation conditions, and minor respiratory depression, but R2S, with its shorter intubation time, higher incidence of anterograde amnesia, and ability to be antagonized by specific antagonists, may be a good alternative sedation regimen for patients undergoing ATI-FB.

患者,女,31 岁,155 cm,62 kg,BMI 25. 8 kg/m2. 因"右上颌骨肿物切除术后 9 年,发现肿物复发增大 2 年"入院.患者 9 年前在全麻下行双侧上颌骨骨化纤维瘤切除术,2 年前发现右面部膨隆,肿物逐渐增大,堵塞两侧鼻腔,影响呼吸. 既往有输血史、乙肝病史. 体格检查:心肺听诊未见异常,面部不对称,右面部膨隆,可见约 10 cm×8 cm×7 cm肿物,肿物质硬、活动度差,右眼上抬,鼻左推,双侧鼻腔完全堵塞,呈张口呼吸.

Abstract Objective To investigate the effect of acute normovolemic hemodilution on long-term prognosis of oral squamous cell carcinoma (OSCC) patients after tumor resection and flap reconstruction. Methods This study retrospectively analyzed follow-up data for 371 OSCC patients who underwent tumor resection and flap reconstruction for the first time at our hospital from January 1, 2015, to December 31, 2020. The patients were split into three groups: no blood transfusion (NBT), acute normovolemic hemodilution (ANH), and allogeneic blood transfusion (ABT). Measurement data were analyzed by ANOVA and enumeration data by χ2 tests. Survival analysis with the Cox model was used to confirm independent prognostic factors. Disease-free (DFS) and overall (OS) survival were calculated by the life table method and K-M curve. Results The ANH group had a 0.523-fold higher risk of recurrence than the NBT group (P = 0.010). The ABT group had a 1.844-fold higher risk of death than the NBT group (P = 0.033). Among those with lymph node metastasis, the ANH group had a lower risk of recurrence, 0.436 times higher than the NBT group (P = 0.017), and the ABT group had a higher risk of death, 2.186 times higher than the NBT group (P = 0.032). Conclusion ANH can reduce immune system suppression by decreasing the amount of allogeneic blood to reduce tumor recurrence and risk of tumor-specific death, and this result is more prominent in OSCC patients with lymph node metastasis. Clinical relevance Preoperative ANH can effectively reduce the recurrence rate of patients with OSCC.

目的 评估支气管内窥镜训练系统在电子软镜插管教学中的效果,并拟合在该系统上行软镜操作的学习曲线,为软镜训练设置合理的学习终点提供理论依据.方法 选取我院2019-01/2020-03期间轮转的30名麻醉专业住院医师规范化培训学员(简称"住培学员")采用随机数字表法,分为试验组和对照组,每组15名.两组学员均先进行电子软镜插管的理论知识培训,随后对照组学员观摩带教老师对患者实施电子软镜插管5例,并在带教老师指导下,完成5例全麻非困难气道患者的电子软镜插管.试验组学员则在带教老师的指导下,使用支气管内窥镜训练系统完成30次软镜模拟训练,记录每次训练的操作时间,拟合学习曲线.完成培训后,2组学员均采用模拟人头进行5次(N1、N2、N3、N4、N5)软镜操作考核,比较2组学员的操作时间及熟练度评分.结果 与对照组比较,试验组学员操作时间短,熟练度评分高,差异有统计学意义(P<0.05);对照组学员自N2次考核后操作时间随着操作次数增加而减少(P<0.05),与N1比较,N3、N4、N5熟练度评分高(P<0.05),与N2、N3比较,N4、N5熟练度评分高(P<0.05).试验组学员在支气管内窥镜训练系统上模拟软镜操作26(23,27)次后,操作时间基本稳定在90(82,101)s,达到专业级水平.结论 使用支气管内窥镜训练系统对麻醉专业住培学员行电子软镜插管训练,安全、 高效,且训练26次后可达到学习目标.

目的:探讨不同潮气量机械通气对4-硝基喹啉-1-氧化物(4NQO)饮水法饲养的大鼠肺组织的影响.方法:30只4周龄雄性SD大鼠采用4NQO饮水法饲养12周后,随机分为对照组(A组)、常规潮气量组(B组)和肺保护性通气组(C组),每组10只,通气4h处死大鼠.酶联免疫吸附试验(ELISA)法测定支气管肺泡灌洗液(BALF)中的白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的浓度变化,BCA法测定BALF中的总蛋白浓度及肺水含量;苏木精-伊红(HE)染色观察大鼠舌头和肺组织病理切片,统计Smith评分,TUNEL法测定肺泡上皮细胞凋亡指数(AI).结果:与A组相比,B组和C组的IL-6、TNF-α、总蛋白浓度及Smith评分、AI水平显著升高(P＜0.05);与B组相比,C组的上述各项指标均明显降低(P＜0.05).结论:肺保护性通气策略(LPVS)可以减轻4NQO饮水法饲养大鼠的肺组织损伤.

目的:探讨保护性肺通气策略(LPVS)对口腔癌患者术后氧合功能的影响.方法:选择全麻下行口腔癌手术患者90例,随机分为3组:常规潮气量组(A组)、小潮气量+低呼气末正压通气(PEEP)组(B组)、小潮气量+低PEEP+肺复张组(C组),每组30例.记录每组患者术前(T1)、机械通气2 h(T3)、手术结束时(T4)、术后24 h(T5)和72 h(T6)的动脉氧分压(PaO2)、肺泡动脉血氧分压差[P(A-a)DO2]和氧合指数(OI);记录患者机械通气后30 min (T2)、T3和T4的气道压峰值(PAP)以及计算动态肺顺应性(CL);记录患者T1、T5和T6的白细胞(WBC)、C反应蛋白(CRP)、临床改良肺部感染评分(mCPIS).结果:3组患者各时点P(A-a)DO2、PaO2均较术前升高,术中PAP值呈上升趋势,T5、T6时点WBC、CRP和mCPIS评分也均较T1时点升高,其中B组、C组PAP、P(A-a)DO2、CRP和mCPIS评分升高幅度明显低于A组(P＜0.05);3组患者各时点OI较术前下降,且术中CL呈下降趋势,其中B组、C组OI、CL下降幅度低于A组(P＜0.05).3组术中均无严重不良事件发生.结论:口腔癌手术患者术中应用LPVS有利于促进术后早期肺氧合功能的恢复.

患儿,男,3月龄,6 kg,ASA Ⅱ级. 因"先天性右侧唇裂Ⅱ度"入院,拟在全麻下行先天性唇裂Ⅱ度整复术+鼻畸形矫正术. 患儿既往无过敏史,血红蛋白93 g/L,其余实验室检查无异常. 入室后予面罩吸入8％七氟醚镇静,开放下肢静脉,静脉滴注5％葡萄糖氯化钠,BP 98/45 mmHg,HR 123次/分,SpO299％,RR 25次/分. 静脉通路开放后关闭七氟醚挥发罐,麻醉诱导:静注阿托品0.2 mg、地塞米松2 mg、咪达唑仑0. 6 mg、丙泊酚10 mg、瑞芬太尼20 μg,面罩加压辅助呼吸,2 min后行气管插管. 听诊两肺呼吸音清且对称.呼吸机控制呼吸, VT 8 ml/kg, RR 28 次/分,气道压力 16 cmH2O,PETCO236 mmHg. 丙泊酚10 mg·kg-1·h-1和瑞芬太尼0. 3 μg·kg-1 ·min-1持续静脉输注维持麻醉.

患儿,男,7月龄,7. 3 kg,ASA Ⅱ级. 因"发现右面部肿物并右上唇、右口角开裂7月余"入院. 术前诊断:( 1)右侧面部肿物待查,(2)右侧唇裂Ⅱ度,(3)右侧面横裂,(4)右硬腭裂伴牙槽突裂. 拟在全麻下行"右侧面部肿物探查摘除术+右侧唇裂整复术+右侧面横裂整复术". 入室后予七氟醚和丙泊酚麻醉诱导. 使用普通喉镜暴露声门,选择ID 3. 5 mm钢丝气管导管插管,发现过声门后不能再置入,换用ID 3. 0 mm普通气管导管仍不能置入,考虑声门下气管狭窄.与主刀医师和家属商议后,决定唤醒患儿,暂缓手术,让患儿进一步完善呼吸道相关检查再行手术. 行电子气管镜检查显示:气管狭窄(狭窄部位位于声门下3～4 cm ). 胸部CT提示:气管颈下端管腔不均匀变窄,最窄处管径约0. 3 cm,累及长度约1. 2 cm. 麻醉科医师评估认为,患儿存在气管狭窄,如果全麻只能选择ID 2. 5 mm气管导管,能否成功插入未能确定,即使顺利插入,偏小的气管导管插管易引起通气不足,甚至痰堵无法通气,风险较大. 该手术为择期手术,建议待患儿气管发育,狭窄改善后再行手术,与手术医师和家属沟通后同意该方案.

Objective To observe the effects of morphine on the growth and proliferation of human breast cancer MCF-7 cells.Methods MCF-7 cells were seeded in 6-well or 96-well plates and divided into 4 groups:0.01 μmol/L morphine group (group M1),0.10 μ mol/L morphine group (group M2),1.00 μmol/L morphine group (group M3) and control group (group C).MCF-7 cells in the logarithmic phase were cultured.The cells in morphine groups were incubated with 0.01,0.10 or 1.00 μmol/L morphine respectively.The cells in control group were incubated normally.The viability of cells was determined by methyl thiazol tetrazolium (MTT) assay and the proliferation of cells was determined by colony formation assay.The cell cycle progression and apoptosis were assessed by flow cytometry.Results The viability of MCF-7 cells was inhibited after exposed to 0.01,0.10 or 1.00 μmol/L morphine respectively.Cell colony formation rate in groups M1,M2,and M3 was (0.76 ±0.09)％,(0.74 ±0.12)％ and (0.78 ± 0.08) ％,respectively,which significantly lower than in group C [(1.25 ± 0.28) ％] (P ＜ 0.05).The apoptotic rate in groups M1,M2,and M3 was (5.33 ± 0.09) ％,(5.21 ± 0.15) ％ and (5.09 ± 0.08) ％,respectively,significantly higher than that in control group [(1.25 ± 0.16) ％] (P ＜ 0.05).In morphine groups,the proportion of cells in G2/M was significantly higher than that in group C (P ＜ 0.05).There was no significant difference in the above indexes among the three morphine groups (P ＞ 0.05).Conclusion Morphine can inhibit growth and proliferation of MCF-7 cells by inducing apoptosis and making cell cycle arrest in vitro.But morphine presents a ceiling effect on inhibiting growth and proliferation of breast cancer cells MCF-7.

Objective To evaluate the effect of fentanyl on the expression of vascular endothelial growth factor A (VEGF-A) and matrix metallopeptidase-9 (MMP-9) in the subcutaneous tumor of human gastric cancer in nude mice.Methods Thirty SPF male BALB/C nude mice,aged 4-5 weeks,weighing 15-20 g,in which the model of subcutaneous tumor of human gastric cancer cell line MGC-803 was established,were randomly divided into 6 groups (n =5 each) using a random number table:control group (C group),normal saline group (NS group) and fentanyl 0.05,0.10,0.20 and 0.40 mg/kg groups (F1-4 groups).The mice in group C received no treatment.Fentanyl 0.05,0.10,0.20 and 0.40 mg/kg were intraperitoneally injected once a day for 14 consecutive days in F1 4 groups,respectively,while the equal volume of normal saline 1.5 ml/kg was given instead of fentanyl in group NS.The nude mice were sacrificed on 1 day after the end of administration,and the tumor tissues were obtained for examination of the ultrastructure of subcutaneous tumor (with a transmission electron microscope) and for detection of the expression of VEGF-A and MMP-9 (by immunohistochemistry and Western blot) and expression of VEGF-A and MMP-9 mRNA (by real-time reverse transcriptase polymerase chain reaction).Results No abnormality in the morphology of the subcutaneous tumor cells was observed in C and NS groups.The swollen nucleus,chromatin margination,nuclear fragmentation and apoptotic bodies were found in the subcutaneous tumor cells in F1-4 groups.Compared with group C,the expression of VEGF-A and MMP-9 protein and mRNA was significantly down-regulated in F1-4 groups (P＜0.05),and no significant change was found in each parameter mentioned above in group NS (P＞0.05).There was no significant difference in the expression of VEGF-A and MMP-9 protein and mRNA among F1-4 groups (P＞0.05).Conclusion The mechanism by which fentanyl inhibits the growth and metastasis of subcutaneous tumor cells of human gastric cancer is related to down-regulation of VEGF-A and MMP-9 expression in nude mice.