To evaluate the effects of remimazolam on painless gastroenteroscopy in elderly patients.

The aged patients scheduled for painless gastroenteroscopy were enrolled and randomly divided into 2 groups.The anesthesia induction regimen of the control group was sufentanil 0.1 μg·kg^-1+ propofol 1.5 mg·kg^-1, and the additional dose of propofol was 0.5 mg·kg^-1 each time during the examination. The administration regimen of the experimental group was sufentanil 0.1 μg·kg^-1 + remimazolam 0.15 mg·kg^-1 induction, and each additional dose of remimazolam was 1/3 of the first dose during the examination. Heart rate, respiratory rate, mean arterial pressure, and blood oxygen saturation during anesthesia were recorded. The time of induction, recovery and exit, and adverse reactions such as injection pain, hypoxemia and hypotension were observed.

A total of 441 patients were included in the analysis, 225 in the control group and 116 in the experimental group. Compared with the control group, the mean arterial pressure of the experimental group was higher than that of the control group at 5 and 10 min after administration, and the difference was significant (P<0.05).The induction, recovery and exit time of the experimental group were (41.8±4.3) s, (5.7±4.4) and (10.2±6.5) min, and those in the control group were (32.6±2.7) s, (6.6±3.9) and (12.9±7.4) min, respectively. The induction time of the experimental group was longer than that of the control group, and the recovery and exit time of the control group were shorter, with significant differences (P<0.05). Compared with the control group, the incidence of injection pain (54.2% vs. 2.3%), hypotension (16.4% vs. 6.9%) and hypoxemia (19.6% vs. 14.8%) in the experimental groups was significantly reduced (P<0.05).

Remimazolam is safe and effective for painless gastroenteroscopy in elderly patients, and has the advantages of fast recovery and low incidence of adverse reactions.

To evaluate the influence of age on the effectiveness of midazolam oral solution in managing preoperative anxiety in pediatric patients.

Pediatric patients, aged 1 to 6 years, scheduled for elective surgery under general anesthesia, regardless of gender, American Society of Anesthesiologists Ⅰ-Ⅱ classification, were divided into two age groups: infants (1 ≤ age ≤ 3 years) and children (3 < age ≤ 6 years). The initial dose of oral midazolam solution administered was 0.5 mg·kg^-1. Subsequent dosages were determined using a bias coin design dose-up-and-down sequential method, based on the patient’s modified Ramsay sedation score, parental separation anxiety score, and facemask induction score after admission. The behavior scores and adverse reactions during sedation between the two groups were recorded and compared. The 95% effective dose (ED₉₅) and corresponding 95% confidence interval (95% CI) of midazolam oral solution for preoperative anxiety relief in children was calculated through isostatic regression analysis.

The ED₉₅ for infants and children was 0.83 mg·kg^-1 (95%CI: 0.69 to 0.88 mg·kg^-1) and 0.89 mg·kg^-1 (95%CI: 0.69 to 0.97 mg·kg^-1), respectively. No statistically significant difference in ED₉₅ was observed between the two groups (P>0.05). A comprehensive analysis of both age groups yielded an overall ED₉₅ of 0.89 mg·kg^-1 (95%CI: 0.79 to 0.97 mg·kg^-1) for midazolam oral solution in alleviating preoperative anxiety in children aged 1 to 6 years. There was a statistically significant difference in the behavior scores between the two groups (P<0.05), but no difference in parental satisfaction (P>0.05).Adverse events including hypoxemia, respiratory depression, nausea and vomiting were not observed in the two groups during the induction period and the anesthesia recovery period.

The efficacy of midazolam oral solution in alleviating preoperative anxiety in children is not affected by age. The dose of ED₉₅ for relieving preoperative anxiety in children aged 1 to 6 years is 0.89 mg·kg^-1.

To evaluate the effects of flurbiprofen combined with quadratus lumborum block (QLB) on postoperative neurocognitive function and inflammatory response in elderly patients undergoing nephrectomy.

Sixty elderly patients undergoing laparoscopic nephrectomy were randomized into group Q (QLB group) and group FQ (flurbiprofen combined with QLB group), 30 patients in each group. Ultrasound guided anterior QLB were performed in all patients on the surgical side. Patients in group FQ received flurbiprofen 1 mg·kg^-1 iv 10 min before surgery. Then both groups received general anesthesia. The dosages of propofol and remifentanil during surgery and the effective number of analgesia pump presses were recorded. The scores of visual analogue scale (VAS) and Bruggrmann comfort scale (BCS) were evaluated at 6, 24, 48 h after surgery. The neurocognitive function was evaluated at 1 d before surgery and 1 d and 7 d after surgery using the mini-mental state examination (MMSE), and the incidence of postoperative neurocognitive disorder (PND) within 7 d after surgery was recorded. Venous blood was collected and the serum levels of high mobility group box protein 1 (HMGB1) and interleukin 6 (IL-6) were tested 1 h before surgery and 30 min and 24 h after the surgery.

Compared with group Q, the dosage of remifentanil was significantly reduced in group FQ (P<0.05), and the effective numbers of analgesia pump presses were reduced in group FQ (P<0.05). At 6, 24 h after surgery, the VAS score was lower, and the BCS score was higher in group FQ than group Q (P<0.05). Compared with group Q, the MMSE score at 1, 7 d after surgery was significantly higher in the group FQ (P<0.05), the incidence of PND within 7 d after surgery was lower in group FQ (P<0.05). The HMGB1 and IL-6 levels at 30 min, 24 h after the surgery were significantly lower in group FQ than group Q (P<0.05).

Flurbiprofen combined with QLB can reduce the incidence of PND in elderly patients undergoing nephrectomy, which may be related to the perfect early postoperative analgesia and the decreased levels of inflammatory cytokines.

To explore the effect of crocin on gastric mucosal epithelial cells injury induced by clopidogrel and the molecular mechanism.

The gastric mucosal epithelial cells GES-1 were divided into control group, model group (0.5 mmol ·L^-1 clopidogrel), and crocin low, medium, and high concentration (0.1, 1, 10 nmol·L^-1) groups, and additionally divided into anti-miR-NC group, miR-877-5p inhibitor group, crocin (10 nmol·L^-1) + miR-NC group, crocin (10 nmol·L^-1) + miR-877-5p mimic group. MTT and colony formation assays were used to detect cell survival rate and the number of colony formation. Flow cytometry was used to detect cell apoptosis. qRT-PCR was used to detect the expression level of miR-877-5p. Western blot was used to detect the expression of occludin, zonula occluden-1 (ZO-1), and p-P38 protein.

Compared with the control group, the survival rate and the number of cell clone formation in model group were decreased, the apoptosis rate and the expression of miR-877-5p and p-P38 were increased, and the expressions of occludin and ZO-1 were decreased (P<0.05). Compared with the model group, the survival rate and the number of cell clone formation in the crocin medium and high concentration groups were increased, the apoptosis rate and the expression of miR-877-5p and p-P38 were decreased, and the expression of occludin and ZO-1 were increased (P<0.05). Compared with the anti-miR-NC group, the survival rate, the number of cell clone formation, and expression of occludin and ZO-1 were increased in the miR-877-5p inhibitor group, and apoptosis rate and expression of miR-877-5p and p-P38 were decreased (P<0.05).Compared with the crocin+miR-NC group, the survival rate, the number of cell clone formation, and the expression of occludin and ZO-1 were decreased in the crocin+miR-877-5p mimic group, while the apoptosis rate and the expression of miR-877-5p and p-P38 were increased (P<0.05).

Crocin may inhibit clopidogrel-induced apoptosis of gastric epithelial cells and promote cell proliferation by down-regulating miR-877-5p.

To quantitative evaluate of selective Janus kinase inhibitors in treatment of atopic dermatitis, and provide scientific basis for drug selection and clinical rational drug use.

According to the Quick Guideline for Drug Evaluation and Selection in Chinese Medical Institutions （the Second Edition）, a comprehensive evaluation of upadacitinib and abrocitinib was conducted from five aspects of pharmaceutical characteristics, efficacy, safety, economy,and other attributes, and scores were assigned.

The total scores of upadacitinib and abrocitinib were 80.5 and 80.2 respectively. Upadacitinib and abrocitinib had definite therapeutic effects in terms of itching relief, and skin lesion clearance. But when combined with topical corticosteroids and other drugs, the improvement in efficacy of abrocitinib was better than that of upadacitinib. Upadacitinib had a wider range of applicability compared to abrocitinib, but the incidence of adverse reactions in the blood system of abrocitinib was lower than that of upadacitinib. Upadacitinib and abrocitinib were recommended for admission.

Abrocitinib is suitable for patients who seek quick results and build confidence, as well as those who need to flexibly adjust treatment plans based on their condition. Upadacitinib is preferred for adolescents over 12 years old, patients with severe renal insufficiency, or concomitant diseases such as rheumatoid arthritis and ulcerative colitis.

To mine the adverse drug event （ADE） signals of ramucirumab based on the database of FDA Adverse Event Reporting System （FAERS）, so as to provide evidence for safe clinical medication.

The ADE reports related to ramucirumab from the second quarter of 2014 to the fourth quarter of 2023 in the FAERS database were extracted, and the reporting odds ratio method of disproportional method and comprehensive standard method of British Medicines and Healthcare Products Regulatory Agency were used for data mining and analysis.

A total of 4 704 ADE reports of ramucirumab were collected. Most reporting objects were male （58.38%）, with the age of 65-85 （40.45%）. The main sources of reported events was Japan （46.64%）. A total of 140 ADE signals were detected,involving 18 system organ class （SOC）. Among them, a large number of reports were general disorders and administration site conditions （18.04%）, neoplasms benign, malignant and unspecified （15.82%）, respiratory, thoracic and mediastinal disorders （13.32%） and gastrointestinal disorders （12.83%）. ADE signals with high frequency were basically consistent with the drug instructions. The ADE signals that need to be focused on clinically were mainly hemorrhagic ADE such as gastrointestinal bleeding, tumor bleeding, colorectal bleeding, and brainstem bleeding, as well as ADE of organ perforation.

The medication evaluation of patients should be done before using ramucirumab. During treatment, close attention should be paid to the occurrence of ADE such as bleeding and perforation, and timely intervention should be taken in case of abnormality.

To evaluate the effects of butorphanol combined with quadratus lumborum block （QLB） on postoperative analgesia and early rehabilitation quality in patients with colorectal cancer.

Sixty patients undergoing elective laparoscopic radical resection of colorectal cancer under general anesthesia were randomly divided into two groups, with 30 cases in each group. The induction and maintenance of anesthesia were the same in the two groups.Patients in group B received patient-controlled intravenous analgesia （PCIA） with butorphanol 0.2 mg·kg^-1 diluted to 200 mL with sodium chloride injection. Patients in group BQ received ultrasound-guided bilateral anterior QLB and 0.25% ropivacaine 20 mL was injected bilaterally on the basis of that in the group B. Visual analogue scale （VAS） and Bruggrmann comfort scale （BCS） were used to evaluate the analgesic effect of the two groups after operation. The serum levels of interleukin （IL）-6, C-reactive protein （CRP） and tumor necrosis factor （TNF） -α were detected before operation and 24 h after operation. The postoperative recovery and hospitalization satisfaction score of the patients were evaluated,the consumption of butorphanol and the requirement for rescue analgesia within 48 h after operation were recorded, and the occurrence of postoperative nausea and vomiting was observed.

The VAS scores of the group BQ were lower than those of the group B at 2, 6, 12 and 24 h after operation （P<0.05）, and the BCS scores of the group BQ were higher than those of the group B （P<0.05）. The levels of IL-6, TNF-α and CRP at 24 h after operation in both groups were higher than those before operation （P<0.05）, but those in the group BQ were lower than those in the group B （P<0.05）. The postoperative anal exhaust time, liquid food intake time, ambulation time and hospitalization time in the group BQ were shorter than those in the group B （P<0.05）, and the hospitalization satisfaction in the group BQ was higher than that in the group B （P<0.05）. The consumption of butorphanol within 48 h after operation in the group BQ was less than that in the group B （P<0.05）, and the requirement for rescue analgesia in the group BQ was lower than that in the group B （P<0.05）.No serious adverse reactions occurred in the two groups, but the incidence of nausea and vomiting in the group BQ was significantly lower than that in the group B （P<0.05）.

Butorphanol combined with QLB for postoperative analgesia in patients undergoing laparoscopic radical resection of colorectal cancer can effectively enhance the postoperative analgesic effect, reduce the inflammatory response of the body, and promote the early recovery of patients.

To provide reference for selection and clinical rational use of third-generation anti-seizure medications in medical institutions through a comprehensive evaluation of perampanel and lacosamide.

A percentage based evaluation system was developed based on the Quick Guide for Drug Evaluation and Selection in Chinese Medical Institutions （the Second Edition）. Referring to drug instructions, clinical treatment guidelines, and relevant literature, perampanel and lacosamide were quantitatively scored from five dimensions of pharmaceutical characteristics,effectiveness, safety, economy, and other attributes.

The final evaluation score was 77.41 for perampanel and 69.06 for lacosamide. The score of perampanel was higher than 70, so the recommendation for entering the drug use catalog of medical institutions was “strong recommendation”. There was a significant difference in effectiveness and economy between the two drugs. Perampanel had more evidence-based proofs and indications for the treatment of drug-resistant epilepsy and lower average daily treatment cost, so the effectiveness and economy of perampanel was slightly better than that of lacosamide. However, in terms of safety, perampanel had a Boxed Warning from the U. S. Food and Drug Administration about severe psychiatric and behavioral reactions, and it was not as recommended as lacosamide in patients with pregnancy or liver dysfunction.

Perampanel and lacosamide each have advantages in different attributes, and medical institutions can decide whether to introduce them based on the characteristics of patient population and the availability of alternative drugs.