Objectives Neuropathic pain (NP) represents a broad scope of various pathological ramifications of the nervous system. Remimazolam is a proved sedative in treating neuropathic pain. Considering the Bradykinin receptor’s vital role and the potentials of Bradykinin receptor B1 (BDKRB1) in the neuropathic pain-signalling pathway, we nominated them as a primary target for remimazolam. Methods In this study, rats were injected with complete freund’s adjuvant (CFA) to construct NP models in vivo. BV2 microglia cells were treated with LPS to establish NP model in vitro. qRT-PCR, ELISA, western blot and immunofluorescence were applied to determine gene expression. Key findings Our findings revealed that BDKRB1 was overexpressed in NP models in vivo, while R715 (an antagonist of BDKRB1) suppressed the levels of BDKRB1 and inhibited the hyperpathia induced by spinal nerve litigation surgery. Moreover, remimazolam inactivated BDKRB1 signalling via suppressing NF-κB translocation and decreased the release of pro-inflammatory cytokines. Additionally, remimazolam suppressed the translocation of NF-κB, and inhibited autophagic lysosome formation in vivo and in vitro. However, R838 (an agonist of BDKRB1) reversed the effects of remimazolam. Conclusions Remimazolam downregulated BDKRB1, inhibited BDKRB1/RAS/MEK signalling pathway and regulated the autophagic lysosome induction, exhibiting a better outcome in the NP.

ObjectiveThis study aimed to evaluate the effect of perioperative transcutaneous electrical acupoint stimulation (TEAS) on postoperative cognitive dysfunction (POCD) in older patients with lumbar spine surgery.MethodsOlder patients (aged 60–80 years old) receiving lumbar spine surgery under general anesthesia were randomly divided into group A, 3-day intervention group; group B, 7-day intervention group; control group C, sham TEAS group, selected “Baihui” (GV 20) and “Dazhui” (GV 14) point was intervened once 30 min before operation with “HANS” transcutaneous electrical stimulation device, and then once a day after operation for 30 min each time. The primary outcome was the incidence of postoperative cognitive impairment assessed by the use of the Mini Mental Rating Scale (MMSE), patients developed POCD according to the Z score method. The secondary outcome was serum interleukin-6 (IL-6), tumor Necrosis factor α (TNF-α), neuron-specific enolase (NSE), and S100β protein levels.ResultsThree days after surgery, the incidence of POCD in groups A((22.4%)) and B ((18.3%)) were lower than those in group C ((42.9%)) (P < 0.05). There was no significant difference between groups A and B (P > 0.05). Seven days after surgery, the incidence of POCD in group B (18.3%) was lower than that in groups A (26.5%) and B (42.9%), and the comparison between groups B and C was statistically significant (P < 0.05). On the 3rd and 7th days after surgery, the levels of IL-6, TNF-α, NSE, and S100β in the two TEAS groups were lower than those in the sham TEAS group (P < 0.01), but higher than the preoperative levels in the three groups (P < 0.01).ConclusionIt seems that Perioperative TEAS intervention could reduce the level of inflammatory factors IL-6, TNF-α in the blood of older patients with lumbar spine surgery, and reduce the incidence of POCD.Clinical trial registrationwww.chictr.org.cn, identifier ChiCTR2200063030.

This study aimed to explore the current situation regarding medical students’ professional identity after COVID-19 in China, as well as the factors that influence it. Questionnaire compiled by Fujian Medical University and self-designed were used, and participators were from one Medical University in Jiangxi Province, a central city of China. Results showed that the professional identity of medical students was upper middle level and the professional attitude was generally positive. There was a significant sex difference in terms of value (t = 2.057, p < 0.05) which the scores for boys were higher than girls, whereas the scores for girls were higher than boys when it came to aspects such as professional environment (t = -3.918, p < 0.001) and professional cognition (t = -3.855, p < 0.001). There was a significant difference in the sense of professional identity between people with and without siblings (t = 2.264, p < 0.05). The scores of students who participated in prevention and control of the epidemic were significantly higher than those who did not (t = 2.267, p < 0.01). Professional identity decreased gradually in related to higher grades, but it increased at the graduate stage; the grade [F (5,635) = 10.302, p < 0.001] and majors [F(2,635) = 5.718, p < 0.01] differences were significant. Factors such as family members’ influence, attitude toward occupation, grades, major, registered residence, and college choosing were the main factors that influenced medical students’ professional identity. Overall, the medical students’ professional identity needs to be further strengthened in the post COVID-19, it should be increased education regarding career development and planning.

ObjectiveThis study aimed to find the best dose of dexmedetomidine in spinal anesthesia for cesarean section.Methods120 American Society of Anesthesiologists (ASA) Class I and II parturients undergoing elective cesarean delivery under spinal anesthesia were randomly allocated into four groups treated with intrathecal ropivacaine (12 mg) alone (Group R) or in combination with dexmedetomidine 5 μg (Group RD1), 7.5 μg (Group RD2) and 10 μg (Group RD3). Characteristics of spinal anesthesia, hemodynamic changes, adverse effects, stress reactions and neonatal outcomes were recorded in the four groups.ResultsPatients in Group RD1, RD2, and RD3 had significantly longer sustained sensory and motor block time than patients in Group R. All four groups had comparable onset times of sensory and motor block. The time for the level of sensory block to lower to S1 was longer in Group RD1 (411.07 ± 106.66 min), Group RD2 (397.03 ± 125.39 min) and Group RD3 (468.63 ± 116.43 min) than in Group R (273.60 ± 88.34 min) (p < 0.001). The time to recover from motor block to a Bromage score of IV was longer in Group RD1 (353.60.07 ± 137.28 min), Group RD2 (350.57 ± 118.01 min) and Group RD3 (404.67 ± 112.83 min) than in Group R (232.70 ± 93.29) (p < 0.01). The incidence of chills was significantly lower in the Group RD1, RD2, and RD3 than in the Group R (p < 0.001). There was no significant difference in the incidence of adverse effects such as hypotension, bradycardia, nausea, vomiting, hypoxemia and pruritus in the four groups (p > 0.05). There was no statistically significant visceral traction response or fentanyl use in the four groups (p > 0.05). Phenylephrine dosing was significantly higher in Group RD2 and RD3 than in Group R (p < 0.05), and there was no significant difference in phenylephrine dosing between Group RD1 and Group R (p > 0.05). There were no statistical differences in postnatal Apgar scores (1 min, 5 min after birth) (p > 0.05). The postoperative concentrations of β-endorphin (β-EP), cortisol (Cor) and tumor necrosis factor-α (TNF-α) in the Group RD1, RD2, and RD3 were lower than that in Group R (p < 0.05).ConclusionIntrathecal 5μg of dexmedetomidine as an adjuvant to ropivacaine relieved intraoperative chills, did not increase intraoperative and postoperative adverse effects, did not increase the amount of intraoperative vasoconstrictor used, and reduced intraoperative stress reactions as well as prolonged the duration of maternal sensory and motor block, so this dose is appropriate for cesarean section.Clinical Trial Registration:[www.chictr.org.cn/], identifier [ChiCTR2200056052].

Objective: The relationship of a diet low in fiber with mortality has not been evaluated. This study aims to assess the burden of non-communicable chronic diseases (NCDs) attributable to a diet low in fiber globally from 1990 to 2019. Design: All data were from the Global Burden of Disease (GBD) Study 2019, in which the mortality, disability-adjusted life-years (DALYs), and years lived with disability (YLDs) were estimated with Bayesian geospatial regression using data at global, regional, and country level acquired from an extensively systematic review. Setting: All data sourced from the GBD Study 2019. Participants: All age groups for both sexes. Results: The age-standardized mortality rates (ASMRs) declined in most GBD regions; however, in Southern Sub-Saharan Africa, the ASMR increased from 4.07 (95% uncertainty interval (UI): [2.08, 6.34]) to 4.60 (95% UI: [2.59, 6.90]), and in Central Sub-Saharan Africa, the ASMR increased from 7.46 (95% UI: [3.64, 11.90]) to 9.34 (95% UI: [4.69, 15.25]). Uptrends were observed in the age-standardized YLDs rates attributable to a diet low in fiber in a number of GBD regions. The burden caused by diabetes mellitus increase in Central Asia, Southern Sub-Saharan Africa and Eastern Europe. Conclusions: The burdens of disease attributable to a diet low in fiber in Southern Sub-Saharan Africa and Central Sub-Saharan Africa and the age-standardized YLDs rates in a number of GBD regions increased from 1990 to 2019. Therefore, greater efforts are needed to reduce the disease burden caused by a diet low in fiber.