Effects of intravenous administration of magnesium sulfate in propofol-based sedation for ERCP in elderly patients: a randomized, double-blind, placebo-controlled study.

BACKGROUND: Propofol-based sedations are widely used in elderly patients for endoscopic retrograde cholangiopancreatography (ERCP) procedure, but respiratory depression and cardiovascular adverse events commonly occur. Magnesium administered intravenously can alleviate pain and decrease propofol requirements during surgery. We hypothesized that intravenous magnesium was used as adjuvant to propofol might be beneficial in elderly patients undergoing ERCP procedures. METHODS: Eighty patients aged from 65 to 79 years who were scheduled for ERCP were enrolled. All patients were intravenously administered 0.1 µg/kg sufentanil as premedication. The patients were randomized to receive either intravenous magnesium sulfate 40 mg/kg (group M, n = 40) or the same volume of normal saline (group N, n = 40) over 15 min before the start of sedation. Intraoperative sedation was provided by propofol. Total propofol requirement during ERCP was the primary outcome. RESULTS: The total propofol consumption were reduced by 21.4% in the group M compared with the group N (151.2 ± 53.3 mg vs. 192.3 ± 72.1 mg, P = 0.001). The incidences of respiratory depression episodes and involuntary movement were less in the group M than those in the group N (0/40 vs. 6/40, P = 0.011; 4/40 vs. 11/40, P = 0.045; respectively). In the group M, the patients experienced less pain than those in the group N at 30 min after the procedure (1 [0-1] vs. 2 [1-2], P < 0.001). Correspondingly, the patients' satisfaction was clearly higher in the group M (P = 0.005). There was a tendency towards lower intraoperative heart rate and mean arterial pressure in group M. CONCLUSIONS: A single bolus of 40 mg/kg of intravenous magnesium can significantly reduce propofol consumption during ERCP, with higher sedation success and lower adverse events. TRIAL REGISTRATION: ID UMIN000044737. Registered 02/07/2021.

[Effect of Xuebijing injection on T helper 17 and CD4+ CD25+ regulatory T cells in patients with sepsis].

OBJECTIVE: To study the level and significance of T helper 17 (Th17) and CD4(+) CD25(+) regulatory T cells (Treg) in peripheral blood of patients with sepsis and to evaluate the effects of Xuebijing injection on them. METHODS: ¹ Sixty-four patients with sepsis in intensive care unit (ICU) of Anhui Provincial Hospital were divided into three groups: sepsis group (n=26), severe sepsis group (n=21), and septic shock group (n=17). Eighteen healthy individuals served as controls. The comparison in the expression of Th17 and CD4(+)CD25(+) Treg within groups and the correlation between their levels and the severity of sepsis was made. ² Sixty-four patients were also randomly divided into two groups: routine group (n=25, received routine bundle treatment) and Xuebijing treatment group (n=39, received bundle treatment + Xuebijing treatment). Patients in Xuebijing treated group were given 50 ml Xuebijing injection two times per day in addition to routine bundle treatment. Seven days constituted one course of treatment. The expressions of Th17 and CD4(+) CD25(+) Treg of 64 patients on the 1 day and 7 days after treatment were detected by flow cytometry. The effects of Xuebijing injection on the patients were evaluated. RESULTS: ¹ The expression rate of Th17 and CD4(+)CD25(+) Treg was (0.84 ± 0.29)% and (0.43 ± 0.20)% respectively in control group, and they were lower than that of patients with sepsis (P<0.05). The expression rate of Th17 was higher in severe sepsis group [(3.18 ± 0.84)%] than that of other two groups (P <0.05). Moreover , The expression rate of CD4(+)CD25(+) Treg was highest [(3.28 ± 0.76)%] in septic shock group (P<0.05) , and it was positive correlated with acute physiology and chronic health evaluation II (APACHEII) score and blood lactate (r(1)=0.519, r(2)=0.451, both P =0.01) in all 64 patients. ² Compared with routine group, our study indicated that Xuebijing injection could reduce the abnormal expression of Th17 [(1.72 ± 0.69)% vs. (2.35 ± 0.81)%,P<0.05] and CD4(+)CD25(+) Treg [(1.78 ± 1.00)% vs. (2.30 ± 0.85)%,P<0.05] and decrease length of stay in ICU [(4.7 ± 2.6) days vs. (7.5 ± 4.3) days,P=0.002]. It also lowered 28-day mortality of patients with sepsis, but the difference between two groups was not significant (20.5% vs. 28.0%,P>0.05). CONCLUSION: The expression of Th17 and CD4(+)CD25(+) Treg was increased in sepsis patients and was positively correlated with severity of sepsis, suggesting that they may play an important role in pathogenesis of sepsis. Xuebijing injection could decrease the abnormal expression of Th17 and CD4(+) CD25(+) Treg and tend to decrease the fatality rate of sepsis.

Bifunctional metal-salen complexes as efficient catalysts for the fixation of CO2 with epoxides under solvent-free conditions.

A bifunctional cobalt-salen complex containing a Lewis acidic metal center and a quaternary phosphonium salt unit anchored on the ligand effectively catalyzes the synthesis of cyclic carbonates from CO2 and epoxides under mild conditions without the utilization of additional organic solvents or co-catalysts. The effects of various reaction variables on the catalytic performance were studied in detail and indicate an optimized reaction temperature of about I00 degrees C and CO2 pressure of around 4 MPa, although the reaction proceeds smoothly even at pressures as low as 2 MPa. The catalyst is applicable to a variety of epoxides, producing the corresponding cyclic carbonates in good yields in most cases. Furthermore, the catalyst can be easily recovered and reused several times without significant loss of its catalytic activity. This process thus represents a greener pathway for the environmentally benign chemical fixation of CO2 to produce cyclic carbonates.