Objective To compare the efficacy of sedation with dexmedetomidine versus midazolam in mechanically ventilated patients.Methods Sixty patients aged 20-64 yr,with body mass index 21-25 kg/m2,APECHE Ⅱ score 10-25,requiring 24 h of nechanical ventilation in intensive care unit (ICU),were randomly divided into 2 groups (n=30 each): midazolam group (group M) and dexmedetomidine group (group D).A loading dose of midazolam 0.05 mg/kg was injected intravenously,followed by infusion at 0.03-0.20 mg· kg-1 · h-1 in group M.A loading dose of dexmedetomidine 1 μg/kg was injected intravenously,followed by infusion at 0.2-0.7 μg· kg-1 · h-1 in group D.Ramsay sedation score was maintained at 2-4.The satisfaction of the doctors in ICU with the sedative efficacy,hypotension and bradycardia were recorded.Delirium was recorded starting from the begging of sedation to 2 h after the end of sedation.The emergence time and occurrence of falling asleep again within 2 h after waking were also recorded.Results Compared with M group,the satisfactory level of the doctors in ICU with the sedative efficacy was significantly increased,the emergence time was significantly shortened and the incidences of falling asleep again within 2 h after waking and delirium were significantly decreased (P ＜ 0.05 or 0.01),and no significant change was found in the incidence of hypotension and bradycardia in group D (P ＞ 0.05).Conclusion The efficacy of sedation with dexmedetomidine is better than that of midazolam in mechanically ventilated patients.

Objective To investigate the role of Wnt/β-Catenin signaling pathway in the endotoxin induced acute lung injury (ALI) during the treatment by mesenchymal stem cells (MSCs).Methods Six SPF male SD rats were isolated and bone marrow mesenchymal stem cells were cultured.A total of 72 SPF male SD rats with 6-week-old were randomly (random number) divided into 4 groups:control group (n =18) in which phosphate buffered solution (PBS) used instead of lipopolysaccharide (LPS);LPS group (n =18) in which LPS used to induce acute lung injury;LPS + MSCs group (n =18) in which MSCs directly transplanted after injection of LPS;Control + MSCs group (n =18) in which MSCs transplanted after injection of PBS.And then 6 rats of each group were sacrificed at 6 h,24 h,and 48 h separately after injection of LPS.At 24 h after the modeling,lung tissue was taken and the levels of Wrnt signaling pathway components were detected by using immunohistochemistry and Western blot.In addition,quantitative realtime PCR was used to detect the expression of Wnt signaling pathway target genes.Results Compare with the PBS control group,significant decrease in lung dry-to-wet ratio and increase in arterial oxygen partial pressure (PaO2) were found in MSCS transplantation groups.According the immunohistological results,Wnt 5a was significantly increased in the LPS-induced ALI rats and decreased after MSCs transplantation.Moreover,decrease in levels of GSK-3β phosphorylation and β-catenin was found in the lung tissue after MSCs transplantation.In addition,the expressions of Wnt signaling target genes Vegf,Axin2 and Klf4 were decreased significantly after MSCs transplantation.Conclusions In the setting of ALI,the therapeutic effect of MSCs was exerted by decreasing the expressions of Wnt 5a,GSK-3β phosphorylation,β-catenin,and Wnt signaling target genes Vegf,Axin2 and Klf4.Wnt signaling implicated in the therapeutic effect of MSC in the setting of ALI.

Objective:To explore the change trend of disease burden in laryngeal cancer attributable to smoking in China from 1990 to 2019.Methods:Based on data from the 2019 Global Burden of Disease Study database, the changes of death cases, mortality, disability adjusted life years (DALY) and DALY rate of laryngeal cancer attributable to smoking among people with different gender and age in China from 1990 to 2019 were analyzed. Joinpoint software was used to evaluate the annual percentage change (APC) and average annual percentage change (AAPC) of attributable mortality and DALY rate. The change trend of laryngeal cancer death attributable to smoking and DALY was analyzed.Results:From 1990 to 2019, the mortality rate and DALY rate of laryngeal cancer attributable to smoking in China showed an overall upward trend (AAPC of mortality was 1.6%, P < 0.05;AAPC of DALY rate was 1.26%, P < 0.05). In 2019, 75.64% of laryngeal cancer deaths in China were attributable to smoking, with 15 336 attributable deaths, 1.08/100 000 attributable mortality rates, 376 143 person-year attributable DALY and 26.45/100 000 attributable DALY rates, respectively. The population attributable fraction, death number, mortality rate, DALY and DALY rate of laryngeal cancer attributable to smoking in males were higher than those in females. In China, the number of laryngeal cancer deaths and DALY attributable to smoking peaked in the age group of 50-69 years old, and the attributable mortality and DALY rate peaked in the age group of ≥70 years old. Conclusions:The disease burden of laryngeal cancer attributable to smoking is high in China from 1990 to 2019, and there are differences in gender and age.

Objective To investigate the clinical characteristics,prevention and treatment strategy of de novo hepatitis B virus (HBV)infection after pediatric living liver transplantation.Methods In total,106 pediatric recipients undergoing living liver transplantation in Organ Transplantation Center of Affiliated Beijing Friendship Hospital of Capital Medical University and Organ Transplantation Center of Tianjin First Center Hospital from July 2010 to July 2014 were enrolled in this study.All surgeries were performed by the same surgical team.According to preoperative test outcomes of donor HBV serological markers,all recipients were divided into the positive (n =45)and negative (n =61)antibody to hepatitis B core antigen (anti-HBc)donor liver groups (positive group and negative group),and the prevalence of de novo HBV infection was compared between two groups.The risk factors of de novo HBV infection in the positive group were analyzed to elucidate the clinical characteristics of de novo HBV infection in affected children.Results The incidences of de novo HBV infection in positive and negative group were 18% (8 /45 )and 2% (1 /61 )respectively.The risk factors of de novo HBV infection in recipients with positive anti-HBc were negative anti-HBs before transplantation and absence of antiviral therapy post-transplantation in recipients (both in P <0.05 ).The median interval between time of onset and time of liver transplantation was 12 months (8-48 months).Seven cases were treated with lamivudine and the remaining two cases were left untreated.All nine recipients survived.Conclusions Application of positive anti-HBc donor liver have a risk of HBV infection in recipients after pediatric liver transplantation.Absence of postoperative nucleoside analogue therapy and negative anti-HBs before transplantation acts as risk factors of de novo HBV infection in the recipients with positive anti-HBc donor liver.After liver transplantation,nucleoside analogue therapy is recommended for the pediatric recipients with positive anti-HBc donor liver to prevent the incidence of de novo HBV infection.Besides,hepatitis B vaccine should be administered prior to liver transplantation.

The overall health condition of patients significantly affects the diagnosis,treatment,and prognosis of endodontic diseases.A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy,as well as selecting appropriate therapeutic approaches.This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence,aiming to provide general guidance on clinical procedures,improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.

Objective:To provide evidence for the selection of fixation devices and CTV to PTV margins (M ptv) in precision radiotherapy for pelvic tumors by analyzing three fixation devices in precision radiotherapy for prostate cancer. Methods:From April 2015 to December 2020, 133 prostate cancer patients treated with pelvic drainage area irradiation in our center were retrospectively analyzed. The patients were fixed with 1.2m vacuum bag (n=39), 1.8m vacuum bag (n=44) and personalized prone plate by our center (n=50). Each patient was asked to complete our bowel and bladder preparation process before positioning and radiotherapy. The registration of CBCT to planned CT before each treatment adopted the same registration box and algorithm. Setup errors in the SI, LR and AP directions under qualified bowel and bladder conditions were recorded. Setup errors in three directions under three fixation devices and corresponding M ptv values were analyzed. The correlation between setup errors with age and body mass index (BMI) was analyzed. Results:Analysis of 3333 setup errors data showed: in the SI and LR directions, the mean setup errors of 1.2m vacuum bag (3.26mm, 2.34mm) were greater than those of 1.8m vacuum bag (2.51mm, P<0.001; 1.90mm, P<0.001), and personalized prone plate (3.07mm, P=0.066; 2.10 mm, P=0.009). In the AP direction, the mean setup errors of 1.2m vacuum bag (supine)(2.20mm) were smaller than those of 1.8m vacuum bag (3.33mm, P<0.001) and personalized prone plate (3.61mm, P<0.001). The setup errors of 1.8m vacuum bag in all directions were smaller than those of personalized prone plate (P≤0.028). According to Van Herk's expansion formula, the M ptv of 1.2m vacuum bag in three directions was approximately 4 mm. The M ptv of 1.8m vacuum bag and personalized prone plate in the SI and LR directions was approximately 3 mm, and more than 5 mm in the AP direction. The setup errors were not correlated with age or BMI. Conclusions:From the setup errors results of three devices, 1.8m vacuum bag is the best, followed by personalized prone plate. And supine position is better than prone position in the AP direction.