Objective:To determine the median effective dose (ED 50) of remimazolam for preoperative sedation in pediatric patients of different ages. Methods:This was a prospective study. American Society of Anesthesiologists Physical Status classification I or Ⅱ pediatric patients, aged 1-6 yr, scheduled for elective surgery in our hospital from July to December 2023, in whom the preoperative anxiety was still not relieved after non-drug intervention (preoperative separation anxiety score [PSAS]≥3), were selected. According to the age, the children were divided into 1-<2 yr group, 2-<3 yr group, 3-<4 yr group, 4-<5 yr group and 5-6 yr group. A child's PSAS score = 1 at the time of separation from parents was classified as satisfactory sedation, and a PSAS score ≥ 2 was classified as unsatisfactory sedation. The initial dose of remimazolam in each group was 0.3 mg/kg, dose ratio 1.15. If the child was satisfactorily sedated, the next patient received a lower dose of remimazolam, or conversely if the child was not satisfactorily sedated, a higher dose was given in the next patient. The test was ended when 7 alternating waveforms appeared. The Dixon-Massey method was used to calculate the ED 50 and 95% confidence interval. Results:In 1-<2 yr group, 2-<3 yr group, 3-<4 yr group, 4-<5 yr group and 5-6 yr group, a total of 120 children were included in this study, with 26, 23, 21, 27 and 23 cases, respectively, and the ED 50 (95% confidence interval) of remimazolam for preoperative sedation was 0.152 (0.126-0.178), 0.159 (0.135-0.183), 0.171 (0.147-0.196), 0.150 (0.126-0.174), and 0.146 (0.121-0.170) mg/kg, respectively. There was no significant difference between the groups ( P>0.05). Conclusions:The ED 50 of remimazolam for preoperative sedation is 0.152, 0.159, 0.171, 0.150 and 0.146 mg/kg for every 1 yr in children aged 1-6 yr, and the age factor does not affect the preoperative sedative effect of remimazolam in children of this age group.

Objective:To evaluate the effect of age factors on the pharmacodynamics of intranasal dexmedetomidine for sedation in the pediatric patients undergoing transthoracic echocardiography(TTE).Methods:American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ pediatric patients, aged 1-24 months, undergoing TTE from August 2019 to May 2022, were selected. This trial was performed in two parts. Part Ⅰ Pediatric patients were divided into 4 age groups: 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The initial dose of dexmedetomidine was 2.0 μg/kg in 0.1 μg/kg increment/decrement. The dose of dexmedetomidine was determined by using modified Dixon′s up-and-down method. The ED 50 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated by the Dexon-Massey method. Part Ⅱ One hundred patients were divided into 4 age groups ( n= 25 each): 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The 4 groups were further divided into 5 subgroups ( n=5 each) according to the dose of dexmedetomidine: 2.1 μg/kg subgroup, 2.2 μg/kg subgroup, 2.3 μg/kg subgroup, 2.4 μg/kg subgroup, and 2.5 μg/kg subgroup. Part Ⅰ and part Ⅱ trials were combined, and the ED 95 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated using the probit method. Results:A total of 220 pediatric patients were enrolled. There was no significant difference in ED 50 and ED 95 of dexmedetomidine intranasally administered for sedation among groups ( P>0.05). Conclusions:The pharmacodynamics of intranasal dexmedetomidine for sedation shows no significant difference in age in the pediatric patients aged 1-24 months undergoing TTE.

OBJECTIVE: To investigate the survival of patients with cardiac arrest and cardiopulmonary resuscitation (CA-CPR), and to analyze the factors influencing survival at 30 days after restoration of spontaneous circulation (ROSC). METHODS: A retrospective cohort study was conducted. Clinical data of 538 patients with CA-CPR admitted to the People's Hospital of Ningxia Hui Autonomous Region from January 2013 to September 2020 were enrolled. The gender, age, underlying disease, cause of CA, type of CA, initial rhythm, presence or absence of endotracheal intubation, defibrillation, use of epinephrine, and 30-day survival rate of patients were collected. The etiology of CA and 30-day survival rate among patients with different ages were compared, as well as the clinical data between patients who survived and died at 30 days after ROSC were also compared. Multivariate Logistic regression was used to analyze the relevant factors affecting the 30-day survival rate of patients. RESULTS: Among 538 patients with CA-CPR, 67 patients with incomplete information were excluded, and 471 patients were enrolled. Among 471 patients, 299 were males and 172 were females. Aged from 0 to 96 years old, 23 patients (4.9%) were < 18 years old, 205 patients (43.5%) were 18 to 64 years old, and 243 patients (51.6%) were ≥ 65 years old. 302 cases (64.1%) achieved ROSC, and 46 patients (9.8%) survived for more than 30 days. The 30-day survival rate of patients aged < 18 years old, 18-64 years old and ≥ 65 years old was 8.7% (2/23), 12.7% (26/205) and 7.4% (18/243), respectively. The main causes of CA in patients younger than 18 years were severe pneumonia (13.1%, 3/23), respiratory failure (13.1%, 3/23), and trauma (13.1%, 3/23). The main causes were acute myocardial infarction (AMI; 24.9%, 51/205), respiratory failure (9.8%, 20/205), and hypoxic brain injury (9.8%, 20/205) in patients aged 18-64 years old, and AMI (24.3%, 59/243) and respiratory failure (13.6%, 33/243) in patients aged ≥ 65 years old. Univariate analysis results revealed that the 30-day survival rate of patients with CA-CPR may be related to the the cause of CA was AMI, initial rhythm was ventricular tachycardia/ventricular fibrillation, endotracheal intubation and epinephrine. Multivariate Logistic regression analysis results showed that CA was caused by AMI [odds ratio (OR) = 0.395, 95% confidence interval (95%CI) was 0.194-0.808, P = 0.011] and endotracheal intubation (OR = 0.423, 95%CI was 0.204-0.877, P = 0.021) was a protective factor for 30 days of survival after ROSC in patients with CA-CPR. CONCLUSIONS The 30-day survival rate of CA-CPR patients was 9.8%. The 30-day survival rate of CA-CPR patients with AMI after ROSC is higher than that of patients with other CA causes, and early endotracheal intubation can improve the prognosis of patients.
Female ; Male ; Humans ; Infant, Newborn ; Infant ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Retrospective Studies ; Survival Rate ; Heart Arrest ; Hospitals ; Epinephrine ; Ventricular Fibrillation

Objective:To develope a self-adjustable automatic planning method of intensity modulated radiotherapy based on predicted dose, in order to enhance the robustness of automatic planning.Methods:After the patients′ dose by 3D U-Res-Net_B network was predicted, the current dose was calculated based on the last iteration result, then the predicted dose was combined to calculate the target dose and optimized. With all iterations completed or exit conditions satisfied, final treatment plannings would be acquired. A total of 30 cases of rectal cancer were tested to verify the effectiveness of the algorithm.Results:The mean value of planning target volumes′ V100% was (95.03±0.91)% for clinical plans, close to (94.67±1.96)% for automatical plans( P>0.05), and better than (92.90±2.13)% for predicted dose with the statisically significant difference ( t=29.0, P<0.05). Automatic planning′s indexes such as V35 of small intestines, V40 of bladders and V20 - V40 of femoral heads were lower than predicted and clinical ones, with the statisically significant difference( t=4.5-118.0, P<0.05). Discrepancy in other indexes of organs at risk was not statistically significantly different( P>0.05). Conclusions:This method made automatic planning processes more robust and more adaptive to difficult clinical situations.

Objective:To compare the clinical value of sequential organ failure assessment (SOFA) score and revised Marshall score in evaluating organ function in acute pancreatitis (AP).Methods:From January 2013 to December 2017, at the Department of Gastroenterology of The First Affiliated Hospital of Nanchang University, the clinical data of 3 957 hospitalized AP patients were collected through the AP electronic database. AP was diagnosed and the severity of the disease was classified according to the revised Atlanta classification criteria. Organ function was evaluated by modified Marshall score and SOFA score. The correlation between SOFA score and mortality, pancreatic necrosis were analyzed. Chi-square test and Spearman correlation analysis were performed for statistical analysis.Results:The incidences of circulatory failure and renal failure determined by the SOFA score were higher than those of the modified Marshall score (4.80%, 190/3 957 vs. 3.03%, 120/3 957; 10.11%, 400/3 957 vs. 6.44%, 255/3 957), and the differences were statistically significant ( χ2=1 599.54 and 2 237.19, both P<0.01). Two score systems were consistent in determining the incidence of respiratory failure, which were 32.22% (1 275/3 957). The incidences of persistent circulatory failure (≥48 h) and persistent renal failure (≥48 h) determined by the SOFA score were higher than those of the modified Marshall score (1.64%, 65/3 957 vs. 0.76%, 30/3 957; 4.78%, 189/3 957 vs. 3.69%, 146/3 957), and the differences were statistically significant ( χ2=1 458.37 and 2 398.01, both P<0.01). The incidence of persistent respiratory failure (≥48 h) was same determined by two score systems, which were 10.24% (405/3 957). The proportion of patients with severe AP determined by SOFA score was higher than that of the modified Marshall score (25.30%, 1 001/3 957 vs. 18.83%, 745/3 957), and the difference was statistically significant ( χ2=718.216, P<0.01). The results of Spearman correlation analysis showed that SOFA total score was positively correlated with the overall mortality and the incidence of pancreatic necrosis (correlation coefficients r were 0.540 and 0.211, respectively), and the differences were statistically significant (both P<0.01). Conclusion:SOFA score can comprehensively evaluate organ function in AP and is an important approach in determining prognosis.

Objective:This review is to systematically summarize the studies examining physical activity questionnaires in children and adolescents and assess the overall validity and reliability, providing evidence on epidemiology research of physical activity in youth.Methods:A meta-analysis was performed using Stata 14.0 software. PubMed/Medline and EMBASE databases using the following terms:'Physical Activity’AND (' Questionnaire’OR'Self-report’OR'Recall’) AND'Valid*’AND (' Reliab*’OR'Reproducib*’OR'Sensitiv*’OR'Responsiv*’) AND (' Child*’ OR'Adolescen*’OR'Youth’) were searched from January 2008 to December 2018. Articles meeting the inclusion criteria were screened and adopting 'COnsensusbased Standards for the selection of health status Measurement Instruments' to evaluate the quality of the included studies.Results:This review yielded 17 articles on 20 different physical activity questionnaires, the total number of 2 778 participants for validity study and 2 137 participants for reliability study. The combined values of correlation coefficients in validity study were 0.27 (95 %CI: 0.23-0.31) for moderate-to-vigorous intensity physical activity, 0.24 (95 %CI: 0.18-0.30) for moderate intensity physical activity, 0.33 (95 %CI: 0.24-0.42) for vigorous intensity physical activity. The combined values of intraclass correlation coefficients in reliability study were 0.75 (95 %CI: 0.68-0.83) for moderate-to-vigorous intensity physical activity, 0.56 (95 %CI: 0.46-0.65) for moderate intensity physical activity, 0.68 (95 %CI: 0.61-0.75) for vigorous intensity physical activity. Conclusion:Until now, no questionnaires were identified for good validity and reliability to assess the physical activity level in young population.

Objective:This review is to systematically summarize the studies examining physical activity questionnaires in children and adolescents and assess the overall validity and reliability, providing evidence on epidemiology research of physical activity in youth.Methods:A meta-analysis was performed using Stata 14.0 software. PubMed/Medline and EMBASE databases using the following terms:'Physical Activity’AND (' Questionnaire’OR'Self-report’OR'Recall’) AND'Valid*’AND (' Reliab*’OR'Reproducib*’OR'Sensitiv*’OR'Responsiv*’) AND (' Child*’ OR'Adolescen*’OR'Youth’) were searched from January 2008 to December 2018. Articles meeting the inclusion criteria were screened and adopting 'COnsensusbased Standards for the selection of health status Measurement Instruments' to evaluate the quality of the included studies.Results:This review yielded 17 articles on 20 different physical activity questionnaires, the total number of 2 778 participants for validity study and 2 137 participants for reliability study. The combined values of correlation coefficients in validity study were 0.27 (95 %CI: 0.23-0.31) for moderate-to-vigorous intensity physical activity, 0.24 (95 %CI: 0.18-0.30) for moderate intensity physical activity, 0.33 (95 %CI: 0.24-0.42) for vigorous intensity physical activity. The combined values of intraclass correlation coefficients in reliability study were 0.75 (95 %CI: 0.68-0.83) for moderate-to-vigorous intensity physical activity, 0.56 (95 %CI: 0.46-0.65) for moderate intensity physical activity, 0.68 (95 %CI: 0.61-0.75) for vigorous intensity physical activity. Conclusion:Until now, no questionnaires were identified for good validity and reliability to assess the physical activity level in young population.

Objective To clarify the accuracy of APACHEⅡ, Ranson, BISAP and CTSI scoring systems for predicting the progression of mild acute pancreatitis ( MAP ) to moderate acute pancreatitis ( MSAP) and severe acute pancreatitis ( SAP ) , and death risk of patients with acute pancreatitis ( AP ) . Methods All data from 2080 consecutive adult patients who were admitted within 3 days of disease onset were selected from AP database between 2014 and 2017. The severity was classified according to the revised Atlanta classification systems. Patients who died during hospitalization or discharged automatically were defined as patients at risk of death. The predictive accuracies for MSAP, SAP and death risk were compared using receiver operating characteristic ( ROC) curves. Results The 2080 patients with AP were divided into MAP (n=857, 41. 2％), MSAP ( n =892, 42. 9％), and SAP ( n =331, 15. 9％) according to the revised Atlanta classification system. ROC curve analysis showed APACHEⅡ score, Ranson score, BISAP score and the CT severity index ( CTSI) had no predictive value for MSAP, but have predictive value for SAP and death risk. APACHEⅡ score had the highest accuracy in predicting SAP with area under the curve ( AUC) values of 0. 785 and 0. 746 on the 1st and 2nd day after admission, respectively, and the APACHEⅡscore on admission day 1 had the highest accuracy in predicting death risk (AUC =0. 845). Conclusions Various scoring systems had predictive value only for SAP and death risk, and APACHEⅡ score had the highese accuracy in predicting SAP and death risk.

Objective To compare the clinical outcomes of low-dose rabbit antithymocyte globulin (rATG ) vs basiliximab as induction therapy in recipients of ABO-incompatible kidney transplantation (ABOi-KT) .Methods Retrospective analysis was conducted for e the clinical data of 40 ABOi-KT recipients between March 2017 and March 2019 .17 recipients of them received induction therapy with basiliximab (basiliximab group) while another 23 recipients received low-dose rATG (rATG group ,rATG 25 mg/d × 3 d) .During a median follow-up period of 282 days , the data of serum creatinine and eGFR at 1 week and 1 month ,graft survival rate and complication rate of two groups were compared .Results No significant difference existed in age ,gender ,dialytic modality/ duration , blood groups of recipients , HLA mis-match , blood group antibody titers , dose of rituximab ,blood groups of donors or donor age ( P > 0 .05 ) . The times of double filtration plasmapheresis in Basiliximab group were more (P< 0 .05) .No significant difference existed in serum creatinine and eGFR at 1 week or 1 month ( P > 0 .05 ) . No significant difference existed in graft survival rate . No significant difference existed in rate of acute rejection ,parvovirus B19 infection , urinary tract infection or hematoma .Conclusions Low-dose of rATG is as effective as basiliximab for ABOi-KT recipients .And rATG does not increase the rate of infection .

With the rapid economic development and dramatic changes in lifestyle, the prevalence of overweight and obesity in China has been increasing significantly and become a serious public health threat. This article introduced the main contents of "China Blue Paper on Obesity Prevention and Control", aiming to facilitate understanding and applications of the "China Blue Paper on Obesity Prevention and Control" by policymakers, researchers and practitioners in related fields. Built upon these, recommendations were made for obesity screening, diagnosis, treatment and management, prevention and control policies and strategies, and future research priorities in China.