Infection microenvironment-triggered nanoparticles eradicate MRSA by thermally amplified chemodynamic therapy and M1 macrophage.

It is of great significance to develop a novel approach to treat bacterial infections, as the frequent misuse of antibiotics leads to the serious problem of bacterial resistance. This study proposed antibiotic-free antibacterial nanoparticles for eliminating methicillin-resistant Staphylococcus aureus (MRSA) based on a multi-model synergistic antibacterial ability of chemodynamic therapy (CDT), photothermal effect, and innate immunomodulation. Specifically, a polydopamine (PDA) layer coated and Ag nanoparticles loaded core-shell structure Fe3O4 nanoparticles (Fe3O4@PDA-Ag) is prepared. The Fe3O4 catalyzes H2O2 present in acidic microenvironment of bacterial infection into more toxic reactive oxygen species (ROS) and synergizes with the released Ag ions to exert a stronger bactericidal capacity, which can be augmented by photothermal action of PDA triggered by near-infrared light and loosen the biofilm by photothermal action to promote the penetration of ROS and Ag ion into the biofilm, result in disrupting biofilm structure along with killing encapsulated bacteria. Furthermore, Fe3O4@PDA-Ag exerts indirect antibacterial effects by promoting M1 macrophage polarizing. Animal models demonstrated that Fe3O4@PDA-Ag effectively controlled MRSA-induced infections through photothermal enhanced CDT, Ag+ releasing, and macrophage-mediated bactericidal properties. The acid-triggered antibacterial nanoparticles are expected to combat drug-resistant bacteria infection.

Physiological and molecular mechanisms of ZnO quantum dots mitigating cadmium stress in Salvia miltiorrhiza.

This study delved into the physiological and molecular mechanisms underlying the mitigation of cadmium (Cd) stress in the model medicinal plant Salvia miltiorrhiza through the application of ZnO quantum dots (ZnO QDs, 3.84 nm). A pot experiment was conducted, wherein S. miltiorrhiza was subjected to Cd stress for six weeks with foliar application of 100 mg/L ZnO QDs. Physiological analyses demonstrated that compared to Cd stress alone, ZnO QDs improved biomass, reduced Cd accumulation, increased the content of photosynthetic pigments (chlorophyll and carotenoids), and enhanced the levels of essential nutrient elements (Ca, Mn, and Cu) under Cd stress. Furthermore, ZnO QDs significantly lowered Cd-induced reactive oxygen species (ROS) content, including H2O2, O2-, and MDA, while enhancing the activity of antioxidant enzymes (SOD, POD, APX, and GSH-PX). Additionally, ZnO QDs promoted the biosynthesis of primary and secondary metabolites, such as total protein, soluble sugars, terpenoids, and phenols, thereby mitigating Cd stress in S. miltiorrhiza. At the molecular level, ZnO QDs were found to activate the expression of stress signal transduction-related genes, subsequently regulating the expression of downstream target genes associated with metal transport, cell wall synthesis, and secondary metabolite synthesis via transcription factors. This activation mechanism contributed to enhancing Cd tolerance in S. miltiorrhiza. In summary, these findings shed light on the mechanisms underlying the mitigation of Cd stress by ZnO QDs, offering a potential nanomaterial-based strategy for enhancing Cd tolerance in medicinal plants.

Biomimetic mercury immobilization by selenium functionalized polyphenylene sulfide fabric.

Highly efficient decontamination of elemental mercury (Hg0) remains an enormous challenge for public health and ecosystem protection. The artificial conversion of Hg0 into mercury chalcogenides could achieve Hg0 detoxification and close the global mercury cycle. Herein, taking inspiration from the bio-detoxification of mercury, in which selenium preferentially converts mercury from sulfoproteins to HgSe, we propose a biomimetic approach to enhance the conversion of Hg0 into mercury chalcogenides. In this proof-of-concept design, we use sulfur-rich polyphenylene sulfide (PPS) as the Hg0 transporter. The relatively stable, sulfur-linked aromatic rings result in weak adsorption of Hg0 on the PPS rather than the formation of metastable HgS. The weakly adsorbed mercury subsequently migrates to the adjacent selenium sites for permanent immobilization. The sulfur-selenium pair affords an unprecedented Hg0 adsorption capacity and uptake rate of 1621.9 mg g-1 and 1005.6 µg g-1 min-1, respectively, which are the highest recorded values among various benchmark materials. This work presents an intriguing concept for preparing Hg0 adsorbents and could pave the way for the biomimetic remediation of diverse pollutants.

Gender differences and risk factors for acute kidney injury following cardiac surgery: A single center retrospective cohort study.

Background: We studied AKI incidence and prognosis in cardiac surgery patients under and over 60 years old. Methods: We studied AKI in patients who underwent cardiac surgery at the First Affiliated Hospital of Wenzhou Medical University between Jan 2020 and Dec 2021, using improved global prognostic criteria for diagnosis. Results: After analyzing 781 patients (402 males, 379 females), AKI incidence after surgery was 30.22 %. Adjusting for propensity scores revealed no significant difference in AKI incidence between young males (24.1 %) and females (19.3 %). However, young females had higher AKI stages. Among older patients, AKI incidence was comparable between males (43.4 %) and females (42.2 %), but females had longer intubation times. Independent risk factors for AKI included age, male gender, and BMI, while intraoperative hemoglobin level was protective. Conclusions: No gender gap in AKI frequency for <60 years old and ≥60 years old post-cardiac surgery, yet women display increased AKI severity and extended intubation duration.

Combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomised controlled trial.

OBJECTIVE: To compare the modified strategy for the right-sided double-lumen tube (R-DLT) placement using a combination of CT measurements and flexible video bronchoscopy guidance with traditional bronchoscopy technique. TRIAL DESIGN, SETTING AND PARTICIPANTS: Double-blind, parallel randomised control trial at a tertiary care medical centre in China. 100 patients undergoing video-assisted thoracoscopic surgery and requiring R-DLT were randomly allocated to the control group and the intervention group. INTERVENTION: The control group used the traditional bronchoscopy-guided technique. In the intervention group, the length and anteroposterior diameter of the right main bronchus (RMB) were measured on CT images to select the side and size of the Rüsch tube, and then a black depth marker was placed on the tube according to the difference between the length of the RMB and the bronchial cuff. Under the guidance of bronchoscopy, the depth marker should be placed parallel to the tracheal carina and a characteristic white line on the tube should be parallel to the midline of the tracheal carina. MAIN OUTCOMES: The primary endpoint was the positioning of right upper lobe (RUL) ventilatory slot and RUL bronchial orifice. The secondary endpoints included intubation data and perioperative adverse events. RESULTS: Compared with the control group, our modified strategy significantly increased the optimal and acceptable position rate (76% vs 98%, respectively; p<0.039), decreased the replacement rate (80% vs 94%; p=0.042), shortened the intubation time (101.4±7.3 s vs 75.2±8.1 s; p=0.019) and reduced the incidence of transient hypoxaemia (25% vs 6%; p=0.022), subglottic resistance (20% vs 6%; p=0.037), tracheobronchial injury (35% vs 13%; p=0.037) and postoperative RUL collapse (15% vs 2%; p=0.059). CONCLUSION: This study demonstrates the superiority of our strategy and provides a new viable method for R-DLT placement. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (ChiCTR1900021676).

Fluidic MXene Electrode Functionalized with Iron Single Atoms for Selective Electrocatalytic Nitrate Transformation to Ammonia.

The growth of renewable energy industries and the ongoing need for fertilizer in agriculture have created a need for sustainable production of ammonia (NH3) using low-cost, environment-friendly techniques. The electrocatalytic nitrate (NO3-) reduction reaction (NO3RR) has the potential to improve both the management of environmental nitrogen and the recycling of synthetic nutrients. However, NO3RR is frequently hindered by the incomplete NO3- conversion, sluggish reaction kinetics, and suppression of the hydrogen evolution reaction (HER). Inspired by specific local electronic structures that are adjustable for single-atom catalysts, this work presents a nanohybrid electrocatalytic filter with iron single atoms (FeSA) immobilized on MXene. The fabricated FeSA/MXene filter exhibited maximum NH3 Faradaic efficiency and selectivity (82.9 and 99.2%, respectively) that were higher than those for filters made of Fe nanoparticles anchored on MXene (FeNP/MXene) (69.2 and 81.3%, respectively) and MXene alone (32.8 and 52.4%, respectively), measured at an initial pH of 7 and an applied potential of -1.4 V vs Ag/AgCl. Density functional theory calculations revealed that, compared to the FeNP/MXene filter, the FeSA/MXene filter prevented the competition from the HER and reduced the activation energy of the potential-limiting step (*NO to *NHO) that made the NH3 synthesis thermodynamically favorable . This work highlights an alternative strategy for achieving a synergistic NO3- removal and nutrient recovery with durable catalytic activity and stability.

Revisiting maize Brittle endosperm-2 reveals new insights in BETL development and starchy endosperm filling.

Rerouting the starch biosynthesis pathway in maize can generate specialty types, like sweet corn and waxy corn, with a drastically increasing global demand. Hence, a fine-tuning of starch metabolism is relevant to create diverse maize cultivars for end-use applications. Here, we characterized a new maize brittle endosperm mutant, referred to as bt1774, which exhibited decreased starch content but a dramatic increase of soluble sugars at maturity. Both endosperm and embryo development was impaired in bt1774 relative to the wild-type (WT), with a prominently arrested basal endosperm transfer layer (BETL). Map-based cloning revealed that BRITTLE ENDOSPERM2 (Bt2), which encodes a small subunit of ADP-glucose pyrophosphorylase (AGPase), is the causal gene for bt1774. A MuA2 element was found to be inserted into intron 2 of Bt2, leading to a severe decrease of its expression, in bt1774. This is in line with the irregular and loosely packed starch granules in the mutant. Transcriptome of endosperm at grain filling stage identified 1,013 differentially expressed genes in bt1774, which were notably enriched in the BETL compartment, including ZmMRP1, Miniature1, MEG1, and BETLs. Gene expression of the canonical starch biosynthesis pathway was marginally disturbed in bt1774. Combined with the residual 60 % of starch in this nearly null mutant of Bt2, this data strongly suggests that an AGPase-independent pathway compensates for starch synthesis in the endosperm. Consistent with the BETL defects, zein accumulation was impaired in bt1774. Co-expression network analysis revealed that Bt2 probably has a role in intracellular signal transduction, besides starch synthesis. Altogether, we propose that Bt2 is likely involved in carbohydrate flux and balance, thus regulating both the BETL development and the starchy endosperm filling.

Deep dewatering of refinery oily sludge by Fenton oxidation and its potential influence on the upgrading of oil phase.

Highly efficient dewatering is essential to the reduction and reclamation disposal of oily sludge, which is a waste from the extraction, transportation, and refining of crude oil. How to effectively break the water/oil emulsion is a paramount challenge for dewatering of oily sludge. In this work, a Fenton oxidation approach was adopted for the dewatering of oily sludge. The results show that the oxidizing free radicals originated from Fenton agent effectively tailored the native petroleum hydrocarbon compounds into smaller organic molecules, hence destructing the colloidal structure of oily sludge and decreasing the viscosity as well. Meanwhile, the zeta potential of oily sludge was increased, implying the decrease of repulsive electrostatic force to realize easy coalescence of water droplets. Thus, the steric and electrostatic barriers which restrained the coalescence of dispersed water droplets in water/oil emulsion were removed. With these advantages, the Fenton oxidation approach derived the significant decrease of water content, in which 0.294 kg water was removed from per kilogram oily sludge under the optimal operation condition (i.e., pH value of 3, solid-liquid ratio of 1:10, Fe2+ concentration of 0.4 g/L and H2O2/Fe2+ ratio of 10:1, and reaction temperature of 50 °C). In addition, the quality of oil phase was upgraded after Fenton oxidation treatment accompanying with the degradation of native organic substances in oily sludge, and the heating value of oily sludge was increased from 8680 to 9260 kJ·kg-1, which would facilitate to the subsequent thermal conversion like pyrolysis or incineration. Such results demonstrate that the Fenton oxidation approach is efficient for the dewatering as well as the upgrading of oily sludge.

Erosion behaviour of rotary kiln refractory and its effects on ringing during steel-rolling oily sludge incineration.

Rotary kiln incineration is a desirable disposal option for steel-rolling oily sludge. However, ringing remains a key challenge in the highly efficient operation of rotary kilns. This study investigates the erosion behaviour of refractory bricks in a rotary kiln during steel-rolling oily sludge incineration and its effects on ringing. The degree of refractory brick erosion (i.e. iron permeation-depth and quantity) depends on the roasting temperature and time. The iron permeation-depth (3.1 mm) after 36 h of roasting at 1350 °C is greater than that (0.7 mm) after 12 h of roasting at 1200 °C. In the same zones of the refractory bricks, iron permeation increases with the roasting temperature and time. This is because the molten substances generated from the steel-rolling oily sludge erode the refractory bricks, whereas the loosened surface of the eroded refractory bricks is conducive to the continual permeation of molten substances in the refractory bricks. Steel-rolling oily sludge is mixed with refractory brick powder to produce briquettes, which are then used to simulate the permeation and erosion processes. Adding 20% refractory bricks to the briquettes decreases the cohesion strength of the briquettes from 9.07 to 11.71 kN to 2.97-4.44 kN when roasting is performed at 1250 °C for 5-30 min. Although haematite contributes to the high cohesive strength of the rings, the primary components of the refractory brick are transformed into eutectic substances, which decreases the cohesive strength of the rings. These findings provide a useful reference for developing ringing mitigation methods for rotary kilns.

MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip.

AIMS: Eccentric reductions may become concentric through femoral head 'docking' (FHD) following closed reduction (CR) for developmental dysplasia of the hip (DDH). However, changes regarding position and morphology through FHD are not well understood. We aimed to assess these changes using serial MRI. METHODS: We reviewed 103 patients with DDH successfully treated by CR and spica casting in a single institution between January 2016 and December 2020. MRI was routinely performed immediately after CR and at the end of each cast. Using MRI, we described the labrum-acetabular cartilage complex (LACC) morphology, and measured the femoral head to triradiate cartilage distance (FTD) on the midcoronal section. A total of 13 hips with initial complete reduction (i.e. FTD < 1 mm) and ten hips with incomplete MRI follow-up were excluded. A total of 86 patients (92 hips) with a FTD > 1 mm were included in the analysis. RESULTS: At the end of the first cast period, 73 hips (79.3%) had a FTD < 1 mm. Multiple regression analysis showed that FTD (p = 0.011) and immobilization duration (p = 0.028) were associated with complete reduction. At the end of the second cast period, all 92 hips achieved complete reduction. The LACC on initial MRI was inverted in 69 hips (75.0%), partly inverted in 16 hips (17.4%), and everted in seven hips (7.6%). The LACC became everted-congruent in 45 hips (48.9%) and 92 hips (100%) at the end of the first and second cast period, respectively. However, a residual inverted labrum was present in 50/85 hips (58.8%) with an initial inverted or partly inverted LACC. CONCLUSION: An eccentric reduction can become concentric after complete reduction and LACC remodelling following CR for DDH. Varying immobilization durations were required for achieving complete reduction. A residual inverted labrum was present in more than half of all hips after LACC remodelling.Cite this article: Bone Joint J 2023;105-B(2):140-147.

Iron Nanoparticles Protected by Chainmail-structured Graphene for Durable Electrocatalytic Nitrate Reduction to Nitrogen.

The electrochemical nitrate reduction reaction (NO3 RR) is an appealing technology for regulating the nitrogen cycle. Metallic iron is one of the well-known electrocatalysts for NO3 RR, but it suffers from poor durability due to leaching and oxidation of iron during the electrocatalytic process. In this work, a graphene-nanochainmail-protected iron nanoparticle (Fe@Gnc) electrocatalyst is reported. It displays superior nitrate removal efficiency and high nitrogen selectivity. Notably, the catalyst delivers exceptional stability and durability, with the nitrate removal rate and nitrogen selectivity remained ≈96 % of that of the first time after up to 40 cycles (24 h for one cycle). As expected, the conductive graphene nanochainmail provides robust protection for the internal iron active sites, allowing Fe@Gnc to maintain its long-lasting electrochemical nitrate catalytic activity. This research proposes a workable solution for the scientific challenge of poor lasting ability of iron-based electrocatalysts in large-scale industrialization.

Iron-Based Nanocatalysts for Electrochemical Nitrate Reduction.

Nitrate has a high level of stability and persistence in water, endangering human health and aquatic ecosystems. Due to its high reliability and efficiency, the electrochemical nitrate reduction reaction (NO3 RR) is regarded as the best available option for mitigating excess nitrate in water and wastewater, especially for the removal of trace levels of nitrate. One of the most critical factors in the electrochemical reduction are the catalysts, which directly affect the reaction efficiency of nitrate removal. Iron-based nanocatalysts, which have the advantages of nontoxicity, wide availability, and low cost, have emerged as a promising electrochemical NO3 RR material in recent years. This review covers major aspects of iron-based nanocatalysts for electrochemical NO3 RR, including synthetic methods, structural design, performance enhancement, electrocatalytic nitrate reduction test, and reduction mechanism. The recent progress of iron-based nanocatalysts for electrochemical NO3 RR and the mechanism of functional advantages for modified structures are reviewed from the perspectives of loading, doping, and assembly strategies, in order to realize the conversion from pollutant nitrate to harmless nitrogen or ammonia and other sustainable products. Finally, challenges and future directions for the development of low-cost and highly-efficient iron-based nanocatalysts are explored.

A Universal Single-Atom Coating Strategy Based on Tannic Acid Chemistry for Multifunctional Heterogeneous Catalysis.

Here, we report a universal single-atom coating (SAC) strategy by taking advantage of the rich chemistry of tannic acid (TA). TA units not only self-assemble into a cross-linked porous polyphenolic framework, but also can grip on different substates via multiple binding modes. Benefiting from the diverse chelating ability of TA, a series of mono-, and bi-metallic SACs can be formed on substrates of different materials (e. g., carbon, SiO2 , TiO2 , MoS2 ), dimensions (0D-3D) and sizes (50 nm-5 cm). By contrast, uniform SAC cannot be achieved using common approaches such as pyrolysis of metal-dopamine complexes or metal-organic frameworks. As a proof-of-concept demonstration, two Co SACs immobilized on graphene and TiO2 were prepared. The former one shows six-fold higher mass activity than Pt/C toward oxygen reduction. The latter one displays outstanding photocatalytic activity owing to the high activity of the single atoms and the formation of the single-atom coating-TiO2 heterojunction.

Role of RGS2 in sevoflurane-induced cognitive dysfunction in aged rats.

After undergoing inhalation anesthesia, some patients, especially elderly patients, experience postoperative cognitive dysfunction, such as personality changes and memory impairment. In the present study, 20-month-old rats were randomly allocated to sevoflurane (Sevo group) and control groups (Con group), and they inhaled 3% sevoflurane or 40% oxygen for 8 hours, respectively. The Morris water maze test found that the cognitive function of rats in the Sevo group were significantly different on 1d and 3d after anesthesia than that of rats in the Con group. The expression of RGS2 mRNA and protein in hippocampus of Sevo group was lower compared to the Con group, while Ca2 + was higher than con group. The expression of CaM and CaMK II in Sevo group was higher compared to the Con group. We found that Bcl-2 reduced, but the expression of Bax and Caspase-3 increased, indicating that apoptosis of hippocampal neurons was increased after sevoflurane inhalation. Both the expression of NGF and BDNF was depressed in the Sevo group. After continuous inhalation of 3% sevoflurane for 8h, the expression of RGS2 in the hippocampi of aged rats is down regulated. RGS2 may be an important factor that leads to cognitive dysfunction in rats.

Removal of flue gas mercury by porous carbons derived from one-pot carbonization and activation of wood sawdust in a molten salt medium.

Porous carbons derived from one-pot carbonization and activation of wood sawdust in a molten salt (LiCl-KCl) medium were employed for Hg0 removal. The carbons derived from molten salt carbonization (MSC) displayed much superior Hg0 removal performance comparing with the carbons derived from N2 pyrolysis method (NC). The best molar ratio of LiCl-KCl was 59:41, the optimal molten salt temperature was 700 °C, and the best mass ratio of wood sawdust to molten salt was 1:10. The MSC displayed good applicability at 50-125 °C. The saturation Hg0 adsorption capacity of MSC was about 7828.39 µg·g-1, far exceeding those for carbonaceous adsorbents reported in literatures. A Hg0 removal mechanism over MSC was proposed, i.e., the hierarchical porous structure accelerated mass transfer of Hg0, and the CO groups served as electron acceptors from Hg0 atoms to form organic matter bonded mercury (Hg-OM). The molten salt could be easily separated from the mixture of MSC for recycling multiple times. Thus, molten salt carbonization method appears to be promising in one-pot carbonization and activation of biomass as efficient adsorbents for gaseous Hg0.

Long Non-coding RNA DANCR in Cancer: Roles, Mechanisms, and Implications.

Long non-coding RNA (lncRNA) DANCR (also known as ANCR)-differentiation antagonizing non-protein coding RNA, was first reported in 2012 to suppress differentiation of epithelial cells. Emerging evidence demonstrates that DANCR is a cancer-associated lncRNA abnormally expressed in many cancers (e.g., lung cancer, gastric cancer, breast cancer, hepatocellular carcinoma). Increasing studies suggest that the dysregulation of DANCR plays critical roles in cancer cell proliferation, apoptosis, migration, invasion, and chemoresistance in vitro and tumor growth and metastasis in vivo. Mechanistic analyses show that DANCR can serve as miRNA sponges, stabilize mRNAs, and interact with proteins. Recent research reveals that DANCR can be detected in many body fluids such as serum, plasma, and exosomes, providing a quick and convenient method for cancer monitor. Thus DANCR can be used as a promising diagnostic and prognostic biomarker and therapeutic target for various types of cancer. This review focuses on the role and mechanism of DANCR in cancer progression with an emphasis on the clinical significance of DANCR in human cancers.

Dexmedetomidine upregulates the expression of miR-493-5p, inhibiting growth and inducing the apoptosis of lung adenocarcinoma cells by targeting RASL11B.

Numerous studies have indicated that microRNAs (miRNAs) play critical roles in the development and progression of cancer. However, how changes to the expression levels of miRNAs in response to dexmedetomidine affects the progression of lung cancer remains poorly understood. In this study, we treated the lung adenocarcinoma cell line-A549 with dexmedetomidine and then examined the changes to the expression levels of miRNAs. We found that one of the most significantly upregulated miRNAs was miR-493-5p, which has an important role in the growth and apoptosis of lung adenocarcinoma (LUAD) cells. In addition, bioinformatics searches and luciferase reporter assays revealed that miR-493-5p targets RASL11B, which has a high degree of similarity to RAS. Finally, database searches revealed that RASL11B is associated with survival of LUAD cells. In conclusion, dexmedetomidine causes changes to the expression levels of miRNAs in LUAD, including significant upregulation of miR-493-5p. MiR-493-5p targets RASL11B, thereby inhibiting cell growth and inducing apoptosis in LUAD.

Synergy between copper and iron sites inside carbon nanofibers for superior electrocatalytic denitrification.

Developing low-cost electrocatalysts for the nitrate reduction reaction (NO3RR) with superior performance is of great significance for wastewater treatment. Herein, we synthesized bimetal Cu/Fe nanoparticles encased in N-doped carbon nanofibers (Cu/Fe@NCNFs) through simple electrospinning followed by a pyrolysis reduction strategy. Metallic copper is beneficial for reducing nitrate to nitrite, and the existence of Fe is conducive to convert nitrate and nitrite into nitrogen. Additionally, the nitrogen-doped carbon nanofibers also facilitate the adsorption of nitrate, and the continuous and complete fiber structure enhances the stability of the catalyst and prevents the corrosion of the active sites. Therefore, the synergetic effect of bimetal Cu/Fe and N-doped carbon fiber plays a key role in promoting the efficiency of nitrate reduction. The obtained Cu/Fe@NCNF catalyst exhibits a satisfactory nitrate conversion efficiency of 76%, removal capacity of 5686 mg N g-1 Cu/Fe and nitrogen selectivity of 94%.

Flexible electrocatalysts: interfacial-assembly of iron nanoparticles for nitrate reduction.

We report a novel template-assisted epitaxial assembly strategy to assemble carbon-coated iron nanoparticles on a functionalized carbon cloth (CC/Fe@C). This delicate assembled architecture provides a useful guideline for designing flexible iron-based electrocatalysts.

Perioperative dexmedetomidine and 5-year survival in patients undergoing cardiac surgery.

BACKGROUND: Dexmedetomidine sedation has been associated with favourable outcomes after surgery. We aimed to assess whether perioperative dexmedetomidine use is associated with improved survival after cardiac surgery. METHODS: This retrospective cohort study included 2068 patients undergoing on-pump coronary artery bypass grafting and/or valve surgery. Among them, 1029 patients received dexmedetomidine, and 1039 patients did not. Intravenous dexmedetomidine infusion of 0.007 µg kg-1 min-1 was initiated before or immediately after cardiopulmonary bypass and lasted for < 24 h. The primary outcome was 5-year survival after cardiac surgery. The propensity scores matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting approaches were used to minimise bias. Survival analyses were performed with Cox proportional-hazard models. RESULTS: The median age was 63 yr old and the male to female ratio was 71:29 in both groups. Baseline covariates were balanced between groups after adjustment using PSM, IPTW, or overlap weighting. Patients receiving dexmedetomidine in cardiac surgical procedures had higher survival during postoperative 5 yr in unadjusted analysis (hazard ratio [HR]=0.63; 95% confidence interval [CI], 0.51-0.78; P<0.001), and after adjustment with PSM (HR=0.63; 95% CI, 0.45-0.89; P=0.009), IPTW (HR=0.70; 95% CI, 0.51-0.95; P=0.023), or overlap weighting (HR=0.67; 95% CI, 0.51-0.89; P=0.006). The 5-yr mortality rate after cardiac surgery was 13% and 20% in the dexmedetomidine and non-dexmedetomidine groups, respectively (PSM adjusted odds ratio=0.61; 95% CI, 0.42-0.89; P=0.010). CONCLUSION: Perioperative dexmedetomidine infusion was associated with improved 5-yr survival in patients undergoing cardiac surgery.