Background and Aim Remimazolam tosilate (RT) is a new short‐acting GABA(A) receptor agonist, having potential to be an effective option for procedural sedation. Here, we aimed to compare the efficacy and safety of RT with propofol in patients undergoing upper gastrointestinal endoscopy. Methods This positive‐controlled, non‐inferiority, phase III trial recruited patients at 17 centers, between September 2017 and November 2017. A total of 384 patients scheduled to undergo upper gastrointestinal endoscopy were randomly assigned to receive RT or propofol. Primary endpoint was the success rate of sedation. Adverse events (AEs) were recorded to evaluate safety. Results The success rate of sedation in the RT group was non‐inferior to that in the propofol group (97.34% vs 100.00%; difference in rate −2.66%, 95% CI −4.96 to −0.36, meeting criteria for non‐inferiority). Patients in the RT group had longer time to adequate sedation (P < 0.0001) but shorter time to fully alert (P < 0.0001) than that in the propofol group. The incidences of hypotension (13.04% vs 42.86%, P < 0.0001), treatment‐related hypotension (0.54% vs 5.82%, P < 0.0001), and respiratory depression (1.09% vs 6.88%, P = 0.0064) were significantly lower in the RT group. AEs were reported in 74 (39.15%) patients in the RT group and 114 (60.32%) patients in the propofol group, with significant difference (P < 0.0001). Conclusion This trial established non‐inferior sedation success rate of RT compared with propofol. RT allows faster recovery from sedation compared with propofol. The safety profile is favorable and appears to be superior to propofol, indicating that it was feasible and well tolerated for patients.

Both PDL and IPL were found to treat acne effectively, but PDL showed a more sustained effect. TGF-beta might play a key role in the resolution of inflammatory acne lesions.

Chronic migraine is a common chronic daily headache featured by frequent headache attacks with at least 15 headache days per month, which brings great disease burden to both the sufferers and the society. Transformed from episodic migraine, the pathophysiology of chronic migraine is not fully understood, even though several risk factors have been associated with migraine progression. Recent studies have identified both structural and functional alterations in some brain regions of chronic migraine patients indicating that maladaptation of the top-down pain modulation and subsequent sensitization of trigeminal system may be important in the pathogenesis of chronic migraine. Moreover, biochemical analysis has confirmed several molecules related to chronic migraine, which may serve as biomarkers and potential therapeutic targets. Chronic migraine is undertreated because of its poor treatment response and limited therapy options. In this article, we reviewed the latest data to outline the clinical feature, pathophysiological mechanism, and management of chronic migraine, in the expectation to provide direction for future research and finally to take good care of chronic migraine patients.