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Droplet microfluidics technology offers refined control over the flows of multiple fluids in micro/nano-scale, enabling fabrication of micro/nano-droplets with precisely adjustable structures and compositions in a high-throughput manner. With the combination of proper hydrogel materials and preparation methods, single or multiple cells can be efficiently encapsulated into hydrogels to produce cell-loaded hydrogel microspheres. The cell-loaded hydrogel microspheres can provide a three-dimensional, relatively independent and controllable microenvironment for cell proliferation and differentiation, which is of great value for three-dimensional cell culture, tissue engineering and regenerative medicine, stem cell research, single cell study and many other biological science fields. In this review, the preparation methods of cell-loaded hydrogel microspheres based on droplet microfluidics and its applications in biomedical field are summarized and future prospects are proposed.
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Hydrogels/chemistry , Microfluidics/methods , Microspheres , Regenerative Medicine , Tissue Engineering/methodsABSTRACT
Objective:To observe the effect of self-designed Buqi Huoxue Decoction on the rehabilitation of patients with stroke sequelae and qi deficiency and blood stasis syndrome.Methods:A total of 116 patients with stroke sequelae treated from October 2019 to October 2020 were selected and divided into observation group and the control group by randomized digital tables, 58 patients in each group. The control group was given the conventional treatment, and the observation group combined self-designed Buqi Huoxue Decoction and conventional treatment. Both groups were treated for 3 months. The soluble vascular cell adhesion molecule-1 (sVCAM-1), nito-oxide (NO), endothelin (ET-1), endothelial-derived hyperpolarization factor (EDHF), insulin-like growth factor (IGF-II), interleukin-1β (IL-1β), interleukin-6 (IL-6) levels were detected by ELISA. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological deficit, motor function was evaluated by the Fugl-Meyer motor function scale (FMA), patients' daily living ability was assessed by daily living ability assessment table (ADL), the QLQ-C30 was used to evaluate the QoL of patients. The TCM syndrome scores were evaluated. The clinical response was compared between the two groups.Results:The total response rate was 94.8%(55/58) in the observation group and 81.0%(47/58) in the control group. There was significant difference between the two groups ( χ2=3.98, P=0.046). After treatment, the scores of TCM syndrome and NIHSS of pruritus in the observation group were significantly lower than those in the control group ( t values were 5.61, 5.21, respectively, all Ps<0.01). After treatment, the scores of FMA, ADL QLQ-C30 of pruritus in the observation group were significantly higher than those in the control group ( t values were 3.61, 3.13, 9.38, respectively, all Ps<0.01). After treatment, the NO[(87.61±19.18) μmol/L vs. (77.93±17.26) μmol/L, t=2.81], EDHF [(21.14±6.14) μmol/L vs. (16.61±4.52) μmol/L, t=4.45] levels in the observation group were significantly higher than those in the control group ( P<0.01). After treatment, the sVCAM-1[(309.58±30.11) μg/L vs. (354.16±33.04) μg/L, t=7.46], ET-1 [(50.07±18.23)ng/L vs. (66.31±17.89)ng/L, t=4.76] levels in the observation group were significantly lower than those in the control group ( P<0.01). After treatment, IL-1β, IGF-Ⅱ, IL-6 levels in the observation group were significantly lower than those in the control group ( t values were 4.66, 8.14 7.43, respectively, all Ps<0.01). Conclusion:The treatment of self-designed Buqi Huoxue Decoction can improve the vascular endothelial function, inhibit the inflammation, reduce the nerve function damage, improve the limb movement function, daily life ability, quality of life and the clinical symptoms.
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Objective:To evaluate the effect of early mobilization on mortality in intensive care unit (ICU) patients with mechanical ventilation after discharge by Meta-analysis.Methods:Databases including SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang data, PubMed, the Cochrane Library, Web of Science, and Embase were searched from inception to September 17th, 2020, to collect randomized controlled trials (RCT) about early mobilization on mortality of patients with mechanical ventilation in ICU after discharge, the references included in the literature were traced. The control group was given routine care, the experimental group was given early mobilization on the basis of the control group, including passive or active mobilization on the bed, sitting on the bed, standing by the bed, transferring to the bedside chair and assisting walking. The literature screening, data extracting, and the bias risk assessment of included studies were conducted independently by two reviewers. Stata 12.0 software was then used to perform Meta-analysis. Funnel plot was used to test publication bias.Results:A total of 10 RCT studies involving 1 323 patients were included, with 660 patients in the control group and 663 patients in the experimental group. The results of literature quality evaluation showed that 7 studies were grade A and 3 studies were grade B, indicating that the overall quality of included literatures was high. The Meta-analysis results showed that early mobilization did not increase the mortality of patients with mechanical ventilation in ICU after discharge [odds ratio ( OR) = 0.92, 95% confidence interval (95% CI) was 0.75-1.13, P = 0.449]. Subgroup analysis results showed that early mobilization had a tendency to reduce the mortality of ICU patients with mechanical ventilation at 3, 6 and 12 months after discharge, but the difference was not statistically significant (3-month mortality: OR = 1.02, 95% CI was 0.74-1.40, P = 0.927; 6-month mortality: OR = 0.95, 95% CI was 0.70-1.27, P = 0.712; 12-month mortality: OR = 0.60, 95% CI was 0.33-1.10, P = 0.101). Funnel plot showed that the distribution of included literatures was not completely symmetrical, suggesting that publication bias might exist. Conclusions:Early mobilization does not increase the mortality of ICU patients with mechanical ventilation after discharge. Although it tends to have a favorable outcome in reducing mortality, and has a trend to reduce the mortality. However, due to the small number of included literatures, small sample size and differences in the specific implementation of early mobilization among various studies, a large number of high-quality RCT studies are still needed for further verification.
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Objective:To evaluate the efficacy and safety of conbercept in patients with choroidal neovascularization secondary to chronic central serous chorioretinopathy (CSC-CNV).Methods:A retrospective case study was performed.The medical records of 13 patients (14 eyes) diagnosed as chronic CSC-CNV in Hangzhou Branch of Eye Hospital of Wenzhou Medical University from September 2015 to January 2018 were collected.All the study eyes received intravitreal injection of conbercept (0.05 ml/0.5 mg) under one intravitreal injection and pro re nata (PRN) treatment.The best corrected visual acuity (BCVA) and central macular thickness (CMT) before initial injection and 1 week, 1 month, 2, 3 and 6 months after initial injection were measured and analyzed.This study followed the Declaration of Helsinki and written informed consent was obtained from each patient before initial injection.The study protocol was approved by the Ethics Committee of Hangzhou Branch of Eye Hospital of Wenzhou Medical University (No.2019-029-K-28).Results:During the 6-month follow-up, the mean administration times was 1.93±0.83, and all the CNV secondary to CSC did not grow outside the retinal pigment epithelium layer.The BCVA values before initial injection and 1 week, 1 month, 2, 3 and 6 months after initial injection were 0.51±0.32, 0.43±0.34, 0.36±0.35, 0.31±0.28, 0.27±0.29 and 0.26±0.30, respectively, with a significant difference among different time points ( F=21.225, P<0.05). The BCVA values at each time point after initial injection were significantly better than that before initial injection (all at P<0.05). The CMT values before initial injection and 1 week and 1 month, 2, 3, 6 months after initial injection were (299.07±132.90), (216.50±70.94), (203.00±61.87), (234.29±95.70), (194.21±46.46) and (207.43±55.46) μm, respectively, and the difference was statistically significant among different time points ( F=3.768, P<0.05). The CMT values at each time point after initial injection were significantly better than that before initial injection (all at P<0.05). No severe treatment complications were observed during the follow-up period. Conclusions:Intravitreal injection of conbercept is safe and can effectively reduce the CMT and improve BCVA of chronic CSC-CNV patients in the short term.
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Objective:To explore the influence of health coaching technology on self-management ability and negative emotions in patients with cirrhosis.Methods:In this single-center, randomized, single-blind controlled trial, 90 patients with cirrhosis hospitalized from May to October 2019 were selected as study subjects by means of convenience sampling method. Subjects were included in the control group (routine chronic disease management in the department of gastroenterology) and the experimental group (health coach technical intervention) with random number table method, with 45 cases each. The self-management Behavior Scale for patients with cirrhosis and the Depression-Anxiety-stress scale (DASS-21) were used to evaluate the intervention effect.Results:Two cases in the experimental group were lost to follow-up, and 3 cases in the control group were lost to follow-up. Finally, 43 cases in the experimental group and 42 cases in the control group completed the study. After the intervention, the experimental group's self-management scores and total scores were (23.02±1.68), (25.07±1.45), (17.72±1.64), (18.95±0.90), (84.77±3.32) points, the control group were (17.14±1.49), (23.43±1.77), (15.24±1.95), (15.88±2.26), (71.69±3.85) points, the difference between the two groups was statistically significant ( t values were 4.678-16.955, P<0.05). The scores of DASS-21 were (8.05±1.73), (7.02±1.85), (12.40±2.20) points in the experimental group and (10.10±1.83), (9.05±2.39), (14.02±1.89) points in the control group. The differences between the two groups were statistically significant ( t values were -5.300, -4.379, -3.659, all P < 0.05). Conclusions:The health coaching technique can effectively improve the self-management ability of patients with cirrhosis and reduce their negative emotions.
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Objective:To investigate the current status of intensive care unit-acquired weakness (ICU-AW) assessment, analyze the assessment barriers, and to provide reference to improve ICU-AW assessment.Methods:A convenient sampling cross-sectional survey was conducted. First, an interview outline which based on related domestic and international literatures and combining with the research purpose of this study were designed. Thirteen medical personnel (8 ICU nurses, 3 ICU doctors, 1 respiratory therapist and 1 physiotherapist) who worked in the intensive care unit (ICU) of the First Hospital of Lanzhou University were enrolled with convenience sampling method to interview. Second, the topics were comprehensively analyzed and extracted, and then a questionnaire was constructed, and the reliability and validity was assessed. Finally, the questionnaire survey including the general situation of ICU medical staffs, the current practices of ICU-AW and influencing factors was implemented in China.Results:The retest reliability was 0.92 and expert validity was 0.96 of the questionnaire. There were 3 563 respondents in 31 provinces, municipalities and autonomous regions which eliminated 357 unqualified questionnaires, including 173 respondents from neonatal or pediatric ICU, 89 respondents whose working time was less than 6 months, and 95 invalid respondents, and then there were finally 3 206 valid questionnaires and the response rate were 90.0%. Those 3 206 respondents included 616 doctors (19.2%), 2 371 nurses (74.0%), 129 respiratory therapists (4.0%), 51 physiotherapist (1.6%) and 39 dietitians (1.2%). The mean age was (30.7±6.3) years old. Most of them had bachelor's degree (65.9%), master and above was 14.1%. Associate senior physician and above was 8.0%; ICU working time was (5.94±4.50) years. In clinical practice, only 26.5% of the ICU medical staffs confirmed that they had treated or taken care for ICU-AW patients; 52.9% of medical staffs evaluated ICU-AW only based on clinical experience, and only 12.3% used ICU-AW assessment tools. The majority of respondents believed that ICU-AW knowledge training should be performed (81.8%), ICU-AW assessment should be as important as other complications (pressure sore, infected ventilator associated pneumonia, etc., 75.1%), and ICU-AW assessment should be part of daily treatment and care activities (61.2%). However, only 10.2% of respondents had received ICU-AW related knowledge training, and 42.7% respondents believed that their ICU-AW related knowledge could not meet clinical needs. Only 18.7% respondents would actively assess whether patients suffered from ICU-AW or not, and 42.3% respondents thought that ICU-AW should be assessed every day, and the assessment tools were also inconsistent. There were 44.0% respondents considered the Medical Research Council Muscle score (MRC-score) scale was the optimal tool for diagnosing ICU-AW, the following were neuro-electrophysiological examination (17.2%) and manual muscle strength (MMT, 11.1%). The main cause of the ICU-AW assessment barriers was the lack of ICU-AW related knowledge (88.1%), and the following were lack of ICU-AW assessment guidelines (76.5%), patients' cognitive impairment or limited understanding ability (84.6%), unable to cooperate with the assessment due to critical illness (83.0%), and inadequate attention to ICU-AW assessment by the department (77.5%).Conclusion:The current status of ICU-AW assessment were unsatisfying in China, and the main barriers were lack of skills and knowledge.
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Objective:To investigate the cognitive impairment after intensive care unit (ICU) discharge and provide theoretical basis for prevention and intervention.Methods:Studies about cognitive impairment after ICU discharge were retrieved in PubMed, Embase, Cochrane Library, Web of Science, Wanfang data, CNKI and SinoMed from their foundation to December 2019. The literature screening and data extraction were performed by two researchers independently, and the quality of different types of researches was evaluated using Cochrane Handbook 5.1.0, Newcastle-Ottawa scale (NOS) and agency for healthcare research and quality criteria (AHRQ). The Meta-analysis was performed by Stata 13.0 software. Sensitivity analysis was used to determine the reliability of the combined effect values. Funnel plot and Egger test were used to analyze publication bias. The non-parametric clipping was used to evaluate the impact of publication bias on the results.Results:A total of 35 studies were enrolled, including 27 prospective cohort studies, 4 retrospective cohort studies, 2 randomized controlled trial (RCT) studies, 1 case-control study, and 1 cross-sectional study. Three literatures were published in Chinese and 32 were in English, which covered 13 countries, and a total of 102 504 ICU survivors were followed up successfully. Literature quality evaluation results showed that the NOS scores of 31 cohort studies were between 6 and 9, of which the case-control study scored 9. The quality grade of 2 RCT studies were both B. According to the AHRQ criteria, 1 cross-sectional study's design was scientifically rigorous and of high quality. Thirty-five studies reported that the overall incidence of cognitive impairment after ICU discharge ranged from 2.47% to 66.07%. For the multiple follow-ups studies, the first survey data was selected for Meta-analysis, and the results showed that the pooled incidence was 38.44% [95% confidence interval (95% CI) was 29.32-47.55]. Each study was removed for sensitivity analysis and the pooled results did not change much, which indicated that the results were reliable. The sub-group analysis was performed on different evaluation methods for cognitive impairment after ICU discharge, different types of ICU patients, and different follow-up time. The results showed that the pooled incidence of studies using neuropsychological test to evaluate cognitive impairment after ICU discharge was 31.42% (95% CI was 21.82-41.02), the pooled incidence of studies using questionnaires or scales was 38.75% (95% CI was 29.54-47.96), and the difference between the two groups was statistically significant ( P < 0.01). The pooled incidence of cognitive impairment after ICU discharge in general ICU patients was 43.42% (95% CI was 30.88-55.95), acute respiratory distress syndrome (ARDS) patients' pooled incidence was 34.40% (95% CI was 23.02-45.79), and the pooled incidence of elderly ICU patients was 12.93% (95% CI was 8.48-17.37), the difference among the three groups was statistically significant ( P < 0.01). The incidences of cognitive impairment < 1 year, 1 to 4 years, ≥ 5 years after ICU discharge were 43.30% (95% CI was 29.47-57.13), 34.21% (95% CI was 26.70-41.72), and 20.22% (95% CI was 4.89-35.55), respectively, and the differences among the three groups were statistically significant ( P < 0.01). The funnel plot showed that the distribution of all studies was asymmetric, and the Egger test result also suggested that there might be publication bias ( P < 0.05). The non-parametric clipping was used to estimate the impact of publication bias on the results, and the result showed that the difference in the incidence of cognitive impairment after ICU discharge before and after non-parametric clipping was large, suggesting that publication bias might influence the stability of the research results. Conclusions:The incidence of cognitive impairment after ICU discharge is relatively high and persistent for a long time, but diagnostic criteria of cognitive impairment and follow-up time are quite different. It is necessary to develop consistent evaluation criteria and rigorous designed research in the further.
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Objective:To evaluate the effect of preventing and treatment of pharmaceuticals on intensive care unit-acquired weakness (ICU-AW) by systematic review.Methods:The randomized controlled trials (RCTs) concerning pharmaceutical prevention and treatment about ICU-AW in SinoMed, CNKI, Wanfang data, PubMed, Cochrane Library, Web of Science, EMbase, and other sources were searched from their foundation to May 30th, 2019. The patients in the intervention group were treated with drugs to prevent or treat ICU-AW; and those in control group were treated with other rehabilitation methods. Data searching, extracting and quality evaluation were assessed by two reviewers independently. Stata 12.0 software was then used for Meta-analysis. Only descriptive analysis was conducted when only one study was enrolled.Results:A total of 11 RCTs were enrolled with 1 865 patients in the intervention group and 1 894 in the control group. The results of quality evaluation showed that 4 studies were A-level and 7 studies were B-level, indicating that the overall quality of the enrolled literature was high. Meta-analysis showed that intensive insulin therapy could prevent ICU-AW [relative risk ( RR) = 0.761, 95% confidence interval (95% CI) was 0.662-0.876, P = 0.000], but reduced phenylalanine loss (nmol·100 mL -1·min -1: -3±3 vs. -11±3, P < 0.05) and glutamine intake (nmol·100 mL -1·min -1: -97±22 vs. -51±13, P < 0.05). There was no significant difference in the prevention and treatment of ICU-AW between other drugs (including growth hormone, glutamine, dexmedetomidine, neostigmine, oxandrolone, and intravenous immunoglobulin) and control group. Conclusions:Intensive insulin therapy can prevent ICU-AW, but the risk of hypoglycemia will increase. Other drugs including growth hormone, glutamine, dexmedetomidine, neostigmine, oxandrolone, and intravenous immunoglobulin have no obvious advantages in the prevention and treatment of ICU-AW, so no drug has been recommended to prevent and treat ICU-AW.
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Objective:To observe the clinical efficacy of half-dose photodynamic therapy (PDT) in the treatment of acute central serous chorioretinopathy (CSC) by enhanced deep imaging-OCT (EDI-OCT).Methods:A retrospective case study. From September 2015 to November 2018, 100 patients with acute CSC who received half-dose PDT in Hangzhou Branch of the Eye Optometry Hospital of Wenzhou Medical University were included in the study. Among 100 patients, 69 patients were males and 31 patients were females; the average age was 49.63±7.97 years; the average duration of disease was 2.19±0.71 months. All patients underwent BCVA, EDI-OCT, FFA, ICGA and other examinations. BCVA was used on the international standard visual acuity chart and converted to logMAR visual acuity records. Before treatment, the average logMAR BCVA was 0.29±0.19, the average macular foveal retinal thickness (CMT) was 370.59±134.98 μm, and the average macular subfoveal choroidal thickness (SFCT) was 366.93±86.95 μm. All patients were treated with half-dose PDT. We compared the changes of BCVA, CMT, SFCT, and subretinal fluid (SRF) of the eye before treatment and 2 weeks after treatment and 1, 3, and 6 months. Pearson correlation analysis method was used to analyze the correlation between BCVA and baseline BCVA, CMT, SFCT after 6 months of treatment.Results:Six months after treatment, SRF was completely absorbed in 98 eyes, with an effective rate of 98.0%. Compared with before treatment, 2 weeks and 1, 3, and 6 months after treatment, the BCVA of the eye significantly increased ( F=66.493, P<0.001), and CMT and SFCT significantly decreased ( F=134.625, 30.394; P<0.001,<0.001). The results of Pearson correlation analysis showed that BCVA was positively correlated with baseline BCVA 6 months after treatment ( r=0.529, P<0.001), and there was no significant correlation with CMT and SFCT. There were no serious complications related to treatment during the follow-up period. Conclusions:Half-dose PDT can effectively increase BCVA in a short period of time for acute CSC. EDI-OCT can observe that CMT, SFCT and SRF absorption are significantly reduced after treatment.
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Objective@#To evaluate the influence of enhanced recovery after surgery (ERAS) nursing model for perioperative patients in orthopedic surgery on complications.@*Methods@#Computer-based search of electronic databases the Cochrane Library, PubMed, Embase, Web of Science, CNKI, WF and CBM Database to search for randomized controlled trials on the application of ERAS nursing models in orthopaedic patients at domestic and foreign before March 16, 2018, data were selected and screened according to the inclusion and exclusion criteria. RevMan 5.3 was used for meta-analysis of the included studies.@*Results@#A total of 25 RCTs were included in the study and a total of 2 412 patients were included. Meta-analysis showed that the incidence of deep venous thrombos[RR=0.38, 95%CI(0.24, 0.61), P<0.01], and incidence of pulmonary infection[RR=0.26, 95% CI (0.10, 0.67), P=0.005], incidence of urinary tract infections[RR=0.28, 95%CI(0.10,0.78), P=0.01], incidence of constipation [RR=0.30, 95% CI (0.17,0.56), P=0.0001], The incidence of bloating [RR=0.35, 95%CI(0.13, 0.95), P=0.04], they were lower in the experimental group than in routine care, they were statistically significant. Incidence of incision infection [RR=0.75, 95% CI(0.17, 3.27), P= 0.70], incidence of pressure sores [RR=0.34, 95% CI(0.09, 1.27), P=0.11], incidence of nausea and vomiting [RR=0.81, 95% CI(0.52, 1.25), P=0.34] were not statistically significant; postoperative hospital stay, hospitalization costs, and patient satisfaction were statistically significant.@*Conclusions@#Compared with routine care, the ERAS nursing model can promote the recovery of orthopedic patients during perioperative period, reduce postoperative deep venous thrombosis, constipation, pulmonary infection, urinary tract infection, postoperative hospital stay, hospitalization costs, and patient satisfaction. All have a positive impact, but more multicentre and large sample clinical trials are needed for validation.
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Objective To compared the macular blood flow parameters among myopic choroidal neovascularization (mCNV), high myopia (HM) and normal subjects.Methods Retrospective study. Forty patients (40 eyes) diagnosed as mCNV (mCNV group) in the Eye Hospital of Wenzhou Medical University at Hangzhou from June 2016 to November 2018, age-matched, sex-matched and diopter-matched 40 HM patients (40 eyes, HM group), age-matched and sex-matched 40 healthy persons (40 eyes, normal group) were enrolled in this study. Retina superficial and deep vessel density, the area of foveal avascular zone (FAZ), a-circularity index (AI) and vessel density around the 300 μm width of the FAZ region (FD) on macular 3 mm×3 mm scan on OCTA of 3 groups were compared.Results There were significant differences in the average retina superficial, deep vessel density, the area of FAZ, AI and FD among 3 groups (F=24.82, 9.18, 3.58, 7.68, 14.15;P<0.05). The average retina superficial and deep vessel density and FD in mCNV group were lower than those in HM group (P<0.05). The average retina superficial and deep vessel density and FD in HM group were lower than those in control group (P<0.05). The average area of FAZ in mCNV group was smaller than that in control group (P<0.05). The average AI in mCNV group was less than that in the other 2 groups (P<0.05). Conclusions The retina superficial, deep vessel density and FD decreased, the area and the form of FAZ remained unchanged in HM subjects comparing with normal subjects. While retina superficial, deep vessel density and FD decreased more, the area of FAZ reduced, the form of FAZ tend to be irregular in mCNV.
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Objective To evaluate the influence of enhanced recovery after surgery (ERAS) nursing model for perioperative patients in orthopedic surgery on complications. Methods Computer-based search of electronic databases the Cochrane Library, PubMed, Embase, Web of Science, CNKI, WF and CBM Database to search for randomized controlled trials on the application of ERAS nursing models in orthopaedic patients at domestic and foreign before March 16, 2018, data were selected and screened according to the inclusion and exclusion criteria. RevMan 5.3 was used for meta-analysis of the included studies. Results A total of 25 RCTs were included in the study and a total of 2 412 patients were included. Meta-analysis showed that the incidence of deep venous thrombos[ RR=0.38, 95% CI (0.24, 0.61), P<0.01], and incidence of pulmonary infection[ RR=0.26, 95% CI (0.10, 0.67), P=0.005], incidence of urinary tract infections[ RR=0.28, 95% CI (0.10,0.78), P=0.01], incidence of constipation [ RR=0.30, 95% CI (0.17,0.56), P=0.0001], The incidence of bloating [ RR=0.35, 95% CI (0.13, 0.95), P=0.04], they were lower in the experimental group than in routine care, they were statistically significant. Incidence of incision infection [ RR=0.75, 95% CI (0.17, 3.27), P= 0.70], incidence of pressure sores [ RR=0.34, 95% CI (0.09, 1.27), P=0.11], incidence of nausea and vomiting [ RR=0.81, 95% CI (0.52, 1.25), P=0.34 ] were not statistically significant; postoperative hospital stay, hospitalization costs, and patient satisfaction were statistically significant. Conclusions Compared with routine care, the ERAS nursing model can promote the recovery of orthopedic patients during perioperative period, reduce postoperative deep venous thrombosis, constipation, pulmonary infection, urinary tract infection, postoperative hospital stay, hospitalization costs, and patient satisfaction. All have a positive impact, but more multicentre and large sample clinical trials are needed for validation.
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Objective To determine the safety criteria for early goal-oriented rehabilition exercise in patients undergoing mechanical ventilation in intensive care unit (ICU) by systematic review.Methods Randomized controlled trails (RCTs) and cohort studies about early goal-oriented rehabilition exercise in patients undergoing mechanical ventilation in ICU were retrieved in CBM,CNKI,Wanfang Data,PubMed,Cochrane Library and Web of Science from their foundation to March 2018,and other sources as supplement was also retrieved.The intervention program of RCT study was ICU routine nursing in control group,early activity in observation group,and early activity in cohort study without control group.Early activities included active and passive activities on the bed,sitting upright,bed-chair transfer,standing and walking.Literature screening and data extraction were performed independently by two researchers.Variables or parameters.related to cardiovascular,respiratory,nervous,orthopedic and other systems were collected for safety criteria.Variables or parameters used in at least three literatures were collected for each system.Cochrane 5.1.0 was used to evaluate the quality of RCT study,and Newcastle-Ottawa scale (NOS) was used to evaluate the quality of cohort study.Results A total of 24 articles about early activity of patients undergoing mechanical ventilation in ICU were enrolled,involving 4647 patients,including 11 RCT studies involving 1 031 patients,509 in control group and 522 in observation group;13 cohort studies including 3616 patients.It was shown by systematic review that safety criteria for early activity in patients undergoing mechanical ventilation in ICU involved five systems,20 variables or parameters.The cardiovascular system included 8 variables or parameters,such as 40 bpm ＜ heart rate (HR) ＜ 130 bpm (n =4),hemodynamic stability (n =5),no myocardial infarction (n =3),no arrhythmia (n =4),no vascular active drugs (n =4),90 mmHg ＜ systolic blood pressure (SBP) ＜ 200 mmHg (1 mmHg =0.133 kPa,n =4),65 mmHg ≤ mean arterial pressure (MAP) ≤ 110 mmHg (n =3),no history of cardiopulmonary resuscitation (CPR,n =5).The respiratory system included 4 variables or parameters,involving 5 times/min ＜ respiratory rate (RR) ＜ 40 times/min (n =5),fraction of inspired oxygen (FiO2) ≤ 0.60 and positive end-expiratory pressure (PEEP) ≤ 10 cmH2O (1 cmH2O =0.098 kPa,n =4),FiO2 ＜ 0.60 or PEEP ＜ 10 cmH2O (n =3),pulse blood oxygenation (SpO2) ＞ 0.88 (n =5).The nervous system included 4 variables,including no neuromuscular disease (n =7),no increase in intracranial pressure (n =7),no coma (n =4),understand and do the right thing (n =4).The orthopedic system included 2 variables,including no fracture (n =3),no unstable fracture (n =8).Other factors included 2 variables,including no open abdomen wound (n =4),and no palliative care (n =3).Conclusions This study identified safety criteria for early goal-directed rehabilition exercise in patients undergoing mechanical ventilation in ICU included five systems of cardiovascular,respiratory,neurological,orthopedic,and other systems,in which cardiovascular and respiratory systems were the most frequently cited variables or parameters.The consistency of each system security criteria or variables reported by different literatures was high,but the parameters need to be further verified by high-quality study.
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Objective:To investigate the effects of mindfulness based stress reduction on irritable bowel syndrome.Methods:PubMed,EMBASE,Cochrane Library,Web of Science,CNKI,Wanfang Data was searched and randomized clinical trials of MBSR treatment in irritable bowel disease were involved.At last two reviewers extracted the data independently.According to Cochrane Handbook5.1.0 handbook,a quality assessment was made.All the data would be analyzed with meta-analysis by the software of Stata.Results:Totally 5 randomized controlled trials were eligible,including 461 participants.Meta-analysis showed that MBSR would be better therapy method to improve the symptom severity of irritable bowel syndrome in 3 months,[SMD =-0.60,95％ CI:-0.86 ～-0.34,P ＜0.01],and the pain index at the 3 months and 6 months was relieved compared to the baseline [SMD =-1.11,95％ CI:-1.45 ～-0.76,P ＜ 0.01,SMD =-0.14,95％ CI:-0.43 ～ 0.14,P ＜ 0.05].Conclusion:Mindfulness based stress reduction therapy could be a adjunctive therapy method in treatment of irritable bowel syndrome.
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Objective To explore effective and objective diagnostic tools for evaluating intensive care unit acquired weakness (ICUAW). Methods The studies about evaluation and diagnosis of adult ICUAW in PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP and Wanfang databases from the date of their foundation to July 1st in 2018 were retrieved by computer. The literatures in Chinese and English were searched. Two investigators independently screened literature and evaluated the literature quality ratings, and extracted the research design, sample size, research object, evaluation item, reliability, validity, clinical application and other indicators, and then systematically analyzed the reliability and validity of ICUAW diagnostic tools, and evaluated diagnostic tools' advantages, disadvantages and application status. Results There were 19 literatures including 14 assessment scales and ultrasound diagnosis. The 14 assessment scales were medical research council score (MRC-Score), Barthel index (BI), 6-minute walk test (6MWT), clinical outcome variables scale (COVS), the Chelsea critical care physical assessment tool (CPAx), functional independence measure (FIM), functional status score for the intensive care unit (FSS-ICU), the ICU mobility scale (IMS), rivermead mobility index (RMI), the Perme ICU score (PERME), the physical function ICU test (PFIT), the physical function ICU test score (PFIT-s), the surgical ICU optimal mobility score (SOMS), and the Manchester mobility score (MMS). Nine scales (60%) were tested reliability and the rang of inter-rater reliability was 0.600-0.996, and the test reliability was 0.970, and the range of internal consistency reliability was 0.680-0.992. Validity of 6 scales (40%) were evaluated, and the range of structure validity was 0.57-0.94, the range of content validity was 0.830-0.988, the range of concurrent validity was 0.730-0.823. It was shown that the reliability of ICUAW assessment scale was relatively good at present, but the degree of accurate assessment of ICUAW was relatively low. The evaluation content of ICUAW can be divided into three categories: in the first, they measured the muscles strength of body just like MRC-Score; in the second, they evaluated the physical function and mobility, such as COVS, CPAx, FIM, FSS-ICU, IMS, PERME, PFIT, RMI, SOMS and MMS; in the third, they evaluated daily activity and physiology parameter just as 6MWT, BI and ultrasound. Different scales were correlated with the length of ICU stay (ICU-LOS), the hospital discharge, and the mortality. For example: COVS, CPAx, FSS-ICU, PFIT, PFIT-s and SOMS could predict the ICU-LOS and hospital discharge, RMI and SOMS can predict patient mortality. However, there was no evidence to testify the consistency between them. Now, the specialist consensus about the observation nodes of threshold and electrophysiological records were the complex action potential (CMAP) range < 0.43-0.65 mV and the sensory nerve action potential (SNAP) range < 17.6 μV. Conclusions There are many diagnostic tools in ICUAW, and the reliability of each scale is relatively good. In future studies, we should collect the advantages of each scale, explore the specific indicators to evaluate ICUAW and improve the accuracy and validity of diagnostic ICUAW.
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@#Objective To compare the differentiating effect of Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (Mini-BESTest) and Brief-BESTest on the risk of falls in chronic obstructive pulmonary disease (COPD) patients. Methods From September, 2016 to March, 2017, 22 COPD patients with history of falls and other age-matched 66 COPD patients without history of falls were assessed with BBS, Mini-BESTest and Brief-BESTest. The data were compared with paired Logistic regression, Log-likelihood estimate, and the skewness coefficient were calculated. Results BBS, Mini-BESTest and Brief-BESTest all were valuable for differentiating the risk of falls in COPD patients. Log-likelihood estimate value was the least in Brif-BESTest (5.372), followed with Mini-BESTest (12.918) and BBS (17.644). There was not a ceiling effect in Brief-BESTest and Mini-BESTest, but there was in BBS. Conclusion All the BBS, Mini-BESTest and Brief-BESTest can predict the risk of falls in patients with COPD, and Brief-BESTest is the most predictive. There is a ceiling effect in BBS for COPD patients, but not in Brief-BESTest and Mini-BESTest.
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Objective To systematically evaluate the efficacy of high-flow nasal cannulae oxygen (HFNC) in patients with respiratory failure.Methods Computerized PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP, Wanfang Database up to March 31st, 2017, all published available randomized controlled trials (RCTs) or cohort studies about HFNC therapy for patients with respiratory failure were searched. The control group was treated with face mask oxygen therapy (FM) or non-invasive positive pressure ventilation (NIPPV), while the experimental group was treated with HFNC. The main outcomemeasurements included endotracheal intubation rate, patient comfort, and the secondary outcome was in-hospital mortality. The quality of the literature was completed by two professionally trained evidence-based medical students, and meta-analysis was performed on quality-compliant literature. Funnel plot was used to analyze the publication bias.Results A total of 17 articles were enrolled including 15 RCTs and 2 cohort studies. There were 3909 patients enrolled, 1907 patients in HFNC group, and 2002 in control group (1068 patients with FM, and 934 with NIPPV). Meta-analysis showed that HFNC had a significant advantage over FM in reducing the tracheal intubation rate of patients with respiratory failure [odds ratio (OR) = 0.51, 95% confidence interval (95%CI) = 0.29-0.89,P = 0.02], but there was no significant difference as compared with that of NIPPV (OR = 0.80, 95%CI = 0.54-1.17,P = 0.25). It was shown by pooled analysis of two subgroups that compared with FM/NIPPV, HFNC had a significant advantage in reducing tracheal intubation rate in patients with respiratory failure (pooledOR = 0.66, 95%CI = 0.47-0.94, P = 0.02). Compared with FM, patients with respiratory failure were more likely to receive HFNC for comfort [standardized mean difference (SMD) = -0.41, 95%CI = -0.56 to -0.26,P < 0.00001]. There was no significant difference in hospital mortality between HFNC and FM (OR = 0.82, 95%CI = 0.55-1.24,P = 0.35) or NIPPV (OR = 0.66, 95%CI = 0.37-1.17, P = 0.16). The results of pooled analysis of two subgroups were still unchanged (pooledOR = 0.75, 95%CI = 0.54-1.05, P = 0.09). It was shown by the funnel analysis that there was a bias in the study of tracheal intubation rate in the literature, while the bias of patient comfort and hospital mortality was low.Conclusions Compared with FM, HFNC could reduce the rate of tracheal intubation in patients with respiratory failure, but no difference was found as compared with NIPPV. Compared with FM, HFNC made patients more comfortable, and it was easier to be accepted and tolerated. However, there was no difference in hospital mortality among FM, NIPPV, and HFNC.
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Objective@#To investigate the surgical effect of reinnervation of bilateral posterior cricoarytenoid muscles(PCA) with left hemi-phrenic nerve and endoscopic laser arytenoid resection in bilateral vocal cord fold paralysis(BVFP) and to analyze the pros and cons of the two methods.@*Methods@#One hundred and seventeen BVFP patients who underwent reinnervation of bilateral PCA using the left hemi-phrenic nerve approach (nerve group, n=52) or laser arytenoidectomy(laser group, n=65) were enrolled in this study from Jan.2009 to Dec.2015.Vocal perception evaluation, video stroboscopy, pulmonary function test and laryngeal electromyography were preformed in all patients both preoperatively and postoperative1y.Extubution rate was calculated postoperative1y.@*Results@#Most of the vocal function parameters in nerve group were improved postoperatively compared with preoperative parameters, albeit without a significant difference(P>0.05), while laser group showed a significant deterioration in voice quality postoperative1y(P<0.05). The two groups showed significant difference in voice quality postoperative1y(P<0.05). Videostroboscopy showed that vocal fold on the operated side in both groups could abduct to various extent postoperatively, which showed significant difference when compared with preoperative abductive movements (P<0.05). But the amplitude in nerve group was larger than that in laser group (P<0.05). 89% of the patients in nerve group were inhale physiological vocal cord abductions. Postoperative glottal closure showed no significant difference in nerve group (P>0.05), while showed various increment in laser group(P<0.05). Differences between the two groups were statistically significant(P<0.05). The pulmonary function in both groups was better after operation, reaching the reference value. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. The decannulation rate were 88.5% and 81.5% in nerve group and laser group respectively. In both groups, patients presented aspiration symptoms postoperatively, and rdieved soon, except 2 patients in laser group suffered repeated aspiration.@*Conclusions@#Reinnervation of bilateral PCA muscles using left hemi-phrenic nerve can restore inspiratory vocal fold abduction to a satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity, and do not affect swallowing function, greatly improving the quality of life of the patients.
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Objective To evaluate the safety and comfort of postoperative patients with hepatocellular carcinoma after interventional therapy in the early stage and late stage, so as to determine the time to get out of bed after operation. Methods We searched PubMed, EMbase, Cochrane Library (2016 second), Web of Science, CBM, Wanfang Data and CNKI database, collect test/ambulation time of hepatocellular carcinoma after interventional therapy were searched from inception to September 10, 2016. Meta analysis was performed by 2 reviewers independently by screening literature, extracting data and evaluating the risk of bias in the study. RevMan 5.0 software was used to analyze the data. Results A total of 9 studies were included in the study, and 1164 patients were included. The Meta analysis results showed that:compared with 24 hours in bed after operation, 12 hours early ambulation method to reduce postoperative pain, postoperative [odds radio (OR)=0.07, 95% confidence interval (CI) 0.03-0.15, P <0.05] and dysuria (OR =0.18, 95% CI 0.10-0.33, P < 0.05), abdominal distension (OR =0.14, 95% CI 0.07-0.29, P<0.05), insomnia (OR=0.15, 95% CI 0.05-0.43, P<0.05). But in the local punctura, such as congestion (OR=0.99, 95%CI 0.45-2.18, P=0.98), hematoma (OR=0.90, 95% CI 0.38-2.13, P=0.80), the difference was not statistically significant. Conclusions The available evidence indicates that the early postoperative 12 hours after interventional therapy can effectively reduce the incidence of postoperative complications. To be included in the quantity and quality of the research, the conclusion still need to carry out more high-quality research to be verified.
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Objective:To validate an enzyme linked immunosorbent assay (ELISA) method for the quantification of rhCNB in long-tailed macaque sera.Methods: The linear,sensitivity,accuracy,precision and recovery were determined using ELISA.Results:The present ELISA method had high linearity within 0.195 ng/ml-12.5 ng/ml,the working curve of rhCNB was Y=15.1X-0.26, R2=0.996 8 , the method showed good sensitivity of 0.195 ng/ml, the accuracy were in the range of 91.9%-108.8%, and the Coefficient of variation ( CV) for inter-assay were 3.55%,1.39%and 4.71%,the intra-assay were 1.59%,3.2%and 3.8%,all less than 10%, the recoveries were in the range of 88.5% -108.3%, <110% .Thus the method was coincidence with requirement.Conclusion:Double antibody sandwich ELISA assay of rhCNB in long-tailed macaque sera has good sensitivity ,accuracy, precision and recovery and it can be used to measure rhCNB concentration in biological samples .