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【Objective】 To evaluate the efficacy and safety of percutaneous nephrolithotomy in Galdakao-modified supine Valdivia (GMSV) position and prone position in the treatment of renal calculi. 【Methods】 PubMed, Embase and Cochrane Library databases were searched systematically to identify all eligible studies. Literature collected were screened and data were extracted by three authors independently. RevMan5.4 software was used for Meta-analysis. 【Results】 A total of 9 articles were enrolled, including 7 randomized controlled studies and 2 case-control studies, with a total of 1 690 patients. The results of Meta-analysis showed that compared with the prone position group, the GMSV group had shorter hospital stay (WMD:-9.04, 95%CI:-16.85--1.22, P=0.02), shorter intraoperative radiation exposure (WMD:-1.23, 95%CI:-1.98--0.48, P=0.001), lower rate of complications (RR:0.72, 95%CI:0.59-0.88, P=0.001), but there were no significant differences in operation time, primary stone clearance rate, postoperative hemoglobin loss, blood transfusion rate, fever rate and non-tubulization rate. 【Conclusion】 Compared with percutaneous nephrolithotomy in prone position, percutaneous nephrolithotomy in GMSV position has the comparable stone clearance rate, but has significant advantages in hospital stay, intraoperative radiation time, and overall complications. It is safe for the treatment of renal stones and upper ureteral stones.
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@#BACKGROUND: The worldwide incidence of osteomyelitis is approximately 21.8 cases per 100,000 person-years. The cornerstone of treatment is prolonged (4-6 weeks) intravenous antibiotic administration. This entails additional cost, inconvenience, and added manpower from the healthcare system. Thus, studies have explored the possible use of oral antibiotics as alternatives to improve patient compliance and reduce costs. Our meta-analysis aimed to compare the efficacy of oral versus intravenous antibiotics in treating adult patients with osteomyelitis. MATERIALS AND METHODS: Electronic databases (PubMed, Medline, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar, and Research Gate) from 1966 to April 2020 were searched using the terms “oral antibiotics”, “osteomyelitis”, “randomized controlled trial”. Only studies that directly compared oral versus intravenous antibiotics and confirmed osteomyelitis through biopsy and/or imaging were included. Primary outcome is remission (resolution of symptoms with no relapse and bacteriologic eradication); secondary outcomes, (a) relapse (persistence of the pathogen after treatment) and (b) adverse events. The validity of included studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. We performed a random-effects model in Review Manager Version 5.3 with 95% confidence interval. The I 2 test was used to assess heterogeneity. RESULTS: Seven of 89 trials comprised of 1,282 patients were included in the final analysis. All studies included patients with osteomyelitis of the lower extremities. Oral antibiotics used were Ciprofloxacin, Ofloxacin, and Co-trimoxazole; intravenous antibiotics used were deemed appropriate by the infectious disease specialist. Patients were only given either oral or intravenous antibiotics. Results showed an 8% increase in remission rates [RR 1.08 (0.81 to 1.44, 95% CI, Z = 0.52, p=0.60)] with no heterogeneity (I2 = 0%) in the intravenous antibiotics group. However, this was not statistically significant. Furthermore, there was a 62% decrease in relapse rates in the intravenous antibiotics group [RR 1.62 (0.85 to 3.07, 95% CI, Z = 1.47, p = 0.14)] with no heterogeneity (I2 = 0%) but was not statistically significant. CONCLUSION: Oral are comparable to intravenous antibiotics in treating osteomyelitis in terms of remission and relapse rates. However, larger and double-blinded trials should be done to generate more robust data to validate these claims.
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Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline, or to a specified level. This has lead to the concept of 'Target” IOP, a range of IOP on therapy, that would stabilize the Glaucoma/prevent further visual field loss, without significantly affecting a patient's quality of life. A clinical staging of Glaucoma by optic nerve head evaluation and perimetric parameters, allows a patient's eye to be categorized as having – mild, moderate or severe Glaucomatous damage. An initial attempt should be made to achieve the following IOP range for both POAG or PACG after an iridotomy. In mild glaucoma the initial target IOP range could be kept as 15-17 mmHg, for moderate glaucoma 12-15 mmHg and in the severe stage of glaucomatous damage 10-12 mmHg. Factoring in baseline IOP, age, vascular perfusion parameters, and change on perimetry or imaging during follow up, this range may be reassessed over 6 months to a year. “Target” IOP requires further lowering when the patient continues to progress or develops a systemic disease such as a TIA. Conversely, in the event of a very elderly or sick patient with stable nerve and visual field over time, the target IOP could be raised and medications reduced. An appropriate use of medications/laser/surgery to achieve such a “Target” IOP range in POAG or PACG can maintain visual fields and quality of life, preventing Glaucoma blindness.
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OBJECTIVE: To evaluate the efficacy and safety of acupuncture in the treatment of epilepsy. METHODS: We first collected research data about randomized control trials (RCTs) of acupuncture treatment of epilepsy from databases CNKI, CBM, VIP and Wanfang using key words "(acupuncture)", "(epilepsy)"or "(epilepsy)"or "(epilepsy)", and from PubMed, Google Scholar, and Cochrane Library using key words "acupuncture" "needling" "prod" "epilepsy" "epilepsies" or "seizure disorder" or "simple seizure" from the date of database construction to May 5, 2017. Then, two researchers extracted the study outcomes and evaluated the evidence qualification of the research data independently using GRADE profile 3.6 software and analyzed the primary outcome indexes using RevMan 5.3 and STATA 14.0. RESULTS: Eleven articles containing 827 cases were included in the Meta-analysis. We found that acupuncture or acupuncture in combination with other conventional drugs had a significantly better efficacy than conventional drugs in the treatment of epilepsy [OR=3.94, 95%CI (2.49, 6.24), Z=5.85, P<0.000 01]. There was a statistical heterogeneity (P=0.04, l2=60%), and the Meta-analysis was not feasible for the studies of acupuncture vs medication. Combination of acupuncture and Chinese traditional drugs was significantly better than simple Chinese traditional drugs [OR = 4.61, 95%CI (2.18, 9.74), Z=4.01, P<0.000 1], and combination of acupuncture and wes-tern medicines was obviously better than simple western medicines [OR=3.07, 95%CI(1.24, 7.65), Z=2.41, P=0.02] in the treatment of epilepsy. CONCLUSION: Acupuncture therapy may have a positive effect in the treatment of epilepsy but the conclusion needs further verification due to very fewer high-quality and well-designed RCTs found at the present.
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Objective: To apply cumulative sum (CUSUM) to monitor a drug trial of nebulized hypertonic-saline in bronchiolitis. To test if monitoring with CUSUM control lines is practical and useful as a prompt to stop the drug trial early, if the study drug performs significantly worse than the comparator drug. Design: Prospective, open label, controlled trial using standard therapy (epinephrine) and study drug (hypertonic-saline) sequentially in two groups of patients. Setting: Hospital offering tertiary-level pediatric care. Patients: Children, 2 months to 2 years, with first episode of bronchiolitis, excluding those with cardiac disease, immunodeficiency and critical illness at presentation. Interventions: Nebulized epinephrine in first half of the bronchiolitis season (n = 35) and hypertonic saline subsequently (n = 29). Continuous monitoring of response to hypertonic-saline using CUSUM control-charts developed with epinephrineresponse data. Main outcome measures: Clinical score, tachycardia and total duration of hospital stay. Results: In the epinephrine group, the maximum CUSUM was +2.25 (SD 1.34) and minimum CUSUM was -2.26 (SD 1.34). CUSUM score with hypertonic-saline group stayed above the zero line throughout the study. There was no statistical difference in the post-treatment clinical score at 24 hours between the treatment groups {Mean (SD) 3.516 (2.816): 3.552 (2.686); 95% CI: -1.416 to + 1.356}, heart rate {Mean (SD) 136 (44): 137(12); 95% CI: -17.849 to +15.849) or duration of hospital stay (Mean (SD) 96.029 (111.41): 82.914 (65.940); 95% CI: -33.888 to +60.128}. Conclusions: The software we developed allows for drawing of control lines to monitor study drug performance. Hypertonicsaline performed as well or better than nebulized epinephrine in bronchiolitis.
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Objective To study the academic level of randomized control trials(RCTs)published from 2004 to 2009 in Chinese Journal of Hepatobiliary Surgery.Methods Published work about RCTs in 72 issues of Chinese Journal of Hepatobiliary Surgery was searched by finding relevant articles published during 2004-2009.Correlated indexes including literature received time, literature publishing time, the total number of citations, number of citations in Chinese, number of citations in English, research funding situations, the number of authors, article affiliations in all RCTs, together with single(or multiple)center study situation, positive conclusions, the starting time, the end time,and number of patients recruited in clinical RCTs were extracted for aggregate analysis.Results During the past six years, a total of 135 articles of RCT were published in Chinese Journal of Hepatobiliary Surgery, accounting for 8.7% in all clinical studies.The average number of RCTs in each issue was 1.88.The average time for publishing time delay was 450 days.The total number of citations in RCTs was 1252 and the average number of RCTs for citations was 9.3.53 RCT studies were financed, accounting for 39% of the total number of research papers.Beijing Friendship Hospital attached to the Capital University of Medical Sciences had published 8 papers of RCT and it is the institution of publishing the largest number of such papers in the journal.The number of multi-center study for RCTs was one and all RCT studies had significant conclusions.The average research duraton in RCTs was 45 months.The total number of patients in 33 clinical RCTs was 2705 and the average number of patients recruited in each RCT was 82.Conclusion Chinese Journal of Hepatobiliary Surgery put emphasis on the strongest evidence and the most valuable RCT researches that have great significance in the field of domestic hepatobiliary surgery for clinical treatment and experimental research.
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To investigate the curative effect of needling bilateral points on apoplectic paralysis and preliminarily study the mechanism of its action, a treatment group of 41 patients was treated by needling bilateral points and a control group of 40 patients, by needling points on the affected side. The effect on apoplectic paralysis after 3 courses of treatment was significantly better in the treatment group than in the control group. Needling bilateral points can improve the curative effect.
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Selected mainly were acupoints in the adjacent areas and along the meridians, assisted by ashi points. Fengmen (BL 12), Geshu (BL 17) and Xuehai (SP 10) were selected for migratory arthralgia;Shenshu (BL 23) and Guanyuan (CV 4) for cold-aggravated arthralgia; Pishu (BL 20), Zusanli (ST 36)and Yinlingquan (SP 9) for damp arthralgia; Dazhui (GV 14) and Quchi (LI 11) for heat-induced arthralgia. Acupuncture in combination with far infra-red radiation was performed.76 patients with rheumatoid arthritis were treated and 74 cases with herb therapy as control. The result showed that there was statistically significant difference in curative effect between the 2 groups, χ 2=10.18, P＜ 0.01, indicating that the curative effect was significantly better in the treatment group than in the control group. Statistics showed that there was no significant difference in curative effect among the 4 syndromic types, namely migratory arthralgia, cold-aggravated arthralgia, damp-induced arthralgia and heat-induced arthralgia. But there was a statistically significant difference in curative effect between the above 4 syndromic types and deficiency-type arthralgia, indicating that the curative effect in deficiency-type arthralgia was worst.
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Purpose: To observe the clinical therapeutic effect of cold moxibustion on rheumatoid interphalangeal arthritis. Methods: 576 cases were randomly divided into 290 cases in the cold moxibustion group and 286 cases in the control group and were treated for two months. Results:There was no significant difference in the total effective rate between the two groups. But, at the end of the second course of the treatment, the complete remission rate reached 77.2% in the former group and only 23.4% in the latter group, with a significant difference between the two groups (P＜0.005).Conclusion: Cold moxibustion is better in the therapeutic effect for rheumatoid interphalangeal arthritis than anti-inflammatory agents of western medicine.
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Purpose: To investigate the effect of Tuina plus acupuncture on treatment of cervical migraine and make a comparison. Method: Eighty outpatients with cervical migraine were divided into three groups and treated by Tuina, acupuncture and Tuina plus acupuncture, respectively. Results: All three groups of patients obtained a good effect. The cure rate was significantly higher in the Tuina plus acupuncture group than in the other two groups. Conclusion: The treatment of cervical migraine by Tuina plus acupuncture is worthy to be clinically popularized.
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Purpose: To observe the clinical effect of combination of acupuncture and Chinese herbal drugs for genual osteoarthritis. Methods: 138 cases of the patients were randomly divided into the treatment group of 85 cases treated by electric acupuncture and moxibustion plus Chinese herbal drugs and the control group of 53 cases treated by oral administration of medications. The patients stopped treatment for one month after the treatment for one month, then the therapeutic effects were observed and compared. Results: The total effective rate was 89.4% in the treatment group and 56.6% in the control group, with extremely significant difference (P ＜ 0.01) between the two groups.Conclusion: Electric acupuncture and moxibustion plus Chinese herbal drugs have a marked and irrefutable therapeutic effect on genual osteoarthritis.
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Purpose: To observe the curative effects of different treatments on genual osteoarthritis.Methods: The 148 cases were randomly divided into 4 groups: acupuncture group; Chinese herbs plus spectrograp irradiation group; comprehensive treatments group and western medicine group. Results:The total effective rate in these groups were 78.9%, 72.7%, 92.3% and 78.9% respectively, and there was not a significant difference among the groups (P＞0.05). The marked effective rate in comprehensive treatments group was higher than that in other three groups (P＜0.05). Conclusion: Acupuncture and Chinese herbs plus sepectrograp irradiation had certain effect on gonitis. Comprehensive therapies could coordinate the actions of acupuncture, and Chinese herbs plus spectrograp irradiation, and raise the curative effect.
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The growing knowledge of cancer immunology during the past 20 years has led to the current implementation of immunotherapy. Immuno-cell therapy, in which ex vivo processed T lymphocytes and dendritic cells are used as agents, has developed and spread and is now accepted as a common treatment with the identification of a number of cancer peptide antigens. The response rate to immuno-cell therapy is reported to be around 10-20%. Some clinical studies have reported that immuno-cell therapy as a postoperative adjuvant therapy improved survival rates. This paper outlines the historic background and the current medical scene of immuno-cell therapy.<br>
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Objective To assess the methodological quality of randomized controlled trials (RCTs) of rheumatoid arthritis (RA) treated with preparations of Tripterygium wilfordii to provide a scientific basis for the improvement of clinical trials and systematic review. Methods CBMdisc (1978-2000) and TCMLRS (1984-2000) were searched for RCTs on rheumatoid arthritis treated with preparations of Tripterygium Wilfordii. Jadad scale and the evaluating scale designed by the EBM methodological research group of Guangzhou University of TCM were used to evaluate the methodological quality of the trials. Results Of the 27 randomized trials included in this study, seven described the methods for randomization and only one had randomized concealment. Blindness was used in six of the trials. Twenty-four of the trials were found to be of low methodological quality with Jadad scores below three. Although all of the trials had their diagnostic standards for subject selection, only 37% described the inclusion and (or) exclusion criteria. Information about drug safety was not reported in 21% of the trials. Conclusions In general, the methodological quality of the studies is disappointing. Many shortcomings exist in the methodology of the included literatures, which calls for future attention to the correct use of the principles of randomization, control and blindness in randomized control trials.
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Objective To evaluate the clinical efficacy and safety of zinc gluconate nasal spray in the prevention of upper respiratory infection. Methods A random, double-blind and placebo-controlled study was conducted in a total of 901 healthy male recruits, who were randomized into 2 groups, experiment group and control group, by using a random-number table. The experiment group, consisted of 447 recruits, was given zinc gluconate nasal spray, and the control group, consisted of 454 recruits, with placebo for one month. During the course of the experiment, 61 in trial group and 67 in control group were eliminated. The incidence of upper respiratory infection, influenza-like illness, and the incidence of all the symptoms were documented after treatment for one month. Results Seven hundred and seventy-three recruits completed the schedule finally up to standard, among them 386 recruits were in experiment group and 387 in placebo group. The incidence of upper respiratory infection and influenza-like illness were lower in experiment group (26.94% and 0.26%, respectively) than in control group (34.37% and 2.06%, respectively; ?2=5.010 for upper respiratory infection, P