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ObjectiveTo compare the efficacy and safety of acupuncture combined with auricular acupoints patches and nicotine transdermal patch in treating moderate to severe nicotine dependence. MethodsIn a rando-mized controlled trial， 64 quit smoking voluntary subjects with moderate to severe nicotine dependence were randomly divided at a ratio of 1∶1 into a treatment group and a control group， with 32 cases in each group. The treatment group was given acupuncture combined with auricular acupoints patches， twice weekly， four weeks as a course for two courses. The control group was given nicotine transdermal patch， one patch per day for 24 hours， 8 weeks. The cure rate was assessed after treatment and at follow-up （the 16th week after treatment）.The daily smoking volume， exhaled carbon monoxide （CO） value， Nicotine Dependence Scale （FTND）， Minnesota Nicotine Withdrawal Symptoms Scale （MNWS）， and Pittsburgh Sleepiness Index Inventory （PSQI） were evaluated before and after treatment and at follow-up， and adverse effects were recorded. ResultsIn terms of the cure rate， there were both six cured cases （20%） after treatment and at follow-up in the treatment group， while in the control group， seven （23.3%） and five （16.7%） patients were cured after treatment and at follow-up， respectively， with no statistically significant differences between the two groups both after treatment and at follow-up （P＞0.05）. The daily smoking volume and exhaled CO value significantly decreased after treatment and at follow-up in both groups （P＜0.05）， but were not significantly different between the groups after treatment and at follow-up （P＞0.05）. After treatment and at follow-up， FTND， MNWS， and PSQI scores were significantly reduced in both groups compared with those before treatment （P＜0.05）. There was no statistically significant difference in the FTND scale scores between the two groups after treatment and at follow-up （P＞0.05）， while the MNWS and PSQI scale scores were lower in the treatment group than in the control group （P＜0.05）. ConclusionAcupuncture combined with auricular acupoint patches for moderate to severe nicotine dependence has comparable effect with the first-line drug nicotine patch in terms of increasing the cure rate and decreasing the degree of nicotine dependence， and is superior to nicotine patch in terms of relieving withdrawal symptoms and improving sleep， with stable long-term effect.
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Objective:To compare the performance and surgical outcomes of domestic single-use digital flexible ureteroscopes with reusable digital flexible ureteroscopes in treatment of upper urinary stones.Methods:A prospective, single-blind, multicenter and randomized controlled study was performed from September 2018 to June 2019. Eligible patients were randomly assigned, in a ratio of 1∶1, to either experimental group or control group. The inclusion criteria for the study were: aged 18-75 years, solitary upper urinary stone with stone size between 0.8 and 2.0 cm and CT value less than 1 400 HU, negative preoperative urine culture and normal renal function. Exclusion criteria included: patients with acute urinary tract infection, intransitable urethral strictures, impassable ureteropelvic junction obstructions, systemic hemorrhagic disease, coagulation function abnormalities or bleeding tendency, severe hypertension or cardiopulmonary insufficiency, severe hip malformation and difficulty in meeting the demand of operation position and pregnant and lactation women. The device used in the experimental group was a domestic single-use digital flexible ureteroscope, and the device used in the control group was an imported Olympus digital flexible ureteroscope. The qualified rate of clinical comprehensive evaluation (including image quality and operational performance), the rate of device failure, the stone-free rate and the occurrence rate of adverse events (including increase in urine red blood cell and white blood cell counts, postoperative hematuria, nausea, vomiting, dizziness, and fever) in the two groups were recorded.Results:A total of 186 eligible study cases were collected from the People's Hospital of Wuhan University, the First Affiliated Hospital of Xiamen University, and the First Affiliated Hospital of Guangzhou Medical University. 90 cases in the final experimental group and 88 cases in the control group completed the trial and were included in the evaluation. There were no statistically significant differences among age [(48.40±11.36) vs. (47.40±12.53)years old, P=0.594], male to female ratio (62/28 vs. 56/32, P =0.874), BMI [(24.8±2.1) kg/m 2 vs. (25.1±2.0)kg/m 2,P =0.331], hydronephrosis (no/slight vs. mild/severe) (62/28 vs. 65/23, P =0.874), stone location and stone size [(12.8±4.7) mm vs. (11.9±5.2) mm, P =0.227]. There were no significant differences in terms of qualified rate of clinical comprehensive evaluation [98.9% (89/90) vs. 100.0% (88/88), P =0.991], lithotripsy success rate [84.4% (76/90) vs. 84.1% (74/88), P =0.888], device failure/defect rate (both 0%), and the incidence of adverse events [50.0% (45/90) vs. 52.0% (51/88), P =0.894]. The highest incidence of adverse events in two groups was the increase of red blood cells and white blood cells of routine urine after operation. There was no serious adverse event in the experimental group and 1 serious adverse event in the control group. Conclusions:There was no significant difference in image quality, device failure/defect rate, lithotripsy success rate, and adverse event rate between single-use digital flexible ureteroscopes and reusable digital flexible ureteroscopes for lithotripsy of upper ureteral and pelvic stones. Domestic single-use digital flexible ureteroscopes have good safety and effectiveness in the treatment and microscopy of upper urinary tract stones.
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Objective:To investigate the availability and safety of a domestic disposable digital flexible cystoscope compared with a reusable Olympus digital flexible cystoscope in cystoscopy and removal of double J stent.Methods:From August 2018 to March 2019, patients were enrolled in this prospective, open, multicenter, randomized, parallel positive controlled clinical trial study, which were from department of Urology in Renmin Hospital of Wuhan University, the First Affiliated Hospital of Xiamen University and the First Affiliated Hospital of Guangzhou Medical University. The experimental group and control group were assigned into a 1∶1 ratio by random table method. Inclusion criteria included age≥18 years and have indications for cystoscopy or removal of double J stent. Exclusion criteria included patients having acute genitourinary tract infection, having tuberculous bladder contracture, bladder capacity less than 50ml, having urethrostenosis, female menstrual period, pregnancy and lactation, having difficulty for lithotomy position, having serious cardio-cerebrovascular disease and liver or kidney dysfunction. A domestic disposable digital flexible cystoscope was adopted in the experimental group, whereas a reusable Olympus digital flexible cystoscope was used in the control group. Acceptability of image was defined as primary availability indicator, while success rate of working and performance score were defined as secondary availability indicators and mean operating time was calculated for cystoscopy only and cystoscopy plus removal of double J stent respectively, yet rate of adverse event as well as rate of equipment defects were sorted as safety indicators.Results:A total of 188 cases which were listed in per protocol set completed the clinical trial study successfully. There were 95 cases in the experimental group and 93 cases in the control group. Acceptability of image was 93.68%(89/95) and 96.77%(90/93) respectively in two groups( P=0.52). Success rate of working was 100.00%(95/95) and 98.92%(92/93) respectively in two groups ( P=0.49). Performance score was 14.41±0.93 and 14.56±0.84 respectively in two groups ( P=0.23). Mean operating time (MOT) only for cystoscopy was (15.3±2.6) min and (15.4±3.3)min respectively in two groups ( P=0.93), while MOT for cystoscopy plus removal of double J stent was (21.0±3.2) min and (21.7±3.9) min respectively in two groups ( P=0.69). Rate of adverse event was 8.42%(8/95) and 9.68%(9/93) respectively in two groups( P=0.76). There was no equipment defects in both groups. Conclusions:There is no statistical difference in acceptability of image, success rate of working, performance score, mean operating time for cystoscopy or removal of double J stent, rate of adverse events and rate of equipment defects. A domestic disposable digital flexible cystoscope has shown non-inferiority in the availability and safety compared with a reusable Olympus digital flexible cystoscope.
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@#Objective To evaluate the effectiveness and safety of a central venous catheter for thoracic drainage after video-assisted thoracoscopic lobectomy compared with a conventional chest tube. Methods This study collected 200 patients with lung cancer who underwent thoracoscopic lobectomy and systematic hilar and mediastinal lymph node dissection between January 2018 and September 2019 in our hospital. The patients were randomly divided into two groups, including a group A (left with 28F chest tubes postoperatively) and a group B (left with 12G central venous catheters postoperatively). Patients in both groups were left with 2 chest tubes after upper lobectomy and 1 chest tube after middle or lower lobectomy. Duration and total volume of drainage, length of hospital stay, maximum visual analogue scale score and so forth were compared between the two groups. Results Finally, 151 patients were included for analysis. There were 73 patients in the group A, including 26 males and 47 females, with an average age of 55.38±9.95 years, and 78 patients in the group B, including 37 males and 41 females, with an average age of 59.86±10.18 years. No statistical difference was found between the two groups in drainage volume on postoperative day 2, and proportion of prolonged air leaks, hemothorax, chylothorax or drain reinsertion (all P>0.05). There was a statistical difference in drainage volume on postoperative day 1 [200.0 (120.0, 280.0) mL vs. 57.5 (10.0, 157.5) mL, P=0.000], postoperative day 3 [155.0 (100.0, 210.0) mL vs. 150.0 (80.0, 215.0) mL, P=0.023], total volume of drainage [890.0 (597.5, 1 530.0) mL vs. 512.5 (302.5, 786.3) mL, P=0.000], maximum pain score (2.29±0.72 points vs. 2.09±0.51 points, P=0.013) and length of hospital stay [7 (7, 9) d vs. 5 (4, 7) d, P=0.000]. Conclusion Compared with conventional chest tubes, central venous catheters for chest drainage in patients with lung cancer after thoracoscopic lobectomy shortens the length of hospital stay and reduces postoperative pain.
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Objective:To evaluate the effect of inhaled nitric oxide (NO) in gestational age ≤34 weeks preterm infants using meta-analysis.Method:A search from PubMed, Embase, Cochrane Central library, China National Knowledge Internet, China biomedical literature database, Wanfang and VIP database from establishment to June 2020.Result:A total of 17 randomized controlled studies were included. The subjects were premature infants (gestational age ≤34 weeks) who needed respiratory support. The total sample size was 4 033.Meta-analysis showed that no significant difference was found in mortality between treatment and control groups ( RR=1.00, 95% CI 0.89~1.11, P=0.930).Risk of bronchopulmonary dysplasia (BPD) at 36 w postmenstrual age (PMA) was significantly lower in preterm infants supplemented with iNO ( RR=0.89, 95% CI 0.82~0.97, P=0.006). Subgroup analysis showed the overall risk of mortality or BPD incidence was significantly reduced for birth weight >1 000 g infants treated with iNO ( RR=0.72, 95% CI 0.58~0.89, P=0.002). Risk of BPD incidence was significantly lower when beginning iNO in the first 7 d of life ( RR=0.83, 95% CI 0.70~0.98, P=0.030). Risk of BPD incidence was significant reduced in infants treated with 5 ppm or ≥10 ppm iNO ( RR=0.89, 95% CI 0.81~0.98, P=0.020; RR=0.90, 95% CI 0.81~0.99, P=0.030). There was a decrease in BPD incidence with iNO treatment time of either ≤7 d or >7 d ( RR=0.77, 95% CI 0.60～0.99, P=0.040; RR=0.87, 95% CI 0.77~0.97, P=0.010). There were no differences concerning mechanical ventilation duration and intracranial hemorrhage incidence ( P>0.05). Significant difference was found between treatment and control group with respect to reduction of oxygenation index (OI) ( WMD=-6.32, 95% CI -12.16~-0.48, P=0.030). Conclusion:For preterm infants born at less than 34 weeks who need respiratory support, iNO treatment may improve oxygenation and reduce the risk of BPD, but not decrease mortality, mechanical ventilation duration or intracranial hemorrhage incidence. A better treatment effect may be achieved if iNO treatment began in the first 7 d of life, and if the infant had a birth weight greater than 1 000 g.
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@#Objective To evaluate the effect of driving pressure-guided lung protective ventilation strategy on lung function in adult patients under elective cardiac surgery with cardiopulmonary bypass. Methods In this randomized controlled trial, 106 patients scheduled for elective valve surgery via median sternal incision under cardiopulmonary bypass from July to October 2020 at West China Hospital of Sichuan University were included in final analysis. Patients were divided into two groups randomly. Both groups received volume-controlled ventilation. A protective ventilation group (a control group, n=53) underwent traditional lung protective ventilation strategy with positive end-expiratory pressure (PEEP) of 5 cm H2O and received conventional protective ventilation with tidal volume of 7 mL/kg of predicted body weight and PEEP of 5 cm H2O, and recruitment maneuver. An individualized PEEP group (a driving pressure group, n=53) received the same tidal volume and recruitment, but with individualized PEEP which produced the lowest driving pressure. The primary outcome was oxygen index (OI) after ICU admission in 30 minutes, and the secondary outcomes were the incidence of OI below 300 mm Hg, the severity of OI descending scale (the Berlin definition), the incidence of pulmonary complications at 7 days after surgery and surgeons’ satisfaction on ventilation. Results There was a statistical difference in OI after ICU admission in 30 minutes between the two groups (273.5±75.5 mm Hg vs. 358.0±65.3 mm Hg, P=0.00). The driving pressure group had lower incidence of postoperative OI<300 mm Hg (16.9% vs. 49.0%, OR=0.21, 95%CI 0.08-0.52, P=0.00) and less severity of OI classification than the control group (P=0.00). The incidence of pulmonary complications at 7 days after surgery was comparable between the driving pressure group and the control group (28.3% vs. 33.9%, OR=0.76, 95%CI 0.33-1.75, P=0.48). The atelectasis rate was lower in the driving pressure group (1.0% vs. 15.0%, OR=0.10, 95%CI 0.01-0.89, P=0.01). Conclusion Application of driving pressure-guided ventilation is associated with a higher OI and less lung injury after ICU admission compared with the conventional protective ventilation in patients having valve surgery.
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Objective:To observe the effect of early rehabilitation exercise on blood pressure of elderly patients with septic shock.Methods:A single-center, prospective, randomized controlled study was conducted in elderly patients with septic shock who were hospitalized in the department of critical care medicine of Huangshan Shoukang Hospital (High-tech Zone Central Hospital of Huangshan) from December 2018 to November 2020. According to the principle of simple random, all patients were divided into control group and intervention group. Both groups were treated with lower limb barometry to prevent deep vein thrombosis, 3 times a day, 30 minutes each time. After comprehensive treatment in the intensive care unit (ICU), the severity of patients was gradually improved, the hemodynamics was relatively stable, and the norepinephrine was reduced to 0.5 μg·kg -1·min -1. The control group continued to receive lower limb barometric treatment without rehabilitation training, while the intervention group began rehabilitation training when the dose of norepinephrine was reduced to 0.5 μg·kg -1·min -1. The duration of norepinephrine use, the length of ICU stay, and the occurrence of adverse events during rehabilitation training in intervention group was recorded. Results:Seventy-two patients were included in the final analysis, 35 in intervention group and 37 in control group. There was no significant difference in gender, age, Oxford acute severity of illness score (OASIS), acute physiology and chronic health evaluationⅡ (APACHEⅡ), mean arterial pressure (MAP) of 3 times and underlying diseases between two groups. Compared with control group, the length of ICU stay and duration of dose of norepinephrine ≤0.5 μg·kg -1·min -1 in intervention group were significantly shorter [length of ICU stay (hours): 193.0 (145.5, 312.0) vs. 242.5 (180.0, 483.5), P < 0.05; duration of dose of norepinephrine ≤0.5 μg·kg -1·min -1 (hours): 120.0 (72.0, 144.0) vs. 144.5 (120.0, 192.0), Z = 2.976, P = 0.003]. In intervention group, 35 patients did not show acute myocardial infarction, arrhythmia, syncope, central venous catheter detachment, and gastric tube detachment during the rehabilitation period, except 1 patient suffered from naked hematuria due to urinary catheter traction, which disappeared the next day after symptomatic treatment. Conclusion:The early rehabilitation exercise was beneficial to the recovery of autonomic blood pressure in elderly patients with septic shock, shorten the time of norepinephrine use and ICU stay.
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Objective@#To evaluate the 1-year clinical outcome of orthokeratology contact lens wear and glasses wear for myopia in children, mainly focusing on the effects on the biological parameters of the eyeballs.@*Methods@#A randomized-controlled clinical study analyzed 200 eyes of 200 adolescent, with low and moderate myopia from January 2018 to August 2018 at Chengdu Aier Eye Hospital.The subjects were divided into an orthokeratology group and a spectacles group, 100 eyes in each group.The axial lengths (AL), central corneal thickness (CCT), anterior chamber depth (ACD), and crystalline lens thickness were measured and compared between the two groups before and 6 months, 12 months after wearing the lenses, and 1 month after stopping lens wear.This study conformed to the tenets of the Declaration of Helsinki.Written informed consent was obtained from each subject prior to entering the study cohort.The study protocol was approved by the Ethics Committee of Chengdu Aier Eye Hospital (No.[2018]01-1).@*Results@#The overall difference in AL was statistically significant in the two groups at various time points(Fgroup= 4.617, P=0.043; Ftime=10.939, P=0.023). Compared with before wearing lenses, the AL was significantly lengthened in both of the groups at 6 and 12 months after wearing lenses and 1 month after stopping lens wear (all at P<0.05). There was no significant difference in AL between 1 month after stopping lens wear and 12 months after wearing lenses in the orthokeratology group (P>0.05). Twelve months after wearing lenses, the AL increases values of the orthokeratology group were significantly lower than those of the spectacles group ([0.13±0.06]mm vs. [0.29±0.08]mm) (t=16.000, P=0.002). The differences in CCT at time points in the two groups were statistically significant (Fgroup=2.297, P=0.013; Ftime=11.219, P<0.01). At 6 and 12 months after wearing the lenses, the CCT in the orthokeratology group was significantly thinner than that before lens wear (all at P<0.05). CCT showed no significant difference between 1 month after stopping lens wear and before wearing lenses in the orthokeratology group (P>0.05). There was no statistically significanant difference in the ACD between the two groups at time points (Fgroup=4.226, P=0.051; Ftime=3.208, P=0.057). The overall differences in crystalline lens thickness at time points before and after wearing lenses in the two groups were statistically significant (Fgroup=13.13, P<0.01; Ftime=0.804, P=0.047). At 6 and 12 months after wearing the lenses and 1 month after stopping lens wear, the crystalline lens thickness in the orthokeratology group was significantly greater than that before lens wear and that in the spectacles group at the same time points (all at P<0.05). There was no significant difference in the crystalline lens thickness between 1 month after stopping lens wear and 12 months after wearing the lenses in the orthokeratology group (P>0.05).@*Conclusions@#Compared with wearing spectacles, orthokeratology lenses wear can effectively slow down the prolongation of the AL, decrease CCT reversibly and increase crystalline lens thickness in adolescent myopic subjects, but it has no significant effect on the ACD.
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Objective To evaluate the 1-year clinical outcome of orthokeratology contact lens wear and glasses wear for myopia in children,mainly focusing on the effects on the biological parameters of the eyeballs.Methods A randomized-controlled clinical study analyzed 200 eyes of 200 adolescent,with low and moderate myopia from January 2018 to August 2018 at Chengdu Aier Eye Hospital.The subjects were divided into an orthokeratology group and a spectacles group,100 eyes in each group.The axial lengths (AL),central corneal thickness (CCT),anterior chamber depth (ACD),and crystalline lens thickness were measured and compared between the two groups before and 6 months,12 months after wearing the lenses,and 1 month after stopping lens wear.This study conformed to the tenets of the Declaration of Helsinki.Written informed consent was obtained from each subject prior to entering the study cohort.The study protocol was approved by the Ethics Committee of Chengdu Aier Eye Hospital (No.[2018]01-1).Results The overall difference in AL was statistically significant in the two groups at various time points (Fgroup =4.617,P =0.043;Ftime =10.939,P =0.023).Compared with before wearing lenses,the AL was significantly lengthened in both of the groups at 6 and 12 months after wearing lenses and 1 month after stopping lens wear (all at P＜ 0.05).There was no significant difference in AL between 1 month after stopping lens wear and 12 months after wearing lenses in the orthokeratology group (P＞0.05).Twelve months after wearing lenses,the AL increases values of the orthokeratology group were significantly lower than those of the spectacles group ([0.13±0.06]mm vs.[0.29±0.08] mm) (t=16.000,P=0.002).The differences in CCT at time points in the two groups were statistically significant (Fgroup =2.297,P =0.013;Ftime =11.219,P＜ 0.01).At 6 and 12 months after wearing the lenses,the CCT in the orthokeratology group was significantly thinner than that before lens wear (all at P＜ 0.05).CCT showed no significant difference between 1 month after stopping lens wear and before wearing lenses in the orthokeratology group (P＞0.05).There was no statistically significanant difference in the ACD between the two groups at time points (Fgroup =4.226,P =0.051;Ftime =3.208,P=0.057).The overall differences in crystalline lens thickness at time points before and after wearing lenses in the two groups were statistically significant (Fgroup =13.13,P＜0.01;Ftime =0.804,P =0.047).At 6 and 12 months after wearing the lenses and 1 month after stopping lens wear,the crystalline lens thickness in the orthokeratology group was significantly greater than that before lens wear and that in the spectacles group at the same time points (all at P＜0.05).There was no significant difference in the crystalline lens thickness between 1 month after stopping lens wear and 12 months after wearing the lenses in the orthokeratology group (P＞0.05).Conclusions Compared with wearing spectacles,orthokeratology lenses wear can effectively slow down the prolongation of the AL,decrease CCT reversibly and increase crystalline lens thickness in adolescent myopic subjects,but it has no significant effect on the ACD.
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Background: Neonatal seizure management has not changed much in the last 50 years. Neuronal apoptosis in animal models and cognitive impairment in human subjects has been reported with the use of Phenobarbitone. Levetiracetam is advantageous as it is effective, well tolerated and has least drug interactions.Methods: This double blinded, randomized, parallel group, active controlled study was conducted among 66 neonates in the Neonatal intensive care unit of a tertiary care hospital for a period of 18 months. Neonates with seizures fulfilling the inclusion criteria were treated either with Phenobarbitone or Levetiracetam. Seizure control was defined as no seizure activity within 40 minutes of the administration of the first drug. Failure of first line agent was treated with Phenytoin. Neonates were observed for a period of 14 weeks for recurrence of seizure and any serious adverse effects.Results: Effective seizure control was achieved in 64.7% neonates in Levetiracetam group as compared to 31.2% in Phenobarbitone group (p <0.05). Early resumption of breast feeds within 6 hours of therapy was achieved in 73.5% neonates treated with Levetiracetam compared to 31.2% neonates treated with Phenobarbitone (p value = 0.001).Conclusions: Levetiracetam is a promising alternative as first line Anti-epileptic drug in neonates with seizures. Prolonged sedation was the adverse effect noted to Phenobarbitone that made breast feeding and neuro- assessment difficult. No serious adverse effects were seen with Levetiracetam.
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Objective To examine the effects of participating in Balint group ( PBG) for reducing occupational burnout among primary care physicians (PCPs). Methods In this randomized controlled trial, 240 PCPs were randomly assigned to PBG (n=70) and control group (n=240) in propotion of 1 ∶ 2. Sub-jects of PBG received Balint group intervention for one year,while control group received natural observation. Maslach Burnout Inventory ( MBI) was used to assess the severity of occupational burnout. Results At baseline all three subscales of MBI had no significant difference between PBG and cotrol group(P>0. 05). After the intervention,PBG had statistically lower subscale scores in emotional exhaustion ((20. 1±8. 3) vs (22. 6±8. 7),t=1. 993,P=0. 048) and depersonalization (( 6. 8± 4. 9) vs ( 10. 8 ± 5. 2),t=5. 355,P<0. 001) than the control group, while had statistically higher score in personal accomplishment subscale ((38. 3±7. 5) vs (34. 6±7. 7),t=3. 311,P=0. 001) than the control group. Conclusions PBG is effective in reducing occupational burnout among PCPs.
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Objective: To compare the clinical and radiographic results between primary total knee arthroplasty (TKA) via mini-subvastus or conventional approach through a prospective randomized controlled study.
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Objective To evaluate the efficacy and safety of surgery combined with intraperitoneal chemotherapy for advanced gastric cancer (AGC). Methods The related randomized controlled trials were searched in the following databases such as Cochrane Library, PubMed, Web of Science from database establishment to April 2017. Data extraction and quality assessment by means of NOS were completed by two researchers.The survival rate,recurrence rate,mortality and morbidity were analyzed by RevMan 5.3 software. Results Seventeen literatures which were strictly filtrated from the original 2 383 literatures were included for Meta-analysis and the NOS score was 6-8. A total of 2 302 AGC cases were included to divide for 1 175 undergoing surgery with intraperitoneal chemotherapy and 1 127 undergoing surgery alone. Meta-analysis results showed that compared with surgery alone, surgery with intraperitoneal chemotherapy could improve the 1-year(OR=1.93,95 % CI 1.41-2.66,P<0.000 1),2-year(OR=1.82,95 % CI 1.41-2.35,P<0.000 01) and 3-year (OR= 1.93, 95 % CI 1.54 - 2.42, P< 0.000 01) survival rate of ACG cases, while the overall mortality was reduced (OR=0.47, 95 % CI 0.34-0.64, P<0.000 01). In terms of recurrence rate, the overall(OR=0.46,95 % CI 0.32-0.68,P<0.000 1)and peritoneal(OR=0.47,95 % CI 0.29-0.76,P=0.002) recurrence rates of surgery with intraperitoneal chemotherapy were both lower than those of surgery alone. There were not significantly differences between surgery with intraperitoneal chemotherapy and surgery alone in lymph nodes and liver metastasis rate. However, surgery with intraperitoneal chemotherapy had more high occurrence rates than surgery alone (OR= 1.47, 95 % CI 1.16 - 1.85, P= 0.001), especially the bone suppression (OR= 3.07, 95 % CI 1.70 - 5.54, P= 0.002) and bleeding (OR= 3.00, 95 % CI 1.09- 8.27, P= 0.03), and there were no differences in other complications. Subgroup results indicated that the overall mortalities were obviously decreased in surgery with intraperitoneal chemotherapy + MMC (OR= 0.35, 95 % CI 0.20-0.62,P=0.000 3)or CDDP+5-Fu(OR=0.32,95 % CI 0.17-0.61,P=0.000 5)compared with surgery alone. Conclusions Surgery with intraperitoneal chemotherapy can improve survival rate of AGC cases over a period of time and reduce mortality and peritoneal recurrence, but it is likely to cause the morbidities.The safety needs to be improved in the future.
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ObjectiveTo evaluate the effect of Rhubarb associated preparations (rhubarb or prescriptions of traditional Chinese medicine including rhubarb) on sepsis patients with acute gastrointestinal dysfunction (AGI).Methods The retrieval of databases from libraries including PubMed, Medline, Cochrane Central Register of Controlled Trials, CNKI, CBMdisc, Wan Fang Database, VIP database were searched to identify randomized controlled trials (RCTs) about Rhubarb associated preparations for treatment of sepsis patients with AGI from the foundation of the various databases to March 2016. And in the mean time, the references of the studies accepted were also retrieved. The retrieving and screening of literatures were performed independently by two researchers, the methodological quality and data extraction of the enrolled literatures were assessed by Jadad scale, and Cochrane Collaboration 5.3 software was used to perform Meta analyses to observe the effects of rhubarb associated preparations on gastrointestinal function score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and 28-day mortality in sepsis patients with AGI; the bias of published literatures was evaluated by funnel plot.Results ① Finally, 16 studies involving 1 171 patients (610 in rhubarb preparation group and 561 in the control group) were identified and enrolled. 12 studies had a Jadad score ≥ 3 and 4 studies < 3. The random method was used in classification of groups in all the studies in which the intergroup baseline data being comparable was clearly indicated. The blind method was applied in 5 contained RCTs.② The results of Meta-analyses showed that rhubarb associated preparation could improve gastrointestinal function score [mean difference (MD) = -0.52, 95% confidence interval (95%CI) = -0.55 to -0.48, P < 0.000 01], reduce the APACHEⅡ score (MD = -3.66, 95%CI = -5.00 to -2.33,P < 0.000 01) and 28-day mortality [odds ratio (OR) = 0.46, 95%CI = 0.30 to 0.71,P < 0.000 01] compared with those in the control group, the differences being statistically significant. No publication bias was seen in 16 literatures containing RCTs from the funnel plot.Conclusions Compared with the control group, the rhubarb associated preparations combined with conventional theraph can significantly improve the gastrointestinal function score, reduce APACHE Ⅱ score and 28-day mortality of sepsis patients with AGI, which suggests the rhubarb associated preparations have better efficacy. In addition, the result of sensitivity analysis has not substantially changed the results of Meta-analysis.
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Background Ex-PRESS glaucoma drainage device implantations have been clinically applied worldwide.In China,50 type and 200 type of Ex-PRESS glaucoma drainage devices are used for different types of open angle glaucoma.However,whether the clinical outcomes are similar between 50 type and 200 type of Ex-PRESS glaucoma drainage devices are not elucidated.Objective This study was to compare the therapeutic efficacy and security of Ex-PRESS implantation between PS0 type and P200 type of Ex-PRESS glaucoma drainage devices for open angle glaucoma Methods A randomized,parallel-group trial was designed,and written informed consent was obtained from each patient prior to entering in the cohort.Eighty eyes of 69 patients with various types of open angle glaucoma were included from March 2012 to April 2013 in Wuhan General Hospital of Guangzhou Military Command.The patients were randomized into 2 groups according to randomized digital table.The P50 type Ex-PRESS glaucoma drainage device was implanted in 40 eyes of 35 patients in the P50 group,and P200 type was implanted in 40 eyes of 34 patients in the patients of the P200 group.The disease composition,best corrected visual acuity (BCVA) recovery time,theoretical hospitalization days,lowing intraocular pressure (IOP) range and postoperative complications were compared between the two groups.Results The average lowing-IOP ranges of the P50 type group and P200 type group were (21.19±11.22) and (24.35±12.27) mmHg,respectively,with an insignificant difference between them (t =-1.201,P＞0.05).The theoretical hospitalization days and BCVA recovery time in the of P50 type group were (3.65±0.92) days and (2.85±0.95)days,and those in the P200 type group were (4.90±0.81) days and (3.40± 0.96) days,showing significant decreases in the P50 type group (t =-6.444,P＜0.01 ;t =-2.584,P＜ 0.05).The incidence of postoperative complications were 6.06％ and 25.00％ in P50 type group and P200 type group,respectively,with a significant difference between the two groups (.x2 =9.800,P＜0.05).Conclusions Although P50 and P200 Ex-PRESS implantation provide a similar effect in lowing IOP,P50 type Ex-PRESS implantation can restore BCVA more rapidly and lessen complications in comparison with P200 type Ex-PRESS implantation in the early postoperative stage.
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This study was aimed to explore the clinical effect of San-Jiao (SJ) acupuncture combined with Chinese medicine and Cisapride tablets in the treatment of senile constipation. A total of 118 patients were selected according to the inclusion criteria. According to the visiting sequence, patients were randomly divided into the acupuncture with Chinese medicine group of 60 cases and drug group of 58 cases. In the acupuncture with Chinese medicine group, SJ acupuncture was combined with Huang-Di (HD) powder in the treatment. In the drug group, Cisapride tablets were applied. Both groups were treated for 20 times. The scale was used in the comprehensive evaluation of integral effect evaluation of main symptoms, psychological evaluation before and after the treatment. The results showed that there was significant difference on the integral before and after treatment in both groups (P< 0.01). The posttreatment integral showed that the acupuncture with Chinese medicine group was better than the drug group (P<0.01). There was no significant difference on total effective rate between two groups. However, comparison on good improvement rate showed that the acupuncture with Chinese medicine group was better than the drug group (χ2 =28.25, P < 0.01). It was concluded that the acupuncture with Chinese medicine group had better effect on the im-provement of clinical symptom integral, psychological integral, and comprehensive effect evaluation. SJ acupuncture combined with HD powder was a safe treatment method with good effect.
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Objective To investigate an effective therapy to cure Diabetic Neurogenic Bladder (DNB).Methods By adopting multi-center,random,comparative and single-blind clinical experiments,138 patients with DNB from three centers were divided equally into two groups,namely a control group and a therapy group.Patients in the therapy group were treated with acupoint injection therapy with Astragalus injection,while others were treated by western medical based therapy.After four weeks,the effectiveness was collected.Results After the treatment,the TCM syndrome integral of the treatment group and the control group was (18.47± 1.67) and (23.19±2.82) respectively,both reduced than that before the treatment[(29.25±2.12) and (29.13 ± 1.69) respectively]; the difference between the two groups after treatment was statistically significant (P＜0.05) ; bladder residual urine volume in the treatment group and the control group was (88.47± 16.7) ml and (143.19±28.2)ml respectively,both reduced than that before the therapy [(308.90±22.6)ml and (305.90± 20.8)ml respectively],the difference between the two groups after treatment was statistically significant (P＜0.05) ;The total effective rate was 88.4％ and 72.5％ in the treatment group and the control group respectively,showing statistical difference(P＜0.05).Conclusion It is confirmed that acupoint injection therapy with Astragalus injection is an effective curative method for DNB.
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Objective Through the application of recombinant human Ⅱ tumor necrosis factor-Fc function protein (rhTNFR:Fc) in the treatment of juvenile idiopathic arthritis (JIA) with randomized control study,clinical characteristic and clinical effect were summarized.Methods According to the randomized controlled principle,124 patients with JIA were divided into control group and treatment group.The basic treatment in two groups were one antirheumatic slow-acting drug,nonsteroidal drug,adrenal cortical hormone.There were no significant differences between clinical type and basic treatment in two groups (P ＞ 0.05).Sixty-two patients of JIA treated with rhTNFR:Fc by subcutaneous injection.The doses was 0.8mg /kg per week.There were 17 cases of oligoarthritis,15 cases of polyarthritis,30 cases of systemic arthritis in the treatment group and control group respectively.The basic antirheumatic drugs,nonsteroidal anti-inflamatory drugs ( NSAIDs),adrenal cortex hormone were allowed to continued.Clinical evaluation index included ACR Pedi 30,ACR Pedi 50 and ACR Pedi 70.The adverse drug reactions were recorded.Results The remission rate of ACR Pedi 30,50,70 in 2 weeks,one month,three monthes and six monthes were different in types of JIA patients in the treatment group ( P ＜ 0.05 ).The remission rate of systemic arthritis was lower than the other two groups of arthritis ( P ＜ 0.05 ).Only 44％ ACR Pedi 50 remission was achieved after three monthes medication in systemic arthritis and 41.7％ ACR Pedi 50,29.2％ ACR Pedi 70 were achieved after six monthes.The remission rate in the types of oligoarthritis and polyarthritis at different time points (2 weeks,one month,three monthes,six monthes) of ACR Pedi 30,50,70 were similar.After six monthes,more than 80％ reached ACR Pedi 50 remission,more than half of patients reached ACR Pedi 70 remission.Three cases of macrophage activation syndrome in systemic arthritis group was effective treated with rhTNFR:Fc.In the treatment group,2 cases of systemic arthritis appeared ache and discomfort after one week treatment,3 cases appeared repeated mild upper respiratory tract infection and diarrhea during treatment,including one varicella infection.The incidence of adverse reactions in the treatment group of systemic arthritis were 16.7％,Other 2 types of patients did not show adverse reaction during rhTNFR:Fc treatment.Conclusion rhTNFR:Fc has good effect on oligoarthritis and polyarthritis of JIA.The adverse reactions of six monthes were rare.The cases of systemic arthritis could reach some clinical remission,but need to guard against infection and the occurrence of adverse reactions.To whom did not respond to conventional therapy in systemic arthritis or systemic arthritis combined with macrophage activation syndrome,it could be considered with rhTNFR:Fc.
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Objective To compare the effectiveness and safety of central venous catheters inserted from the left side and right side during peripheral inserted central catheterizations (PICC). Methods Totally 458 adult patients undergoing PICC between May 2007 and May 2008 were enrolled in this study and divided randomly into right-sided group (n = 228)and left-slded group (n = 230). Chest X-ray was performed immediately after catheterization to identify the initial tip locations. Other parameters were evaluated during follow-up. Results The rate of difficult insertion was significantly lower in right-sided group than in left-sided group (14.9% vs 24. 8% , P =0.003). The rate of tip projection angle ＞40°was also significantly lower in right-sided group (2.2% vs 23.4% ,P = 0. 000). The rate of tips reaching the central veins was not significantly different between two groups (54.4%vs 53.0% , P = 0. 538). Compared with right-sided catheters, the tip positions in the left-sided group was significantly less frequently located in the inferior segment of superior vena cave in the central tip locations (6. 6% vs 21.0% , P =0. 001)and more commonly positioned in the nominate vein in non-central tip locations (66. 7% vs 48.1% , P = 0. 008). In addition, the catheter detaining time (P = 0. 617), incidence of local phlebitis after puncture (P = 0. 561), catheter obstruction rate (P = 0. 774), and catheter-related infection rate (P = 0. 854)showed no significant differences between two groups. The incidence of swollen limb was significantly lower inright-sided group than in left-sided group (4. 4% vs 8.3%, P = 0. 043). Conclusions Right-sided catheters provide better outcomes than left-sided catheters. PICC through the right elbow veins should be preferred in clinical practices.
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[Objective]To evaluate the effectiveness of moxibustion treatment for patients with nocturia in a randomized controlled trial.<BR>[Methods]Subjects were 36 patients with refractory nocturia, randomly allocated to a moxibustion group (n = 20) and a sham moxibustion group (n = 16). Moxibustion treatment to Chung-Chi (CV3) was performed three times/day for one week by the patients themselves. The average number of nocturia in the week before and the week during moxibustion treatment were compared between groups.<BR>[Results]The average number of nocturia during moxibustion was significantly decreased in the moxibustion group compared to that before treatment. No significant change was seen in the sham moxibustion group.<BR>[Conclusion]Moxibustion treatment appears to reduce the average number of nocturia. Moxibustion to Chung-Chi seems to represent an effective therapeutic option for nocturia.