Timing umbilical therapy in treatment of neurogenic bladder after spinal cord injury based on midnight-noon and ebb-flow doctrine: a randomized controlled trial / 中国针灸

OBJECTIVES@#To observe the clinical efficacy of timing umbilical therapy for neurogenic bladder after spinal cord injury based on the midnight-noon and ebb-flow doctrine.@*METHODS@#Sixty patients with neurogenic bladder after spinal cord injury were randomly divided into a trial group and a control group, with 30 patients in each group. In the trial group, based on the midnight-noon and ebb-flow doctrine, umbilical therapy was given at the time zone, 15:00 to 17:00. In the control group, umbilical therapy was delivered at any time zones except the period 15:00 to 17:00. The herbal plaster was remained on the umbilicus for 4 h each time, once daily. One course of treatment was composed of 2 weeks and the treatment lasted 4 weeks. Before and after treatment, the urodynamic indexes (maximum urinary flow rate [Qmax], maximum detrusor pressure [Pdet-max], residual urine volume [RUV]), voiding diary (average daily number of voiding, average daily number of leakage, average daily voided volume), neurogenic bladder symptom score (NBSS), the score of urinary symptom distress scale (USDS) and the score of World Health Organization quality of life assessment-BREF (WHOQOL-BREF) were compared between the two groups; and the clinical efficacy of the two groups was assessed.@*RESULTS@#After treatment, Qmax, Pdet-max, the average daily voided volume and the scores of WHOQOL-BREF were increased (P<0.05); and RUV, the average daily number of voiding, the average daily number of leakage, NBSS and the scores of USDS were all reduced (P<0.05) in comparison with those before treatment in the two groups. When compared with those in the control group, Qmax, Pdet-max, the average daily voided volume and the score of WHOQOL-BREF were all higher (P<0.05); and RUV, the average daily number of voiding, the average daily number of leakage, NBSS and the score of USDS were lower (P<0.05) in the trial group. The total effective rate was 96.7% (29/30) in the trial group, higher than that (76.7%, 23/30) in the control group (P<0.05).@*CONCLUSIONS@#Timing umbilical therapy, based on the midnight-noon and ebb-flow doctrine, effectively relieves the symptoms of dysuria and improves the quality of life in patients with neurogenic bladder after spinal cord injury.

Efficacy of noninvasive correction on congenital auricle deformities at different time points: a meta analysis / 中华医学美学美容杂志

Objective:To evaluate the efficacy and safety of nonsurgical methods in early postnatal correction of congenital auricle malformation.Methods:The clinical trials regarding non-surgical treatment for congenital ear deformity published before May 2021 were searched in databases of Cochrane Library, PubMed, Medline, CNKI, VIP and Wanfang. The information of included studies was extracted. The Meta-analysis was performed by using RevMan 5.3 software.Results:A total of 15 trials were included, involving 1 349 patients. The Meta-analysis results showed that the effect of the group <6 weeks was better than the group over 6 weeks ( OR=4.67, 95% CI: 3.21, 6.78, Z=8.09, P<0.001); The complications incidence of the group < 6 weeks was lower than the group over 6 weeks ( OR=0.27, 95% CI: 0.08, 0.88, Z=2.18, P=0.03); The correction time required of the group <6 weeks was shorter than the group over 6 weeks ( MD=-11.81, 95% CI: -18.36, -5.26, Z=3.54, P=0.001). Conclusions:Non-surgical correction of congenital ear malformation within 6 weeks after birth has better efficacy and safety.

Risk factors for death in elderly patients admitted to intensive care unit after elective abdominal surgery: a consecutive 5-year retrospective study / 中华危重病急救医学

Objective:To investigate the risk factors that were associated with the death of elderly patients who were admitted to the intensive care unit (ICU) after elective abdominal surgery, and to find reliable and sensitive predictive indicators for early interventions and reducing the mortality.Methods:A retrospective case-control study was conducted. The clinical data of elderly (age≥65 years old) patients after elective abdominal surgery admitted to the ICU of the Affiliated Hospital of Guizhou Medical University from January 1st 2016 to December 31st 2020 were collected, including the patient's gender, age, body mass index (BMI), medical history, American Society of Anesthesiologists (ASA) grades, surgical classification, intraoperative blood loss, duration of operation, interval time between end of operation and admission to the ICU, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score and the worst laboratory examination results within 24 hours of ICU admission, the first blood gas analysis in ICU, the duration of invasive mechanical ventilation, and the length of ICU stay. Postoperative abdominal infection was evaluated by the pathogenic culture of peritoneal drainage fluid and clinical symptoms and signs. The patients were divided into death group and survival group based on clinical outcomes, and clinical data were compared between the two groups. Binary multivariate Logistic regression analysis was used to screen the risk factors of death, and the receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive values of these risk factors.Results:A total of 226 elderly patients with elective abdominal surgery were admitted to the ICU of our hospital during the past 5 years, of whom, two patients who did not undergo laboratory examinations within 24 hours of admission to the ICU were excluded. Finally, 224 patients met the criteria, with 158 survivors and 66 deaths. Univariate analysis showed that: compared with survival group, APACHEⅡscore, blood lactate acid (Lac) and the proportion of postoperative abdominal infection were higher in death group [APACHEⅡ score: 27.5 (25.0, 31.3) vs. 23.0 (18.0, 27.0), Lac (mmol/L): 2.9 (1.8, 6.6) vs. 1.8 (1.1, 2.8), the proportion of postoperative abdominal infection: 65.2% (43/66) vs. 35.4% (56/158), all P < 0.01], prothrombin time (PT), activated partial thromboplastin time (APTT) and interval time between end of surgery and admission to ICU were longer [PT (s): 17.20 (14.50, 18.63) vs. 14.65 (13.90, 16.23), APTT (s): 45.15 (38.68, 55.15) vs. 39.45 (36.40, 45.70), interval time between end of surgery and admission to ICU (hours): 39.2 (0.7, 128.9) vs. 0.7 (0.3, 2.0), all P <0.01], postoperative hemoglobin (Hb), platelet count (PLT), prealbumin (PA), mean arterial pressure (MAP) and oxygenation index (PaO 2/FiO 2) were lower in death group [Hb (g/L): 95.79±23.64 vs. 105.58±19.82, PLT (×10 9/L): 138.5 (101.0, 177.5) vs. 160.5 (118.5, 232.3), PA (g/L): 80.88±43.63 vs. 116.54±50.80, MAP (mmHg, 1 mmHg = 0.133 kPa): 76.8±19.1 vs. 91.6±19.8, PaO 2/FiO 2 (mmHg): 180.0 (123.5, 242.5) vs. 223.5 (174.8, 310.0), all P < 0.05]. Binary multivariate Logistic regression analysis showed that APACHEⅡscore [odds ratio ( OR) = 1.187, 95% confidence interval (95% CI) =1.008-1.294, P < 0.001], interval time between end of operation and admission to ICU ( OR = 1.005, 95% CI = 1.001-1.009, P = 0.016) and postoperative abdominal infection ( OR = 2.630, 95% CI = 1.148-6.024, P = 0.022) were independent risk factors for prognosis in these patients. MAP ( OR = 0.978, 95% CI = 0.957-0.999, P = 0.041) and PaO 2/FiO 2 ( OR = 0.994, 95% CI = 0.990-0.998, P = 0.003) were protective factors for the patients' prognosis. Lac, Hb, PLT, PA, PT and APTT had no predictive value for the prognosis of elderly patients admitted to ICU after elective abdominal surgery [ OR value and 95% CI were 1.075 (0.945-1.223), 1.011 (0.99-1.032), 1.000 (0.995-1.005), 0.998 (0.989-1.007), 1.051 (0.927-1.192) and 1.003 (0.991-1.016), respectively, all P > 0.05. ROC curve analysis showed that APACHEⅡscore, interval time between end of operation and admission to the ICU and the postoperative abdominal infection had certain predictive values for the prognosis of elderly patients, the area under ROC curve (AUC) were 0.755, 0.732 and 0.649 respectively, all P < 0.001; When the cut-off of APACHEⅡscore and interval time between end of operation and admission to the ICU were 24.5 scores and 2.15 hours, the sensitivity were 78.8% and 66.7%, respectively, and the specificity were 62.0% and 76.6%, respectively. The combined predictive value of the three variables was the highest, which AUC was 0.846, the joint prediction probability was 0.27, the sensitivity was 83.3%, and the specificity was 75.3%. Conclusion:APACHEⅡscore, interval time between end of surgery and admission to ICU, and postoperative abdominal infection may be independent risk factors for the death of elderly patients who were admitted to the ICU after elective abdominal surgery, there would be far greater predictive values when the three variables were combined.

Efficacy of acupuncture-moxibustion on peripheral facial paralysis at different time points: a Meta-analysis / 中国针灸

OBJECTIVE@#To systematically evaluate the efficacy and safety differences between acupuncture-moxibustion at acute stage and non-acute stage for peripheral facial paralysis.@*METHODS@#The clinical trials regarding acupuncture- moxibustion for peripheral facial paralysis published before May 31st 2019 were searched in databases of CNKI, WF, VIP, SinoMed, PubMed, Cochrane Library and Google Scholar. The information of included studies was extracted and the quality was assessed by two independent researchers. The Meta-analysis was performed by using RevMan 5.3 software.@*RESULTS@#A total of 11 trials were included, involving 1741 patients. The Meta-analysis results showed that: (1) the curative rate of acupuncture-moxibustion at acute stage was higher than that at non-acute stage (=2.45, 95%: 1.91-3.14, =7.06, <0.01); (2) the average curative time of acupuncture-moxibustion at acute stage were shorter than that of non-acute stage (=5.26, 95%: 3.44, 7.08, =5.67, <0.01); (3) the incidence rate of sequelae in 6-month follow up of acupuncture-moxibustion at acute stage were lower than that of non-acute stage (=2.71, 95%: 1.26, 5.84, =2.56, <0.05); (4) one study reported that there were no adverse reactions during treatment in both treatment group and control group.@*CONCLUSION@#Based on current evidence, the efficacy of acupuncture-moxibustion at acute stage is superior to non-acute stage, which could promote the recovery of the disease and shorten the course of treatment, and reduce the occurrence of sequelae. More high-quality, large-sample randomized controlled trials are needed for further verification.

"Introduction to the Application of Acupoint Sticking Therapy in the ""Treating Disease before Its Onset""" / 浙江中医药大学学报

Objective] To summarize the clinical key points of acupoint sticking therapy in the application of treating disease before its onset. [Method] From the treatment timing, treatment principle, acupoint selection to expound the academic perspective and clinical experience of our department in the application of acupoint sticking therapy by consulting the ancient literature and summarizing clinical practice. [Result] Through the correct selection of treatment timing for acupoint sticking therapy, which is mainly used in summer, secondly used in winter, and focusing on tonifying Yang-qi, and point selection by pattern identification, paying attention to the accumulation of curative effect, this therapy has good curative effect in the treating disease before its onset.[Conclusion] Nowadays, there are more and more sub-health people. Since acupoint sticking therapy has advantages of“easy, convenient, cheap, uesful”and safe, it is a good therapy to apply for treating disease before its onset.

Symptom Remission Related to Increased Drug Response after Conversion Into Schizophrenia in Early Psychosis : A Case Report / 대한정신분열병학회지

In recent years, early intervention is the paradigm in psychosis treatment. The logic of early intervention paradigm is based on the view that the earliest possible detection and intervention for psychosis will deliver the best outcome for patients. Therefore, in recent decades, most of studies focused on indentifying people with psychosis as early as possible, reducing the duration of untreated psychosis. However, while there are well documented and sometimes serious side effects associated with antipsychotic medication in the short-term, the iatrogenic risks of atypical antipsychotic medication are underscored. Furthermore, against this paradigm, the recent of longitudinal studies of schizophrenia suggest a new paradigm shift in treatment timing of psychosis. In this respect, this case which showed symptom remission after conversion into schizophrenia in early psychosis suggests wondering about the time of treatment. Similar cases have not been reported. And review of the effects of timing, in fact, has yet to be done. If similar cases would be reported in the future more, treatment timing may be the next paradigm shift in the therapeutics of early psychosis.