Protocolos de recuperación mejorada en cirugía cardiaca. Revisión sistemática con metanálisis de ensayos clínicos aleatorizados / Improved recovery protocols in cardiac surgery: Systematic review with metaanalysis of randomized clinical trails

Introducción: Múltiples son los esfuerzos realizados para incluir los protocolos de recuperación mejorada como un indicador de calidad en la atención al paciente quirúrgico, bajo la premisa de acelerar la recuperación de los enfermos, sin que esto vaya en detrimento del proceso asistencial y obtener su alta satisfacción. Para ello se hace necesario el desarrollo de la investigación avalada por la mejor evidencia científica y práctica. Objetivo: Estimar, a través de la literatura publicada, la efectividad de la aplicación de los protocolos de recuperación precoz sobre la evolución perioperatoria de pacientes a los que se les realizan procedimientos quirúrgicos cardíacos. Método: Se incluyeron ensayos clínicos controlados y aleatorizados, publicados entre enero del año 2013 y mayo de 2020. La revisión sistemática se realizó según las recomendaciones del manual 5.1.0 para revisores de la biblioteca Cochrane. Resultados: Se analizaron 6 estudios (687 pacientes/Grupo estudio=345, Grupo Control=342). La calidad metodológica de la mayoría de las investigaciones evaluadas fue buena. Se muestra una superioridad de los protocolos, ya que se acompañan de una disminución en la incidencia de complicaciones perioperatorias (RR=0,61 [0,40, 0,93]). De forma similar se encuentran relacionados con la disminución la estadía hospitalaria (diferencia de medias, efecto aleatorio, fue de -2,98 [-3,31, -2,65]. Conclusiones: A pesar de los pocos estudios incluidos, la evidencia sugiere que estos programas mejoran la evolución perioperatoria de los pacientes(AU)

Introduction: Multiple efforts are made to include improved recovery protocols as an indicator of quality in care for surgical patients, under the premise of accelerating the recovery of patients, without this being detrimental to the care process, and thus guarantee high patient satisfaction. In view of this, the development of research supported by the best scientific and practical evidence is necessary. Objective: To estimate, through the published literature, the effectiveness of the application of early recovery protocols on the perioperative evolution of patients who undergo cardiac surgical procedures. Method: Randomized controlled clinical trials, published between January 2013 and May 2020, were included. The systematic review was carried out according to the recommendations of the Cochrane Library manual 5.1.0 for reviewers. Results: Six studies were analyzed (687 patients/study group: 345, control group: 342). The methodological quality of most of the researches assessed was good. A superiority of the protocols is shown, since they are accompanied by a decrease in the incidence of perioperative complications (RR=0.61 [0.40, 0.93]). Similarly, they are related to the decrease in hospital stay (mean difference, random effect, was -2.98 [-3.31, -2.65]). Conclusions: Despite the few studies included, the evidence suggests that these programs improve the perioperative outcome of patients(AU)

Evaluación de la eficacia de los protocolos de recuperación mejorada en cirugía cardiaca. Protocolo de Ensayo Clínico Aleatorizado / Assessment of the efficacy of improved recovery protocols in cardiac surgery. Randomized Clinical Trial Protocol

Introducción: Múltiples son los artículos publicados que abordan el tema de la ciencia abierta y su importancia para la sociedad, especialmente para la comunidad de investigadores. Esta constituye, ineludiblemente, el presente y futuro de las revistas científicas como método de expandir las investigaciones con alta calidad y credibilidad. La ciencia abierta como movimiento, tiene varios componentes y dentro de ellos, la gestión de citas y referencias de datos, códigos y materiales, que fundamentan la necesidad de que los autores tengan disponibles los contenidos subyacentes a los artículos que se publican y que constituyen la base de los resultados obtenidos en cada investigación. Objetivo: Evaluación de la eficacia de los protocolos de recuperación mejorada en cirugía cardiaca. Métodos: El protocolo que se propone fue elaborado por la investigadora principal (registro público cubano de ensayos clínicos RPCEC00000304) y se describe acorde a las recomendaciones de la lista internacional de chequeo para ensayos clínicos (SPIRIT). Conclusiones: Estarían en relación a si se puede demostrar, después de terminada la investigación, si el protocolo motivo de la Intervención, es mejor, igual o peor que el protocolo de control(AU)

Introduction: There are multiple articles published that address the subject of open science and its importance for society, especially for the research community. This constitutes, inevitably, the present and future of scientific journals as a method of expanding research with high quality and credibility. Open science, as a movement, has several components including the management of citations and references of data, codes and materials, which support the need for authors to have available the underlying content of the articles published and constituting the base for the results obtained in each investigation. Objective: Assessment of the efficacy of improved recovery protocols in cardiac surgery. Methods: The proposed protocol was prepared by the main researcher (Cuban public registry of clinical trials: RPCEC00000304) and is described according to the recommendations of the international checklist for clinical trials (SPIRIT). Conclusions: They would be related to whether it can be demonstrated, after the end of the investigation, if the protocol reason for the intervention is better, equal to, or worse than the control protocol(AU)

Patterns of complications and outcome of laparoscopic cholecystectomy

Background: Cholelithiasis is known to be one of the most common biliary pathologies. Laparoscopic cholecystectomy is the gold standard for the removal of the gallbladder, because of its cosmetic benefit, short stay, cost-effective and lesser side effects. But no procedure is immune to complications and other procedure-related side effects. The present study was conducted to study the patterns of complications and outcome of laparoscopic cholecystectomy.Methods: the present study was conducted prospectively on patients undergoing laparoscopic cholecystectomy for symptomatic gall bladder pathology. the patients undergoing laparoscopic cholecystectomy were distributed and analysed on various parameters i.e. age, sex, ultrasound abdomen findings, complications related to access, per-operative condition of gallbladder, per-operative and postoperative complication.Results: In our study cases major complication rate 1% leading to biliary stricture for which hepaticojejunostomy was done, minor complication rate 11% and conversion to open cholecystectomy rate 2%.Conclusions: It is concluded that laparoscopic cholecystectomy is the safe and standard procedure for the laparoscopic cholecystectomy and its major complication are preventable by strictly following the basic principles of laparoscopic cholecystectomy and keeping a low level of the threshold for converting to open cholecystectomy.

Protocolos de recuperación precoz en cirugía cardiaca. ¿Utopía o realidad? / Protocols of early recovery in heart surgery: utopia or reality?

Introducción: El concepto de protocolos de recuperación rápida o precoz fue insertado en la práctica clínica por Henrik Kehlet en 1997, con el objetivo de mejorar la calidad en los cuidados perioperatorios y disminuir la morbilidad y mortalidad. Objetivo: Determinar que la implementación de los protocolos en cirugía cardiaca ya no constituye una utopía. Métodos: La búsqueda bibliográfica estuvo constituida por todos los artículos publicados que evaluaron la utilidad de los protocolos de recuperación rápida o precoz. Desarrollo: Los protocolos de recuperación precoz han sido desarrollados durante décadas y abarcan un conjunto de acciones que cubren todo el periodo perioperatorio. Para lograr la completa adherencia se necesita de un equipo multidisciplinario. Su implementación comenzó en la cirugía colorectal y fueron gradualmente expandidos y adaptados a casi todas la especialidades quirúrgicas. En la cirugía cardiaca por razones no específicas, que incluyen el uso de la circulación extracorpórea, la implementación ha sido demorada pero la evidencia científica existente, aunque no es suficiente, muestra que la adherencia a estos influye de manera positiva en la recuperación de los enfermos, por lo que surge la necesidad de estandarizarlos. Conclusiones: La implementación de estos protocolos en la cardiocirugía ya es una realidad. En abril de 2017 se constituyó la sociedad responsable de dicho proceso, cuyo lema es el de optimizar los cuidados perioperatorios a través de un análisis colaborativo, el consenso de expertos y la diseminación de las mejores prácticas(AU)

Introduction: The concept of rapid or early recovery protocols was inserted into clinical practice by Henrik Kehlet in 1997, with the aim of improving the quality of perioperative care and decreasing morbidity and mortality. Objective: To determine that the implementation of protocols in heart surgery is no longer a utopia. Methods: The bibliographic search was made up of all the published articles that evaluated the usefulness of the rapid or early recovery protocols. Development: Early recovery protocols have been developed for decades and comprise a set of actions that cover the entire perioperative period. A multidisciplinary team is needed to achieve complete adherence. Its implementation began in colorectal surgery and it was gradually expanded and adapted to almost all surgical specialties. In heart surgery for non-specific reasons, including the use of extracorporeal circulation, the implementation has been delayed but the existing scientific evidence, although not enough, shows that adherence to these protocols influences positively the recovery of patients; so, the need to standardize them has arisen. Conclusions: The implementation of these protocols in heart surgery is now a reality. In April 2017, the company responsible for this process was created, whose motto is to optimize perioperative care through a collaborative analysis, consensus of experts and the dissemination of best practices(AU)

Effect of early negative fluid balance on the early postoperative recovery in children after surgical repair of congenital heart disease with enlarged right ventricle / 中国小儿急救医学

Objective To estimate the effect of early fluid removal on the early postoperative recov-ery in children after surgical repair of congenital heart disease with enlarged right ventricle via a randomized trial. Methods One hundred and twenty patients with right-sided complex congenital heart defect who un-derwent cardiac surgery by cardiopulmonary bypass during January 2017 to June 2017 were enrolled and were divided into two groups,Group-E and Group-C,when the hemodynamics was stable within 3 hours after the surgery. Patients in Group-E were treated with early fluid removal,but Group-C remained conventional thera-py. The data of the hemodynamics and outcomes were collected from the postoperative day to the 2nd day post-operation. Results Fluid removal therapy was started in Group-E at (4. 39 ± 0. 85) h postoperatively vs (10. 17 ± 2. 77) h in Group-C (P < 0. 05). Patients in Group-E showed lower extravascular lung water index (ELWI),lower fluid overload and lower NT-proBNP compared with patients in Group-C on the first day of post-operation(P < 0. 01). Also, the advantages remained in Group-E on the second day but the ELWI showed no remarkable difference. The rate of reintubation(P < 0. 05),the duration of mechanical ventilation and the length of ICU stay (P < 0. 01)were significantly reduced in Group-E. Conclusion In patients with right ventricle enlarged complex congenital heart defect who underwent cardiac surgery by cardiopulmonary bypass,utilizing early negative fluid balance when the hemodynamics are stable and the right ventricle is ob-viously enlarged could achieve negative fluid balance,get extubated and discharge from ICU earlier,also pres-ent lower extravascular lung water index, lower incidence of weaning-induced pulmonary edema and reintubation.

The clinical characteristics and prognosis of patients with peripartum cardiomyopathy / 中华内科杂志

Objective To explore the clinical characteristics and risk factors in patients with peripartum cardiomyopathy (PPCM).Methods A total of 35 patients admitted in Peking Union Medical College Hospital and diagnosed with PPCM between January 1995 and December 2014 was included and analyzed in this study.The subjects were divided into two groups:the early recovery and delayed recovery.Early recovery was defined as normalization of left ventricle ejection fraction (LVEF) ≥ 50％ before 6 months post-diagnosis.Delayed recovery was defined if the length of time required for recovery of LVEF was longer than 6 months or death was reported during follow-up.Risk factors for delayed recovery were assessed.Results The incidence of PPCM was 1 per 1 067 deliveries between the study periods.The age of the 35 patients was (28.9±5.6) years old.Among them,20 (57.1％) patients were not in the first pregnancy,13 (37.1％) had delivered before,and 5 (14.3％) patients had twin pregnancies.The LVEF at diagnosis was (34.1 ±8.0) ％.62.9％ (22 cases) of the subjects were in the early recovery,while 37.1％ (13 cases) of the subjects were in the delayed recovery group,2 of whom suffered death.Multivariate logistic regression indicated that LVEF (OR =1.339,95％ CI 1.063-1.688,P =0.013) and left ventricle end-dilated diameter(OR 0.763,95％CI 0.607-0.960,P =0.021)were independent risk factors for delayed recovery.Conclusions PPCM is a rare but life-threatening complication of pregnancy.LVEF and left ventricle end-dilated diameter at diagnosis were two independent factors associated with the prognosis of PPCM.

Effect of three different fertilization modes of frozen-thawed embryos and blastocysts on pregnancy outcome / 国际检验医学杂志

Objective To compare the effect of three different fertilization modes of frozen-thawed embryos and blastocysts on the pregnancy outcome after thawed transplantation .Methods 3 586 cycles of frozen embryos transplantation (FET ) treatment in our center from January 2012 to December 2013 were retrospectively analyzed and divided into 3 groups according to the fertilization modes .The group A adopted the conventional in vitro fertilization (IVF) of frozen-thawed embryo transfer in 2 008 cases and blas-tocysts transfer in 954 cases .The group B adopted intracytoplasmic sperm injection (ICSI) of frozen-thawed embryo transfer in 361 cases and blastocysts transfer in 129 cases ;the group C was given early remedy intracytoplasmic sperm injection (r-ICSI) of frozen-thawed embryo transfer in 87 cases and blastocysts transfer in 47 cases .The recovery rate of embryo and blastocyst ,pregnancy rate ,abortion rate ,ectopic pregnancy rate were compared for determining whether the differences among the indexes existed . Results The thawing recovery rate ,pregnancy rate ,abortion rate and ectopic pregnancy rate in the three different fertilization modes of embryo and blastocyst had no statistically significant differences (P>0 .05) .Conclusion Compared with conventional in vitro fertilization and intracytoplasmic sperm injection ,early r-ICSI is one of effective treatment means .

Desplazamiento forzado, niñez y adolescencia: escenarios en relación con su estabilización socioeconómica / Forced displacement, childhood and adolescence: scenarios regarding socioeconomic stability

Objetivo Describir y analizar escenarios de estabilización socioeconómica para población en situación de desplazamiento forzado, en los que se preste especial atención a la situación de niños, niñas y adolescentes. Métodos Se utiliza, a partir de talleres de expertos, el método Analytic Hierarchy Process (AHP), elaborado por el profesor Thomas Saaty con participación investigadores, ONG y de comunidades en situación de desplazamiento del Área Metropolitana de Bucaramanga. Resultados El resultado parcial de esta investigación muestra como algunos adultos mayores de comunidades en situación de desplazamiento forzado prefieren adaptarse a los centros urbanos, antes que retornar sus lugares de origen, en particular cuando se trata de la protección y el bienestar de sus hijos menores. El índice de consistencia y la relación de consistencia del método están dentro de los parámetros previstos. Conclusión Es necesario repensar los programas de estabilización socioeconómica promovidos por el gobierno en relación con la población en situación de desplazamiento forzado, en particular cuando se prevén situaciones que comprometen el bienestar de los niños, niñas y adolecentes.

Objective Describing and analysing socio-economic stabilisation scenarios for populations which have been forcibly displaced paying special attention to the situation of children and adolescents. Method The analytic hierarchy process (AHP) multi-criteria decision-making method developed by Professor Thomas Saaty was used through expert workshops, involving researchers, leaders of NGOs and displaced communities living in the city of Bucaramanga. Results The partial result of this research showed that some elderly adults from forcibly displaced communities preferred to adapt themselves to urban centres, rather than return to their places of origin, particularly when it came to protecting younger children and dealing with their welfare. The method's consistency index and consistency ratio came within the expected parameters. Conclusion Government-promoted social and economic stabilisation programmes must be rethought regarding forcibly displaced populations, particularly when situations are envisaged involving the welfare of children and adolescents.

Effect of early enteral nutrition after hepatectomy in hepatocellular carcinoma patients

BACKGROUNDS/AIMS: To evaluate the effect of early enteral nutrition after hepatectomy in hepatocellular carcinoma (HCC) patients on postoperative gastrointestinal motility recovery and admission days, liver function and nutrition recovery, and postoperative complication. METHODS: From August 2010 to July 2011, 102 patients with primary HCC underwent hepatectomy. Forty two patients took a sip of water (SOW) at postoperative day (POD)#1, soft blended diet (SBD) at POD#2 (early diet group, ED group), otherwise 60 patients took a SOW at POD#3, SBD at POD#4 (conventional diet group, CD group). Postoperative flatus-pass day, stool-pass day, nausea, vomiting, admission days, immediate postoperative (POD#0) and POD#1, 3, 5, 7 profiles of albumin, prothrombin time (PT) INR, total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), white blood cell (WBC), and POD#1, 3, 5, 7 profiles of C-reactive protein (CRP), and postoperative complications cases were compared between ED group and CD group. All clinical data were compared retrospectively. RESULTS: Flatus-pass days (p<0.01), stool-pass days (p<0.01) and postoperative admission days (p=0.012) were shorter in ED group. Total bilirubin levels were higher at POD#0, 1, 3 but lower or similar at POD#5, 7 in ED group. AST, ALT levels were higher at POD#0 but lower at POD#1, 3, 5. There were no significant differences in albumin, PT INR, WBC, CRP and postoperative complication rates. CONCLUSIONS: ED group had no difference in nutritional recovery and postoperative complication rates compared to CD group but it has better gastrointestinal motility recovery, liver function recovery, and shorter postoperative admission days.

Is a Fast-track Critical Pathway Possible in Gastric Cancer Surgery?

PURPOSE: The postoperative hospital stay after gastric cancer surgery is usually 8 to 14 days. The main reason for a prolonged hospital stay may be the 3 to 4 day period of postoperative starvation. The aim of this study is to investigate the feasibility of a critical pathway for early recovery after gastric cancer surgery, and this pathway included early postoperative feeding. MATERIALS AND METHODS: One hundred three consecutive patients who underwent gastric resection and reconstruction for gastric cancer from October 2007 to June 2008 at St. Mary's Hospital were prospectively enrolled in a fast-track critical pathway. The pathway included minimal preoperative procedures, optimal pain relief, proper fluid administration, early mobilization and early enteral nutrition at postoperative 1 day. The exclusion criteria were determined preoperatively, intraoperatively and postoperatively. RESULTS: Of the 103 patients, 19 patients were excluded for preoperative (5), intraoperative (7) and postoperative (7) reasons. Eighty-four patients (81.6%) were included in the fast-track critical pathway. Sixty-eight (88.6%) of 84 patients were discharged at the planned 8 day after surgery during the initial period of the study, and the postoperative hospital stay was shortened up to 6 days during the more recent period. Postoperative complications occurred in 22 patients (26.2%), and these were gastrointestinal track-related complications in 6 cases (3 cases of ileus, 1 case of stasis and 2 cases of leakage) and infection-related complications in 8 cases. There was no statistical difference in the incidence of morbidity according to the clinic-operative features that included age, gender, stomach resection and lymphadenectomy. CONCLUSION: The fast-track critical pathway with using the available exclusion criteria was a valid option for patients who underwent gastric cancer surgery.

The Effects of Recombinant Human alpha-Interferon on Epidemic keratoconjunctivitis

We investigated the clinical effects and drug toxicities of high concentrated recombinant human alpha-interferon eyedrops in acute epidemic keratoconjunctivitis(ARK). We examined the side effects of alpha-interferon eyedrops after instillation to the 34 general healthy patients, and compared the clinical effects after randomized blind administration of the different concentration eyedrops or placebo in 117 AEK. No significant ocular complications in the 34 general healthy patients was observed. In AEK, improvement of symptoms and signs were observed at the mean 3.2 days of 10.000 IU/ml group, 3.1 days of 100,000 IU/ml group, and 3.2 days of 500,000 IU/ml group after instillation of alpha-interferon. comparing 4.4 days of placebo(P<0.01). We have also observed early absorption of conjunctival pseudomembrane, and the decreased incidence of keratitis. We suggest that the topical application of alpha-interferon might be clinically useful to help early recovery and decrease the incidence of ocular complications of AEK.