Comparison of oxycodone and sufentanil in patient-controlled intravenous analgesia for postoperative patients: a meta-analysis of randomized controlled trials.

BACKGROUND: Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA. METHODS: We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients' satisfaction and side effects. RESULTS: Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = -0.71, 95% confidence interval [CI]: -1.01 to -0.41; P < 0.001; I2 = 93%), demonstrated better relief from visceral pain (MD = -1.22, 95% CI: -1.58 to -0.85; P < 0.001; I2 = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35-1.19; P < 0.001; I2 = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35-0.60; P < 0.001; I2 = 11%). There was no statistical difference in the degree of patients' satisfaction (OR = 1.13, 95% CI: 0.88-1.44; P = 0.33; I2 = 72%) and drug consumption (MD = -5.55, 95% CI: -14.18 to 3.08; P = 0.21; I2 = 93%). CONCLUSION: Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries. REGISTRATION: PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.

[Effect of Smoking on Cancer Surgery Outcomes and Recommendations for Perioperative Smoking Cessation Intervention]. / 吸烟对癌症手术效果的影响以及围手术期戒烟干预建议.

Smoking, a common behavior that causes health risks among adults around the world, is closely associated with the risks of developing various kinds of cancers. Nevertheless, the impact of smoking on preoperative risks and postoperative outcomes of cancer surgeries has been largely overlooked. Extensive basic medical and clinical research findings and prognosis data demonstrate that smoking is associated with increased risks of multiple perioperative complications, and that smoking affects the general prognosis of patients. Smoking cessation during the preoperative and perioperative periods effectively reduces these risks and improves the long-term postoperative outcomes of cancer patients. At present, health workers and patients are not giving adequate attention to smoking cessation interventions and the quality of interventions available is poor. Herein, we discussed the necessity of comprehensive and standardized smoking cessation services and made recommendations regarding the implementation of comprehensive and standardized smoking cessation services, providing support for cancer patients to access evidence-based care during the perioperative period.

Barriers to prescribing oral anticoagulants to inpatients aged 80 years and older with nonvalvular atrial fibrillation: a cross-sectional study.

BACKGROUND: To investigate the temporal trend of the prevalence of underprescription of anticoagulation treatment and explore the factors associated with underprescription of oral anticoagulants (OACs) among inpatients aged ≥ 80 years with nonvalvular atrial fibrillation (NVAF). METHODS: We retrospectively reviewed the medical records of inpatients with a discharge diagnosis of NVAF from a medical database. We used the Pearson chi-square or Fisher's exact test to compare categorical variables between patients with and without OAC prescriptions during hospitalization. Logistic regression analysis was used to assess the association between risk factors and underprescription of OACs. RESULTS: A total of 4375 patients aged ≥ 80 years with AF were assessed in the largest academic hospital in China from August 1, 2016, to July 31, 2020, and 3165 NVAF patients were included. The prevalence of underprescription of OACs was 79.1% in 2017, 71.3% in 2018, 64.4% in 2019, and 56.1% in 2020. Of all participants, 2138 (67.6%) were not prescribed OACs; 66.3% and 68.2% of patients with and without prior stroke did not receive OACs, respectively. Age (85-89 vs 80-84, OR = 1.48, 95% CI (1.25-1.74); 90 + vs 80-84, OR = 2.66, 95% CI: 2.09-3.42), clinical department where patients were discharged (Reference = Cardiology, Geriatrics: OR = 2.97, 95% CI: 2.45- 3.61; neurology: OR = 1.25, 95% CI: 0.96, 1.63; others: OR = 4.23, 95% CI: 3.43- 5.24), use of antiplatelets (OR = 1.69, 95% CI: 1.45- 1.97), and history of stroke (OR = 0.83, 95% CI: 0.71- 0.98 adjusted age), and dementia (OR = 2.16, 95% CI: 1.60- 2.96) were significantly associated with not prescribing OACs. CONCLUSIONS: The prevalence of underprescription of OACs has decreased over the past several years. The rate of underprescription of OACs was higher among NVAF patients who were older, prescribed antiplatelets, discharged from nondepartmental cardiology, and suffered from comorbidities. This study found iatrogenic factors affecting the underprescription of OACs in inpatients aged ≥ 80 years, providing clues and a basis for the standardized use of OACs in inpatients.

Study on the preparation and function of regulatory T cells from human peripheral blood.

BACKGROUND: Regulatory T cells (Tregs) are an important cell subgroup of CD4+ T cells. Treg cells are critically involved in inducing immune tolerance, maintaining immune environment homeostasis, and preventing the occurrence of autoimmune diseases. Under normal conditions, the number of Tregs in the body is very small. This research was designed to establish an effective method to expand human peripheral blood Tregs in vitro and to analyze phenotype, purity, and function of Treg cells post-expansion. METHODS: Peripheral blood was obtained from healthy donors. CD4+CD25+CD127dim/- Treg cells were isolated from peripheral blood mononuclear cells (PBMCs) by magnetic-activated cell sorting (MACS), and an optimized culture system was used for amplification. The in vitro amplification ability of Treg cells was evaluated to determine the expression and purity of Treg cell-specific surface markers in different culture cycles. The suppressive function of Treg was determined by in vitro lymphocyte proliferation assay. RESULTS: Treg cells could be successfully isolated by magnetic activated cell sorting (MACS). After 21 days of in vitro culture, the mean expansion fold was 2,009±452.2 in ≤60 years, and there was a significant difference between the younger group and the older than 60 years group (1,238±330.0). Flow cytometry analysis revealed that the percentages of CD4+CD25+ cells and FOXP3+ cells were (93.25±3.05)% and (94.19±4.21)% on day 14, and (92.86±4.36)% and (91.55±5.62)% on day 21, respectively. In addition, the proportions of CD8+ T, CD19+ B, CD3-CD56+ natural killer cell (NK), and CD3+ CD56+ natural killer T cell (NKT) were extremely low. Lymphocyte proliferation assay demonstrated that Tregs could inhibit the proliferation of CD8+ T cells more effectively than that of CD4+ T cells. Furthermore, the suppressive capacity of Tregs was correlated with Treg-to-PBMCs ratios. CONCLUSIONS: We successfully established a technical protocol for manufacturing a large quantity of Tregs with high efficiency in vitro. The expanded Tregs have a steady FOXP3 expression and exhibited a potent immune suppression, which might have great significance in adoptive Treg therapy for treating graft-versus-host disease and autoimmune diseases.

A case report of sharp recanalization in a hemodialysis patient with severe occlusion of both superior and inferior vena cave.

We present the case of a 53-year-old woman with a history of maintenance hemodialysis through arteriovenous fistula, CUFF catheter (cuffed tunneled catheter) and artificial vascular graft successively. Some signs of superior vena cava syndrome have presented including chronic edema in the face and left arm and varicose veins. Both CT (computed tomography) and angiography showed narrowing and occlusion in multiple veins, especially the right innominate vein, superior vena cava, inferior vena cava, left jugular vein, and bilateral common iliac veins. The first attempt at recanalization of the AVG (arteriovenous graft) failed due to severe occlusion of central venous. Finally, the patient was treated with a minimally invasive surgical approach involving percutaneous direct superior vena cava puncture driven by a single bend and vascular snare that were placed in the right atrium via hepatic vein percutaneous direct puncture under a double C arm angiographic device. The initial attempt failed with RUPS 100 (Cook, Chicago, USA) and was complicated by pericardial tamponade. The second attempt succeeded and the catheter was placed without hindrance and edema or varicose veins and its patency has remained for over 18 months following the intervention. It is the first successful case of sharp recanalization in combined superior and inferior vena cava syndromes with long-segment occlusion. This creative approach to providing vascular access offers a novel way to address refractory lesions in central veins.

Acupuncture for polycystic ovary syndrome: An overview of a protocol for systematic reviews and meta analyses.

BACKGROUND: As the results of previous systematic reviews and meta-analyses on acupuncture for polycystic ovary syndrome (PCOS) have provided inconsistent evidence. This overview of systematic reviews (SRs) and meta-analyses will aim to critically appraise the methodology and reporting quality of the relevant SRs and meta-analyses with the aim of identifying whether acupuncture could provide an effective treatment for patients with PCOS or not. METHODS: Electronic databases including MEDLINE via Ovid, EMBASE, PubMed, Cochrane library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP database), and Wanfang Database will be searched for related SRs and meta-analyses from inceptions to the search date without language restrictions. Two reviewers will independently select SRs and meta-analyses and collect related data, and a third reviewer will be introduced if any disagreement happened during the assessing. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and the latest Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklists will be employed to evaluate the reporting and methodology quality. RESULTS: This overview will be published in a peer-reviewed journal. CONCLUSION: This overview will identify related SRs and meta-analyses of acupuncture for treating PCOS. ETHICS AND DISSEMINATION: Ethics approval and patient consent are not required as this study is an overview based on published systematic reviews and meta-analyses.

[Prevention of falls of hospitalized elderly patients using clinical pathway].

OBJECTIVE: To explore effective strategies for preventing falls of hospitalized elderly patients using clinical pathway. METHODS: A total of 2442 patients aged > or = 70 years who were hospitalized during December 2009 and December 2010 were recruited for the study. The patients were assessed with "Falls Risk Assessment and Nursing Care Inventory" and 1796 were identified as with high risk of falls. The clinical pathway for preventing falls was applied to those patients with high risk of falls. The interventions included timely assessments, safe environment and facilities, targeted health education, extended nursing care on patients with high risk, improved hand-off, rational use of medicine, and so on. RESULTS: Only 4 patients fell, with an incidence of 0.22%. Sex, age, disease, psychological factors, clothing, hospital environment, drug effects, and history of falls were associated with the occurrence of falls. CONCLUSION: Risk assessment and targeted intervention through clinical pathway are effective strategies for preventing falls of hospitalized elderly patients.

[Effects of PI3K signaling pathway on pathogenesis of ulcerative colitis].

OBJECTIVE: To elucidate the role of PI3K/Akt in the pathogenesis of UC patients and DSS-induced colitis model in mice. METHODS: (1) The mucosa biopsy specimens were collected from 40 patients with ulcerative colitis, and normal mucosa from 20 colon cancer cases served as control. Effects of wortmannin on expression of TNF-alpha in intestinal mucosal specimens from patients with ulcerative colitis were determined on the condition of tissue culture. (2) Thirty six Balb/c mice were divided randomly into four groups: normal control group, DSS-induced colitis group, DMSO control group and wortmannin treatment group. Colitis was induced by feeding 5% DSS in mice. Disease activity index (DAI) was evaluated and the level of TNF-alpha was measured by ELISA. RESULTS: (1) The TNF-alpha level of intestinal mucosa in wortmannin treatment group was significantly lower than that in UC group (P < 0.05). (2) The DAI scores and TNF-alpha levels were lower significantly in wortmannin treatment group compared with DSS group and DMSO group (P < 0.05), and were higher than those of normal control group (P < 0.05). There were no significance between DSS group and DMSO group (P > 0.05). CONCLUSIONS: PI3K/Akt signal transduction pathway participates in the expression regulation of pro-inflammatory cytokine TNF-alpha. Wortmannin can inhibit PI3K/Akt signal transduction pathway.