[Efficacy of radial shock wave guided by soft tissue surgery theory in the treatment of lateral epicondylitis].

Objective: To explore the efficacy of radial shock wave therapy (RSWT) for lateral epicondylitis (LE). Methods: A total of 54 cases suffering from LE from Department of Pain Medicine of Fujian Provincial Hospital between December 2017 to October 2019 were randomly assigned to experimental group (n=27) and control group (n=27). Subjects in the experimental group were applied with RSWT in the lateral elbow area plus scapular back area, while patients in control group were applied with RSWT only in the lateral elbow area. Patients in both groups underwent RSWT one session per week for four weeks. Numeric rating scale (NRS), pain-free grip (PFG) test and patient-rated tennis elbow evaluation (PRTEE) in both groups were evaluated and compared at the pre-treatment, one week, one month and three months after treatment. Results: The NRS scores at pre-treatment, one week, one month and three months after treatment in experimental group were 6.5±1.6, 4.0±1.1, 3.9±1.5, 1.7±1.1, respectively, while those in control group were 6.2±1.4, 3.8±1.3, 4.2±1.2, 2.6±1.2, respectively. Compared with those at pre-treatment, the NRS scores in both groups were significantly decreased at one week, one month and three months after treatment (all P<0.05). The PRTEE and PFG results showed significant improvement after treatment (all P<0.05). The NRS scores and PRTEE at three months after treatment in the experimental group were 18±11, 1.7±1.1, respectively, which were significantly lower than those in the control group (25±11, 2.6±1.2, respectively) (both P<0.05). Conclusions: RSWT exerts a beneficial effect on LE. Guided by the soft tissue surgery theory, RSWT in the lateral elbow area plus scapular back area produces better pain reduction and functional improvement compared with RSWT only in the lateral elbow area.

Dexmedetomidine vs remifentanil intravenous anaesthesia and spontaneous ventilation for airway foreign body removal in children.

BACKGROUND: To compare the safety and efficacy of dexmedetomidine/propofol (DP)-total i.v. anaesthesia (TIVA) vs remifentanil/propofol (RP)-TIVA, both with spontaneous breathing, during airway foreign body (FB) removal in children. METHODS: Seventy-seven children undergoing rigid bronchoscopy for FB removal were randomly allocated to receive either RP-TIVA and spontaneous ventilation (Group RP, n=38) or DP-TIVA and spontaneous ventilation (Group DP, n=39). Heart rate, arterial pressure, pulse oxygen saturation (Sp(O2)), respiratory rate, end-tidal CO2 (E'(CO2)), and induction time were recorded. Adverse events, the intervention for these events, and postoperative care duration were also assessed. RESULTS: The mean induction times were comparable between the two groups (Group RP 12.2 min vs Group DP 13.1 min, P>0.05). At the end of the procedure, the mean (E'(CO2)) was higher in Group RP (Group RP 6.8 kPa vs Group DP 5.8 kPa, P<0.001), and respiratory rate was lower in Group RP (Group RP 20.4 vs Group DP 35.8, P<0.001). Additionally, the perioperative haemodynamic profile was more stable in Group DP than that in Group RP. The incidence rate of breath-holding and intervention were comparable between the two groups. In the post-anaesthesia care unit (PACU), no hypoxaemia was observed, and emergence time increased in Group DP (Group DP 65.1 min vs Group RP 23.8 min, P<0.0001). The incidence of cough in PACU was higher in Group RP (Group RP 55.3% vs Group DP 10.3%, P<0.0001). CONCLUSIONS: Compared with RP-TIVA, DP-TIVA provided more stable respiratory and haemodynamic profiles, but required a longer recovery time. Clinical trial registration China Clinical Research Information Service, ChiCTR-TRC-13003018.

[Improvement of China's legal system for public health emergency management from the perspective of lifecycle management].

A crucial lesson gained through the pandemic preparedness and response to COVID-19 is that all measures for epidemic control must be law-based. The legal system is related not only to public health emergency management per se but also to all aspects of the institutional supporting system throughout the lifecycle. Based on the lifecycle emergency management model, this article analyses the problems of the current legal system and the potential solutions. It is suggested that the lifecycle emergency management model shall be followed to establish a more comprehensive public health legal system and to gather the intelligence and consensus of experts with different expertise, including epidemiologists, sociologists, economists, jurist and others, which will collaboratively promote the science-based legislation in the field of epidemic preparedness and response for the establishment of a comprehensive legal system for public health emergency management and with Chinese characteristics.

Randomized Clinical Trial on Sodium Fluoride with Tricalcium Phosphate.

This 24-mo randomized controlled trial was based on a double-blind parallel design, and it compared the effectiveness of 2 fluoride application protocols in arresting dentine caries in primary teeth. Three-year-old children with active dentine caries were recruited and randomly allocated to 2 treatment groups. Children in group A received a semiannual application of a 25% silver nitrate (AgNO3) solution followed by a commercially available varnish with 5% sodium fluoride (NaF) on the carious tooth surfaces. Children in group B received a semiannual application of a 25% AgNO3 solution followed by another commercially available varnish with 5% NaF containing functionalized tricalcium phosphate (fTCP). Carious tooth surfaces that were hard when probing were classified as arrested. Intention-to-treat analysis and a hierarchical generalized linear model were undertaken. A total of 408 children with 1,831 tooth surfaces with active dentine caries were recruited at baseline, and 356 children (87%) with 1,607 tooth surfaces (88%) were assessed after 24 mo. At the 24-mo evaluation, the mean (SD) number of arrested carious tooth surfaces per child were 1.8 (2.2) and 2.6 (3.3) for group A (without fTCP) and group B (with fTCP), respectively (P = 0.003). The arrest rates at the tooth surface level were 42% for group A and 57% for group B (P < 0.001). Results of the hierarchical generalized linear model indicated that protocol B (with fTCP) had a higher predicted probability (PP = 0.656) in arresting dentine caries than protocol A (without fTCP; PP = 0.500) when the carious lesions were on buccal/lingual surfaces, were on anterior teeth, had dental plaque coverage, and were in children from low-income families (P = 0.046). In conclusion, protocol B, which applied a 25% AgNO3 solution followed by a commercially available 5% NaF varnish with fTCP semiannually, is more effective in arresting dentine caries in primary teeth as compared with protocol A, which applied a 25% AgNO3 solution followed by another commercially available 5% NaF varnish without fTCP semiannually (ClinicalTrials.gov NCT03423797).

A combination of three probiotic strains for treatment of acute diarrhoea in hospitalised children: an open label, randomised controlled trial.

Acute diarrhoea continues to be a leading cause of morbidity, hospitalisation, and mortality worldwide, and probiotics have been proposed as a complementary therapy in the treatment of acute diarrhoea. The goal of this study is to assess the efficacy and safety of three combined probiotic strains, Bifidobacterium lactis Bi-07, Lactobacillus rhamnosus HN001, and Lactobacillus acidophilus NCFM, as an adjunct to rehydration therapy in treatment of acute watery diarrhoea in hospitalised children. Eligible diarrheal children were randomised into intervention group (IG, n=96, conventional treatment for diarrhoea in combination with probiotics) and control group (CG, n=98, conventional treatment for diarrhoea without probiotics). The primary assessments of this study were duration of diarrhoea and hospital stay and improvement in diarrhoea symptoms. Significantly more children in the IG showed improvements in diarrhoea (defined as a decrease of stool frequency to no more than four times per day and an improved stool consistency within 24-48 h after the treatment) than those in the CG (96.9 vs 79.6%, P<0.05). Children supplemented with the mixed strains had a 22.5 h shorter (121.4±13.7 h vs 143.9±19.8 h) mean duration of diarrhoea and 1.2 d shorter hospital stays (5.1±1.2 d vs 6.3±1.4 d) than children only receiving the rehydration therapy (P<0.05). The prevalence of constipation of children in the IG (3.1%) was markedly lower (P<0.05) than that of children in the CG (13.3%) after treatment. In conclusion, the mixture of three probiotic strains given to children aged 1-3 years resulted in shorter durations of diarrhoea and hospitalisation and a higher percentage of improved children.

The cost-effectiveness of syndromic management for male sexually transmitted disease patients with urethral discharge symptoms and genital ulcer disease in Taiwan.

OBJECTIVE: To assess the cost-effectiveness of syndromic management for the treatment of sexually transmitted diseases (STD) in comparison with the strategies currently used in STD clinics in Taiwan. METHODS: Between July 2004 and June 2005, all male patients with genitourinary symptoms attending two hospitals were included in this study. Current clinical procedures (presumptive treatment and laboratory tests), aetiological diagnosis and syndromic management were compared in terms of diagnostic accuracy, treatment appropriateness, costs and effectiveness. RESULTS: 473 patients met the inclusion criteria and were enrolled in the study. 335 patients (71%) had urethral symptoms (discharge, dysuria or painful urination) and 138 (29%) had genital ulcers, sores and skin rashes. For the current approach, the sensitivity, specificity and positive predictive value (PPV) for the detection of chlamydial, gonococcal and combined forms of infection were 100%, 40.0% and 60.4%, respectively. In contrast, the sensitivity, specificity and PPV for the detection of syphilis were 100%, 86.7% and 70.2%, respectively. For syndromic management, the sensitivity, specificity and PPV detection of chlamydial, gonococcal and combined forms of infection were 85.0%, 40.0% and 56.4%, respectively. In contrast, the sensitivity, specificity and PPV for the detection of syphilis were 78.8%, 18.1% and 23.2%, respectively. The average cost of implementing a correct treatment using the current approach was US$54.27 and US$30.74 for urethritis and syphilis, respectively. For the aetiological approach, the average cost of implementing a correct treatment was US$32.83 and US$21.58 for urethritis and syphilis, respectively. For the syndromic approach, the average cost for a correct treatment was US$3.86 and US$14.30 for urethritis and syphilis, respectively. CONCLUSIONS: In this sample of patients attending STD clinics in Taiwan, syndromic management was found to be a more cost-effective protocol in terms of cost per treated STD patient compared with the current and aetiological protocols for STD.

Rhabdomyolysis after liver transplantation: a case report.

Our aim was to present the case of a pediatric biliary atresia patient who experienced rhabdomyolysis with severe cardiac arrhythmias associated with hyperkalemia, metabolic acidosis, and myoglobulinemia during liver transplantation. A 5-year-old girl, weighing 16.5 kg, with end-stage liver disease due to biliary atresia underwent living donor liver transplantation. A sudden onset of atrial fibrillation with rapid ventricular response was noted during the transplantation. The cardiac arrhythmia was associated with hyperkalemia, metabolic acidosis, and myoglobulinemia. Rhabdomyolysis was suspected. Hyperkalemia and metabolic acidosis were not corrected despite treatment with 10 mL of 50% glucose plus 6 U of regular insulin in 4 succeeding boluses and 110 mEq sodium bicarbonate before sending the patient to the intensive care unit. A corresponding decrease and normalization in serum potassium and correction of metabolic acidosis were noted as responses to a single dose of intravenous (20 mg) dantrolene. The patient was extubated 5 days after transplantation. The kidney function remained within normal limits during the rhabdomyolysis and the entire hospital stay. The patient was discharged 7 weeks later and is surviving with the original liver graft and satisfactory kidney function to date.

Anesthesia management in a patient with an abdominal aortic aneurysm undergoing liver transplantation: a case report.

We describe the anesthetic management in a 56-year old man with hepatocellular carcinoma and cirrhosis who underwent liver transplantation (LT). Pretransplantation workup showed a 3-cm wide by 10-cm long infrarenal abdominal aortic aneurysm (AAA) with chronic dissection. He subsequently underwent living donor LT. The total operative time was 12 hours. The systolic blood pressure was maintained at normal levels. Severe hypertension was not noted. Hypotension noted during the anhepatic phase was managed with increased volume infusion and small doses (0.1 mg) of intravenous phenylephrine. Metabolic acidosis and ionized hypocalcemia were corrected accordingly. Total blood loss was 460 mL. Blood or blood products were not given. The intravascular volume was replaced with 1400 mL of 5% albumin and 10,610 mL of crystalloid. Extubation was performed in the intensive care unit at 12 hours after the operation. The postoperative course was unremarkable. The patient is alive at 3 years after LT. Patients with AAA undergoing LT present a challenge to the anesthesiologist because among the risk factors for rupture, blood pressure is the only factor under his or her control during the operation. If blood loss can be kept to a minimum and hemodynamic stability achieved, a chronically small dissected AAA may not be a contraindication to LT.

Transplantation After Successful Downstaging by Multimodal Treatments of American Joint Committee on Cancer Stage IIIB Hepatocellular Carcinoma With Portal Vein Thrombi: A Case Report.

The effective treatment for hepatocellular carcinoma (HCC) with American Joint Committee on Cancer stage IIIB remains controversial and challenging because of the high recurrence rate after resection and low survival rate. The median survival of those with macroscopic portal vein tumor thrombus (PVTT) is short. We reported such a case which received liver transplantation (LT) after successful consecutive downstaging therapies. A 40-year-old man with alcohol related liver cirrhosis and repeated esophageal varices bleeding had HCC with tumor thrombi in right main portal vein and the second portal branch of segment VI (stage IIIB). The received percutaneous alcohol injection, radiofrequency ablation, 8 sessions of transcatheter hepatic arterial chemoembolization, radiotherapy, and target therapy with sorafenib. Computed tomography (CT) scan and magnetic resonance imaging after treatments showed no viable fragments in the tumor and revealed both the right main portal vein and V1 branch were patent. One month later, the patient received a deceased LT. The perioperative course was rather smooth. After discharge, the interval follow-up CT studies of the chest and liver and whole body bone scan showed no tumor recurrence or metastasis up to 20 months postoperation.

[Exploration and practice in the construction of curriculum on epidemiology in preventive medicine].

Epidemiology is one of main courses for undergraduate students majoring in preventive medicine. There are some limitations in the traditional epidemiology teaching, which is usually characterized in indoctrinated education: "lectured by the teachers and listened by the students." In Zhejiang University, staff of the epidemiology division tried to explore a new teaching mode as 'student-centered, teacher-leading, question-based, and combining with literature discussion and course practice.' After practicing for two years, students were inspired in learning initiatives, with teaching effectiveness obviously improved.

Using an integrated infection control strategy during outbreak control to minimize nosocomial infection of severe acute respiratory syndrome among healthcare workers.

Healthcare workers (HCWs) are at risk of acquiring severe acute respiratory syndrome (SARS) while caring for SARS patients. Personal protective equipment and negative pressure isolation rooms (NPIRs) have not been completely successful in protecting HCWs. We introduced an innovative, integrated infection control strategy involving triaging patients using barriers, zones of risk, and extensive installation of alcohol dispensers for glove-on hand rubbing. This integrated infection control approach was implemented at a SARS designated hospital ('study hospital') where NPIRs were not available. The number of HCWs who contracted SARS in the study hospital was compared with the number of HCWs who contracted SARS in 86 Taiwan hospitals that did not use the integrated infection control strategy. Two HCWs contracted SARS in the study hospital (0.03 cases/bed) compared with 93 HCWs in the other hospitals (0.13 cases/bed) during the same three-week period. Our strategy appeared to be effective in reducing the incidence of HCWs contracting SARS. The advantages included rapid implementation without NPIRs, flexibility to transfer patients, and re-inforcement for HCWs to comply with infection control procedures, especially handwashing. The efficacy and low cost are major advantages, especially in countries with large populations at risk and fewer economic resources.

Cost-effectiveness of elective cesarean delivery in human immunodeficiency virus-infected women(1).

OBJECTIVE: To evaluate the cost-effectiveness of an elective cesarean delivery strategy in human immunodeficiency virus (HIV)-infected women receiving zidovudine therapy to prevent perinatal transmission. METHODS: A decision-analysis model was constructed to compare two delivery strategies in HIV-infected women: usual care and recommendation for elective cesarean delivery. The model followed a hypothetical cohort of 7000 HIV-infected pregnant women in the United States who were receiving zidovudine therapy for 1 year. The third-party payer perspective was taken. Cost of delivery method with and without complications and lifetime medical care cost for pediatric HIV infection were considered. The main outcome measure was cases of perinatal HIV transmission prevented. RESULTS: Compared with the usual care strategy, the elective cesarean delivery strategy resulted in an additional 3486 cesarean deliveries each year, prevented 142 cases (52.4%) of perinatal HIV transmission, and resulted in incremental overall cost savings to society of $5.3 million per year ($37,284 saved per case of perinatal transmission prevented). With other estimates held constant, the elective cesarean delivery strategy would not be cost saving when the baseline perinatal HIV transmission rates were all reduced by 43.3%. CONCLUSIONS: Elective cesarean delivery in HIV-infected women receiving zidovudine is one management strategy for prevention of perinatal HIV transmission and can be cost saving. However, if other strategies, such as use of combination antiretroviral therapy and/or measurement of viral load, result in at least 50% reduction of the baseline perinatal HIV transmission rates, elective cesarean delivery will not be cost saving.

A research-based use of Tai Chi/movement therapy as a nursing intervention.

Tai Chi has been widely practiced in China for centuries as an art form, religious ritual, relaxation technique, exercise, and a method of self-defense for people of all ages. It has been used to improve balance; promote postural stability; decrease falls; enhance cardiovascular and ventilatory functions; rehabilitate persons with acute myocardial infarction and rheumatoid arthritis; and reduce pain, stress, and nightmares. The purpose of this article is to summarize, synthesize, and critically evaluate the research-based use of Tai Chi presented in the current literature and give implications and directions for future research. Additional studies about the effects of Tai Chi from a nursing perspective are needed to make clear when it is beneficial as a nursing intervention.

The effect of heated humidifier in the prevention of intra-operative hypothermia.

Unintentional hypothermia is common in patients undergoing "routine anesthesia in surgery". The aims of the study were to estimate the difference of changes of body temperature during abdominal and limb operations and to evaluate the effectiveness of the heated humidifier for reducing intraoperative heat loss. Forty-three patients were randomly being allocated into 3 groups. Group I consisted of 14 patients undergoing abdominal operation without the use of heated humidifier. Another 22 patients were being assigned as group II to have a heated humidifier on the inspiratory limb of the breathing circuit. The inspired gas was warmed to 39 degrees C and the relative humidity was 90%. 7 patients undergoing limb operation were attributed to group III without using heated humidifier to humidify and warm up the inspired gas. For body temperature monitoring, the probe was placed on the patient's nasopharynx and the temperature was measured immediately before induction of anesthesia, post-intubation, and then once again every 15 minutes up to 3 hours after induction. All patients in the 3 groups showed a rapid decrease of body temperature in the first hour and then the hypothermic change was slow down. The lowest level of body temperature was reached at about 2 hours after induction. Patients undergoing abdominal operation decreased body temperature greater than those undergoing limb operation for about 2 degrees C after 3 hours of anesthesia and surgery. Warming and humidifying the inspired gas effectively reduced the heat loss. We concluded that abdominal operation induce hypothermia more than limb operation. The use of heated humidifier was effective in maintaining body temperature.

[Clinical and experimental studies on royal made ping an dan in preventing motion sickness].

Royal Made Ping An Dan (PAD) is a royal clandestine prescription of the Qing Dynasty Imperial hospital for emperors, empresses, ministers, imperial maids and eunuchs. Experimental study confirmed; (1) PAD had apparent peripheral effect in inhibiting vomiting and improving mental state (P < 0.05). (2) PAD possessed markedly sedative effect (P < 0.05). (3) PAD was able to strengthen the defence ability of gastric mucosa and decreased its damage induced by chemical irritation. (4) PAD could markedly relieve the spasm of intestinal smooth muscle in vitro. (5) PAD could inhibit the growth of common pathogenic bacteria in intestine and stomach such as B. coli and B. dysenteriae. (6) The study of toxicology suggested that PAD was safe for clinical use. The clinical results showed that PAD possessed the effect in preventing 274 persons on motion sickness. The total effective rate of PAD group was 83.9%, while that of Dramamine group was 60.8%. PAD revealed better effect than that of Dramamine. Therefore, the authors realize that PAD is a better preventive drug for motion sickness.

Use of twin dorsal middle phalangeal finger flaps for thumb or index finger reconstruction.

Amputation or degloving injuries of the thumb or index finger are highly disabling. We describe the use of twin dorsal middle finger flaps harvested from the dorsal aspects of the middle and ring fingers, and based on one palmar proper digital artery, its venae comitantes, and the dorsal branches of the palmar digital nerves of the middle and ring fingers, respectively. These flaps offer advantages when large soft tissue defects of the thumb or index finger are present. In this study, twin dorsal middle finger flaps were used in nine patients (six thumbs, three index fingers). All flaps completely survived. At the mean follow-up of 20 months, the appearance of the reconstructed thumbs or index fingers was acceptable, the length was maintained, and the mean static 2-point discrimination values were 10 mm in the palmar flap and 13 mm in the dorsal flap of the reconstructed digit. All patients were satisfied with the appearance and mobility of the donor fingers. All but one donor finger showed normal finger pulp sensibility, with a static 2-point discrimination between 3 and 6 mm.

Individualized medication of voriconazole: a practice guideline of the division of therapeutic drug monitoring, chinese pharmacological society

BACKGROUND: Voriconazole (VRZ) is a second-generation triazole antifungal agent with broad-spectrum activity. It is available in both intravenous and oral formulations, and is primarily indicated for treating invasive aspergillosis. The most commonly used dose for adults is 4 mg/kg or 200 mg twice daily. VRZ presents nonlinear pharmacokinetics in adults, whereas drug-drug interactions and cytochrome P450 2C19 (CYP2C19) polymorphism are of great concern for VRZ. Because the liquid chromatography method has been widely used for measuring VRZ blood concentration, and target VRZ blood concentration has been recommended in some guidelines regarding efficacy and safety, therapeutic drug monitoring is considered as a useful tool for VRZ-individualized medication. Also, the CYP2C19 genotype test is available for guiding relevant drugs use in some health care facilities. Our objective was to develop an evidence-based practice guideline for VRZ-individualized medication. METHODS: We followed the latest guideline definition from the Institute of Medicine and referred to the World Health Organization handbook for guideline development. The guideline was initially registered in the International Practice Guidelines Registry Platform (IPGRP-2015CN001). The guideline is, in principle, targeted at all Chinese health care providers. The quality of evidence and strength of the recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. RESULTS: Twenty-six recommendations were formulated regarding therapeutic drug monitoring, special groups of patients, drug safety, off-indication use, and drug-drug interactions. Of them, 12 were strong recommendations. Most quality of evidence was low, very low, or expert opinions. CONCLUSIONS: We developed an evidence-based practice guideline for VRZ-individualized medication, which provided comprehensive and practical recommendations for health care providers. The development of the guideline exposed several research gaps to improve VRZ use.