Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial.

BACKGROUND: Pecto-intercostal fascial block (PIFB) provides analgesia for cardiac median sternotomy, but many patients complain of severe drainage pain that cannot be covered by PIFB. Rectus sheath block (RSB) has been attempted to solve this problem, but whether PIFB combined with RSB can achieve better analgesia is uncertain. METHODS: This was a single-center randomized controlled trial at Peking University People's Hospital from September 22, 2022 to December 21, 2022. Patients undergoing elective cardiac surgery with a median sternotomy were randomized at a 1:1 ratio to receive either bilateral PIFB and RSB (PIFB + RSB group) or PIFB (PIFB group). The primary outcome was intravenous opioid consumption within 24 h after surgery. Secondary outcomes included opioid consumption within 48 h, postoperative pain scores, time to extubation, and length of stay in the hospital. Interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α before and the first 24 h after surgery were measured. RESULTS: A total of 54 patients were analyzed (27 in each group). Intravenous opioid consumption within 24 h after surgery was 2.33 ± 1.77 mg in the PIFB + RSB group vs 3.81 ± 2.24 mg in the PIFB group (p = 0.010). Opioid consumption within 48 h after surgery was also reduced in the PIFB + RSB group (4.71 ± 2.71 mg vs 7.25 ± 3.76 mg, p = 0.006). There was no significant difference in pain scores, time to extubation, length of stay in hospital, or the levels of IL-6, IL-10 and TNF-α between the two groups. CONCLUSIONS: The combination of PIFB and RSB reduced postoperative intravenous opioid consumption until 48 h after cardiac surgery. TRIAL REGISTRATION: This trial is registered at the Chinese Clinical Trial Registry ( www.chictr.org.cn , ChiCTR2200062017) on 19/07/2022.

Nitroglycerin plus clopidogrel for acute myocardial infarction and the effect on cardiac function indices.

To evaluate the efficacy of nitroglycerin plus clopidogrel for acute myocardial infarction and the effect on the cardiac function indices. From April 2019 to April 2020, 90 patients with acute myocardial infarction enrolled in our hospital were recruited and assigned to receive either oral clopidogrel (control group) or nitroglycerin plus clopidogrel (experimental group), with 45 cases in each group. Outcome measures included clinical efficacy, inflammatory factors, cardiac function indices, myocardial enzymatic indexes, Selvester QRS score, myocardial infarction area and quality of life. Nitroglycerin plus clopidogrel resulted in significantly higher treatment efficiency versus clopidogrel alone (P<0.05). Patients with nitroglycerin plus clopidogrel showed significantly reduced levels of inflammatory factors, a lower ST reduction and a lower end-systolic volume index (ESVI) versus those with single clopidogrel (P<0.05). Nitroglycerin plus clopidogrel was associated with a shorter prothrombin time, higher end-diastolic volume index (EDVI) and SF-36 scores and lower myocardial enzymatic indexes and QRS scores versus clopidogrel (P<0.05). Patients with combined therapy had a smaller myocardial infarction area than those with monotherapy (P<0.05). Nitroglycerin plus clopidogrel ameliorates the cardiac function indices of patients with acute myocardial infarction, mitigates the inflammatory responses, and improves the patient's quality of life. Further research is required prior to clinical promotion.

Handover Patterns in the PACU: A Review of the Literature.

PURPOSE: Currently, there is no standardized handover pattern for patients undergoing general anesthesia when being transferred to the postanesthesia care unit (PACU). DESIGN: A review of the literature. METHODS: In this study, a review of the literature was conducted to analyze the PACU handover status, factors for poor handover, and commonly used handover patterns. FINDINGS: Important handover information was often omitted during the handover of PACU patients, and there were many factors influencing postoperative patient handover quality. This study analyzed and compared several commonly used handover patterns for patients. Among these, the Situation-Background-Assessment-Recommendation tool is relatively mature. However, there is currently no unified standardized patient handover pattern, and the validity and applicability of tools still need to be verified. CONCLUSIONS: PACU is an important place for the recovery of surgical patients. Anesthesia providers need to provide PACU nurses with complete and comprehensive postoperative handover information. A standardized handover model for clinical nurses is needed to improve patient safety management and work efficiency.

Highly Monodisperse Cu-Sn Alloy Nanoplates for Efficient Nitrophenol Reduction Reaction via Promotion Effect of Tin.

The hexagonal copper-tin alloy (Cu-Sn) nanoplates were synthesized using a high temperature solvent method, the length of six equilateral edges of hexagonal Cu-Sn nanoplates was 23 nm, and the thickness was 13 nm. The obtained hexagonal Cu-Sn nanoplates were highly monodisperse and allowed the formation of nanoarrays arranged with long-range order. The hexagonal Cu-Sn nanoplates exhibited high catalytic activity on catalytic hydrogenation of 4-nitrophenol to 4-aminophenol. Due to the promotion effect of Sn, the apparent rate constant (ka) of hexagonal Cu-Sn nanoplates was three times that of Cu nanoparticles. The density functional theory (DFT) calculations and experimental results demonstrated that Sn could promote the coordination process of -NO2 of 4-nitrophenol with Cu-Sn nanoplates and contribute to activation of 4-nitrophenol. In addition, the hexagonal Cu-Sn nanoplates showed high stability and reusability for the reduction reaction, good adaptability in different pH and the ionic strength, and wide applicability for the degradation of methylene blue, methyl orange, and rhodamine B, even in the industrial wastewater, suggesting that the Cu-Sn nanoplates are promising catalysts in organic industry wastewater treatment.

A 30-year systematic review and meta-analysis of hepatitis B virus among blood donors in mainland China: revealing increase of new threats.

BACKGROUND: Although screening strategies have been routinely implemented in blood centers, the residual risk of transfusion-transmitted hepatitis B virus (HBV) still poses a public health concern in China. The aim of this study is to investigate the HBV blood screening reactive rate and to illustrate the demographics of the corresponding blood donors with revealing of heterogeneity between previous studies and discovering potentially negligent threats. STUDY DESIGN AND METHODS: Literature reporting the HBV screening reactive rate in Chinese blood donors was identified by systematic searching of four electronic databases. We followed the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses guidelines, and data manipulation and statistical analyses were performed by Stata 12.0. RESULTS: Our results showed that the pooled postdonation screening reactive rate was 1.32% (95% confidence interval [CI], 1.28%-1.36%) with a significant variation from 3.93% (95% CI, 3.45%-4.40%) before 1998 to 1.22% (95% CI, 1.18%-1.27%) after 1998 when the Blood Donation Law was implemented. Importantly, the HBV screening reactive rates were significantly higher among replacement and planned donors than among individual voluntary donors. CONCLUSION: Our results indicated blood centers in China should recruit more individual and group voluntary donors and convert more eligible first-time donors into repeat donors to reduce the risk of transfusion-transmitted HBV.

Effect of catgut implantation at acupoints for the treatment of allergic rhinitis: a randomized, sham-controlled trial.

BACKGROUND: The effect and safety of catgut implantation at acupoints o treat allergic rhinitis (ICD-10 code J30.4) remain controversial. Here, we used a sham catgut implantation group to determine whether catgut implantation at acupoints is an effective and safe treatment for allergic rhinitis. METHODS: A randomized double-blind clinical trial, with parallel groups was conducted. Skin prick and puncture test (SPT) was performed to confirm the diagnosis before enrollment. The participants received two sessions of treatments of active or sham catgut implantation at acupoints (once every two weeks) with a follow-up phase of 8 weeks. The visual analogue scale (VAS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were used to determine the severity of allergic rhinitis. The use of anti-allergic medication was used as a secondary indicator. The incidence of adverse events was also recorded and analyzed. RESULTS: An improvement of the VAS and RQLQ scores was observed in both the active and sham-controlled group sat four and eight weeks after the treatment in the self-control analysis. Comparison revealed no significant difference between the treatment and sham-controlled groups until 8 weeks after the 2-week treatment regimen (t = -2.424, P = 0.017). However, the RQLQ scores significantly differed between the two groups after 4 weeks of treatment completion (t = -2.045, P = 0.05) and this difference lasted until the end of 8-week follow-up (t = -2.246, P = 0.033). Throughout the treatment regimen, none of the participants took any relief medication, and no severe adverse events occurred. CONCLUSION: Our findings suggest that catgut implantation at acupoints is an effective and safe method for symptomatic treatment of allergic rhinitis. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-TRC- 12002191 (Date of Registration: 2012-05-09).

Metformin Prevents or Delays the Development and Progression of Osteoarthritis: New Insight and Mechanism of Action.

For over 60 years, metformin has been widely prescribed by physicians to treat type 2 diabetes. Along with more in-depth research on metformin and its molecular mechanism in recent decades, metformin has also been proposed as an effective drug to prevent or delay musculoskeletal disorders, including osteoarthritis (OA). The occurrence and development of OA are deemed to be associated with the impaired mitochondrial functions of articular chondrocytes. Metformin can activate the pathways and expressions of both AMPK and SIRT1 so as to protect the mitochondrial function of chondrocytes, thereby promoting osteoblast production. Moreover, the clinical significance of the metformin combination therapy in preventing OA has also been demonstrated. This review aimed to comprehensively summarize the current research progress on metformin as a proposed drug for OA prevention or treatment.

Curative effect of different drainage methods on laparoscopic inguinal hernia repair: A meta-analysis.

BACKGROUND: Laparoscopic inguinal hernia repair has developed rapidly as an important surgical method for inguinal hernia repair; however, postoperative complications, especially postoperative seroma, are becoming an important factor hindering its development. Many studies have shown that placing a negative-pressure drainage tube in the preperitoneal space can effectively reduce postoperative seromas. Accordingly, this study aimed to compare differences in postoperative seroma between surgical procedures with drainage tubes (DRG) and those without drainage tubes (nonDRG). METHODS: PubMed/Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched from the establishment of the database to May 1, 2021. Odds ratio (OR), mean difference (MD), standardized mean difference (SMD), and 95% confidence interval (CI) were selected as the effect scale indices for the evaluation of the difference in seroma, operation time, hospital stay time, blood loss, and recovery time. All of these were compared using RevMan 5.3 Software. RESULTS: Sixteen studies involving 4369 patients, 2856 in the DRG group and 1513 in the nonDRG group, were included. The incidence of seroma in the DRG group was lower than that in the nonDRG group (OR = 0.16, 95% CI: 0.07-0.35, P < .001). Additionally, the operation time (min) in the DRG group was longer than that in the nonDRG group (MD = 3.67, 95% CI: 2.18-5.17, P < .001). Nevertheless, no significant differences were found in hospital stay (days) (SMD = 0.22, 95% CI: -0.10-0.54, P = .17), blood loss (mL) (MD = 0.28, 95% CI: -0.14-0.69, P = .19), and recovery time (h) (SMD = 0.54, 95% CI: -0.60-1.69, P = .35) between the 2 groups. CONCLUSION: Despite the slightly prolonged operation time, negative pressure drainage in the preperitoneal space during laparoscopic inguinal hernia repair can significantly reduce the occurrence of postoperative seroma without increasing blood loss, recovery, and hospital stay.

Global trends in smoking cessation research from 2002 to 2021: A bibliometric and visual analysis.

This study aimed to analyze the scientific outputs of smoking cessation research and explore its hotspots and frontiers from 2002 to 2021, using bibliometric methods. We use the core collection of Web of Science as a data source, and apply bibliometric methods to visually analyze articles published in smoking cessation research from 2002 to 2021, including publication year, countries/regions, journals, authors, institutions, and keywords. The VOSviewer (1.6.16) tool was used for the analysis. A total of 8797 articles related to smoking cessation research were identified. The USA was the leading contributor with 4671 publications. NICOTINE＆TOBACCO RESEARCH contributed the most publications (528), with the most citations (13746) and the highest H-index (59). The most contributing institutions were the University College London and University of California San Francisco. Robert West was most productive author. We found active collaborations among both productive authors and productive institutions. There were five hot topics in smoking cessation research: (1) Public health harm from tobacco; (2) The role of e-health in smoking cessation; (3) Role of primary health care in eliminating tobacco dependence; (4) Nicotine replacement therapy and pharmacotherapy; (5) The biological and clinical understanding of addiction. Our current study showed a growing trend in smoking cessation based on the number of published articles over the last 20 years. There was active cooperation between institutions, and authors. Electronic cigarettes, mHealth, eHealth, public health and mental health are foci of new and emerging research.

Theme Trends and Knowledge Structure on Mobile Health Apps: Bibliometric Analysis.

BACKGROUND: Due to the widespread and unprecedented popularity of mobile phones, the use of digital medicine and mobile health apps has seen significant growth. Mobile health apps have tremendous potential for monitoring and treating diseases, improving patient care, and promoting health. OBJECTIVE: This paper aims to explore research trends, coauthorship networks, and the research hot spots of mobile health app research. METHODS: Publications related to mobile health apps were retrieved and extracted from the Web of Science database with no language restrictions. Bibliographic Item Co-Occurrence Matrix Builder was employed to extract bibliographic information (publication year and journal source) and perform a descriptive analysis. We then used the VOSviewer (Leiden University) tool to construct and visualize the co-occurrence networks of researchers, research institutions, countries/regions, citations, and keywords. RESULTS: We retrieved 2802 research papers on mobile health apps published from 2000 to 2019. The number of annual publications increased over the past 19 years. JMIR mHealth and uHealth (323/2802, 11.53%), Journal of Medical Internet Research (106/2802, 3.78%), and JMIR Research Protocols (82/2802, 2.93%) were the most common journals for these publications. The United States (1186/2802, 42.33%), England (235/2802, 8.39%), Australia (215/2802, 7.67%), and Canada (112/2802, 4.00%) were the most productive countries of origin. The University of California San Francisco, the University of Washington, and the University of Toronto were the most productive institutions. As for the authors' contributions, Schnall R, Kuhn E, Lopez-Coronado M, and Kim J were the most active researchers. The co-occurrence cluster analysis of the top 100 keywords forms 5 clusters: (1) the technology and system development of mobile health apps; (2) mobile health apps for mental health; (3) mobile health apps in telemedicine, chronic disease, and medication adherence management; (4) mobile health apps in health behavior and health promotion; and (5) mobile health apps in disease prevention via the internet. CONCLUSIONS: We summarize the recent advances in mobile health app research and shed light on their research frontier, trends, and hot topics through bibliometric analysis and network visualization. These findings may provide valuable guidance on future research directions and perspectives in this rapidly developing field.

Comparison Between Stable Sagittal Vertebra and First Lordotic Vertebra Instrumentation for Prevention of Distal Junctional Kyphosis in Scheuermann Disease: Systematic Review and Meta-analysis.

STUDY DESIGN: This study was a systematic review and meta-analysis. OBJECTIVES: To compare stable sagittal vertebra (SSV) and first lordotic vertebra (FLV) instrumentation for prevention of distal junctional kyphosis (DJK) in Scheuermann disease. SUMMARY OF BACKGROUND DATA: The SSV has been increasingly chosen as the lowest instrumented vertebra to prevent DJK, and some studies have provided supportive results. However, other studies demonstrate that lowest instrumented vertebra located in the FLV has similar DJK incidence with the benefit of saving levels. MATERIALS AND METHODS: Electronic searches of PubMed, Embase, the Cochrane Database, and Web of Science were performed. Radiographic parameters, incidence of DJK, and revision surgery rates were compared between SSV and FLV groups. The odds ratio (OR) was used to identify differences between the groups and P<0.05 was considered statistically significant. RESULTS: Four studies with a total of 173 patients were included. There were no differences between the SSV and FLV groups in most radiographic parameters. The incidence of DJK among 173 patients was 20.8% (36/173). The SSV group demonstrated a significantly lower DJK rate than the FLV group (OR, 0.11; 95% confidence interval, 0.04-0.30; P<0.0001; I=39%). In this study, 5.9% (5/85) of the SSV group and 43.6% (24/55) of the FLV group developed DJK; 27.8% (10/36) who developed DJK underwent revision surgery, including 25.0% (6/24) in the FLV group and 40.0% (2/5) in the SSV group. The revision surgery rate was lower in the FLV group than in the SSV group, with no statistical difference (OR, 3.27; 95% confidence interval, 0.26-41.73; P=0.36; I=0%). CONCLUSIONS: The overall DJK rate in Scheuermann disease was 20.8%, and 27.8% of DJK patients needed revision surgery. A distal fusion level including the SSV demonstrated a significantly lower DJK rate.

Diagnosis and Treatment of Pythium Insidiosum Corneal Ulcer in a Chinese Child: A Case Report and Literature Review.

BACKGROUND Pythium insidiosum keratitis is a rare but sight-threatening disease with a high morbidity rate. It can be misdiagnosed as fungal keratitis in clinic settings. We report a case of severe Pythium insidiosum keratitis in a Chinese child, treated with combined approaches. CASE REPORT A 7-year-old boy from Hainan province in the south of China developed a suppurative corneal ulcer after being in a forest. A mass of hyphae was detected by confocal imaging in vivo, fungal smear test, and histochemical examination. Treatment with Natamycin, fluconazole, and Voriconazole for 1 month was unsuccessful, and a penetrating keratoplasty with anterior vitrectomy was performed. The infection reappeared 1 day after surgery, immediately after which anterior chamber irrigation with 0.02% Fluconazole and amphotericin B solution was performed. Finally, the globe was saved and there was no further recurrent infection. A cultured mycelial organism, which was hard to identify by biomorphology, was confirmed by PCR to be Pythium insidiosum. The zoospores were observed in water environments. The imaging characteristics of P. insidiosum in confocal microscopy are described herein. CONCLUSIONS This is the first case of Pythium insidiosum keratitis reported in China. It can be misdiagnosed as fungal keratitis in the clinic. Improving the awareness of clinicians, promoting early diagnosis, and a multidisciplinary approach, especially early surgery, improve the prognosis.

[Clinical features of primary biliary cirrhosis and treatment of it by integrated traditional Chinese and western medicine].

OBJECTIVE: To investigate the clinical features of primary biliary cirrhosis (PBC) and its treatment by integrated traditional Chinese and western medicine. METHODS: 16 PBC patients were observed. Ursodeoxycholic acid (UDCA) was used in the dose of 13 to 15 mg.kg(-1).d(-1), with some traditional Chinese herb prescription. Results (1) The proportion of women to men was 15:1, the mean age was 52.5 years. AMA-M2 was positive in 14 subjects (87.5%). Biliary tract enzymes and ESR were elevated in all subjects. The ratio of hypercholesterolemia (CHOL) and abnormality in IgM was high (62.5%). Fatigue, pruritus, arthralgia, jaundice, splenomegaly were noted in more than half cases. Every patient had one to four complications. (2) ALP, GGT and Glb declined evidently after 3 months' treatment by western medicine associated with traditional Chinese medicine, and declined markedly after 12 months' treatment (P<0.05 respectively). TBIL and CHOL declined gradually during the treatment course. Symptoms and signs were lightened. CONCLUSION: PBC has complicated and especial clinical features. UDCA therapy is effective in PBC, while traditional Chinese medicine has extraordinary effect in treating the symptoms and signs.

Ologen implant versus mitomycin C for trabeculectomy: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the application of the Ologen implant compared to mitomycin C (MMC) on the outcome of trabeculectomy and to examine the balance of risks and benefits. METHODS: A systematic literature search (Pubmed, Embase, the Cochrane Library, and the Chinese Biomedicine Database) was performed. Randomized controlled trials comparing the Ologen implant with MMC in trabeculectomy were selected. The efficacy measures were the weighted mean differences (WMDs) for the intraocular pressure reduction (IOPR), the reduction in glaucoma medications, and the relative risks (RRs) for success rates. The tolerability measures were RRs for adverse events. The pooled effects were calculated using the random-effects model. RESULTS: Seven randomized controlled trials including 227 eyes were included in this meta-analysis. The WMDs of the IOPR comparing the Ologen group with the MMC group were -2.98 (95% Cl: -5.07 to -0.89) at one month, -1.41 (-3.72 to 0.91) at three months, -1.69 (-3.68 to 0.30) at six months, -1.94 (-3.88 to 0.01) at 12 months, and 0.65 (-2.17 to 0.47) at 24 months. There was no statistically significance except at one and 12 months after surgery. No significant difference in the reduction in glaucoma medications or complete and qualified success rates were found. The rates of adverse events also did not differ significantly between Ologen and MMC. CONCLUSIONS: The Ologen implant is comparable with MMC for trabeculectomy in IOP-lowering efficacy, reduction in the number of glaucoma medications, success rates, and tolerability. However, the results should be interpreted cautiously since relevant evidence is still limited, although it is accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.

Fornix-based versus limbus-based conjunctival flap in trabeculectomy: a quantitative evaluation of the evidence.

OBJECTIVE: To evaluate the efficacy and tolerability of limbus-based (LBCF) compared with fornix-based conjunctival flaps (FBCF) for trabeculectomy in the treatment of patients with uncontrolled glaucoma. METHODS: A comprehensive literature meta-analysis was performed according to the Cochrane Collaboration methodology to identify controlled clinical trials comparing LBCF with FBCF in trabeculectomy. The efficacy measures were the weighted mean differences (WMDs) for intraocular pressure reduction (IOPR), the reduction in glaucoma medications, and the relative risks (RRs) for success rates. Tolerability estimates were measured by RR for adverse events. The pooled effects were calculated using the random effects model. RESULTS: Sixteen controlled clinical trials meeting the predefined criteria were included in the meta-analysis. A total of 1,825 eyes from 1,392 patients with medically uncontrolled glaucoma were included. The WMD of the IOPR from baseline was 1.12 (95% CI: -0.88 to 3.12) when comparing LBCF with FBCF. LBCF was associated with numerically greater but non-significant IOP lowering efficacy than FBCF (P = 0.270). LBCF was comparable with FBCF in the reduction of glaucoma medication, with a WMD of 0.15 (-0.05 to 0.36) at the follow-up endpoint (P = 0.141). The pooled RR comparing LBCF with FBCF were 1.08 (0.94, 1.23) for the complete success rate and 1.01 (0.92, 1.10) for the qualified success rate. Rates of adverse events did not differ significantly between LBCF and FBCF. CONCLUSIONS: There is no significant difference in IOP lowering, number of glaucoma medications, or proportion of patients who reached the IOP target between LBCF and FBCF trabeculectomy. Both incision techniques may contribute equally to adverse events.

[Kinetic analysis of laccase catalyze phenolic and aniline compounds and detecting catechol in wastewater].

Phenolic or aniline compounds were important pollutants in the industrial wastewaters to seriously polluted water environment. This research developed a detecting method of phenolic and aniline compounds based on the kinetic parameters of the substrates of laccase. Catalytic reaction between laccase and phenolic and aniline compounds was characterized using spectrophotometic method, which resulted 0-10 mg/L substrate reaction rate and calibration curve of substrate concentration and reaction rate. And then the non-volatile phenols in three kinds of coking wastewater were screened and the contents were detected. The result showed that polyhydric phenol, multi-amine and aminophenol were the main substrates of laccase. The optimum pH of phenols was around 7.0 and anilines 4.5-5.0, K(m) values of each substrates was 0.4-10 mmol/L. The calibration curve performed good first order kinetics linear relationship except benzidine with correlation coefficients above 0.96. Using laccase method, the contents of catechol in three kinds of coking wastewater were respectively detected to be 190.5, 265.8 and 155.3 mg/L with recoveries ranged from 89.9% to 115.8%.