Perioperative Rosuvastatin in Cardiac Surgery.

BACKGROUND: Complications after cardiac surgery are common and lead to substantial increases in morbidity and mortality. Meta-analyses of small randomized trials have suggested that perioperative statin therapy can prevent some of these complications. METHODS: We randomly assigned 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery to receive perioperative rosuvastatin (at a dose of 20 mg daily) or placebo. The primary outcomes were postoperative atrial fibrillation within 5 days after surgery, as assessed by Holter electrocardiographic monitoring, and myocardial injury within 120 hours after surgery, as assessed by serial measurements of the cardiac troponin I concentration. Secondary outcomes included major in-hospital adverse events, duration of stay in the hospital and intensive care unit, left ventricular and renal function, and blood biomarkers. RESULTS: The concentrations of low-density lipoprotein cholesterol and C-reactive protein after surgery were lower in patients assigned to rosuvastatin than in those assigned to placebo (P<0.001). However, the rate of postoperative atrial fibrillation did not differ significantly between the rosuvastatin group and the placebo group (21.1% and 20.5%, respectively; odds ratio 1.04; 95% confidence interval [CI], 0.84 to 1.30; P=0.72), nor did the area under the troponin I-release curve (102 ng×hour per milliliter and 100 ng×hour per milliliter, respectively; between-group difference, 1%; 95% CI, -9 to 13; P=0.80). Subgroup analyses did not indicate benefit in any category of patient. Rosuvastatin therapy did not result in beneficial effects on any of the secondary outcomes but was associated with a significant absolute (±SE) excess of 5.4±1.9 percentage points in the rate of postoperative acute kidney injury (P=0.005). CONCLUSIONS: In this trial, perioperative statin therapy did not prevent postoperative atrial fibrillation or perioperative myocardial damage in patients undergoing elective cardiac surgery. Acute kidney injury was more common with rosuvastatin. (Funded by the British Heart Foundation and others; STICS ClinicalTrials.gov number, NCT01573143.).

The primary health-care system in China.

China has made remarkable progress in strengthening its primary health-care system. Nevertheless, the system still faces challenges in structural characteristics, incentives and policies, and quality of care, all of which diminish its preparedness to care for a fifth of the world's population, which is ageing and which has a growing prevalence of chronic non-communicable disease. These challenges include inadequate education and qualifications of its workforce, ageing and turnover of village doctors, fragmented health information technology systems, a paucity of digital data on everyday clinical practice, financial subsidies and incentives that do not encourage cost savings and good performance, insurance policies that hamper the efficiency of care delivery, an insufficient quality measurement and improvement system, and poor performance in the control of risk factors (such as hypertension and diabetes). As China deepens its health-care reform, it has the opportunity to build an integrated, cooperative primary health-care system, generating knowledge from practice that can support improvements, and bolstered by evidence-based performance indicators and incentives.

Cesarean section to prevent mother-to-child transmission of hepatitis B virus in China: A meta-analysis.

BACKGROUND: Hepatitis B virus (HBV) is predominantly transmitted through mother-to-child transmission (MTCT). To date, it remains unclear whether the method of parturition affects MTCT of HBV. In order to clarify whether cesarean section, when compared with vaginal delivery, could reduce the risk of MTCT of HBV in China, we conducted this meta-analysis. METHODS: A systematic literature search was performed of the PubMed (Medline), Embase, ISI Web of Science, China Biological Medicine Database, China National Knowledge Infrastructure, and VIP Database for Chinese Technical Periodicals databases for articles written in English or Chinese through July 2015.The reference lists of relevant articles were also scrutinized for additional papers. Randomized controlled trials, cohort studies, or case-control studies investigating the effect of delivery mode on MTCT of HBV were included. RESULTS: This analysis involved 28 articles containing 30 datasets. The data encompassed 9906 participants. The MTCT rate of HBV was 6.76% (670 of 9906) overall, with individual rates of 4.37% (223 of 5105) for mothers who underwent cesarean section and 9.31% (447 of 4801) for those who underwent vaginal delivery. The summary relative risk (RR) was 0.51 (95%CI: 0.44-0.60, P < 0.001), indicating a statistically significant decrease in HBV vertical transmission via cesarean section compared with vaginal delivery. The heterogeneity among studies was moderate with an I 2 of29.3%.Publication bias was not detected by the Egger's and Begg's tests, and the funnel plot was symmetric. In the subgroup analyses, maternal hepatitis B e antigen status and follow-up time did not affect the significance of the results, but hepatitis B immune globulin (HBIG) administration to mother and infant did. CONCLUSIONS: Cesarean section could reduce the risk of MTCT of HBV in comparison to vaginal delivery in China. However, owing to several limitations of our meta-analysis, future well-designed randomized controlled trials with adequate statistical power, might be a more appropriate next step.

Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system.

China has an immediate need to address the rapidly growing population with cardiovascular disease events and the increasing number of people living with this illness. Despite progress in increasing access to services, China faces the dual challenge of addressing gaps in quality of care and producing more evidence to support clinical practice. In this Review, we address opportunities to strengthen performance measurement, programmes to improve quality of care, and national capacity to produce high-impact knowledge for clinical practice. Moreover, we propose recommendations, with implications for other diseases, for how China can immediately make use of its Hospital Quality-Monitoring System and other existing national platforms to assess and improve performance of medical care, and to generate new knowledge to inform clinical decisions and national policies.

Effective Treatment for Malignant Pleural Effusion and Ascites with Combined Therapy of Bevacizumab and Cisplatin.

OBJECTIVE: To record the efficacy and toxicity of combining bevacizumab with cisplatin in treating malignant pleural effusion and ascites through intrapleural and intraperitoneal infusion. PATIENTS AND METHODS: Forty-three patients were admitted to the Oncology Department of Yantai Yuhuangding Hospital with confirmed malignant effusion since January, 2011. Twenty of them received intrapleural and intraperitoneal perfusion of 200 mg bevacizumab plus 60 mg cisplatin every three weeks, and 23 patients received 60 mg cisplatin alone after draining effusion as much as possible. Reduction of effusion was determined by type-B ultrasonography. RESULTS: The complete remission rate and effective rate of bevacizumab group was superior to that of the cisplatin group. The quality of life recovery rate of bevacizumab group was superior to that of the cisplatin group. The anhelation and abdominal distention of bevacizumab group was significantly improved. There was no significant difference in level III/IV toxicities and adverse effects between two groups. CONCLUSION: Bevacizumab significantly improved the objective response rate and quality of life of patients with malignant pleural effusion and ascites, while not causing notable adverse events.

Association of preprocedural low-density lipoprotein cholesterol levels with myocardial injury after elective percutaneous coronary intervention.

BACKGROUND: Lower levels of low-density lipoprotein cholesterol (LDL-C) are associated with less cardiovascular risk in patients with coronary artery disease. OBJECTIVES: To assess whether lower preprocedural LDL-C levels are associated with less risk of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention (PCI). METHODS: We enrolled 2529 consecutive patients with normal preprocedural cardiac troponin I (cTnI) who successfully underwent elective PCI. The association between preprocedural LDL-C levels and peak cTnI levels within 24 hours after PCI was evaluated. RESULTS: Preprocedural LDL-C levels were correlated to postprocedural cTnI levels (r = 0.059, P = .003). In the multivariable model, preprocedural LDL-C levels between 70 and 99 mg/dL were associated with less risk of postprocedural cTnI elevation above 1 × upper limit of normal (ULN) (odds ratio [OR]: 0.804; 95% confidence interval [CI]: 0.663-0.975; P = .027) up to 15 × ULN (OR: 0.709; 95% CI: 0.530-0.949; P = .021) compared with preprocedural LDL-C levels ≥100 mg/dL. Moreover, preprocedural LDL-C levels <70 mg/dL were more strongly associated with less risk of postprocedural cTnI elevation above 1 × ULN (OR: 0.736; 95% CI: 0.584-0.927; P = .009) up to 15 × ULN (OR: 0.655; 95% CI: 0.452-0.950; P = .026). CONCLUSIONS: Lower preprocedural LDL-C levels were associated with less risk of periprocedural myocardial injury in patients undergoing elective PCI.

Underuse of statins in patients with atherosclerotic ischemic stroke in China.

BACKGROUND: Well designed randomized trials and meta-analyses have clearly shown that statins reduce the risk of major vascular events, including ischemic stroke, in a wide range of patients and their routine use is recommended for patients at an increased cardiovascular risk. Survivors of a first ischemic stroke are at a risk of recurrence and of other vascular events and statins are generally recommended to reduce this risk. This study investigated how widely statins were being used for such patients in China. METHODS: Totally 6422 patients with a history of ischemic stroke were identified by reviewing medical records at 51 highest-ranking hospitals in 14 cities in China, and invited to attend a screening clinic to assess eligibility for a randomized trial. Their current statin and other drug uses were recorded alongside clinical and demographic characteristics. Univariate chi-square test and multivariate Logistic regression were used to determine the factors associated with treatment. RESULTS: Only 24% of these patients reported currently taking a statin. The most important predictor of statin use among these patients was prior history of coronary heart disease. History of diabetes or hypertension, as well as treated in university affiliated hospitals is related to increased use. The status had improved significantly during a 2-year period. Atorvastatin (40%) and simvastatin (39%) were the most commonly used. CONCLUSIONS: In China, statins are still underused for secondary prevention among survivors of ischemic stroke. Reasons for this poor use need to be understood in order to increase use of these evidence based therapies.

[Decompression and monitor of facial nerve during cholesteatoma surgery in petrous part of temporal bone].

OBJECTIVE: To study the application of facial nerve monitoring and to estimate the therapeutic effectiveness of the total decompression of facial nerve during the surgery for cholesteatoma in petrous bone by middle cranial fossa-mastoid process approach. METHOD: Eight cases who suffered from chronic suppurative otitis media (cholesteatoma type) in petrous bone were treated with open technique, three other cholesteatoma cases whose tympanic membranes were intact was treated with close technique. Monitoring for facial nerve integrity during operation was applied. Total decompression of facial nerve was performed in all patients. House-Brackmann grading system was used to evaluated the recovery of facial nerve function. RESULT: Facial paralysis recovered gradually during the period of 3 to 6 months after operation. After 6 to 12 months follow-up in 11 cases, 1 case regained basically normal status, 9 cases recovered to mild facial paralysis and 1 case still needed further follow-up. There was no recurrence of cholesteatoma in all patients. CONCLUSION: Middle cranial fossa-mastoid process combining approach technique is effective for cholesteatoma in petrous bone and total decompression of facial nerve at the same stage. Nerve monitor is helpful in orientating facial nerve during operation and in preventing possible damage to the facial nerve.