Transcutaneous electrical acupoint stimulation for postoperative nausea and vomiting in patients undergoing craniotomy: A randomized controlled trial.

BACKGROUND: The incidence of nausea and vomiting following craniotomy is high, and pericardium 6 (P6; Neiguan) acupoint stimulation is an important strategy for treating postoperative nausea and vomiting (PONV). Here, we aimed to evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) at P6 as an adjunct to antiemetic drugs to prevent PONV after craniotomy. MATERIALS AND METHODS: This randomized placebo-controlled trial enrolled 120 patients scheduled for craniotomy. The enrolled patients were randomly assigned to a TEAS or sham TEAS group. The incidence of PONV, pain score, and postoperative remedial treatment with antiemetics and analgesics at 0-2, 2-6, and 6-24 h after craniotomy were assessed. RESULTS: The patient characteristics did not significantly differ between the two groups (P > 0.05). During 0-2 and 6-24 h after craniotomy, the incidence of vomiting was not significantly different between the two groups (P > 0.05). During 2-6 h, the incidence of vomiting was higher in the sham TEAS group than in the TEAS group (29.3 % vs. 14.0 %, P = 0.047). During 0-2 and 2-6 h, the pain scores did not differ significantly between the two groups (P > 0.05). During 6-24 h after craniotomy, the pain score was significantly higher in the sham TEAS group than in the TEAS group (P = 0.001). The degree of nausea and proportion of patients requiring antiemetic drugs were not significantly different between the two groups in each period (P > 0.05). CONCLUSION: TEAS at P6 may reduce vomiting incidence and pain scores following craniotomy.

Scedosporium spp lung infection in immunocompetent patients: A systematic review and MOOSE-compliant meta-analysis.

Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.

Theoretical insight into the binding energy and detonation performance of ε-, γ-, ß-CL-20 cocrystals with ß-HMX, FOX-7, and DMF in different molar ratios, as well as electrostatic potential.

Molecular dynamics method was employed to study the binding energies on the selected crystal planes of the ε-, γ-, ß-conformation 2,4,6,8,10,12-hexanitrohexaazaisowurtzitane (ε-, γ-, ß-CL-20) cocrystal explosives with 1,1-diamino-2,2-dinitroethylene (FOX-7), 1,3,5,7-tetranitro- 1,3,5,7-tetrazacyclooctane with ß-conformation (ß-HMX) and N,N-dimethylformamide (DMF) in different molar ratios. The oxygen balance, density, detonation velocity, detonation pressure, and surface electrostatic potential were analyzed. The results indicate that the binding energies E b (*) and stabilities are in the order of 1:1 > 2:1 > 3:1 > 5:1 > 8:1 (CL-20:FOX-7/ß-HMX/DMF). The values of E b (*) and stabilities of the energetic-nonenergetic CL-20/DMF cocrystals are far larger than those of the energetic-energetic CL-20/FOX-7 and CL-20/ß-HMX, and those of CL-20/ß-HMX are the smallest. For CL-20/FOX-7 and CL-20/ß-HMX, the largest E b (*) appears in the cocrystals with the 1:1, 1:2 or 1:3 molar ratio, and the stabilities of the cocrystals with the excess ratio of CL-20 are weaker than those in the cocrystals with the excess ratio of FOX-7 or ß-HMX. In CL-20/FOX-7, CL-20 prefers adopting the γ-form, and ε-CL-20 is the preference in CL-20/ß-HMX, and ε-CL-20 and ß-CL-20 can be found in CL-20/DMF. The CL-20/FOX-7 and CL-20/ß-HMX cocrystals with low molar ratios can meet the requirements of low sensitive high energetic materials. Surface electrostatic potential reveals the nature of the sensitivity change upon the cocrystal formation. Graphical Abstract MD method was employed to study the binding energies on the selected crystal planes in the ε-, γ-, ß-CL-20 cocrystals with FOX-7, ß-HMX and DMF in different molar ratios. Surface electrostatic potential reveals the nature of the sensitivity change in cocrystals.

[A randomized controlled clinical trial for acupuncture stimulation of Neiguan (PC 6) to prevent postoperative nausea and vomiting].

OBJECTIVE: To observe whether acupuncture stimulation of Neiguan (PC 6) can prevent postoperative nausea and vomiting (PONV) in patients undergoing craniotomy. METHODS: A total of 60 patients scheduled for craniotomy were randomly assigned to acupuncture group (n = 30) and control group (n = 30). When regaining consciousness from the surgical anesthesia, patients of the acupuncture group received immediate acupuncture stimulation of bilateral Neiguan (PC 6). After insertion, the filiform needles were manipulated with uniform reinforcing-reducing method for about 1 min (re-manipulated once again 10 min later), followed by retaining it for 20 min. Patients of the control group received no treatment. Vomiting or retching (having vomitus) was considered as an emetic episode. Nausea was assessed by a four-point verbal rating scale (none, mild, moderate, severe). RESULTS: Following the treatment, in the acupuncture group, 1 patient had a vomiting from 0 to 2 h, and 1 patient had a vomiting from 2 to 6 h after the operation, and no patients had this symptom 6 h after the operation. While in the control group, the vomiting occurred in 11 patients from 0 to 2 h, 8 cases from 2 to 6 h, and other 8 cases from 6 to 24 h after the operation. Comparison between two groups showed that the nausea scores in the 3 time-stages were significantly lower in the acupuncture group than in the control group (P < 0.05). CONCLUSION: Acupuncture stimulation of PC 6 is effective in preventing and treating PONV in patients undergoing craniotomy.

P6 acupoint stimulation for prevention of postoperative nausea and vomiting in patients undergoing craniotomy: study protocol for a randomized controlled trial.

BACKGROUND: The incidence of postoperative nausea and vomiting (PONV) is 50 to 79% after neurosurgery. Our study is designed to evaluate the efficacy of pericardium 6 (P6; also known as Neiguan) acupoint stimulation versus placebo, and versus routine antiemetic for the prevention of PONV after craniotomy, as well as to compare the efficacy of invasive acupuncture with non-invasive transcutaneous electrical nerve stimulation (TENS) on P6. METHODS/DESIGN: This is a single-center, prospective, double-blind, five-arm, parallel-group, randomized controlled trial (RCT). All groups will be given routine intravenous ondansetron 8 mg administered before skin closure. Upon regaining consciousness from general anaesthesia, patients will receive one of five interventions: 1) P6 acupuncture bilaterally for 30 minutes, stimulated every 10 minutes to keep de qi sensation; 2) sham acupuncture bilaterally for 30 minutes with no stimulation; 3) P6 stimulation via active TENS electrodes bilaterally for 30 minutes, with stimulation frequency and intensity set to when de qi sensation is felt; 4) sham P6 stimulation via inactive TENS electrode bilaterally for 30 minutes; and 5) usual practice of pharmacological emesis prevention. The incidence of postoperative vomiting during the first 24 hours is the main outcome. Secondary outcomes include: complete response rate, severity of nausea, total rescue metoclopramide dose used and patient satisfaction with PONV management. DISCUSSION: The results from this study could potentially confirm that P6 acupoint stimulation is an effective adjunct to standard antiemetic drug therapy for the prevention of PONV in patients undergoing craniotomy. Our study may also confirm that conventional acupuncture is more effective than TENS. TRIAL REGISTRATION: This study is registered with the Chinese Clinical Trial Registry: ChiCTR-TRC-13003026.

The efficacy and safety of Baoji Tablets for treating common cold with summer-heat and dampness syndrome: study protocol for a randomized controlled trial.

BACKGROUND: Despite the high incidence and the economic impact of the common cold, there are still no effective therapeutic options available. Although traditional Chinese medicine (TCM) is widely used in China to treat the common cold, there is still a lack of high-quality clinical trials. This article sets forth the protocol for a high-quality trial of a new TCM drug, Baoji Tablets, which is designed to treat the common cold with summer-heat and dampness syndrome (CCSDS). The trial is evaluating both the efficacy and safety of Baoji Tablets. METHODS/DESIGN: This study is designed as a multicenter, phase II, parallel-group, double-blind, double-dummy, randomized and placebo-controlled trial. A total of 288 patients will be recruited from four centers. The new tablets group are administered Baoji Tablets 0.9 g and dummy Baoji Pills 3.7 g. The old pills group are administered dummy Baoji Tablets 0.9 g and Baoji Pills 3.7 g. The placebo control group are administered dummy Baoji Tablets 0.9 g and dummy Baoji Pills 3.7 g. All drugs are taken three times daily for 3 days. The primary outcome is the duration of all symptoms. Secondary outcomes include the duration of primary and secondary symptoms, changes in primary and secondary symptom scores and cumulative symptom score at day 4, as well as an evaluation of treatment efficacy. DISCUSSION: This is the first multicenter, double-blind, double-dummy, randomized and placebo-controlled trial designated to treat CCSDS in an adult population from China. It will establish the basis for a scientific and objective assessment of the efficacy and safety of Baoji Tablets for treating CCSDS, and provide evidence for a phase III clinical trial. TRIAL REGISTRATION: This study is registered with the Chinese Clinical Trial Registry. The registration number is ChiCTR-TRC-13003197.