Randomized, Controlled Trial: Efficacy of Ultrasound and Exercise in Patients With Ankylosing Spondylitis.

CONTEXT: The aim in treating ankylosing spondylitis (AS) is to reduce patients' symptoms, including pain, stiffness, and fatigue; to correct their posture; and to improve their quality of life. Currently, no definitive therapy is available for treating AS. Previous studies have reported positive results regarding the efficacy of exercise. OBJECTIVE: This study aimed to assess the efficacy of ultrasound, combined with exercise, in patients with AS. DESIGN: The research team designed a randomized, double-blind, 2-arm parallel-group, placebo-controlled trial. SETTING: The study took place at the Affiliated Hongqi Hospital of Mudanjiang Medical University (Mudanjiang, China). PARTICIPANTS: Participants were 62 individuals with AS who were patients at the hospital. INTERVENTION: Participants were randomly assigned to one of 2 groups: (1) the intervention group, who received exercise and ultrasound therapy; or (2) the control group, who received exercise and placebo ultrasound therapy, without an active probe, both for 8 wk. OUTCOME MEASURES: The outcome measures included (1) the numerical rating scale (NRS), (2) the Bath ankylosing spondylitis metrology index (BASMI), (3) the Bath ankylosing spondylitis disease activity index (BASDAI), (4) the Bath ankylosing spondylitis functional index (BASFI), and (5) the ankylosing spondylitis quality of life (ASQoL) questionnaire. All outcomes were measured at baseline and at the end of 4 and 8 wk of treatment. RESULT: Fifty-seven patients fulfilled the requirements of the study. Ultrasound and exercise therapy showed greater efficacy than the placebo ultrasound and exercise in decreasing the scores for the NRS, daily and at night; the BASMI; the BASDAI; the BASFI; and the ASQoL, at the end of both 4 and 8 wk of treatment. No adverse events were noted in either group. CONCLUSIONS: The study demonstrated that 8 wk of ultrasound and exercise therapy was efficacious in patients with AS.

Research progress of Paris polyphylla in the treatment of digestive tract cancers.

Cancer has become one of the most important causes of human death. In particular, the 5 year survival rate of patients with digestive tract cancer is low. Although chemotherapy drugs have a certain efficacy, they are highly toxic and prone to chemotherapy resistance. With the advancement of antitumor research, many natural drugs have gradually entered basic clinical research. They have low toxicity, few adverse reactions, and play an important synergistic role in the combined targeted therapy of radiotherapy and chemotherapy. A large number of studies have shown that the active components of Paris polyphylla (PPA), a common natural medicinal plant, can play an antitumor role in a variety of digestive tract cancers. In this paper, the main components of PPA such as polyphyllin, C21 steroids, sterols, and flavonoids, amongst others, are introduced, and the mechanisms of action and research progress of PPA and its active components in the treatment of various digestive tract cancers are reviewed and summarized. The main components of PPA have been thoroughly explored to provide more detailed references and innovative ideas for the further development and utilization of similar natural antitumor drugs.

[Clinical research of minimal extracorporeal circulation in perioperative blood conservation of coronary artery bypass graft].

OBJECTIVE: To analyze the clinical effect of minimal extracorporeal circulation (MECC) in blood conservation perioperatively coronary artery bypass graft (CABG). METHODS: The data of 120 cases received simple CABG since August 2006 to October 2009 was analyzed retrospectively. All the patients were divided to three groups according to the mode of circulation support in-operation: MECC, conventional extracorporeal circulation (cECC) or off-pump, 40 cases in each group. Jostra MECC system with normal temperature was used in MECC group, and common membrane oxygenator with moderate hypo-temperature was used in cECC group. Collect the data of coagulation and the blood cytological examination perioperatively, the draining volume during the first 24 h after operation, and consumption of blood products perioperatively. RESULTS: Standard and logistic EuroSCORE were higher in MECC group than the others (P < 0.01). The operative time and the number of distal anastomosis of off-pump group were less than MECC and cECC groups (P < 0.05), while no difference between MECC group and cECC group. Intrinsic coagulation (activated partial thromboplastin time) were much more prolonged early postoperatively in cECC group, and higher than in MECC group and off-pump group at 2 h, 6 h and 12 h postoperatively (P < 0.05), but no difference in extrinsic coagulation (prothrombin time) among three group. Adjusted by hematocrit of the same sample, free hemoglobin level rose up during the ECC procedure and reached the maximum at the end of ECC in cECC group and MECC group, but the levels were more higher in cECC group than in MECC group (P < 0.05). The draining volume during the first 24 h after operation of cECC group was larger than MECC group and off-pump group (P < 0.05). Although the decreased platelet count perioperatively and more consumed of the blood products in cECC group, but no difference among the three groups. CONCLUSION: MECC could reduce the ruin to blood cell and interfere to coagulation function during the conventional ECC procedure, decrease the postoperative draining volume and requirement of blood products.

[Analysis in primary clinic outcomes of minimal extracorporeal circulation in the coronary artery bypass grafting].

OBJECTIVE: To analysis comparatively the primary clinic outcomes between minimal extracorporeal circulation (MECC) and conventional extracorporeal circulation (cECC). METHODS: Forty cases accepted coronary artery bypass grafting from August to October at 2006 were divided into MECC group and cECC group at random, 20 cases for each group. Record and analysis of the general information, clinic data perioperatively, and complications postoperatively for each group were performed. RESULTS: There were no deference between groups in gender, anamnesis and preoperative cardiac function, while age (P < 0.05), standard EuroSCORE and logistic EuroSCORE were much more higher in MECC group than in cECC group (P < 0.01). Similarly, there were no deference in operative time, bypass time, ischemic time and graft number between two groups. Contrasted with cECC group, the values of cTNI were lower in MECC group at 2 h, 6 h and 12 h post-ECC (P < 0.01), oxygen index were higher post-operatively and there was a statistic deference at 12 h post-ECC (P < 0.05). The valves of ALT and TBIL in cECC group were higher abnormally at early post-ECC, and significant higher than in MECC group at 2 h, 6 h post-ECC of ALT (P < 0.05), and at termination, 2 h post-ECC of TBIL (P < 0.05). The values of activated partial thromboplastin time were almost at physiological status in MECC group, but were significantly prolonged in cECC group at early post-ECC, and were statistically longer than in MECC group at 2 h, 6 h, 12 h post-ECC (P < 0.05). The concentration of free hemoglobin in cECC group were higher than in MECC group peri-operative, and there was a statistic deference at 2 h post-ECC (P < 0.05). There were no deference between the two group in Cr, PLT and WBC. CONCLUSIONS: Compared with cECC, MECC carries more biocompatibility, more safe and credible. MECC system can alleviate the organ injury postoperatively and decrease the incidence of complications, especially in high-risk patients.

[Relative factors of recent discovered atrial fibrillation following isolated coronary artery bypass grafting].

OBJECTIVE: To identify the relative factors of recent discovered atrial fibrillation (AF) following isolated coronary artery bypass grafting (CABG). METHODS: Classified the 649 cases undergoing isolated CABG from January 2005 to December 2006 to two groups according to whether AF appeared after operation. Collected the peri-operative data and operative strategy, then analyzed with single-factor analysis and Logistic regression. RESULTS: The incidence of AF was 8.0% (52 cases), and 84.6% (44 cases) recovered sinus-rhythm leaving hospital. Age, standard European system for cardiac operative risk evaluation (EuroSCORE), ratio of high-operative-risk, left atrium diameter and ratio of left coronary artery dominance were higher in AF group than in non-AF group. Age, eject fraction, left atrium diameter, operative risk evaluation, left coronary artery dominance and anastomosis on right coronary artery were the relative factors of recent discovered AF following isolated CABG. But off-pump operation, prescription of adrenergic beta-antagonists pre-operatively and degree of coronary artery stenosis had no influence to AF. CONCLUSIONS: AF following CABG is a result of common influence by many factors. EuroSCORE might forecast partially the incidence of AF following CABG. Improve the myocardial protection and reduce the surgical damage during operative progress maybe the mostly approach to decrease the incidence of AF following CABG.

[Impact of intraoperative autotransfusion on RBC's in vivo half-life].

OBJECTIVE: To explore the changes of in vivo half-life of processed erythrocytes following intraoperative autotransfusion(IAT) in off-pump coronary artery bypass grafting(CABG). METHODS: From November 2003 to January 2004,20 consecutive patients undergoing scheduled off-pump CABG were randomly divided into experimental group and control group. Intra-operative autotransfusion was used in the experimental group. The samples were drawn immediately after the saving procedure in the experimental group and immediately after anesthesia introduction through central venous catheter in the control group. A single isotope technique ((51)Cr) was used to determine in vivo half-life of the RBCs in the two groups. RESULTS: There was no significant difference in in vivo half-life between the two groups. CONCLUSION: The in vivo half life of processed erythrocytes following intraoperative autotransfusion ZITI-3000 Cell saving system has not changed significantly in off-pump CABG.

[Analysis of prognosis assessment with acute physiology and chronic health evaluation III, multiple organ dysfunction score and sequential organ failure assessment for the postoperative patients in cardiovascular surgery].

OBJECTIVE: To analyze the clinical significance of the prognosis assessment with acute physiology and chronic health evaluation III (APACHEIII), multiple organ dysfunction score (MODS) and sequential organ failure assessment (SOFA) for postoperative patients in cardiovascular surgery. METHODS: Prognosis of 68 patients undergoing cardiovascular operation from February 2004 to June 2004 in our ward was assessed by APACHE III, MODS and SOFA. Then the scores were calculated and compared everyday while they stayed in Cardiac Surgery Intensive Care Unit (CSICU). RESULTS: The scores of three methods showed no significant difference from one another in the first three postoperative days, but were significantly higher than all the scores calculated just after the entrance to the CSICU (A0, M0, S0; all P<0.01). There were no differences in the changes of APACHE III, MODS and SOFA(DeltaA, DeltaM and DeltaS) in the first three postoperative days respectively, although they all showed a decreasing tendency. APACHE III scores were positively correlated with MODS although the correlation were diminishing (P<0.01 at first day but P<0.05 at third day), while they were positively correlated with SOFA only in the first two days (both P<0.01). The MODS was positively correlated with SOFA at various time points (P<0.001). The length of stay in CSICU was positive correlated with A0 and maximum of APACHEIII (Amax, P<0.05), and M0, maximum of MODS (Mmax) as well as S0, maximum of SOFA (Smax, P<0.001), respectively. CONCLUSION: For the patients who have undergone cardiovascular operation, A0 could assess the prognosis fairly precisely, but MODS and SOFA assessment seem to be better than APACHE III. Individual Smax and kinetic DeltaS might be the most suitable indexes for cardiovascular surgery.

[Clinical application of intro-aortic balloon pump and centrifugal pump in low cardiac output syndrome after coronary artery bypass grafting].

OBJECTIVE: To explore the clinical application of Intra-aortic balloon pump (IABP) and centrifugal pump in low cardiac output syndrome (LCOS) after coronary artery bypass grafting (CABG). METHODS: From April 2000 to January 2004, 5 patients suffered serious LCOS after CABG in our department. Because maximum vasoactive agent had no significant effect, we supported these 5 patients with IABP and centrifugal pumps. The centrifugal pumps were connected with cannulas of right superior pulmonary vein and ascending aorta. The flow rate of the centrifugal pumps were increased to 3-4 L/min gradually. The dosage of vasoactive agent and flow rate of the centrifugal pumps were decreased gradually after hemodynamics stabilized. RESULTS: All 5 patients' hemodynamics were improved significantly after the left ventricular assist by IABP and centrifugal pumps. Five patients were weaned from the centrifugal pumps after 4 to 7 days successfully. But some degree damage to blood cells and renal function were detected. Renal function of 3 patients were recovered gradually after centrifugal pumps removed and discharged successfully, One patient died of acute renal failure, 1 patient died of multiple organ failure, 5 patients need transfusion of whole blood or concentrated erythrocytes and 4 patients need transfusion of platelets. CONCLUSIONS: There were significant improvements in hemodynamics after support with IABP and centrifugal pumps in the patients who suffered serious LCOS with less effect of maximum vasoactive agent after CABG. Some complications on blood cells and renal function should be paid more attention.