Analysis of the Therapeutic Effect of Hemorrhoids Suppositories Plus Fumigation and Hip Bath with Chinese Medicine on Postoperative Pain and Edema of Patients with Mixed Hemorrhoids / 广州中医药大学学报

Objective To investigate the clinical efficacy of hemorrhoids suppositories plus fumigation and hip bath with Chinese medicine on postoperative pain and edema of patients with mixed hemorrhoids.Methods A total of 62 cases of mixed hemorrhoids to be treated surgically were randomly divided into the trial group and the control group,with 31 cases in each group.Both groups of patients were given the surgery of mixed hemorrhoids(high ligation of hemorrhoids or Milligan-Morgan hemorrhoidectomy)and routine postoperative nursing.Additionally,the control group was treated with rectal hemorrhoids suppository,and the trial group was treated with rectal hemorrhoids suppository plus fumigation and hip bath with Chinese medicines of Carthami Flos,Persicae Semen,Corydalis Rhizoma,Talcum,Toosendan Fructus,Aurantii Fructus,Phellodendri Chinensis Cortex,Myrrha,and Olibanum.The course of treatment for the two groups covered 2 weeks.The changes of pain score and edema score in the two groups were observed before and after treatment,and time for the relief of the symptoms,clinical efficacy and therapeutic satisfaction were also compared.Results(1)After 2 weeks of treatment,the total effective rate of the trial group was 96.77%(30/31),and that of the control group was 80.65%(25/31).The intergroup comparison(tested by chi-square test)showed that the therapeutic efficacy of the trial group was significantly superior to that of the control group,and the difference was statistically significant(P＜0.05).(2)After treatment,the pain scores and edema scores of patients in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease of the scores in the trial group was significantly superior to that in the control group with statistically significant difference(P＜0.01).(3)The time for pain relief and time for edema subsidence in the trial group were significantly shorter than those of the control group,and the differences were statistically significant(P＜0.01).(4)The total satisfaction rate of the trial group was 96.77%(30/31),while that of the control group was 77.42%(24/31).The intergroup comparison(tested by chi-square test)showed that the therapeutic satisfaction of the trial group was significantly superior to that of the control group,and the difference was statistically significant(P＜0.05).Conclusion The therapeutic effect of hemorrhoids suppository plus fumigation and hip bath with Chinese medicine in treating postoperative pain and edema of mixed hemorrhoids is remarkably,and the therapy can effectively improve the degree of edema and pain,promote the recovery of the patients,and improve the patient's therapeutic satisfaction.

Meta-analysis of Absorb Bioresorbable Vascular Scaffold Versus Cobalt Chromium-everolimus Eluting Stent for Treating the Patients With Coronary Artery Disease / 中国循环杂志

Objective: To systemically review the safety and efficacy of Absorb bioresorbable vascular scaffold (Absorb BVS) versus cobalt chromium-everolimus eluting stent (CoCr-EES) for treating the patients with coronary artery disease (CAD) by percutaneous coronary intervention (PCI). Methods: We searched relevant literatures in PubMed, Embase, Cochrane Library, CNKI and Wanfang database from 2008-01 to 2015-10, meanwhile, collected published data and randomized controlled trials from meeting abstracts and websites to compare Absorb BVS and CoCr-EES for treating CAD patients. The quality of literatures were assessed and extracted by modiifed Jadad score, Meta-analysis was conducted by STATA 12.0 soft ware. Results: There were 4 eligible trials with 3,389 patients were enrolled. Absorb BVS group, n=2,164 and CoCr-EES group, n=1,225. During the mean of 1.1 years follow-up period, the following incidences were similar between 2 groups:target lesion failure (OR=1.29, 95%CI 0.95-1.74, P=0.10), all cause death (OR=1.31, 95%CI 0.60-2.87, P=0.50), cardiac death (OR=1.38, 95%CI 0.45-4.24, P=0.57), myocardial infarction (OR=1.30, 95%CI 0.93-1.80, P=0.12), deifnite or probable stent thrombosis (OR=2.08, 95%CI 0.95-4.54, P=0.07), re-vascularization (OR=1.03, 95%CI 0.80-1.33, P=0.81), target lesion re-vascularization (OR=1.06, 95%CI 0.67-1.66, P=0.81) and the patient-oriented composite endpoint (OR=0.95, 95%CI 0.66-1.35, P=0.76). Conclusion: Absorb BVS and CoCr-EES had the similar safety and efifcacy for treating the low and moderate risk CAD patients who had angina, ischemia while without symptoms. The longer period of follow-up study and larger randomized, controlled clinical trials were needed for Absorb BVS application in clinical practice.

Clinical impact of dual antiplatelet therapy use in patients following everolimus-eluting stent implantation: insights from the SEEDS study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Studies have suggested that use of prolonged dual antiplatelet therapy (DAPT) following new generation drug-eluting stent implantation may increase costs and potential bleeding events. This study aimed to investigate the association of DAPT status with clinical safety in patients undergoing everolimus-eluting stent (EES) implantation in the SEEDS study (A Registry to Evaluate Safety and Effectiveness of Everolimus Drug-eluting Stent for Coronary Revascularization) at 2-year follow-up.</p><p><b>METHODS</b>The SEEDS study is a prospective, multicenter study, where patients (n = 1900) with small vessel, long lesion, or multi-vessel diseases underwent EES implantation. Detailed DAPT status was collected at baseline, 6-month, 1- and 2-year. DAPT interruption was defined as any interruption of aspirin and/or clopidogrel more than 14 days. The net adverse clinical events (NACE, a composite endpoint of all-cause death, all myocardial infarction (MI), stroke, definite/probable stent thrombosis (ST), and major bleeding (Bleeding Academic Research Consortium II-V)) were investigated according to the DAPT status at 2-year follow-up.</p><p><b>RESULTS</b>DAPT was used in 97.8% of patients at 6 months, 69.5% at 12 months and 35.4% at 2 years. It was observed that the incidence of NACE was low (8.1%) at 2 years follow-up, especially its components of all-cause death (0.9%), stroke (1.1%), and definite/probable ST (0.7%). DAPT was not an independent predictor of composite endpoint of all-cause death/MI/stroke (hazard ratio [HR]: 0.693, 95% confidence interval [CI]: 0.096-4.980, P = 0.715) and NACE (HR: 1.041, 95% CI: 0.145-7.454, P = 0.968). Of 73 patients who had DAPT interruption, no patient had ST at 12-month, and only 1 patient experienced ST between 1- and 2-year (1.4%). There was a high frequency of major bleeding events (53/65, 82.5%) occurred in patients receiving DAPT treatment.</p><p><b>CONCLUSIONS</b>Prolonged DAPT use was not associated with improved clinical safety. The study emphasized that duration of DAPT needs to be shortened in Chinese patients following EES implantation (ClinicalTrials.gov identifier: NCT 01157455).</p>

Meta Analysis of Dual Antiplatelet Therapy≤6 Months and Dual Antiplatelet Therapy≥12 Months in Patients After Drug-eluting Stent Implantation / 中国循环杂志

Objective: To systematically review the safety and efifciency for dual antiplatelet therapy (DAPT) ≤ 6 months and DAPT ≥ 12 months in patients after drug eluting stent (DES) implantation. Methods: We collected the data for randomized clinical trials for DAPT ≤ 6 months and DAPT ≥ 12 months in patients after DES implantation up to 2015-01 by searching the literatures of PubMed, EMBASE, Cochrane Library, Scopus and Chinese literature database, and meanwhile collected the relevant reporting cases from both domestic and international cardiovascular conferences for this study. There were 2 investigators independently conducted the literature screening, data extraction and quality evaluation, Meta analysis was performed with STATA 12.0 software. Results: A total of 15,378 patients from 7 eligible studies were enrolled and the patients were divided into 2 groups: DAPT ≤ 6 months group,n=7672 and DAPT ≥ 12 months group,n=7706. Meta analysis indicated that DAPT ≤ 6 months could effectively reduce the major bleeding (OR=0.58, 95% CI 0.37-0.91,P=0.017). While the other incidences between 2 groups were similar as all cause death (OR=0.90, 95% CI 0.73-1.11,P=0.314), cardiac death (OR=0.93, 95% CI 0.70-1.24,P=0.617), myocardial infarction (OR=1.13, 95% CI 0.91-1.41,P=0.275), in stent thrombosis (OR=1.21, 95% CI 0.79-1.85,P=0.382) and cerebrovascular accidents (OR=1.00, 95% CI 0.66-1.51,P=1.000). Conclusion: The incidence rates of cardiovascular and cerebrovascular events are similar in patients with DAPT ≤ 6 months and DAPT ≥ 12 months after DES implantation. DAPT ≤ 6 month had the lower risk of bleeding, which is rather suitable for the patients received new generation of DES, with higher risk of bleeding, lower risk of thrombosis and with poor compliance to medication; however, the large and randomized clinical trials are needed to make ifnal conclusion.