Effect of Ultrasound-Guided Erector Spinae Plane Block on Pain After Laparoscopic Transabdominal Preperitoneal Repair: A Prospective, Double-Blind, Randomized Controlled Study.

Objective: The present study was performed to evaluate the effect of ultrasound-guided erector spinae plane block (ESPB) on pain after laparoscopic transabdominal preperitoneal (TAPP) repair. Therefore, improved postoperative pain management is crucial for enhancing the overall patient experience and recovery. Methods: This prospective, double-blind, randomized controlled trial enrolled 40 male patients with a unilateral inguinal hernia at Xi'an Aerospace General Hospital from November 1, 2020, to February 1, 2021. Participants were assigned through a random number table at a 1:1 ratio to receive either ESPB with 20 ml 0.5% ropivacaine in the experimental group (Group E) or ESPB with 20 ml normal saline in the control group (Group C), with 20 cases in each group. The primary outcome was assessed using visual analogue scale (VAS) scores for exercise pain at 2h, 6h, 12h, 18h, and 24h postoperatively. Secondary outcomes included time lapses before patient-controlled intravenous analgesia (PCIA) use, intraoperative remifentanil usage, additional sufentanil, postoperative nalbuphine consumption, analgesic remedies at 24h postoperatively, and incidence of postoperative adverse events. Results: Group E provided more pain mitigation for patients than Group C, as evidenced by the significantly lower VAS scores during exercise pain at 2h (Group C: 1.95±1.19; Group E:4.00±1.38), 6h (Group C: 2.00±1.12; Group E:3.90±1.37), and 12h (Group C: 2.05±1.05; Group E:3.55±1.36) postoperatively (P < .05), and the pain mitigation for Group C was significant only at 18h and 24h postoperatively compared to at 2h postoperatively (P < .05). Group E resulted in significantly reduced intraoperative use of remifentanil and, additional sufentanil and postoperative nalbuphine consumption versus Group C (P < .05). Group E exhibited a better pain tolerance than Group C, as demonstrated by the longer time lapse before the use of PCIA (RR value=5.709, t=8.446, P < .05). Group C required more analgesic remedies within 24 h after surgery than Group E (P < .05). Group E did not increase the risk of postoperative adverse events, given the absence of statistical significance in the intergroup comparison (P > .05). Conclusion: Ultrasound-guided ESPB demonstrates notable benefits by decreasing intraoperative and postoperative anesthetic drug requirements, enhancing pain management, and elevating postoperative comfort and quality of life for patients. While acknowledging the study's limitations, it is crucial to highlight the potential clinical implications of these findings. The incorporation of ESPB with ropivacaine into postoperative pain management protocols could represent a significant advancement in clinical practice. The observed improvements in pain management and reduced reliance on anesthetic drugs may lead to more tailored and efficient postoperative care, potentially enhancing patient recovery experiences. Further research and practical implementation studies are warranted to fully elucidate the specific impact and optimal integration of ESPB with ropivacaine within broader clinical settings.

Effectiveness and Safety of Ayurvedic Medicines in Type 2 Diabetes Mellitus Management: A Systematic Review and Meta-Analysis.

Introduction: Many Ayurvedic medicines have the potential for managing type 2 diabetes mellitus (T2DM), with previous systematic reviews demonstrating effectiveness and safety for specific Ayurvedic medicines. However, many of the reviews need updating and none provide a comprehensive summary of all the Ayurvedic medicines evaluated for managing T2DM. Objective: The objective of this systematic review was to evaluate and synthesize evidence on the effectiveness and safety of Ayurvedic medicines for managing T2DM. Inclusion criteria: Published and unpublished RCTs assessing the effectiveness and safety of Ayurvedic medicines for managing T2DM in adults. Methods: The JBI systematic review methodology was followed. A comprehensive search of sources (including 18 electronic databases) from inception to 16 January 2021 was made. No language restrictions were applied. Data synthesis was conducted using narrative synthesis and random effects meta-analyses, where appropriate. Pooled results are reported as mean differences (MD) with 95% confidence intervals (CI). Results: Out of 32,519 records identified from the searches, 219 articles were included in the systematic review representing 199 RCTs (21,191 participants) of 98 Ayurvedic medicines. Overall, in the studies reviewed the methodology was not adequately reported, resulting in poorer methodological quality scoring. Glycated hemoglobin (HbA1c) was reduced using Aegle marmelos (L.) Corrêa (MD -1.6%; 95% CI -3 to -0.3), Boswellia serrata Roxb. (-0.5; -0.7 to -0.4), Gynostemma pentaphyllum (Thunb.) Makino (-1; -1.5 to -0.6), Momordica charantia L. (-0.3; -0.4 to -0.1), Nigella sativa L. (-0.4; -0.6 to -0.1), Plantago ovata Forssk. (-0.9; -1.4 to -0.3), Tinospora cordifolia (Willd.) Hook.f. and Thomson (-0.5; -0.6 to -0.5), Trigonella foenum-graecum L. (-0.6; -0.9 to -0.4), and Urtica dioica L. (-1.3; -2.4 to -0.2) compared to control. Similarly, fasting blood glucose (FBG) was reduced by 4-56 mg/dl for a range of Ayurvedic medicines. Very few studies assessed health-related quality of life (HRQoL). Adverse events were not reported in many studies, and if reported, these were mostly none to mild and predominately related to the gastrointestinal tract. Conclusion: The current evidence suggests the benefit of a range of Ayurvedic medicines in improving glycemic control in T2DM patients. Given the limitations of the available evidence and to strengthen the evidence base, high-quality RCTs should be conducted and reported.

Development of a Yoga Program for Type-2 Diabetes Prevention (YOGA-DP) Among High-Risk People in India.

Introduction: Many Indians are at high-risk of type-2 diabetes mellitus (T2DM). Yoga is an ancient Indian mind-body discipline, that has been associated with improved glucose levels and can help to prevent T2DM. The study aimed to systematically develop a Yoga program for T2DM prevention (YOGA-DP) among high-risk people in India using a complex intervention development approach. Materials and Methods: As part of the intervention, we developed a booklet and a high-definition video for participants and a manual for YOGA-DP instructors. A systematic iterative process was followed to develop the intervention and included five steps: (i) a systematic review of the literature to generate a list of Yogic practices that improves blood glucose levels among adults at high-risk of or with T2DM, (ii) validation of identified Yogic practices by Yoga experts, (iii) development of the intervention, (iv) consultation with Yoga, exercise, physical activity, diet, behavior change, and/or diabetes experts about the intervention, and (v) pretest the intervention among Yoga practitioners and lay people (those at risk of T2DM and had not practiced Yoga before) in India. Results: YOGA-DP is a structured lifestyle education and exercise program, provided over a period of 24 weeks. The exercise part is based on Yoga and includes Shithilikarana Vyayama (loosening exercises), Surya Namaskar (sun salutation exercises), Asana (Yogic poses), Pranayama (breathing practices), and Dhyana (meditation) and relaxation practices. Once participants complete the program, they are strongly encouraged to maintain a healthy lifestyle in the long-term. Conclusions: We systematically developed a novel Yoga program for T2DM prevention (YOGA-DP) among high-risk people in India. A multi-center feasibility randomized controlled trial is in progress in India.

Barriers and facilitators to physical activity among ethnic Chinese children: a systematic review protocol.

OBJECTIVE: The purpose of this systematic review is to summarize the barriers and facilitators to physical activity among ethnic Chinese children. INTRODUCTION: Several studies have been conducted to determine the barriers and facilitators to physical activity among ethnic Chinese children. However, no qualitative systematic review on this topic has been published in English. INCLUSION CRITERIA: This review will consider studies conducted among ethnic Chinese children (between six and 17 years of age) residing in either Chinese or non-Chinese territories or among people who have responsibility for the children (such as their ethnic Chinese/non-Chinese parents, guardians or teachers). Any study setting will be included, such as home, community and school. Studies that present qualitative data on the views and experiences of the barriers and facilitators to physical activity will be considered. METHODS: MEDLINE, Embase, CINAHL, PsycINFO, British Nursing Index, Allied and Complementary Medicine Database, Web of Science, Scopus, CNKI, Wanfang and VIP will be searched to identify published studies. EThOS, OpenGrey, ProQuest Dissertations and Theses, CNKI and Wanfang will be searched to identify unpublished studies. Databases will be searched from their inception dates, and no language restrictions will be applied. The Joanna Briggs Institute (JBI) systematic review guidelines will be followed to conduct the review. The JBI process of meta-aggregation will be used to identify categories and synthesize findings. The ConQual approach will be used to assess confidence in the findings.