Comparison of Ultrasound Guided and Conventional Techniques for Peripheral Venous Catheter Insertion in Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Ultrasound guided cannulation for peripheral venous insertion is a well-established methodology. However, there has never been a systematic review completed to synthesize evidence within the pediatric population. The current systematic review and meta-analysis was completed to compare the efficacy and safety profile of ultrasound guided peripheral cannulation against the conventional palpation technique within pediatric patients. METHODS: A comprehensive search was conducted within the digital databases including Medline, EMBASE, ScienceDirect, Google Scholar and Cochrane library from inception until August 2021. A meta-analysis was then completed with random-effects model and reported pooled risk ratio (RR) or standardized mean difference (SMD) with 95% confidence interval (CI). RESULTS: In total, 9 studies were analyzed, which included 1,312 participants, and the majority of studies (5 out 9 studies) were considered high quality. Amongst efficacy outcomes, first attempt success rate had a pooled RR of 1.53 (95% CI: 1.14-2.04), overall success rate had a pooled RR of 1.13 (95% CI: 1.01-1.26), number of attempts before successful cannulation had a pooled SMD of -1.93 [95%CI: -3.44 to -0.42], time taken for successful cannulation had a pooled SMD of -0.46 [95%CI: -1.20 to 0.28], needle redirections before successful cannulation had a pooled SMD of -1.26 [95%CI: -2.47 to -0.06]. Amongst safety outcomes, venous extravasation had a pooled RR of 1.59 (95% CI: 0.99-2.54) and phlebitis had an RR of 0.31 (95% CI: 0.07-1.50). CONCLUSION: Within pediatric patients, ultrasound guided peripheral venous cannulation is more efficacious when compared to the conventional palpation technique.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021275305, identifier: CRD42021275305.

Shi-Style Cervical Mobilizations Versus Massage for Cervical Vertigo: A Multicenter, Randomized, Controlled Clinical Trial.

Objectives: Large sample and high-quality evidence to evaluate the preliminary safety of the mobilizations and massage for cervical vertigo are not yet available. Thus, the present study aimed to investigate the comparative effectiveness and preliminary safety of Shi-style cervical mobilizations (SCM) compared with traditional massage (TM) in cervical vertigo patients. Design: A prospective, multicenter, open-label, randomized, controlled clinical trial with a 1:1 allocation ratio. Settings: Five academic medical centers. Subjects: A total of 360 adult patients with a diagnosis of cervical vertigo. Interventions: The patients were randomly allocated to either an SCM (n = 180) or TM (n = 180) group. The patients were treated during six sessions over 2 weeks. The primary outcome was the Dizziness Handicap Inventory (DHI) total scale score, and secondary outcomes included the DHI subscales, Chinese version of the Short-Form 36 Health Survey (CSF-36), and adverse events (AEs). Outcomes were assessed in the short term at 2 weeks, 1 month, and 3 months, and in the intermediate term at 6 months after randomization. Results: Significant changes were observed from the baseline in the DHI total scale and subscales at 2 weeks and 1, 3, and 6 months in both groups (all p < 0.05). However, the differences between the two groups were not significant (all p > 0.05). Furthermore, we noted significant changes from the baseline in SF-36 scores at 2 weeks in both groups (all p < 0.05), whereas CSF-36 scores were not significantly higher in the SCM group (all p > 0.05) compared with the TM group. No serious AEs were reported in either of the two groups. Conclusions: No differences in outcomes were detected between the SCM and TM groups in terms of treatment of cervicogenic dizziness. Efficacy trials are required to determine whether the improvement observed for each treatment was causally related to the interventions.

Shi-style cervical manipulations for cervical radiculopathy: A multicenter randomized-controlled clinical trial.

BACKGROUND: There is a lack of high-quality evidence supporting the use of manipulation therapy for patients with cervical radiculopathy (CR). This study aimed to evaluate the effectiveness of Shi-style cervical manipulations (SCMs) versus mechanical cervical traction (MCT) for CR. METHODS: This was a randomized, open-label, controlled trial carried out at 5 hospitals in patients with CR for at least 2 weeks and neck pain. The patients received 6 treatments of SCM (n = 179) or MCT (n = 180) over 2 weeks. The primary outcome was participant-rated disability (neck disability index), measured 2 weeks after randomization. The secondary outcomes were participant-rated pain (visual analog scale) and health-related quality of life (36-Item Short Form Health Survey [SF-36]). Assessments were performed before, during, and after (2, 4, 12, and 24 weeks) intervention. RESULTS: After 2 weeks of treatment, the SCM group showed a greater improvement in participant-rated disability compared with the control group (P = .018). The SCM group reported less disability compared with the control group (P < .001) during the 26-week follow-up. The difference was particularly important at 6 months (mean -28.91 ±â€Š16.43, P < .001). Significant improvements in SF-36 were noted in both groups after 2 weeks of treatment, but there were no differences between the 2 groups. CONCLUSION: SCM could be a better option than MCT for the treatment of CR-related pain and disability.

A 12-Words-for-Life-Nurturing Exercise Program as an Alternative Therapy for Cervical Spondylosis: A Randomized Controlled Trial.

In this paper, we carried out a randomized controlled clinical trial to explore the effect of 12-words-for-life-nurturing exercise on patients presenting with cervical spondylosis. After exercise intervention, the mean VAS and NDI scores of the patients decreased significantly and the scores of BP, VT, and MH in SF-36 Health Questionnaire were significantly higher. Exercise therapy showed significant effect on relieving pain and improving vitality and mental health. The 12-words-for-life-nurturing exercise may be a potential effective therapy for patients with cervical spondylosis.

[Professor Shi Qi's experience of applying herbal paste for treating chronic musculoskeletal conditions].

Professor Shi Qi is a famous traditional Chinese medicine doctor specializing in orthopaedics and traumatology, who has formatted a set of systematic protocols for the diagnosis and treatment of chronic musculoskeletal conditions. When it is time for using tonics in winter, he advocates applying herbal paste for treating chronic musculoskeletal diseases. This paper introduces Professor Shi Qi's commonly used prescription for treating chronic musculoskeletal conditions and puts forward demands and understandings in concocting herbal paste, experience in herbal paste for treating chronic musculoskeletal diseases such as cervical spondylosis, lumbar disc herniation, lumbar spinal stenosis, lumbar muscle strain, ankylosing spondylitis, osteoporosis, knee osteoarthritis and avascular necrosis of femoral head, and the advantages of herbal paste for treating chronic musculoskeletal conditions as opposed to alternative treatments.

Morphometry of axons in optic nerves of Siamese's twins.

PURPOSE: To observe the development of optic nerve, we examined four optic nerves from Siameses Twins by absolute counts of axons. METHODS: Mean axon diameter, mean axon density, totally axonal population and optic nerve area were noted for each optic nerve. The mean axon diameter and the mean axon density were compared between paraxial (inner sectors) and cortical(outer sectors) areas of the nerves. RESULTS: More myelinated axons were seen in the inner sectors as compared to the outer sectors (average 11 axons/1000 microm2 in inner sectors and 34 axons/1000 microm2 in outer sectors (P = 0.036). The myelinated fibers were also smaller (63 microns) in the outer sectors as compared to the inner sectors (72 microns) (P = 0.001). The average cross sectors area for the four 40 week stage optical nerves of Siamese Twins was 3.32 x 103 as compared to 1 million axons for 32-week-old normals. CONCLUSION: Our finding of fewer axonal number and small myelinated fibers in the Siamese Twins suggests hypoplasia. Myelination was more abnormal in the paraxial optic nerve than that in the peripheral sectors, suggesting anomalous development of optic nerve peripherally and delayed developnent centrally. Axonal density is higher in inner sectors than that in outer sectors, suggesting delayed development of the outer nerve sector.