Objective To determine the efficacy and prognosis of noninvasive positive pressure ventilation (NPPV) in exacerbations of chronic obstructive pulmonary disease (COPD). Methods Trials were located through electronic searches of MEDLINE, EMBASE, Springer, and Foreign Journals Integration System (from the start date to March 2008). We also checked the bibliographies of retrieved articles. Statistical analysis was performed with The Cochrane Collaboration’s software RevMan 4.2.10. Results A total of 19 trials involving 1 236 patients were included. Results showed that: (1) NPPV vs. conventional therapy: NPPV was superior to conventional therapy in terms of intubation rate (RR 0.36, 95%CI 0.27 to 0.49), failure rate (RR 0.62, 95%CI 0.43 to 0.90), and mortality (RR 0.49, 95%CI 0.34 to 0.69). The length of hospital stay was shorter in the NPPV group compared with the conventional group (WMD – 3.83, 95%CI – 5.78 to – 1.89), but the length of ICU stay was similar. The changes of PaO2, PaCO2, and pH were much more obvious in the NPPV group compared with the conventional group. The change of respiratory rate was more significant in the NPPV group compared with the conventional group (WMD – 3.75, 95%CI – 5.48 to – 2.03). At discharge and follow-up, there were no significant differences in FEV1, pH, PaCO2, PaO2, and vital capacity between the two groups. (2) NPPV vs. invasive ventilation: the mortality was similar between the two groups. The incidence of complications was lower in the NPPV group compared with the invasive group (RR 0.38, 95%CI 0.20 to 0.73). The length of ICU stay, duration of mechanical ventilation, and weaning time were shorter in the NPPV group than those of the invasive group. At discharge and follow-up, clinical conditions were similar between the two groups. Conclusion The limited current evidence showed that NPPV was superior to conventional therapy in improving intubation rate, mortality, short term of blood-gas change, the change of respiratory rate; and superior to invasive ventilation in the length of hospital stay and the incidence of complication. There were no difference among them in discharge and follow-up.
Objective To carry out a meta-analysis to evaluate the efficacy and safety of dexmedetomidine in comparison with midazolam as preoperative drug. Methods All randomized controlled trials (RCTs) about dexmedetomidine as preoperative drug compared with midazolam were identified. Meta analysis was performed by using the statistical software RevMan 4.2.10 on the basis of strict quality evaluation. Results Thirteen RCTs involving 806 patients were included. The results of meta analyses showed that dexmedetomidine was better than midazolam in decreasing perioperative blood pressure and heart rate, decreasing dosage of anesthetics, shortening of emergence time, and decreasing the occurrence of agitation, while the occurrence of perioperative hypotention and bradycardia of dexmedetomidine was much more than midazolam. The statistical outcomes showed that there were no differences between the two drugs in the satisfactory score, postoperative sedation score, the number of people needing analgesia, and occurrence of nausea and vomitting. Conclusion Significant advantages in favour of dexmedetomidine as preoperative drug are observed. Dexmedetomidine is safe except for more incidences of hypotension and bradycardia.
Objective We aimed to determine the efficacy and complication of sevoflurane maintenance in children. Methods Trials were collected through electronic searches of MEDLINE, EBSCO, OVID, Springer, Foreign Journals Integration System, CNKI, and CMBdisk (from the date of building the database to April 2008). We also checked the bibliographies of retrieved articles. Results A total of 20 trials involving 1 592 patients were included. The Metaanalysis showed: ① Recovery time: sevoflurane was similar with propofol [WMD=0.22, 95%CI (–2.86, 3.30)], but slower than desflurane [WMD=5.01, 95%CI (2.87, 7.16)], and faster than isoflurane [WMD= –0.55, 95%CI (– 0.74, –0.37)]; ② Discharge time: sevoflurane was similar with propofol [WMD= –4.39, 95%CI (–10.02, 1.25)], desflurane[WMD=1.13, 95%CI (–3.25, 5.51)], and isoflurane [WMD= –8.17, 95%CI (–17.94, 1.60)]; ③ Postoperative agitation: sevoflurane was much more obvious than propofol [RR=5.53, 95%CI (2.99, 10.21)], but superior than desflurane [RR=0.55, 95%CI (0.35, 0.88)], and similar with isoflurane [RR=1.24, 95%CI (0.85, 1.800]; ④ Postoperative nausea and vomiting (PONV): sevoflurane was much more severe than propofol [RR=2.17, 95%CI (1.21, 3.90)], and no difference with desflurane [RR=0.88, 95%CI (0.61, 1.25)]; ⑤ Oculocardiac reflex: sevoflurane was less than propofol [RD= – 0.42, 95%CI (–0.56, –0.27)], and no difference with desflurane [RR=0.93, 95%CI (0.61, 1.41)]. Conclusion The limited current evidence shows no difference between sevoflurane and propofol in recovery time, while the effect of sevoflurane is faster than isoflurane and slower than desflurane. There are no differences among sevoflurane, desflurane, isoflurane, and propofol in discharge time. The incidence of postoperative agitation of sevoflurane is higher than that of propofol, but lower than that of other inhaled anesthetics. The incidence of PONV of sevoflurane is higher than that of propofol. The incidence of oculocardiac reflex of sevoflurane is lower than that of propofol and similar with that of desflurane.
Objective To determine the efficiency and safety of dexmedetomidine in general anesthesia. Methods Trials were located through electronic searches of the PubMed, EBSCO, OVID, Springer, Foreign Journals Integration System, CNKI, CMBdisk (from the date of establishment of the databases to April 2008). Bibliographies of the retrieved articles were also checked. Result A total of 25 trials involving 1 241 patients were included. The Meta-analysis showed: dexmedetomidine reduced peri-operative heart rate and blood pressure, reduced the occurrence of postoperative nausea and vomitting [RR=0.57, 95%CI (0.38, 0.84)], postoperative agitation [RR=0.29, 95%CI (0.17, 0.51)], shivering [RR=0.45, 95%CI (0.29, 0.68)], increase the occurrence of bradycardia [RR=2.16, 95%CI (1.58, 2.95)], hypotension [RR=2.97, 95%CI (1.42, 6.18)]. Dexmedetomidine reduced administration of thiopental, isoflurane and fentanyl, while there was no difference in muscle relaxant. Dexmedetomidine showed no difference in emergency time compared with the control group. As a result of low incidence of adverse reaction, dexmedetomidine showed superior in discharge time [WMD15.17, 95%CI (3.87, 26.46)]. Conclusions The limited current evidence shows that dexmedetomidine is better in maintaining the hemodynamic balance; reducing occurrence of nausea, vomiting, agitation and shivering; and reducing doses of anesthetics. In emergency time, dexmedetomidine shows no difference except discharge time.
Since the emergence of novel coronavirus pneumonia in late 2019, it has quickly spread to many countries and regions around the world, causing a significant impact on human beings and society, posing a great threat to the global public health system. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was highly infectious, and some complications emerged rapidly in some patients, including acute respiratory distress syndrome, and multiple organ failure. The virus could trigger a series of immune responses, which might lead to excessive immune activation, thereby bringing about the immune system imbalance of the body. Up to now, there was no specific antiviral drug, and we conjectured that immunomodulatory therapy might play an essential part in the treatment of coronavirus disease 2019 (COVID-19) as adjuvant therapy. Therefore, we analyzed the possible mechanism of immune imbalance caused by the new coronavirus, and summarized the immunotherapeutic means of COVID-19 based on the mechanisms, to provide some reference for follow-up research and clinical prevention and treatment of COVID-19.
In order to provide more standardized guidance for the management of patients with chronic hepatitis B (CHB) in China and to achieve the World Health Organization’s goal of “eliminating viral hepatitis as public health threats by the year 2030”, the Hepatology and Infectious Diseases Societies of the Chinese Medical Association organized experts to update the guideline for the prevention and treatment of CHB, emphasizing more extensive screening for hepatitis B virus (HBV) markers in the general population and more active antiviral treatment for HBV-infected patients. This article introduced and studied the key update points of the new guideline.
The infection of Hepatitis B virus (HBV) can result in severe consequences, including chronic hepatitis, liver fibrosis, cirrhosis, and even liver cancer. Effective antiviral treatment has the potential to slow down the progression of the disease. HBV serum biomarkers play a crucial role in the dynamic management of chronic hepatitis B (CHB) patients. However, the conventional hepatitis B virus markers, such as hepatitis B serologic testing and HBV DNA, are insufficient to meet the clinical requirements. This review provided a comprehensive overview of the current research on the quantification of HBsAg and anti-HBc, HBV RNA and HBV core-associated antigen, which summarized the crucial role these markers play in the administration of antiviral medications, predicting the efficacy of treatment and anticipating the likelihood of virologic rebound following drug cessation, as well as assessing disease progression in CHB patients.
Autophagy is a programmed cell degradation process that is involved in a variety of physiological and pathological processes including malignant tumors. Abnormal induction of autophagy plays a key role in the development of hepatocellular carcinoma (HCC). We established a prognosis prediction model for hepatocellular carcinoma based on autophagy related genes. Two hundred and four differentially expressed autophagy related genes and basic information and clinical characteristics of 377 registered hepatocellular carcinoma patients were retrieved from the cancer genome atlas database. Cox risk regression analysis was used to identify autophagy-related genes associated with survival, and a prognostic model was constructed based on this. A total of 64 differentially expressed autophagy related genes were identified in hepatocellular carcinoma patients. Five risk factors related to the prognosis of hepatocellular carcinoma patients were determined by univariate and multivariate Cox regression analysis, including TMEM74, BIRC5, SQSTM1, CAPN10 and HSPB8. Age, gender, tumor grade and stage, and risk score were included as variables in multivariate Cox regression analysis. The results showed that risk score was an independent prognostic risk factor for patients with hepatocellular carcinoma (HR = 1.475, 95% CI = 1.280–1.699, P < 0.001). In addition, the area under the curve of the prognostic risk model was 0.739, indicating that the model had a high accuracy in predicting the prognosis of hepatocellular carcinoma. The results suggest that the new prognostic risk model for hepatocellular carcinoma, established by combining the molecular characteristics and clinical parameters of patients, can effectively predict the prognosis of patients.
As a novel technology, wearable physiological parameter monitoring technology represents the future of monitoring technology. However, there are still many problems in the application of this kind of technology. In this paper, a pilot study was conducted to evaluate the quality of electrocardiogram (ECG) signals of the wearable physiological monitoring system (SensEcho-5B). Firstly, an evaluation algorithm of ECG signal quality was developed based on template matching method, which was used for automatic and quantitative evaluation of ECG signals. The algorithm performance was tested on a randomly selected 100 h dataset of ECG signals from 100 subjects (15 healthy subjects and 85 patients with cardiovascular diseases). On this basis, 24-hour ECG data of 30 subjects (7 healthy subjects and 23 patients with cardiovascular diseases) were collected synchronously by SensEcho-5B and ECG Holter. The evaluation algorithm was used to evaluate the quality of ECG signals recorded synchronously by the two systems. Algorithm validation results: sensitivity was 100%, specificity was 99.51%, and accuracy was 99.99%. Results of controlled test of 30 subjects: the median (Q1, Q3) of ECG signal detected by SensEcho-5B with poor signal quality time was 8.93 (0.84, 32.53) minutes, and the median (Q1, Q3) of ECG signal detected by Holter with poor signal quality time was 14.75 (4.39, 35.98) minutes (Rank sum test, P=0.133). The results show that the ECG signal quality algorithm proposed in this paper can effectively evaluate the ECG signal quality of the wearable physiological monitoring system. Compared with signal measured by Holter, the ECG signal measured by SensEcho-5B has the same ECG signal quality. Follow-up studies will further collect physiological data of large samples in real clinical environment, analyze and evaluate the quality of ECG signals, so as to continuously optimize the performance of the monitoring system.
At the end of December 2019, some hospitals in Wuhan, Hubei, China found unexplained pneumonia cases one after another. On January 12, 2020, World Health Organization officially named the new coronavirus that caused the outbreak as “2019 new coronavirus”. The National Health Committee of China has organized experts to compile a “pneumonia diagnosis and treatment program for new coronavirus infection” to guide the prevention, control, diagnosis and treatment of the disease. However, due to the limited knowledge of the disease, there are still many problems to be solved in the diagnosis and treatment of the disease. We reviewed the researches on coronavirus infections related to severe acute respiratory syndrome and Middle East respiratory syndrome, combined with our own experience in diagnosis and treatment, and proposed some thoughts on several unclear hot issues such as the mode of disease transmission, the incubation period, the practical application of diagnostic standards, and the choice of treatment drugs in the diagnosis and treatment plan.