Cardiac surgery has always been one of the major specialties in the development of “fast track surgery”. Enhanced recovery after surgery (ERAS) has become a widespread topic in perioperative medicine over the past 20 years, and it results in substantial improvements in clinical outcomes and cost savings. This frontier concept has also been increasingly applied and promoted in cardiac surgery. However, compared with other surgical fields, current studies regarding cardiac surgery are still limited in quantity, scale and universality of application. Therefore, this review focuses on current concept and progress of ERAS in adult patients undergoing cardiac surgery with cardiopulmonary bypass, aiming to provide guidance for the establishment of a better framework.
Objective To evaluate the clinical effectiveness of helicobacter pylori (HP) eradication in treating functional dyspepsia (FD) patients with HP infection. Methods The randomized controlled trials (RCTs) about HP eradication vs. general treatment for FD patients published by April, 2012 were searched in the following databases: CBM, CNKI, WanFang Data, PubMed, Ovid, EMbase and The Cochrane Library (Issue 1, 2012). According to the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated the methodological quality. Then the meta-analysis was conducted using RevMan 5.1 software. Results The total 14 RCTs were included. Among all 2 665 patients involved in, 1 339 were in the treatment group, while the other 1 326 were in the control group. The results of meta-analysis showed that HP eradication was superior to general treatment for FD patients in clinical effects (RR=3.90, 95%CI 3.08 to 4.94, Plt;0.000 01), symptomatic score (WMD=−1.68, 95%CI −1.88 to −1.47, Plt;0.000 01), and improvement of upper abdominal pain (RR=2.84, 95%CI 2.02 to 3.99, Plt;0.000 01). Conclusion With obviously clinical effects, HP eradication can decrease the symptomatic score of dyspepsia, and especially improve upper abdominal pain. For the quality and quantity limitations of the included studies, more well-designed and double blind RCTs are required to further prove this conclusion.
Objective To explore the effect of applying evidence-based medicine theory to quality management in long-term-system clinical medicine teaching. Methods We introduced the concept of evidence-based quality management system of clinical medicine to the delivery of teaching with Internet-based teaching quality real time supervision system as the core. A special quality scale was used to assess the teaching quality of teachers and the results were analyzed by SPSS 10.0 using u test. Results The system stored 853 280 pieces of data from the years 2001 to 2003. Up to 96.4% (275/285) of the evaluated topics scored over 85 points. Whether the teachers had overseas experience or not and whether their ages were over 45 or not had no significant influence on the teaching quality (P ＞0.05), but their degrees had influence on the teaching quality (P ＜0.05). Conclusion In long-term-system clinical medicine teaching quality management, we should apply the concept and approach of EBM to our practice so that we can ensure that the teaching quality of long-term-system clinical medicine will improve steadily.
【摘要】 目的 对比玻璃体手术和巩膜环扎术对治疗非复杂性孔源性视网膜剥离（rhegmotogenous retinal detachment，RRD）的疗效。 方法 检索Pubmed、Embase、Cochrane对照试验中心注册数据库，对相关的随机对照临床试验（randomized controlled trialc，RCT）按Cochrane协作网推荐的方法进行Meta分析。 结果 有晶状体组包括3篇RCT共523例，人工晶状体/无状晶体组包括4篇RCT共690例。有晶状体组玻璃体手术（pars plana vitrectomy，PPV）术后白内障的发生率更高[OR=4.18，95%CI（2.75，6.35），Plt;0.000 01]。人工晶状体/无晶状体组PPV术后最终解剖复位率更高[OR=1.97，95%CI（1.04，3.73），P=0.04]。 结论 巩膜环扎术通过降低术后白内障的发生率在治疗非复杂性有晶状体眼RRD中占有优势；PPV可提高最终解剖复位率，更适合人工晶状体/无晶状体眼RRD。【Abstract】 Objective To compare the efficacy of pars plana vitrectomy (PPV) and scleral buckling (SB) in treating uncomplicated rhegmatogenous retinal detachment (RRD). Methods Randomized controlled trials (RCTs) were searched from Pubmed, Embase and the Cochrane Central Register. Meta-analysis was conducted using the methods recommended by the Cochrane Collaboration. Results Three RCTs with 523 phakic eyes and four RCTs with 690 pseudophakic/aphakic eyes were included. In the phakic group, the rate of postopertative cataract was higher with PPV [OR=4.18, 95% CI (2.75,6.35), Plt;0.000 01]. In the pseudophakic/aphakic group, final anatomic success outcome was in favor of PPV [OR=1.97, 95% CI (1.04,3.73), P=0.04]. Conclusions SB results better in terms of postoperative cataract in phakic RRDs. PPV is more likely to achieve a favorable final reattachment in pseudophakic/aphakic RRDs.
Objective To overview the systematic reviews/meta-analyses of efficacy of FNB used as a postoperative analgesic technique among patients undergoing TKR. Methods We electronically searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and VIP from inception to July, 2016. Two reviewers independently screened literature and extracted data. AMSTAR tool was used to assess the methodological quality of included studies. The primary outcome was pain scores and the consumption of opoid medicine to evaluate the effectiveness of FNB. Results A total of 16 systematic reviews/meta-analyses were included, involving the FNBvs. LIA, PMDI, EA, PCA and ACB, respectively. The results of quality assessment indicated medium scores with 3 to 9 scores. The overviews’ results showed that: at rest, FNB was not superior to LIA at 6h after TKR; it was superior to PMDI at 12h after TKR; it was also superior to PCA and LIA, but not superior to ACB at 24h after TKR. On movement, FNB was superior to PCA and LIA at 24h after TKR; it was also superior to PCA at 48h after TKR. As to the consumption of opoid medicine, the consumption in FNB group was more than LIA group at 12h after TKR. In addition, the consumption in FNB group was less than PCA and LIA at 24h after TKR, and it was also less than PCA and ACB at 48h. The satisfaction of patients who received FNB was better than ACB, EA and PCA. Conclusion The current overview shows that FNB is more effective than PCA and LIA, the patients’ satisfaction is better. Due to the limitations of the quantity and quality of included studies, the above conclusions are needed to be verified by more studies.
Objectives To overview the systematic reviews/meta-analyses of safety of femoral nerve block (FNB) used as a postoperative analgesic technique in patients undergoing total knee arthroplasty (TKA). Methods We searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, and VIP from inception to July, 2016. Two reviewers independently screened literature, extracted data and used AMSTAR to evaluate the methodological quality of the included studies. The major indexes used to evaluate the safety of FNB were the incidence rates of symptoms including nausea, vomiting, sedation, retention of urine, dizziness, pruritus, hypotension, falls, nenous thromboembolism and deep infection. Results A total of 12 systematic reviews/meta-analyses were included.They assessed the safety of FNB compared with local infiltration analgesia (LIA), periarticular multimodal drug injection (PMDI), epidural analgesia (EA), patient-controlled intravenous analgesia of opioids (PCA) and adductor canal block (ACB), respectively. The methodological quality of included studies were medium, with the scores between 3 to 10. The results of overview indicated that: FNB had lower incidence rates of nausea and vomiting compared with EA and PCA, but had higher than ACB. FNB had lower incidence rates of sedation and retention of urine compared with EA and PCA. FNB had lower incidence rates of dizziness compared with EA and PCA, and lower incidence rate of hypotension compared with EA. Conclusion Current evidence suggests that FNB is safer than EA and PCA. Due to the limited quantity and quality of the included studies, the above conclusions are needed to be verified by more high-quality studies.
ObjectiveTo explore the effectiveness of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh.MethodsBetween December 2016 and June 2019, 12 patients with skin malignant tumor on the thigh were treated. There were 9 males and 3 females, aged from 8 to 65 years (median, 38.5 years). The etiologies included basal cell carcinoma in 3 cases, squamous cell carcinoma in 7 cases, fibrosarcoma in 1 case, and malignant melanoma in 1 case. The disease duration ranged from 5 months to 10 years (median, 7.5 years). Color Doppler ultrasound was used to detect and mark at least one perforator vessel before operation. After extensive resection, the size of wound ranged from 5.0 cm×3.5 cm to 8.5 cm×6.5 cm. In the range of 1-3 cm from the edge of the lesion, the perforator vessels were explored again from the deep surface of the deep fascia to confirm and mark. The perforator vessel with diameter greater than 0.5 mm and closest to the edge of the lesion was taken as the rotation point of the flap. According to the wound size and shape, the free-style perforator pedicled propeller flap in size of 8.0 cm×3.5 cm to 12.5 cm×6.0 cm was designed. The wound was repaired with the big blade of the flap. The donor site was closed directly with the aid of the small blade.ResultsThe distal part of the skin flap was necrosis after operation, and healed after symptomatic treatment such as dressing change; the other flaps survived successfully and the wounds healed by first intention. All incisions at the donor site healed by first intention. All patients were followed up 5-24 months (mean, 10.2 months). During the follow-up, there was no recurrence of tumor. The flap had good elasticity and texture with no obvious swelling or scar hyperplasia, and the appearance was satisfactory; the hip and knee joint activities were normal.ConclusionBased on the extensive skin blood supply and abundant perforator vessels of the thigh, the free-style perforator pedicled propeller flap is an ideal flap for repairing small or medium wound after extensive resection of skin malignant tumor on the thigh.
Objective To investigate the significance of spread through air spaces (STAS) in early-stage non-small cell lung cancer (NSCLC) patients undergoing either sublobar resection or lobectomy by pooling evidence available, and to assess the accuracy of frozen sections in determining types of resection among patients with suspected presence of STAS. MethodsStudies were identified by searching databases including PubMed, EMbase, Web of Science, and The Cochrane Library from inception to July 2022. Two researchers independently searched, screened, evaluated literature, and extracted data. Statistical analysis was conducted using RevMan 5.4 and STATA 15.0. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the study. ResultsA total of 26 studies involving 23 surgical related studies (12 266 patients) were included, among which, 11 compared the outcomes of lobectomy with sublobar resection in the STAS-positive patients. NOS score≥6 points. Meta-analysis indicated that presence of STAS shortened patients' survival in both lobectomy group and sublobar resection group (RFS: HR=2.27, 95%CI 1.96-2.63, P＜0.01; OS: HR=2.08, 95%CI 1.74-2.49, P＜0.01). Moreover, lobectomy brought additional survival benefits to STAS-positive patients compared with sublobar resection (RFS: HR=1.97, 95%CI 1.59-2.44, P＜0.01; OS: HR=1.91, 95%CI 1.47-2.48, P＜0.01). Four studies were included to assess the accuracy of identifying presence of STAS on intraoperative frozen sections, of which the pooled sensitivity reached 55% (95%CI 45%-64%), the pooled specificity reached 92% (95%CI 77%-97%), and the pooled area under the curve was 0.68 (95%CI 0.64-0.72) based on the data available. Conclusion This study confirms that presence of STAS is a critical risk factor for patients with early-stage NSCLC. Lobectomy should be recommended as the first choice when presence of STAS is identified on frozen sections, as lobectomy can prolong patients' survival compared with sublobar resection in STAS-positive disease. The specificity of identifying STAS on frozen sections seems to be satisfactory, which may be helpful in determining types of resection. However, more robust methods are urgently in need to make up for the limited sensitivity and accuracy of frozen sections.
Objective To assess the effectiveness and safety of tinidazole buccal tablets produced by China Associate Pharmaceutical Co. , Ltd. on periodontitis and pericoronitis. Methods A mukicenter randomized controlled doubleblind trial was designed. Three units from Shanghai, Hangzhou and Chengdu joined the study. The trial tablet oftinidazole was supplied by the mentioned Pharmaceuticals company. A marketed tinidazole produced by Zhejiang Hacon Marine BioPharmaceutical Co. Ltd. , was used as positive control. Both drugs were administered at a dose of 5 mg four times daily for 6 days. Outcomes measurement included symptoms, clinical signs of the patients with periodontitis or pericoronitis, and gingival index （GI）, bleeding index （BI）, plaque index （PI） and periodontal depth （PD） were measured for the patients with periodontitis. Subgingival bacterial samples taken from subgingival plaque of diseased teeth of the cases with periodontitis or from exudates of diseased wisdom teeth of the cases with pericoronitis were cultivated aerobically and anaerobically. Putative microorganisms were isolated and colony forming unit （CFU） were counted before and after treatments. All adverse drug reactions （ADIL） were observed, recorded, properly treated and followed. Results Altogether, 157 cases met the inclusion criteria and entered the study. Lost to follow-up happened in 14 cases with drop-out rate of 8.9%. In per-protocal cases there were 109 with periodontitis （57 in trial group and 52 in control group） and 34 with pericoronitis （17 in trial group and 17 in control group）. Basehne analysis demonstrated that the two groups were comparable. At the final examination, it was found that 85% of the cases in the periodontitis group showed significant）mprovement gingival bleeding, both gingival pain and biting pain subsided, PD, BI, GI and PI reduced with no significant difference between trial and control groups （P 〉0.05）. The symptoms of sixty percent of cases with pericoronitis were improved. More than 75% of the cases with pericoronal pus, the pus were ehminated. Over 60% of the cases with lymphadenitis, the node swelling was subsided. Mouth opening increased in all cases with pericoronitis. All improvements in the cases with pericoronitis showed no significant difference between trial and control groups （ P 〉0.05 ）. The effective rate only including cured and markedly improved cases reached 88.2% in both groups of pericoronitis. Various species of putative microorganisms were detected in patients with periodontitis or pericoronitis before treatment. A great proportion of the putative microorganisms eliminated or the quantity reduced after treatment, with no significant difference between trial and control groups （P 〉0.05 ）. Candida albicans was not detected before and after treatment. Nine patients developed ADRs, 5 （6.8% ）in trial group and 4 （5.8% ）in control group. All the ADRs were mild and transient, not interfering with drug administration. Conclusions This study showed the tinidozole buccal tablet with commercial name “Jinhe” supphed by China Associate Pharmaceutical Co. , Ltd. do inhibit the common putative microorganisms of periodontitis and pericoronitits, and do not influence balance of the local commensal microganisms. It reduces severity of the infectious inflammation and benefits improvement and/ or rehabilitation of periodontitis and pericoronitis, with only mild and transient ADRs. The trial and control tablets have similar efficacy and safety for patients with periodontits or pericoronitis.