Objective To summarize contents of enhanced recovery after surgery (ERAS) and understand it’s status and prospect in application of patients with hepatolithiasis. Methods The descriptions of ERAS in recent years and applications in hepatolithiasis were reviewed. Results The ERAS programme mainly included the preoperative managements, such as the education, nutrition management, and gastrointestinal tract management; the intraoperative managements, such as the minimally invasive surgery, reasonable choice of anesthesia, infusion volume management, and maintenance of body temperature, analgesia, and preventing postoperative nausea and vomiting medication selection; the postoperative early feeding, early exercise, early extubation, multimodal analgesia, T tube management, reasonable discharge standard and follow-up management. Although the ERAS was rarely reported in patients with hepatolithiasis, it had some advantages of promoting recovery and improving patient satisfaction, and it was still effective and safe. Conclusions Application of ERAS concept in patients with hepatolithiasis has achieved precision management and individualized treatment during perioperative period. It could achieve a good short-term therapeutic effect and optimize medical management model. However, there are still some problems at the present stage in implementation and promotion of patients with hepatolithiasis, such as lacks of criteria and specifications, evidence-based medicine. It is needed to further strengthen communication and collaboration among multiple disciplinary teams so as to further improve ERAS programme and popularize it.
ObjectiveTo systematically review the efficacy of double autologous hematopoietic stem cell transplantation (ASCT) in newly diagnosed multiple myeloma (NDMM). Methods PubMed, EMbase, The Cochrane Library, CNKI, and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on double ASCT for NDMM from inception to February 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 6 RCTs involving 2 226 NDMM patients were included. The results of meta-analysis indicated that compared with single ASCT, more patients who received double ASCT could achieve satisfactory partial response (VGPR) or better (RR=1.12, 95%CI 1.01 to 1.25, P=0.03). Double ASCT resulted in a higher progression-free survival (PFS) rate from the second year for high-risk patients (2-year: RR=0.49, 95%CI 0.28 to 0.86, P=0.01; 5-year: HR=0.61, 95%CI 0.43 to 0.85, P=0.004). There were no statistical differences in treatment-related mortality and 5-year overall survival between the two groups. ConclusionsCompared with single ASCT, double ASCT can improve the VGPR rate of NDMM patients and the PFS rate of high-risk patients with comparable toxicities. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
ObjectiveTo evaluate the effect of intravenous immunoglobulin (IVIG) on prognosis of patients with idiopathic systemic capillary leakage syndrome (ISCLS). MethodsCase reports and case series related to IVIG on prognosis of ISCLS were electronically searched from the PubMed, CNKI and WanFang Data databases from inception to December 31, 2021. Two researchers screened literature and extracted the data independently, then, prognostic data were analyzed. ResultsA total of 143 case reports (175 patients) and 5 case series (169 patients) were included. About 75% of patients had monoclonal gamma globulin, most of those were IgG κ type. A total of 40 patients received prophylaxis with IVIG, most of whom received a high dose (2 g/kg) of IVIG per month. The 5-year and 10-year survival rates of ISCLS patients receiving IVIG secondary prevention treatment were 96% and 72%, respectively, significantly better than the rates of 66% and 43% in the group without IVIG. The median number of acute episodes per year was 0 (0-20) in the group receiving secondary prevention with IVIG and 2 (1-16) in the group not receiving IVIG. ConclusionHigh-dose (2g/kg) IVIG can improve the long-term survival of ISCLS patients, but efficacy of IVIG in acute episodes is unclear.
To solve the problems such as the incomplete and non-standard reporting outcomes in clinical trials, international methodologists have simultaneously launched guidelines for reporting outcomes in trial protocols and reports in 2022 on the basis of the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 and the Consolidated Standards of Reporting Trials (CONSORT) statement 2010. The SPIRIT-Outcomes 2022 extension and CONSORT-Outcomes 2022 extension recommend outcome-specific reporting items should be included prospectively in trial protocols and reports, regardless of trial design or population. This paper introduces and interprets the two guidelines for reporting outcomes, and discusses their significance and enlightenment to the research in the field of traditional Chinese medicine. For example, using the outcome reporting guidelines will help clinical researchers comprehensively consider issues related to outcomes when reporting protocols or results, which may improve the quality of research design and reporting. For core outcome set, the five core elements of outcomes may help researchers extracting and analyzing outcomes, which will standardize research; the explanation of medical terminology in the outcome reporting guidelines will contribute to the improvement of methodology in the field of traditional Chinese medicine.
Objective To investigate the correlation between D-dimer level within 2 hours on admission and early in-hospital major adverse events (MAEs) in patients with acute type A aortic dissection undergoing arch replacement and the frozen elephant trunk (FET) implantation. Methods The patients with acute type A aortic dissection undergoing arch replacement and the FET implantation, who hospitalized in our hospital from September 2017 to December 2022, were included in this retrospective study. Grouping based on the occurrence of in-hospital major adverse events (MAEs) after total arch replacement and FET implantation, with no in-hospital MAEs as a control group and in-hospital MAEs as an observation group. The perioperative data were compared between the two groups. Univariate and multivariate analyses were used to investigate the risk factors for MAEs (in-hospital mortality, gastrointestinal bleeding, paraplegia, acute kidney failure, reopening the chest, low cardiac output syndrome, cerebrovascular accident, respiratory insufficiency, multiple organ dysfunctionsyndrome, gastrointestinal bleeding, and severe infection). Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the prediction area under the ROC curve (AUC). Results Finally 218 patients were collected, including 157 males and 61 females with an average age of 51.54±9.79 years. There were 152 patients in the control group and 66 patients in the observation group. In-hospital mortality was 2.8% (6/218). The level of D-dimer, lactic acid, cardiopulmonary bypass time, aortic cross-clamping time, ventilator-assisted time and ICU stay in the observation group were higher or longer than those in the control group (P=0.013). Multivariate logistic analysis showed that D-dimer (OR=1.077, 95%CI 1.020-1.137, P＜0.05) was an independent risk factor for MAEs in hospital. The level of D-dimer within 2 hours admission predicted that the AUC of MAEs in hospital was 0.83 (95%CI 0.736-0.870, P＜0.05), and the optimal critical point was 2.2 μg/mL, with sensitivity and specificity of 84.8% and 73.0%, respectively. Conclusion Increased D-dimer levels at admission are associated with early in-hospital MAEs in the patients with acute type A aortic dissection undergoing arch replacement and FET. These results may help clinicians optimize the risk evaluation and perioperative clinical management to reduce early adverse events.
There are many problems in the selection of outcomes in clinical trials of traditional Chinese medicine (TCM), such as insufficient research on the applicability of outcomes, insufficient research of individualized outcomes for syndrome differentiation and treatment, incomplete selection methods for overall/comprehensive evaluation outcomes, lack of evidence in the importance of outcomes for researchers, and insufficient reflection of the humanistic value of outcomes. Although the core outcome sets (COS) may help clinical trialists to select outcomes to a certain extent, the COS has not been widely used at present, and the judgment of the importance of the outcomes in the COS is mainly based on the personal experience of the participants. The lack of methodology will also lead to multiple COS in the same disease area. The authors believe that it is necessary to improve the methodology of outcomes research, especially in the development of COS. Developing evidence and humanistic values framework may be a potential way to help researchers select core outcomes in clinical efficacy evaluation of TCM.
ObjectiveTo explore the postoperative characteristics and management experience of patients with coronavirus disease 2019 (COVID-19) undergoing cardiac and vascular surgery. MethodsFrom December 7, 2022 to January 5, 2023, the patients with COVID-19 who were admitted to Cardiovascular Hospital Affiliated to Kunming Medical University and underwent cardiac and vascular surgery were selected. The clinical history, surgical information, postoperative recovery process and treatment plan were analyzed retrospectively. ResultsThere were 18 patients in this group, including 11 (61.1%) males and 7 (38.9%) females, with an average age of 58.1±10.9 years. There were 7 patients of hypertension, 5 patients of diabetes, 3 patients of respiratory diseases, and 2 patient of chronic renal insufficiency. There were 5 (27.8%) patients receiving emergency operations and 13 (72.2%) elective operations. All the 18 patients underwent cardiac and vascular surgery in the period of COVID-19, and the time between the last positive nucleic acid test and the surgery was 1.50 (1.00, 6.25) days. There were 8 patients of pulmonary imaging changes, including 3 patients with chest patch shadow, 3 patients with thickened and disordered lung markings, and 2 patients with exudative changes before operation. Antiviral therapy was not adopted in all patients before operation. Three patients were complicated with viral pneumonia after operation, including 2 patients with high risk factors before operation, who developed into severe pneumonia after operation, and underwent tracheotomy. One patient with thrombus recovered after anticoagulation treatment. Another patient of mild pneumonia recovered after antiviral treatment. The other 15 patients recovered well without major complications. There was no operation-related death in the whole group. One patient died after surgery, with a mortality rate of 5.6%. Conclusion Patients with COVID-19 are at high risk of cardiac and vascular surgery, and patients with high-risk factors may rapidly progress to severe pneumonia. Patients with preoperative lung imaging changes or other basic visceral diseases should consider delaying the operation. Early antiviral combined with immunomodulation treatment for emergency surgery patients may help improve the prognosis.
Objective To examine the research status and predict trends in ME research findings from 1997-2023 on a global scale. Methods Web of Science Core Collection database was searched for original articles on ME published between 1997 and 2023, and then analyzed using CiteSpace, VOSviewer and the Online Analysis Platform of Literature Metrology to map scientific knowledge. Results A total of 748 articles were eventually included. The number of ME publications increased year by year, with the USA being the most productive country. Osteoarthritis, MRI, medial meniscus posterior root repair, biomechanical evaluation, lateral meniscus allograft transplantation, radiographic joint space narrowing are the high frequency keywords in co-occurrence cluster analysis and cocited reference cluster analysis. Medial meniscus posterior root tear and lateral meniscus allograft transplantation are current and evolving research hotspots in citation burst detection analysis. Conclusions The understanding of ME has been improved significantly during the past decades. Current research focuses on optimizing surgical repair methods and obtaining long-term follow-up outcomes for medial meniscal posterior root repair and developing methods to reduce ME after lateral meniscal allograft, as well as they are the highlights of future research on ME.
ObjectivesWith the increasing number of core outcome sets (COS) in traditional Chinese medicine (TCM), some problems gradually emerged, which may affect the popularization and application of COS. This paper analyzes the COS research status in the field of TCM based on registry and literature databases, so that researchers may pay attention to it. Methods Registry platforms and literature databases of Chinese and English were both searched from inception to June, 2022. Qualitative analysis was used to analyze the research status of COS. ResultsSeventy-two COS studies were identified from registry platforms, and the results showed some problems, such as uneven disease distribution, insufficient attention to TCM characteristics, unclear COS scope, and insufficient patient and public participation. Ninety-nine studies were identified from different databases, only 7.07% (7/99) of the studies were COS results, and few of them were cited by clinical trials and/or systematic reviews. ConclusionThe authors proposed that standardizing the registration of COS in the field of TCM, improving the methodology of COS studies, expanding the application settings of COS, and strengthening the cooperation of different stakeholder groups are important to ameliorate sustainable development of COS.
Evidence-based research in traditional Chinese medicine (TCM) has made many important achievements and promoted the modernization and internationalization of TCM. The ability to produce research evidence to guide clinical practice in an emergency treatment situation is a major test of the development of evidence-based Chinese medicine (EBCM) when emerging infectious diseases outbreaks. Along with the development of EBCM, TCM has experienced emerging infectious disease events such as atypical pneumonia (SARS), influenza A (HIN1), and corona virus disease 2019 (COVID-19), and the ability of TCM to conduct clinical research in emergency treatment work has been continuously improved. This article provides an overview of the clinical research conducted in TCM to resist emerging infectious diseases in the past, focusing on the clinical research results obtained in the present time of COVID-19 rescue and treatment, and discusses the role of EBCM development to enhance the clinical research capacity of TCM in emerging infectious diseases.