ObjectiveTo analyze the significance of application of pulse indicated continuous cardiac output (PICCO) as hemodynamic monitoring for low cardiac output patients after coronary artery bypass grafting (CABG) operation. Method We retrospectively analyzed the clinical data of 110 patients conducted non-extracorporeal circulation CABG operation in Beijing Anzhen Hospital between June 2013 and October 2014. The patient were divided into two groups including a PICCO applied group and a non-PICCO applied group. There were 49 patients including 29 males and 20 females at average age of 60.80±9.34 years in the PICCO group. There were 61 patients with 37 males and 24 females at age of 62.22±10.41 years in the non-PICCO group. We compared the treatment effects between the two groups. ResultsComparing to the non-PICCO group, the PICCO group had shorter average days of postoperative intra-aortic balloon pump (IABP) usage (t=2.155, P=0.039), less usage rate of endotracheal reintubation (χ2=5.098, P=0.039), shorter average postoperative mechanical ventilation time (t=2.087, P=0.044), less occurrence rate of cardiac arrhythmia (χ2=4.011, P=0.045), less occurrence rate of multiple organ dysfunction syndrome (MODS) (χ2=5.075, P=0.035), shorter days in ICU (t=2.141, P=0.040) and in-hospital time (t=2.061 P=0.048). During monitoring, the PICCO group had slower average heart rate, higher average arterial pressure, lower blood lactate, greater oxygenation and greater left ventricular ejection fraction (LVEF) than those in the non-PICCO group. ConclusionThe application of PICCO reduces occurrence of postoperative complications for low cardiac output patients with post coronary artery bypass grafting operation, increases cure rate.
Objective To be aware of the treatment status and economic burden of people with hemophilia (PWH) in mainland China, so as to seek the optimal therapy for them. Methods The relevant Chinese and English databases such as CBM, CNKI, VIP, WanFang Database, PubMed, EMbase and The Cochrane Library (Issue 6 of 12, June 2011) were searched in June, 2011. The economic analyses and studies on PWH treatment and economic burden published from 1980 to 2011 were collected. Results The diagnosis and treatment of PWH in mainland China lagged behind. More than 30% of PWH did not receive or occasionally received treatment, and less than 10% received prophylactic therapy. Lots of PWHs still used FFP or cryoglobulin which were easily to cause blood-borne viral diseases. More than half of PWH families could afford a little or completely could not afford the therapy. Low dose prophylactic therapy was cost-efficient than on-demand therapy. Based on the therapy status, it was estimated that approximately RMB 53 844 yuan per year per patient should be put into practice in order to have PWH received low-dose prophylactic therapy, and to prevent 80% of bleeding. Conclusion PWH in mainland China is poor in treatment status and heavy in economic burden, so it is an optimal way to adopt comprehensive care model and low-dose prophylactic therapy in mainland China.
Objective To evaluate the effectiveness of oral appliance (OA) vs. continuous positive airway pressure (CPAP) in treating patients with mild to moderate obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods The following databases including PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang data and CNKI were searched from inception to November 30, 2012 to collect the randomized controlled trials (RCTs) on OA vs. CPAP in treating OSAHS. The relevant conference proceedings were also retrieved without limitation of type and publication time. In accordance with the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated quality. And then meta-analysis was performed using RevMan 5.1 software. Besides, the level of evidence was graded using GRADEpro 3.6 software. Results A total of 7 RCTs were included. The results of meta-analysis showed that: a) compared with OA, CPAP significantly reduced the degree of apnea-hypopnea index (AHI) (WMD=9.13, 95%CI 8.77 to 9.50, Plt;0.000 01); and b) there was no significant difference in the Epworth sleeping scale (ESS) between OA and CPAP (WMD=0.00, 95%CI −0.12 to 0.12, P=0.97). Conclusion Compared with OA, CPAP takes remarkable effects in improving AHI for mild to moderate OSAHS, but it shows no significant difference in improving ESS. For the quality and quantity limitation of the included studies, this conclusion still needs to be proved by conducting more high quality RCTs.
The resistance of non-small cell lung cancer (NSCLC) to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) has been brought into focus. COX-2 signal pathway was found to be closely related to EGFR signal pathway by recent researches, and there has been a growing interest to focus the researches on whether COX-2 pathway inhibition improves the efficacy of EGFR-TKIs in treating advanced NSCLC. In this review, we will illustrate recent advances of combined inhibition of EGFR and COX-2 signal pathways in NSCLC therapy.
Objective To explore the effects of the centralized management of bed use in a large-scale integrated hospital. Methods We selected the staff with good quality for centre work after setting up the bed use centralized management centre in the West China Hospital. Then, we formulated unified an admission principle and incorporated it into the systematic management and control, made a short instructional video for rolling show in the centre so as to let the patient know basic conditions of this hospital before admission; and regulated the admission process for patients’ convenience. Results After more than one year, the centre simplified the in-patient admission procedures, regulated the process, saved nursing manpower (24 persons), and increased patients’ satisfaction (from 89.30% to 93.25%). Meanwhile, the bed use rate was increased and the average length of stay was shortened the to some extent, which improved the order in wards. Conclusion Unified bed use management centre established in large-scale integrated hospitals, can save nursing manpower, simplify the admission process of patients, and meet the need for the development of hospitals, which is worthy of promoting application.
Traditional Chinese medicine (TCM) has some unique advantages in the prevention and treatment of cancer. Due to different ideas and mechanism of between TCM and biomedicine in the prevention and treatment of cancer, the clinial effect evaluation approches of biomedicine could not be used as a beneficial method to scientifically evaluate the effects of TCM. From three angles, this article analyzes the key issues regardsing the evaluation methods of TCM as an adjuvant therapy of cancer. It draws lessons from the idea of quality-adjusted survival (QAS), proposes Two-in-One (TIO) method to evaluate the effects of TCM as adjuvant therapy of cancer, which reflects the combined value of the individual patient dynamic information and provides methodological support for the effect evaluation of TCM.
This investigation analyzes the management of medical schools merged with comprehensive universities through internet search and research review in order to reveal management model and effect of the merger. The conclusion is safely reached that governance models are divided into two different patterns: centralized management and decentralized management. Eight universities, representing the two models, were selected and evaluated comprehensively. Among them, the universities that carried out decentralized management have greater development after the merger based on a quality comparison concerning freshmen, faculty, teaching and research between the two patterns. In China, decentralized management in comprehensive universities is more beneficial to the development of medical schools
Objective To explore the rehabilitation effects of musicokinetic therapy on perimenopausal syndrome, so as to provide scientific basis for the treatment of perimenopausal syndrome. Methods Perimenopausal women living in Yiyang city were screened and then 100 cases aged 45 to 55 years with Kupperman score ≥15 and depression score (SDS) ≥0.5 were selected. They were then divided into two groups (experimental group: 50 cases treated by musicokinetic therapy; control group: 50 cases). Evaluation was taken using Kupperman scale and SDS scale 24 weeks after training. Results Compared to the control group, Kupperman scores and SDS scores in the musicokinetic therapy group were lower with a significant difference (Plt;0.01). There were significant differences in Kupperman scores and SDS scores (Plt;0.01) and in the single items of Kupperman scores in the musicokinetic therapy group before and after the experiment (Plt;0.05). Conclusion Musicokinetic therapy could significantly alleviate physical and psychological status of women with perimenopausal syndrome.
Objective To systematically review the effectiveness and safety of intracoronary glycoprotein IIb/IIIa inhibitors (GPIs) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) compared with intravenous administration. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 9, 2012), Ovid, CBM, CNKI and VIP were electronically searched for randomized controlled trials (RCTs) about intracoronary GPIs administration versus intravenous administration undergoing PCI for ACS from inception to September 30th, 2012. Meanwhile, domestic relevant papers published in recent 1 year were also retrieved manually. References of the included studies were retrieved, too. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed the methodologically quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results 10 RCTs involving 3 553 ACS patients were finally included. The results of meta-analysis showed that: compared with intravenous administration, intracoronary GPIs administration decreased the major adverse cardiovascular event (MACE) (OR=0.54, 95%CI 0.34 to 0.85, P=0.008). The incidences of re-infarction (MI), revascularization (TVR) and heart failure were (OR=0.62, 95%CI 0.39 to 0.97, P=0.04), (OR=0.59, 95%CI 0.36 to 0.97, P=0.04), (OR=0.52, 95%CI 0.32 to 0.84, P=0.008), respectively. But for the mortality, there were no significant differences between the two groups (OR=0.81, 95%CI 0.58 to 1.14, P=0.23). Intravenous administration and intracoronary administration were alike in the incidences of mild/serious bleeding (mild: OR=0.94, 95%CI 0.75 to 1.19, P=0.63; serious: OR=1.18, 95%CI 0.76, 1.84, P=0.47). Conclusion Compared with routine GPIs regimen of intravenous bolus, intracoronary administration with initial dosage showed significant benefits in clinical outcomes in ACS patients undergoing PCI, which could not increase the incidence of bleeding.
Objective To evaluate the efficacy and safety of acellular dermal matrix (ADM) in preventing Frey syndrome.Methods Studies of acellular dermal matrix in preventing Frey syndrome were searched in The Cochrane Library (Issue 1, 2010), MEDLINE, EMbase, SIGLE, GreyNet, NTIS, CBMdisc, VIP, CNKI and WANFANG DATA from 1995 to 2010. All the studies were selected, extracted and evaluated by four reviewers independently, and meta-analyses were performed with RevMan 5.0.0 software. Results A total of 15 studies involving 472 participants were included in the review. The studies showed that implantation of the ADM was able to efficiently reduce the incidence of Frey syndrome, and the difference in both subjective and objective was significant between the two groups after the therapy (RR=0.11, 95%CI 0.06 to 0.18, Plt;0.01; RR=0.14, 95%CI 0.10 to 0.19, Plt;0.01). The rate of temporary facial nerve paralysis was lower than that of the control group but the difference was not significant (OR=0.78, 95%CI 0.37 to 1.66, P=0.53). The incidens of both seroma and mucocele were higher than that of the control group but the difference was not significant(OR=2.63, 95%CI 0.09 to 79.25, P=0.58) and they could be alleviated by placing drainage tube and partial pressure bandage. The incidence rate of salivary fistula was lower than that of the control group and the difference was significant (OR=0.24, 95%CI 0.08 to 0.69, P=0.009). Conclusion The result of this system review shows that, the ADM can effectively and safely reduce the incidence of Frey syndrome. To perform preoperative hypersensitivity check for iodine or iodophors, to conduct rapid frozen section for defining the character of tumor, to fix the ADM stably, to place vacuum-drainage and to make partial pressure bandage are suggested.