ObjectiveTo summarize the recent advancements in the researches on the pathogenesis of postoperative ileus and explain the clinical significances of postoperative ileus mechanisms for the diagnosis, treatment, and prevention. MethodsRelevant literatures about the postoperative ileus mechanism published recently were collected and reviewed. ResultsThe occurrence of postoperative ileus were related to postoperative nerve reflex inhibition, inflammatory response, effects of drugs, and other factors, it was a variety of mechanisms modulating each other. ConclusionThe gastrointestinal motility of postoperative ileus is mainly regulated by neural reflexes, inflammatory reactions, and drug interactions, three of which act differently but as a whole in different time segments while the inflammatory response play a key role of postoperative ileus persistence.
Objective To investigate the impact of edaravone on serum reactive oxygen species during the perioperative period of off-pump coronary artery bypass grafting （OPCAB）. Methods A total of 40 patients who underwent selective OPCAB in the First Hospital of Hebei Medical University between June 2011 and November 2012 were prospectively enrolled in this study. All the patients were randomly divided into a trial group and a control group by a random digitaltable method with 20 patients in each group. There were 13 males and 7 females in the trial group with their age of 40-67（51.8±11.5） years， and 9 males and 11 females in the control group with their age of 42-70 （53.5±13.1） years. Afteranesthesia induction， patients in the trial group received continuous intravenous infusion of edaravone 60 mg （diluted in 100 ml saline）， while patients in the control group received continuous intravenous infusion of saline 100 ml， both of whichwere finished within 30 minutes. Venous blood samples were taken 24 hours preoperatively （T1）， 1 hour after skin incision（T2）， at the end of the surgery （T3） and 24 hours postoperatively （T4） to examine the concentration of superoxide dismutase（SOD） and malondialdehyde （MDA）. The data of the two groups were compared. Results All the patients successfully underwent their surgery and were included in the analysis. At the T2， T3 and T4 time point， SOD concentration was 80.3±21.3 U/ml， 78.5±17.4 U/ml and 81.4±17.5 U/ml， and MDA concentration was 10.2±1.8 nmol/ml， 11.3±1.9 nmol/ml，14.8±2.1 nmol/ml respectively in the control group；SOD concentration was 92.8±18.4 U/ml，90.0±18.1 U/ml，and 88.7±18.7 U/ml，and MDA concentration was 7.2±1.7 nmol/ml，8.2±1.2 nmol/ml，10.2±1.3 nmol/ml respectively in the trial group. At each above time point， SOD activity was significantly higher in the trial group than the control group （F=2.90，P=0.003；F=2.80，P=0.003；F=2.80，P=0.001）， and MDA concentration was significantly lower in the trial group than the control group （F=2.79，P=0.001；F=2.80，P=0.001；F=2.90，P=0.000）. Conclusion Edaravone can decrease serum reactive oxygen species caused by OPCAB and reduce myocardial injury.
Objective To study the effects and adverse reaction of imatinib mesylate used to prevent the recurrence of gastrointestinal stromal tumor (GIST) after resection. Methods 22 patients with primary gastrointestinal stromal tumor were included in the First Affiliated Hospital of Chongqing Medical University from January, 2007 to November, 2009 who received resection and were imageologically diagnosed as no residual tumor by enhanced CT or enhanced MRI after resection. They were all given imatinib mesylate 400 mg for oral use daily after resection (median-risk GIST: more than 1 year; high-risk GIST: more than 2 years). Patients’ 1-year and 2-year relapse-free survival (RFS) and adverse reaction were recorded during follow-up. Results Among 22 patients, there were 13 males and 9 females, with median age of 57.4 years, and 9 high-risk cases were included. The median follow-up lasted 34 months (24 to 48 months). Patients’ 1-year and 2-year RFS was 100% and 94.5%, respectively. Adverse reaction mainly included edema, nausea, abdominal pain, muscle or bone pain, thrombocytopenia, weakness, skin rashes, etc., most of which were mild or moderate and could be alleviated after treating symptoms. Conclusion Imatinib mesylate therapy given after resection is a safe and reliable method which could prolong RFS and prevent or delay the recurrence of GIST. However, further high-quality randomized controlled trial was required to verify its curative effects, since no control group has been set in our study.
Objectives To compare the differences of the medical charity donations between at home and abroad in West China Hospital of Sichuan University, so as to provide the evidence for the management and development of medical charity in West China Hospital and China. Methods A cross-sectional study was conducted to investigate and analyze the current situation and problems of the medical charity donations at home and abroad in West China Hospital from January 2005 to December 2006. Results The total amount of the charity funds at home and abroad was 2.043 mill ion and 14.6 mill ion, respectively. The main target diseases of domestic donation were tumor, hematologic disease, dangerous and severe diseases and congenital heart disease, which accounted for 43.3%, 35.9%, 15.8% and 1.0%, respectivley. While the main targeted interventions and diseases of overseas donation were hearing rehabilitation, prosthetic replacement, cataract and congenital heart disease, which took up 52.1%, 27.4%, 13.7% and 6.8%, respectively. Conclusions There are differences in the amount of charity funds, target diseases, behavioral motivations, organizations, objectives and criteria of the charity donation between the donations at home and abroad. It would probably cause the problems in recruitment, distribution and monitoring of the charity funds. It is suggested that the hospital management committee of charity funds and the related law to regulate the charity behaviors should be developed.
目的 觀察對比卒中單元早期康復護理對卒中偏癱患者肢體功能恢復的效果。 方法 將2011年6月－12月期間住院的腦卒中偏癱患者88例，按照發病時間分為試驗組和對照組，發病5 d以內急性期入院者為試驗組，5 d以上入院的超過急性期者為對照組。在規范治療基礎上予以相同的康復護理干預，對其日常生活活動能力采用改良的Rakin量表MRS評分來進行功能評定。 結果 試驗組和對照組生活能自理人數分別占25%、13.6%，能部分自理的人數分別占56.8%、40.9%，試驗組肢體功能恢復明顯高于對照組（P＜0.05）。 結論 卒中單元早期康復護理對腦卒中偏癱患者肢體功能恢復有重要意義。
Objective To investigate the prevalence of cognitive impairment and identify its influencing factors among lung cancer patients undergoing chemotherapy, providing a scientific basis for targeted interventions. Methods A convenience sample of lung cancer patients receiving chemotherapy at West China Hospital, Sichuan University between April and October 2024 was enrolled. Data were collected using a general information questionnaire, the Mini-Mental State Examination, Nutritional Risk Screening 2002, Hospital Anxiety and Depression Scale, Barthel index, and FRAIL scale. Univariate analyses and multivariate logistic regression were performed to determine factors associated with cognitive impairment. Results A total of 380 patients undergoing chemotherapy for lung cancer were enrolled, and 205 (53.9%) of them had cognitive impairment. Univariate analyses revealed that there were statistically significant differences between the cognitively normal group and the cognitive impairment group in age, educational level, work status, nutritional status, Barthel index, and FRAIL scale score (P<0.05). Multivariate logistic regression showed that advanced age [odds ratio (OR)=1.045, 95% confidence interval (CI) (1.015, 1.075), P=0.002] and FRAIL scale score [OR=1.369, 95%CI (1.165, 1.609), P<0.001] were identified as independent risk factors for cognitive impairment, whereas higher educational attainment served as a protective factor, compared with patients with primary school education or below, patients with junior high school, high school/secondary vocational school, college, or undergraduate education and above had a lower risk of cognitive impairment [OR=0.437, 0.258, 0.243, 0.120, P<0.05]. Conclusions Cognitive impairment is highly prevalent among lung cancer patients undergoing chemotherapy and is significantly influenced by age, educational level, and frailty. Healthcare providers should develop targeted interventions based on these factors to reduce the prevalence of cognitive impairment.
Objectives To assess the effectiveness and safety of carnitine in the treatment of idiopathic asthenozoospermia. Methods The Cochrane Library, MEDLINE, EMbase, and CNKI were searched between Jan 1995 and Dec 2006. Both English and Chinese studies were included in the review if they were randomized controlled trials (RCTs) involving men with idopathic asthenozoospermia who were treated with carnitine. Trial screening, data extraction, and quality assessment of included trials were conducted by method recommended by Cochrane Collaboration. Statistical analysis was conducted using RevMan 4.2.10 software. Results Five RCTs involving 346 patients met the inclusion criteria, and 307 patients were included in the meta-analysis. The results showed that: after being treated with carnitine for 3 and 6 months, the difference of the patients’ partners’ spontaneous pregnancy rate between treatment group and control group was statistically significant with RR2.46 and 95% CI1.12 to 5.43 (Z=2.23, P=0.03). After being treated with carnitine for 3 and 6 months, the difference of forward motile sperm per ejaculate between treatment group and control group was not statistically significant with WMD 9.16 and 95%CI 0.14 to 18.18 (Z=1.99, P=0.05) and WMD 5.28 and 95%CI –4.45 to 15.01 (Z=1.06, P=0.29). After being treated with carnitine for 3 and 6 months, the difference of percentage of forward sperm motility between treatment group and control group was not statistically significant with WMD 14.56 and 95%CI –4.49 to 33.61( Z=1.50 ,P=0.13), and WMD 7.34 and 95%CI –5.93 to 20.61 (Z=1.08, P=0.28). After being treated with carnitine for 3 and 6 months, the difference of total motile sperm per ejaculate between treatment group and control group was not statistically significant with WMD 15.32 and 95%CI –1.34 to 31.98 (Z=1.80, P=0.07) and WMD 6.20, 95%CI –3.00 to 15.39 (Z=1.32, P=0.19).After being treated with carnitine for 3 and 6 months, the difference of percentage of total sperm motility between treatment group and control group was not statistically significant with WMD 2.97 and 95%CI –5.75 to 11.69 (Z=0.67, P=0.50) and WMD 4.48 and 95%CI-9.17 to18.14 (Z=0.64, P=0.52). After being treated with carnitine for 3 and 6 months, the difference of semen volume between treatment group and control group was not statistically significant with WMD –0.12 and 95%CI –0.55 to 0.30 (Z=0.57, P=0.57) and WMD 0.03 and 95%CI –0.38 to 0.45 (Z=0.16, P=0.87). After being treated with carnitine for 3 and 6 months, the difference of sperm concentration between treatment group and control group was not statistically significant with WMD 7.92 and 95%CI – 2.85 to18.68 (Z=1.44, P=0.15), and WMD 1.02 and 95%CI –5.09 to 7.14 (Z=0.33, P=0.74). Three RCTs reported that there were no serious side effects of carnitine during the treatment period. Conclusions The available evidence indicates that spontaneous pregnancy rate would increase with carnitine therapy, while it is short of improvement of semen parameters. There is no serious side effect of carnitine. Because of lack of evidence, we cannot conclude that carnitine is effective in improving the prognosis of infertile patients with idiopathic asthenozoospermia. More high quality trials with large sample are proposed.
Based on the principles and methods of systematic review of randomized controlled clinical trials, systematic review of economic analyses can integrate information from multiple economic studies which focus on the same clinical questions. It can also provide important insights by systematically examining how differences among studies lead to different results. Generally, there are seven steps to conduct such a review: 1) formulating questions; 2) establishing eligibility criteria; 3) searching and selecting eligible economic analyses; 4) assessing the validity of economic analyses; 5) acquiring data; 6) analyzing and synthesizing data; and 7) presenting results. Owing to the specificity of economic analyses, many methodological challenges exist, including the varieties of economic models, analytic perspectives, time horizons, and uncertainty and sensitivity analysis among different economic analyses. This may cause difficulties for critical assessment of the economic analyses.
Objective To investigate the regulations and implementation effect for high-risk drugs of the FDA and MHRA on the basis of natalizumab, and to provide references for the risk regulation of the innovative drugs and high-risk drugs of China. Methods We searched MEDLINE, EMBASE.com, the official website of Food and Drug Administration (FDA) and the Medicines and Healthcare Products Regulatory Agency (MHRA) for the marketing/withdrawal and risk regulation information of natalizumab as well as the relevant information of drug marketing/withdrawal and approval track. Results (1) Natalizumab was initially approved by the FDA through accelerated approval in November, 2004 with the phase three clinical trial still being conducted. But in February 2005, it was withdrawn after 3 patients developed PML. FDA resumed its marketing under a specially restricted distribution program called the Touch Prescribing Program in March, 2006. (2) Natalizumab was marketed in the European Union in April 2006. No cases of PML have been reported in the UK for this drug. (3) To speed the development of drugs that treat serious diseases, the FDA developed 3 distinct and successful approaches to make such drugs available as rapidly as possible: Priority Review, Accelerated Approval, and Fast Track. The proportion of new molecular entity and new biologic approved by fast tract were 45% and 74%, respectively between 2002 and 2009. (4) Drug regulation of MHRA contained: Yellow Card Scheme, Black Triangle products, Download Drug Analysis Prints (DAPs), and Defective Medicines Report Centre (DMRC). Self-reporting and monitoring system were fairly perfect, thus they can fulfill the close monitoring for high-risk drugs under the existing conditions and then realize the risk-minimization. Conclusion (1) The risk-minimization program of FDA for high-risk drugs is effective, and plays a role in the policy support for the researching and marketing of irreplaceable innovative drugs. (2) The risk regulation for high-risk drugs of MHRA is integrated into drug regulation program and enforces hierarchical management, and acquires risk-minimization effect. (3) We should learn from the policy and operational experience for the international new molecular entity and new biologic on the re-evaluation for innovative drugs and high-risk drugs. Combined with drug specific characteristics, evaluation indicators and criteria are developed base on evidence, risk management system and mechanism for innovative drugs are established and improved, and policy and administration security for the safety application of innovative drugs and high-risk drugs are provided.
Objective To systematically review the efficacy of preoperative administration of oral carbohydrates in patients undergoing elective hip replacement surgery. Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) about preoperative oral carbohydrate treatment in patients undergoing elective hip arthroplasty from inception to January, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 10 RCTs were included. The results of meta-analysis showed that: compared with the placebo group, the preoperative oral carbohydrate group had no significant differences in postoperative insulin resistance (SMD=5.14, 95%CI –1.05 to 11.33, P=0.10), length of hospital stay (MD=–0.26, 95%CI –1.11 to 0.58, P=0.54), rate of complications (OR=1.46, 95%CI 0.53 to 4.07, P=0.47), postoperative glucose and insulin level. Conclusion Current evidence shows that preoperative oral carbohydrate can not mediate postoperative insulin resistance. It also does not reduce length of hospital stay, postoperative glucose and insulin level. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.