Objective To assess the effectiveness of acupuncture for tension-type headache. Methods A systematic review of the relevant randomized controlled trials (RCTs) of acupuncture for tension-type headache was performed using the methods of The Cochrane Collaboration. Trials were collected from The Cochrane Library, Issue 4, 2003, MEDLINE (1966 to March 2004), CBM (1978 to August 2003), VIP (1989 to April 2003) and handsearched all related articles published in Chinese in 2003. The quality of literature was reviewed, and data were extracted by two reviewers independently. Meta-analysis was conducted using RevMan 4.2 software. Results Thirteen RCTs involving 571 patients were included, of the thirteen RCTs, six were of high methodological quality according to Jadad scale (the Jadad score≥3), and “sham acupuncture” was used as controlled intervention in eight trials. Meta-analysis indicated that no statistical difference was detected between acupuncture and sham acupuncture groups on effectiveness with RR 1.55, 95%CI 0.97 to 2.47 and P=0.07 at the end of treatment. No statistical difference was detected between acupuncture and sham acupuncture groups on visual analogue scale at the end of treatment with WMD －0.55, 95%CI －1.20 to 0.09 and P=0.09; at the end of follow-up of less than 2 months with WMD －0.22, 95%CI －0.87 to 0.42 and P= 0.50 and at the end of follow-up of more than 2 months with WMD －0.65, 95% CI －1.41 to 0.11 and P=0.09. Conclusions Comparing acupuncture with sham acupuncture and other treatments, current evidence can not evaluate whether acupuncture is significantly effective for tension-type headache, more RCTs of high methodological quality are required.
Objective Mucin 1 （MUC1）and Thomsen-Friedenreich related antigens （TFRA）gene play an important role in the occurrence and development of tumor，so we will discuss its research advancements and clinical applications below. Methods Foreign and native related literatures published in recent 10 years were retrieved，and a further exploration on the expression relationship and clinical research progression of MUC1 and TFRA were reviewed. Results MUC1 and TFRA expressed in a high degree of specificity in malignant tumors，and their expressions interacted with each other. Many MUC1 related vaccines had been introduced to clinical in recent years，and some drugs based on TFRA had been put into clinical experiment as gene therapy methods too. Conclusions MUC1 and TFRA may be used as new target antigens of specific immunotherapy for malignant tumor. That they express in high or low level is closely related to tumor biological behavior and prognosis， moreover， they are important to the diagnosis and treatment of cancer.
Colorectal cancer is one of the common malignant tumor in the world, and about 57.6% of colorectal cancer surgical cases in our country are rectal cancer patients, which occupies a major proportion. Some patients with rectal cancer may already have emergencies such as intestinal obstruction or limited perforation at the time of consultation, which require immediate relevant treatment measures. Currently, there are multiple surgical and endoscopic treatment strategies available for obstructive and perforated rectal cancer. Surgeons need to perform an accurate and comprehensive assessment of the disease, define the goals of the current treatment, and formulate an appropriate treatment plan based on the patient’s clinical and oncological status in order to optimize the patient’s oncological outcome while minimizing the risk of complications associated with emergency colorectal surgery.
Interventional radiology (IR) has developed rapidly since its introduction into our country. More and more patients choose this minimally invasive procedure for treatment, but the incidence of infectious complications and potential mortality following IR procedures should not be underestimated. As the number and breadth of IR procedures grow, it becomes increasingly evident that interventional radiologists and infection control practitioners must possess a thorough understanding of these potential infectious complications and put more emphasis on the quality of care, so as to control the infections and expenses, and maximize the patient safety. This article reviews infectious complications associated with percutaneous ablation of liver tumors, transarterial embolization of liver tumors, percutaneous transhepatic cholangial drainage, and intravascular stents or grafts. Emphasis is placed on incidence, risk factors, and prevention. With the use of these strategies, IR procedures can be performed with reduced risk of infectious complications.
Objective To review the research progress of injection sites of local infiltration analgesia (LIA) in total knee arthroplasty (TKA). MethodsThe relevant domestic and foreign literature in recent years was extensively reviewed. The neuroanatomy of the knee, and the research progress of the selection and the difference of effectiveness between different injection sites of LIA in clinical studies were summarized. ResultsLarge concentrations of nociceptors are present throughout the various tissues of the knee joint. Patellar tendon, subpatellar fat pad, lateral collateral ligament insertions, iliotibial band insertions, suprapatellar capsule, and posterior capsule were more sensitive to pain. Most current studies support injections into the lateral capsule, collateral ligament, retinaculum, quadriceps tendon, fat pad, and subcutaneous tissue. Whether to inject into the back of the knee and subperiosteum is controversial. ConclusionThe relative difference of knee tissue sensitivity to pain has guiding significance for the selection of LIA injection site after TKA. Although researchers have conducted clinical trials on injection site and technique of LIA in TKA, there are certain limitations. The optimal scheme has not been determined yet, and further studies are needed.
ObjectiveTo compare the application effects between personal specific instrumentation (PSI) and computer-assisted navigation surgery (CAS) in total knee arthroplasty (TKA). MethodsThe literature comparing the application effects of PSI and CAS in TKA in recent years was widely consulted, and the difference between PSI-TKA and CAS-TKA in operation time, lower limb alignment, blood loss, and knee function were compared. ResultsCompared to CAS-TKA, PSI-TKA simplifies operation procedures and shortens operation time but probably has worse lower limb alignment. It is still controversial in comparison of perioperative blood loss and knee function between two techniques. ConclusionPSI-TKA and CAS-TKA both have advantages and disadvantages, and their differences need to be confirmed by further high-quality clinical trial.
Objective To collect the data of nosocomial infection surveillance in secondary and tertiary medical institutions in Jiangsu Province and conduct comparative analysis among different regions to find out the gaps and provide basis for targeted continuous improvement. MethodsCombined with the requirements of grade hospital evaluation and high-quality development of public hospitals, the data of nosocomial infection incidence in medical institutions of Jiangsu Province in the first quarter of 2023 were collected by autonomous reporting and information capture, and the province was divided into three regions according to location: South Jiangsu, Central Jiangsu and North Jiangsu for analysis, so as to evaluate the regional level. Results A total of 109 medical institutions were included, including 78 tertiary hospitals and 31 secondary hospitals. The overall incidence rate of nosocomial infection was 0.81% (0.90%). The incidence of central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinarytract infection (CAUTI) were 0.113‰, 1.553‰ and 0.424‰, respectively. The proportion of prophylactic drugs in Class Ⅰ incision and the incidence of surgical site infection in Class Ⅰ incision were 17.72% and 0.16%, respectively. In the above infection indicators, the incidences of CLABSI and VAP were higher in Central Jiangsu, while the other indicators were higher in South Jiangsu than in Central Jiangsu than in North Jiangsu. The utilization rate of antibiotics and the detection rate of pathogens in inpatients were 41.07% and 41.50%, respectively. Among South, North, and Central Jiangsu, the utilization rate of antibiotics was 41.83%, 41.51%, and 39.51%, respectively (χ2=446.789, P<0.001), and the detection rate of pathogens was 46.09%, 40.94%, and 35.09%, respectively (χ2=3036.865, P<0.001). In the detection rate of drug-resistant bacteria infection, the top 3 were carbapenem-resistant Acinetobacter baumannii (0.067%), carbapenem-resistant Klebsiella pneumoniae (0.031%) and methicillin-resistant Staphylococcus aureus (0.029%). Among them, the infection rate of drug-resistant bacteria in South Jiangsu was significantly higher than that in the other two regions. The detection rates of carbapenem-resistant Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus were close to each other (83.77% vs. 53.91%), while the detection rates of carbapenem-resistant Escherichia coli (χ2=95.619, P<0.001), carbapenem-resistant Klebsiella pneumoniae (χ2=520.855, P<0.001) and carbapenem-resistant Pseudomonas aeruginosa (χ2=191.918, P<0.001) in South Jiangsu were significantly higher than those in Central and North Jiangsu. Conclusions There are significant differences in nosocomial infection surveillance data of medical institutions in different regions of Jiangsu Province. It is emphasized that targeted quality control feedback, supervision and rectification should be carried out while hospital infection monitoring.
Objective To analyze the impact of robot assistance on the restoration of limb length and offset distance in total hip arthroplasty (THA). Methods A retrospective analysis was conducted on the clinical data of 316 patients who underwent unilateral primary THA between September 2019 and August 2023. Among them, 117 patients underwent robot-assisted THA (group A), and 199 patients underwent conventional THA (group B). There was no significant difference between the two groups in the gender, age, or side of the hip replacement (P>0.05); but there was a significant difference in the preoperative diagnosis (P<0.05). The leg length discrepancy (LLD) and global offset (GO) dfference were measured on preoperative anteroposterior pelvic X-ray films, and absolute values were used for comparison between groups. Results The operations in both groups were successfully completed. Postoperative imaging measurements showed that the LLD and GO dfference in group A were significantly lower than those in group B (P<0.05). Among them, group A had 32 cases (27.4%), 5 cases (4.3%), and 0 case (0) of LLD>3 mm, >5 mm, and >10 mm, respectively, while group B had 115 cases (57.8%), 75 cases (37.7%), and 22 cases (11.1%), respectively; and the differences in above indicators between groups were significant (P<0.05). Group A had 40 cases (34.2%), 3 cases (2.6%), and 0 case (0) of GO dfference>5 mm, >10 mm, and >20 mm, respectively; group B had 103 cases (51.8%), 54 cases (27.1%), and 7 cases (3.5%), respectively. There was no significant difference in the proportion of patients with GO>20 mm between groups (P>0.05), while there were significant differences in other indicators between groups (P<0.05). Conclusion Compared with traditional THA, robot assisted THA has more advantages in restoration of limb length and offset distance.
Objective To investigate the effect of rivaroxaban on the risk of bleeding after total knee arthroplasty (TKA). Methods A total of 119 cases undergoing primary TKA because of knee osteoarthritis between June 2009 and May 2011, were randomly divided into the rivaroxaban group (59 cases) and the control group (60 cases). There was no significant difference in gender, age, height, weight, side, disease duration, and grade of osteoarthritis between 2 groups (P gt; 0.05). Thepreoperative preparation and operative procedure of 2 groups were concordant. At 1-14 days after TKA, rivaroxaban 10 mg/d were taken orally in the rivaroxaban group, and placebo were given in the control group. The blood routine examination was performed before operation and at 2 days postoperatively; the total blood loss and hemoglobin (HGB) decrease were calculated according to the formula; the blood loss, postoperative wound drainage, and wound exudate after extubation were recorded to calculate the dominant amount of blood loss; and the bleeding events were recorded within 35 days postoperatively. Results The total blood loss and HGB decrease were (1 198.34 ± 222.06) mL and (33.29 ± 4.99) g/L in the rivaroxaban group and were (1 124.43 ± 261.01) mL and (31.57 ± 6.17) g/L in the control group, showing no significant difference (P gt; 0.05); the postoperative dominant blood loss in the rivaroxaban group [(456.22 ± 133.12) mL] was significantly higher than that in the control group [(354.53 ± 96.71) mL] (t=4.773, P=0.000). The bleeding events occurred in 3 cases (5.1%) of the rivaroxaban group and in 1 case (1.7%) of the control group, showing no significant difference (χ2=1.070, P=0.301). Conclusion Rivaroxaban has some effects on the risk of bleeding after TKA. In general, rivaroxaban is safe.