Pub Date : 2024-10-29DOI: 10.3760/cma.j.cn112137-20240422-00954
As a technical tool to guide the optimal allocation of healthcare resources, pharmacoeconomic evaluation has been gradually applied to national healthcare decisions, including the adjustment of the National Reimbursement Drug List in China. With the acceleration of drug market approval and access to insurance coverage, the demand for pharmacoeconomic evaluation in healthcare decision-making is also increasing. Designing a pharmacoeconomic evaluation alongside clinical trials has become an important research direction and the source of evidence. In order to facilitate the standardization of this research field, the current consensus focuses on the topic of how to conduct a pharmacoeconomic evaluation alongside clinical trials from the Chinese healthcare system and decision-making context. The consensus group reconciled expert opinions and developed recommendations covering the entire process of study design, data collection and management, data analysis, and methods and results reporting. A total of 24 recommendations regarding to methodology and practice were developed from eighteen aspects including target population, selection of comparators, calculation of sample size, data collection of healthcare resource utilization, data collection of health-related quality of life, cost analysis, health outcome analysis, addressing the missing and censored data, etc., with the aim to provide reference for scholars and decision makers in this research filed.
{"title":"[Expert consensus on pharmacoeconomic evaluations alongside clinical trials (2024 edition)].","authors":"","doi":"10.3760/cma.j.cn112137-20240422-00954","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240422-00954","url":null,"abstract":"<p><p>As a technical tool to guide the optimal allocation of healthcare resources, pharmacoeconomic evaluation has been gradually applied to national healthcare decisions, including the adjustment of the National Reimbursement Drug List in China. With the acceleration of drug market approval and access to insurance coverage, the demand for pharmacoeconomic evaluation in healthcare decision-making is also increasing. Designing a pharmacoeconomic evaluation alongside clinical trials has become an important research direction and the source of evidence. In order to facilitate the standardization of this research field, the current consensus focuses on the topic of how to conduct a pharmacoeconomic evaluation alongside clinical trials from the Chinese healthcare system and decision-making context. The consensus group reconciled expert opinions and developed recommendations covering the entire process of study design, data collection and management, data analysis, and methods and results reporting. A total of 24 recommendations regarding to methodology and practice were developed from eighteen aspects including target population, selection of comparators, calculation of sample size, data collection of healthcare resource utilization, data collection of health-related quality of life, cost analysis, health outcome analysis, addressing the missing and censored data, etc., with the aim to provide reference for scholars and decision makers in this research filed.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 40","pages":"3736-3744"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.3760/cma.j.cn112137-20240410-00839
M He, Y Q Lai, X W Zhang, B Xu, Z J Ma, Q G Zhang, W T Song, X B Yang, K Hua, H Cui, X Lei, Y X Wang, C C Ma, Z H Zhang, X Y Wang, L J Cai, S Shen, H Xu
Objective: To investigate the clinical characteristics and correlated factors of preoperative sleep disorders in patients undergoing various types of cardiac surgery. Methods: The data of patients at the Structural Heart Surgery Center of Beijing Anzhen Hospital, Capital Medical University, from April 2023 to February 2024 were retrospectively collected. Patients were categorized into five groups based on cardiac surgical diagnosis: coronary heart disease, valvular disease, large vessel disease, congenital heart disease, and others. Each group was further subdivided into normal sleep (NS) and sleep disorder (SD) groups based on the Pittsburgh Sleep Quality Index (PSQI) scores. Demographic information, cognitive function, psychiatric symptoms, and other relevant data were collected. Clinical characteristics were compared between groups, and factors associated with preoperative sleep disorders were analyzed using multivariate logistic regression. Results: A total of 1 016 patients aged (58.6±12.7) years were included in the study, including 701 males and 315 females. The incidence of SD was 45.6% (463/1 016). Multivariate logistic regression analysis showed that aging was a risk factor for sleep disorders in patients with coronary heart disease (OR=1.050, 95%CI: 1.026-1.077) and valvular disease (OR=1.033, 95%CI: 1.013-1.053). High Self-rating Depression Scale (SDS) score was a risk factor for sleep disorders in patients with valvular disease (OR=1.050, 95%CI: 1.013-1.091). High score on the Montreal Cognitive Assessment (MoCA) subitem-abstraction ability was a protective factor for sleep disorders in patients with coronary heart disease (OR=0.695, 95%CI: 0.490-0.981). Conclusions: The risk factors of preoperative sleep disorders in cardiac surgery patients vary based on the type of cardiac disease. Aging, depression and abstraction ability correlate with sleep disorders in cardiac surgical patients.
{"title":"[Characteristics and correlated factors of preoperative sleep disorders in cardiac surgical patients].","authors":"M He, Y Q Lai, X W Zhang, B Xu, Z J Ma, Q G Zhang, W T Song, X B Yang, K Hua, H Cui, X Lei, Y X Wang, C C Ma, Z H Zhang, X Y Wang, L J Cai, S Shen, H Xu","doi":"10.3760/cma.j.cn112137-20240410-00839","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240410-00839","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the clinical characteristics and correlated factors of preoperative sleep disorders in patients undergoing various types of cardiac surgery. <b>Methods:</b> The data of patients at the Structural Heart Surgery Center of Beijing Anzhen Hospital, Capital Medical University, from April 2023 to February 2024 were retrospectively collected. Patients were categorized into five groups based on cardiac surgical diagnosis: coronary heart disease, valvular disease, large vessel disease, congenital heart disease, and others. Each group was further subdivided into normal sleep (NS) and sleep disorder (SD) groups based on the Pittsburgh Sleep Quality Index (PSQI) scores. Demographic information, cognitive function, psychiatric symptoms, and other relevant data were collected. Clinical characteristics were compared between groups, and factors associated with preoperative sleep disorders were analyzed using multivariate logistic regression. <b>Results:</b> A total of 1 016 patients aged (58.6±12.7) years were included in the study, including 701 males and 315 females. The incidence of SD was 45.6% (463/1 016). Multivariate logistic regression analysis showed that aging was a risk factor for sleep disorders in patients with coronary heart disease (<i>OR</i>=1.050, 95%<i>CI</i>: 1.026-1.077) and valvular disease (<i>OR</i>=1.033, 95%<i>CI</i>: 1.013-1.053). High Self-rating Depression Scale (SDS) score was a risk factor for sleep disorders in patients with valvular disease (<i>OR</i>=1.050, 95%<i>CI</i>: 1.013-1.091). High score on the Montreal Cognitive Assessment (MoCA) subitem-abstraction ability was a protective factor for sleep disorders in patients with coronary heart disease (<i>OR</i>=0.695, 95%<i>CI</i>: 0.490-0.981). <b>Conclusions:</b> The risk factors of preoperative sleep disorders in cardiac surgery patients vary based on the type of cardiac disease. Aging, depression and abstraction ability correlate with sleep disorders in cardiac surgical patients.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 40","pages":"3745-3750"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.3760/cma.j.cn112137-20240314-00578
J J Wang, Q Hua, H J Li, D M Zhang, Y L Wang
<p><p><b>Objective:</b> To investigate the repair effect of human umbilical cord blood mesenchymal stem cells (hUCB-MSC) on endometrium of intrauterine adhesion (IUA) by establishing animal model. <b>Methods:</b> Eighteen healthy female New Zealand white rabbits were divided into a control group, an IUA group and an hUCB-MSC transplantation group according to random number table method. The control group underwent laparotomy only. The IUA group underwent IUA modeling surgery using curettage and lipopolysaccharide (LPS) cotton placed in uterine cavity for double injury. The hUCB-MSC transplantation group received the same IUA modeling surgery followed by multipoint injection of hUCB-MSC suspension (2×10<sup>6</sup> cells/ml, 500 μl) into the bilateral uterine myometrium one week after surgery. Four weeks after the IUA modeling surgery, the rabbits were euthanized and samples were collected. Hematoxylin and eosin (HE) staining and Masson staining were used to assess the number of endometrial glands and the fibrosis rate. RNA sequencing was performed on the endometrium of the IUA group and hUCB-MSC transplantation group.The mRNA and protein expression of the fibrosis markers [transforming growth factor β1 (TGF-β1) and tissue inhibitors of metalloproteinase 1 (TIMP1)] and RNA sequencing-related parameters were detected by quantitative real-time PCR (qRT-PCR) and Western blot. <b>Results:</b> Compared with the control group, the number of glands in IUA group decreased (26.33±1.53 vs 4.33±1.53, <i>P</i><0.001), and the fibrosis rate increased (18.01%±2.21% vs 69.55%±2.42%, <i>P</i><0.001), indicating successful modeling. HE and Masson staining revealed that the number of glands in the hUCB-MSC transplantation group was increased compared with that in IUA group (17.33±2.52 vs 4.33±1.53, <i>P</i><0.001), and the fibrosis rate decreased (69.55%±2.42% vs 41.55%±1.99%,<i>P</i>=0.001). Western blot analyses of fibrosis-related proteins (TGF-β1 and TIMP1) showed elevated levels of TGF-β1 (0.91±0.05) and TIMP1 (0.99±0.01) proteins in the IUA group compared to control group (0.61±0.04, 0.68±0.07) (<i>P</i>=0.001, 0.015). The hUCB-MSC transplantation group exhibited reduced expression of TGF-β1 (0.69±0.04) and TIMP1 (0.62±0.08) proteins compared to the IUA group (<i>P</i>=0.005, 0.014). Western Blot results related to the PI3K/AKT signaling pathway [phosphorylated phosphatidylinositol 3-kinase (p-PI3K), phosphorylated protein kinase B (p-AKT)] showed that the expression of p-PI3K(1.05±0.05) and p-AKT(1.17±0.06) in the IUA group increased compared to the control group (0.78±0.03, 0.85±0.05) (<i>P</i>=0.002, 0.002). The expression of p-PI3K (0.74±0.02) and p-AKT (0.93±0.04) proteins in the hUCB-MSC transplantation group decreased compared to the IUA group (<i>P</i>=0.003, 0.005). <b>Conclusion:</b> hUCB-MSC can repair the damaged endometrium in rabbit intrauterine adhesion model by increasing the number of endometrial glands and improving its level of fibrosis.</p
{"title":"[Effect of mesenchymal stem cell derived from umbilical cord blood on rabbit intrauterine adhesion model].","authors":"J J Wang, Q Hua, H J Li, D M Zhang, Y L Wang","doi":"10.3760/cma.j.cn112137-20240314-00578","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240314-00578","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the repair effect of human umbilical cord blood mesenchymal stem cells (hUCB-MSC) on endometrium of intrauterine adhesion (IUA) by establishing animal model. <b>Methods:</b> Eighteen healthy female New Zealand white rabbits were divided into a control group, an IUA group and an hUCB-MSC transplantation group according to random number table method. The control group underwent laparotomy only. The IUA group underwent IUA modeling surgery using curettage and lipopolysaccharide (LPS) cotton placed in uterine cavity for double injury. The hUCB-MSC transplantation group received the same IUA modeling surgery followed by multipoint injection of hUCB-MSC suspension (2×10<sup>6</sup> cells/ml, 500 μl) into the bilateral uterine myometrium one week after surgery. Four weeks after the IUA modeling surgery, the rabbits were euthanized and samples were collected. Hematoxylin and eosin (HE) staining and Masson staining were used to assess the number of endometrial glands and the fibrosis rate. RNA sequencing was performed on the endometrium of the IUA group and hUCB-MSC transplantation group.The mRNA and protein expression of the fibrosis markers [transforming growth factor β1 (TGF-β1) and tissue inhibitors of metalloproteinase 1 (TIMP1)] and RNA sequencing-related parameters were detected by quantitative real-time PCR (qRT-PCR) and Western blot. <b>Results:</b> Compared with the control group, the number of glands in IUA group decreased (26.33±1.53 vs 4.33±1.53, <i>P</i><0.001), and the fibrosis rate increased (18.01%±2.21% vs 69.55%±2.42%, <i>P</i><0.001), indicating successful modeling. HE and Masson staining revealed that the number of glands in the hUCB-MSC transplantation group was increased compared with that in IUA group (17.33±2.52 vs 4.33±1.53, <i>P</i><0.001), and the fibrosis rate decreased (69.55%±2.42% vs 41.55%±1.99%,<i>P</i>=0.001). Western blot analyses of fibrosis-related proteins (TGF-β1 and TIMP1) showed elevated levels of TGF-β1 (0.91±0.05) and TIMP1 (0.99±0.01) proteins in the IUA group compared to control group (0.61±0.04, 0.68±0.07) (<i>P</i>=0.001, 0.015). The hUCB-MSC transplantation group exhibited reduced expression of TGF-β1 (0.69±0.04) and TIMP1 (0.62±0.08) proteins compared to the IUA group (<i>P</i>=0.005, 0.014). Western Blot results related to the PI3K/AKT signaling pathway [phosphorylated phosphatidylinositol 3-kinase (p-PI3K), phosphorylated protein kinase B (p-AKT)] showed that the expression of p-PI3K(1.05±0.05) and p-AKT(1.17±0.06) in the IUA group increased compared to the control group (0.78±0.03, 0.85±0.05) (<i>P</i>=0.002, 0.002). The expression of p-PI3K (0.74±0.02) and p-AKT (0.93±0.04) proteins in the hUCB-MSC transplantation group decreased compared to the IUA group (<i>P</i>=0.003, 0.005). <b>Conclusion:</b> hUCB-MSC can repair the damaged endometrium in rabbit intrauterine adhesion model by increasing the number of endometrial glands and improving its level of fibrosis.</p","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 40","pages":"3757-3764"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.3760/cma.j.cn112137-20240717-01637
Influenza is the most common acute respiratory infectious diseases among children in China. The annual seasonal influenza outbreak has a significant impact on children's health, poses a significant disease and socioeconomic burden, and arouses a wide public concern. In recent years, a number of new influenza vaccines and influenza antivirals have been approved for use in children, expanding the choices for prevention and treatment of influenza. Pediatric Infection Group, Chinese Society of Infectious Diseases of Chinese Medical Association and Infection Group, Pediatric Expert Committee of National Health Commission Capacity Building and Continuing Education, and China Clinical Practice Guidelines Alliance Methodology Committee organized a multidisciplinary guideline development group (GDG) consisting of experts in pediatrics, infectious diseases,epidemiologists,health policy,and guideline methodology proposed eight key issues concerning influenza vaccination and antiviral use from a practice perspective. Through research question construction, evidence retrieval and synthesis, evidence appraisal and evidence-to-decision discussion, recommendations and implementation suggestions were formulated. This guideline is intended to provide guidance for pediatricians at different facility levels and healthcare providers engaged in vaccination services,and institutional professionals dealing with prevention and control of infectious diseases.
{"title":"[Practice guideline of influenza vaccination and antiviral drugs use in children(2024 editon)].","authors":"","doi":"10.3760/cma.j.cn112137-20240717-01637","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240717-01637","url":null,"abstract":"<p><p>Influenza is the most common acute respiratory infectious diseases among children in China. The annual seasonal influenza outbreak has a significant impact on children's health, poses a significant disease and socioeconomic burden, and arouses a wide public concern. In recent years, a number of new influenza vaccines and influenza antivirals have been approved for use in children, expanding the choices for prevention and treatment of influenza. Pediatric Infection Group, Chinese Society of Infectious Diseases of Chinese Medical Association and Infection Group, Pediatric Expert Committee of National Health Commission Capacity Building and Continuing Education, and China Clinical Practice Guidelines Alliance Methodology Committee organized a multidisciplinary guideline development group (GDG) consisting of experts in pediatrics, infectious diseases,epidemiologists,health policy,and guideline methodology proposed eight key issues concerning influenza vaccination and antiviral use from a practice perspective. Through research question construction, evidence retrieval and synthesis, evidence appraisal and evidence-to-decision discussion, recommendations and implementation suggestions were formulated. This guideline is intended to provide guidance for pediatricians at different facility levels and healthcare providers engaged in vaccination services,and institutional professionals dealing with prevention and control of infectious diseases.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 40","pages":"3705-3725"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.3760/cma.j.cn112137-20240605-01273
M Zhang, M Y Sun, W Y He, S F Yu, W C Ma
<p><p><b>Objective:</b> To investigate the therapeutic effects and mechanisms of Ultrasound-targeted microbubble destruction (UTMD) technology combined with CoQ10 loaded PEGylated nanoliposomes (CoQ10-PEG-lips) on diabetic cardiomyopathy (DCM) in rats. <b>Methods:</b> CoQ10-PEG-lips were prepared using the thin-film dispersion method combined with ultrasonic hydration, followed by quality assessment. Sixty healthy and clean male SD rats were selected, and 50 were randomly chosen using a random number table to establish a type 1 diabetes mellitus (DM) model via a single intraperitoneal injection of streptozotocin. The remaining 10 rats were assigned as the normal control group. A total of 47 rats successfully developed the DM model, and 40 were selected using the random number table method. Based on different intervention methods, these rats were then randomly divided into DM model group, CoQ10 solution group, CoQ10-PEG-Lips group, and CoQ10-PEG-Lips+UTMD group (<i>n</i>=10 per group). Normal control group and DM model group rats were injected with 1 ml of normal saline through caudal vein. CoQ10 solution group and CoQ10-PEG-Lips group were injected with 1 ml of CoQ10 solution or CoQ10-PEG-Lips solution containing 10 mg/kg of CoQ10 through caudal vein, respectively. Rats in the CoQ10-PEG-Lips+UTMD group were injected with 1 ml of CoQ10-PEG-Lips solution containing 10 mg/kg of CoQ10+100 mg of freeze-dried ultrasound microbubble powder through caudal vein and were given UTMD treatment at the same time, with the intervention given twice a week. After 12 weeks of intervention, cardiac function indexes [left ventricular end-systolic diameter (LVEDs), left ventricular end-diastolic diameter (LVEDd), and left ventricular ejection fraction (LVEF)]of each group were measured by ultrasonic cardiac function detection in vivo. Simultaneously, ex-vivo histopathological examination was conducted to assess myocardial cell morphology, cross-sectional area, collagen volume fraction (CVF), and apoptosis index (AI) in each group. Additionally, molecular biology techniques were employed to measure oxidative stress-related indicators and the expression of apoptosis-related pathway proteins. <b>Results:</b> The prepared CoQ10-PEG-lips had a well-rounded morphology, good dispersibility, and a high encapsulation efficiency of 87.45%±3.23%. After 12 weeks of intervention, the myocardial cell morphology in the CoQ10-PEG-Lips+UTMD group was intact, with orderly arrangement, closely resembling that of the normal control group. There were no statistically significant differences between the two groups in terms of LVEDs [(1.53±0.07) mm vs (1.42±0.04) mm], LVEDd [(2.93±0.15) mm vs (2.81±0.05) mm], or LVEF (80.76%±3.42% vs 84.60%±2.10%) (all <i>P</i>>0.05). Similarly, there were no significant differences between the two groups in myocardial cell cross-sectional area, CVF, or AI (all <i>P</i>>0.05). The CoQ10-PEG-Lips+UTMD group showed statistically significant differences in th
{"title":"[Experimental study on the treatment of diabetic cardiomyopathy in rats by using ultrasound-targeted microbubble destruction combined with coenzyme Q10 loaded long-circulating nanoliposomes].","authors":"M Zhang, M Y Sun, W Y He, S F Yu, W C Ma","doi":"10.3760/cma.j.cn112137-20240605-01273","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240605-01273","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the therapeutic effects and mechanisms of Ultrasound-targeted microbubble destruction (UTMD) technology combined with CoQ10 loaded PEGylated nanoliposomes (CoQ10-PEG-lips) on diabetic cardiomyopathy (DCM) in rats. <b>Methods:</b> CoQ10-PEG-lips were prepared using the thin-film dispersion method combined with ultrasonic hydration, followed by quality assessment. Sixty healthy and clean male SD rats were selected, and 50 were randomly chosen using a random number table to establish a type 1 diabetes mellitus (DM) model via a single intraperitoneal injection of streptozotocin. The remaining 10 rats were assigned as the normal control group. A total of 47 rats successfully developed the DM model, and 40 were selected using the random number table method. Based on different intervention methods, these rats were then randomly divided into DM model group, CoQ10 solution group, CoQ10-PEG-Lips group, and CoQ10-PEG-Lips+UTMD group (<i>n</i>=10 per group). Normal control group and DM model group rats were injected with 1 ml of normal saline through caudal vein. CoQ10 solution group and CoQ10-PEG-Lips group were injected with 1 ml of CoQ10 solution or CoQ10-PEG-Lips solution containing 10 mg/kg of CoQ10 through caudal vein, respectively. Rats in the CoQ10-PEG-Lips+UTMD group were injected with 1 ml of CoQ10-PEG-Lips solution containing 10 mg/kg of CoQ10+100 mg of freeze-dried ultrasound microbubble powder through caudal vein and were given UTMD treatment at the same time, with the intervention given twice a week. After 12 weeks of intervention, cardiac function indexes [left ventricular end-systolic diameter (LVEDs), left ventricular end-diastolic diameter (LVEDd), and left ventricular ejection fraction (LVEF)]of each group were measured by ultrasonic cardiac function detection in vivo. Simultaneously, ex-vivo histopathological examination was conducted to assess myocardial cell morphology, cross-sectional area, collagen volume fraction (CVF), and apoptosis index (AI) in each group. Additionally, molecular biology techniques were employed to measure oxidative stress-related indicators and the expression of apoptosis-related pathway proteins. <b>Results:</b> The prepared CoQ10-PEG-lips had a well-rounded morphology, good dispersibility, and a high encapsulation efficiency of 87.45%±3.23%. After 12 weeks of intervention, the myocardial cell morphology in the CoQ10-PEG-Lips+UTMD group was intact, with orderly arrangement, closely resembling that of the normal control group. There were no statistically significant differences between the two groups in terms of LVEDs [(1.53±0.07) mm vs (1.42±0.04) mm], LVEDd [(2.93±0.15) mm vs (2.81±0.05) mm], or LVEF (80.76%±3.42% vs 84.60%±2.10%) (all <i>P</i>>0.05). Similarly, there were no significant differences between the two groups in myocardial cell cross-sectional area, CVF, or AI (all <i>P</i>>0.05). The CoQ10-PEG-Lips+UTMD group showed statistically significant differences in th","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 40","pages":"3765-3774"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.3760/cma.j.cn112137-20240814-01870
Immunoglobulin-G4 related ophthalmic disease (IgG4-ROD) is an immune-mediated fibroin flammatory condition characterized by ocular mass lesions and elevated plasma IgG4 level. Since all the ocular tissues can be involved, and it can be accompanied by multiple organ and systemic diseases, the diagnosis and treatment require multidisciplinary collaboration. The Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association and the Chinese Rheumatology Association convened experts in ophthalmology, and rheumatology and immunology, and formulated "Expert consensus on the diagnosis and treatment of immunoglobulin-G4 related ophthalmic disease (2024 edition)" for the diagnosis and treatment of IgG4-ROD based on domestic and international studies and experience. The consensus mainly standardized the diagnostic criteria of IgG4-ROD from the aspects of ocular imaging, serum IgG4 level and ocular histopathology, and recommended the methods and indications of drug therapy (glucocorticoids, immunosuppressants and biologics) and surgical treatment.
{"title":"[Expert consensus on the diagnosis and treatment of immunoglobulin-G4 related ophthalmic disease (2024 edition)].","authors":"","doi":"10.3760/cma.j.cn112137-20240814-01870","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240814-01870","url":null,"abstract":"<p><p>Immunoglobulin-G4 related ophthalmic disease (IgG4-ROD) is an immune-mediated fibroin flammatory condition characterized by ocular mass lesions and elevated plasma IgG4 level. Since all the ocular tissues can be involved, and it can be accompanied by multiple organ and systemic diseases, the diagnosis and treatment require multidisciplinary collaboration. The Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association and the Chinese Rheumatology Association convened experts in ophthalmology, and rheumatology and immunology, and formulated \"Expert consensus on the diagnosis and treatment of immunoglobulin-G4 related ophthalmic disease (2024 edition)\" for the diagnosis and treatment of IgG4-ROD based on domestic and international studies and experience. The consensus mainly standardized the diagnostic criteria of IgG4-ROD from the aspects of ocular imaging, serum IgG4 level and ocular histopathology, and recommended the methods and indications of drug therapy (glucocorticoids, immunosuppressants and biologics) and surgical treatment.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 40","pages":"3726-3735"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.3760/cma.j.cn112137-20240422-00952
H Zheng, D Zhao, M Gu, Q H Wang, C H Li, X Li, J Li, N Y Che, Y Hu
<p><p><b>Objective:</b> To analyze the clinical characteristics and prognostic factors of non-small cell lung cancer (NSCLC) patients with sensitive epidermal growth factor receptor (EGFR) mutations who developed small cell lung cancer (SCLC) transformation after treatment with EGFR tyrosine kinase inhibitors (TKI). <b>Methods:</b> We conducted a retrospective collection of clinical data for 21 patients with advanced EGFR mutant NSCLC who developed SCLC transformation after EGFR-TKI treatment at Beijing Chest Hospital, Capital Medical University from January 2015 to December 2021. The clinical characteristics were summarized and the prognosis analysis was conducted. Patients were followed up until February 2024. The efficacy was evaluated using Solid Tumor Response Evaluation Criteria, and survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to compare the differences in survival time (OS) between limited stage and extensive stage in transformed SCLC patients. Cox proportional hazards model was used to analyze the influencing factors of survival after SCLC transformation. <b>Results:</b> Among the 21 patients, there were 5 males and 16 females, with an age range of 33-74 years old [(58.9±2.6) years old]. All 21 patients were adenocarcinoma with sensitive EGFR mutations. There were 18 cases (85.7%) with EGFR gene 19del mutation, including 1 case of 19del+anaplastic lymphoma kinase (ALK) mutation, and 3 cases of L858R mutation. Among the transformed SCLC, there were 11 cases of pure SCLC and 10 cases of mixed SCLC (coexisting of adenocarcinoma and small cell carcinoma components). The median time from diagnosis of NSCLC to SCLC transformation was 12.0 months (95%<i>CI</i>: 7.6-16.3 months). Among the 21 cases of SCLC transformation, there were 13 cases with the extensive stage and 8 cases with the limited stage. Among them, 16 patients received systemic chemotherapy based on etoposide, of which 13 cases could be evaluated for efficacy, 11 cases could be calculated for PFS. Five cases had partial remission, 5 cases were stable, 3 cases had disease progression, and 3 cases cloud not be evaluated. The median progression free survival time (PFS) was 4.8 months (95%<i>CI</i>: 2.8-6.8 months). The median survival time (OS) after SCLC transformation in 21 patients was 10.6 months (95%<i>CI</i>: 7.0-14.2 months), with a median OS of 8.8 months (95%<i>CI</i>: 6.3-11.4 months) for patients with the extensive stage and 27.5 months (95%<i>CI</i>: 9.6-34.4 months) for patients with the limited stage, with statistically significant differences (<i>P</i>=0.002). Cox proportional hazards model analysis showed that the limited stage after SCLC transformation was a protective factor for OS (<i>HR</i>=0.32, 95%<i>CI</i>: 0.12-0.73, <i>P</i>=0.010). The median OS of 21 patients from the diagnosis of lung cancer was 24.9 months (95%<i>CI</i>: 13.0-36.7 months). <b>Conclusions:</b> NSCLC patients with SCLC transformation are all ade
{"title":"[Clinical characteristics and prognostic factors of epidermal growth factor receptor-mutated non-small cell lung cancer transformed into small-cell lung cancer after treatment].","authors":"H Zheng, D Zhao, M Gu, Q H Wang, C H Li, X Li, J Li, N Y Che, Y Hu","doi":"10.3760/cma.j.cn112137-20240422-00952","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240422-00952","url":null,"abstract":"<p><p><b>Objective:</b> To analyze the clinical characteristics and prognostic factors of non-small cell lung cancer (NSCLC) patients with sensitive epidermal growth factor receptor (EGFR) mutations who developed small cell lung cancer (SCLC) transformation after treatment with EGFR tyrosine kinase inhibitors (TKI). <b>Methods:</b> We conducted a retrospective collection of clinical data for 21 patients with advanced EGFR mutant NSCLC who developed SCLC transformation after EGFR-TKI treatment at Beijing Chest Hospital, Capital Medical University from January 2015 to December 2021. The clinical characteristics were summarized and the prognosis analysis was conducted. Patients were followed up until February 2024. The efficacy was evaluated using Solid Tumor Response Evaluation Criteria, and survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to compare the differences in survival time (OS) between limited stage and extensive stage in transformed SCLC patients. Cox proportional hazards model was used to analyze the influencing factors of survival after SCLC transformation. <b>Results:</b> Among the 21 patients, there were 5 males and 16 females, with an age range of 33-74 years old [(58.9±2.6) years old]. All 21 patients were adenocarcinoma with sensitive EGFR mutations. There were 18 cases (85.7%) with EGFR gene 19del mutation, including 1 case of 19del+anaplastic lymphoma kinase (ALK) mutation, and 3 cases of L858R mutation. Among the transformed SCLC, there were 11 cases of pure SCLC and 10 cases of mixed SCLC (coexisting of adenocarcinoma and small cell carcinoma components). The median time from diagnosis of NSCLC to SCLC transformation was 12.0 months (95%<i>CI</i>: 7.6-16.3 months). Among the 21 cases of SCLC transformation, there were 13 cases with the extensive stage and 8 cases with the limited stage. Among them, 16 patients received systemic chemotherapy based on etoposide, of which 13 cases could be evaluated for efficacy, 11 cases could be calculated for PFS. Five cases had partial remission, 5 cases were stable, 3 cases had disease progression, and 3 cases cloud not be evaluated. The median progression free survival time (PFS) was 4.8 months (95%<i>CI</i>: 2.8-6.8 months). The median survival time (OS) after SCLC transformation in 21 patients was 10.6 months (95%<i>CI</i>: 7.0-14.2 months), with a median OS of 8.8 months (95%<i>CI</i>: 6.3-11.4 months) for patients with the extensive stage and 27.5 months (95%<i>CI</i>: 9.6-34.4 months) for patients with the limited stage, with statistically significant differences (<i>P</i>=0.002). Cox proportional hazards model analysis showed that the limited stage after SCLC transformation was a protective factor for OS (<i>HR</i>=0.32, 95%<i>CI</i>: 0.12-0.73, <i>P</i>=0.010). The median OS of 21 patients from the diagnosis of lung cancer was 24.9 months (95%<i>CI</i>: 13.0-36.7 months). <b>Conclusions:</b> NSCLC patients with SCLC transformation are all ade","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 40","pages":"3751-3756"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.3760/cma.j.cn112137-20240724-01698
Y Wang, R Li
Chronic endometritis (CE) is an important factor leading to decreased endometrial receptivity, infertility, and repeated pregnancy loss; endometrial immune dysfunction, abnormal microbial flora, inflammatory status, and other factors play important roles in the occurrence and development of CE. Meanwhile, these factors are closely related to the pathophysiological mechanisms of common diseases that cause infertility, such as endometriosis, polycystic ovary syndrome, tubal diseases, and endometrial polyps. Through further development of high-quality prospective clinical research, microbiome and immunomics of CE and endometriosis,polycystic ovary syndrome and other diseases, to provide a new therapeutic idea for the treatment of refractory CE. In the course of clinical practice, the effective integration of the diagnosis and treatment principles of CE concomitant diseases in the treatment of CE is expected to provide a new choice for preventing the recurrence of CE.
慢性子宫内膜炎（CE）是导致子宫内膜接受能力下降、不孕和反复妊娠失败的重要因素；子宫内膜免疫功能失调、微生物菌群异常、炎症状态等因素在CE的发生和发展中起着重要作用。同时，这些因素与子宫内膜异位症、多囊卵巢综合征、输卵管疾病、子宫内膜息肉等导致不孕的常见疾病的病理生理机制密切相关。通过进一步开展高质量的前瞻性临床研究，将 CE 与子宫内膜异位症、多囊卵巢综合征等疾病的微生物组学和免疫组学相结合，为难治性 CE 的治疗提供新的治疗思路。在临床实践过程中，有效整合 CE 伴随疾病的诊治原则于 CE 的治疗中，有望为预防 CE 复发提供新的选择。
{"title":"[Call attention to the reproductive disorders of chronic endometritis].","authors":"Y Wang, R Li","doi":"10.3760/cma.j.cn112137-20240724-01698","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240724-01698","url":null,"abstract":"<p><p>Chronic endometritis (CE) is an important factor leading to decreased endometrial receptivity, infertility, and repeated pregnancy loss; endometrial immune dysfunction, abnormal microbial flora, inflammatory status, and other factors play important roles in the occurrence and development of CE. Meanwhile, these factors are closely related to the pathophysiological mechanisms of common diseases that cause infertility, such as endometriosis, polycystic ovary syndrome, tubal diseases, and endometrial polyps. Through further development of high-quality prospective clinical research, microbiome and immunomics of CE and endometriosis,polycystic ovary syndrome and other diseases, to provide a new therapeutic idea for the treatment of refractory CE. In the course of clinical practice, the effective integration of the diagnosis and treatment principles of CE concomitant diseases in the treatment of CE is expected to provide a new choice for preventing the recurrence of CE.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 39","pages":"3631-3635"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.3760/cma.j.cn112137-20240516-01129
Q H Li, R F Wang, F M Xue, X Q Li
Objective: To compare the characteristics of high-resolution anorectal manometry (HR-ARM) in children with outlet obstructive constipation (OOC) in different age groups. Methods: Retrospective inclusion of clinical data of functional constipation (FC) patients who underwent HR-ARM examination in the Department of Gastroenterology of Children's Hospital Affiliated of Zhengzhou University from January 2019 to September 2023 was conducted. The patients were divided into low age group (4 years old≤age<6 years) and high age group (6 years old≤age≤15 years old) according to age. They were divided into OOC group (the pediatric patients with uncoordinated pelvic floor muscle contractions, insufficient rectal thrust during defecation, or insufficient relaxation of anal sphincter muscles during contraction) and non-OOC group based on HR-ARM results. The rectal motility [rectal resting pressure, maximum squeeze pressure (MSP), rectal pressure during force delivery, residual anal pressure, rectal anal pressure gradient], rectal sensory function (initial rectal sensory capacity threshold, initial fecal sensory capacity threshold, defecation distress capacity threshold, and maximum tolerance capacity threshold) and other indicators were compared between OOC group and non-OOC group in 2 age groups, respectively. Results: A total of 228 children with FC were included, including 146 males and 82 females, with an age [M (Q1, Q3)] of 7.5 (6.0, 9.7) years, including 54 in the low age group and 174 in the high age group. There were 131 cases in the OOC group and 97 cases in the non-OOC group. Compared with non OOC children (24 cases), there were no statistically significant differences in rectal resting pressure, anal sphincter resting pressure, MSP, rectal pressure during force delivery, initial rectal sensory capacity threshold, initial fecal sensory capacity threshold, defecation distress capacity threshold, and maximum tolerance capacity threshold among OOC children (30 cases) in the low age group (all P>0.05). In the high age group, the residual anal pressure of the OOC children (101 cases) was higher than that of the non-OOC children (73 cases) [102 (70, 113) vs 41 (24, 58) mmHg (1 mmHg=0.133 kPa), P<0.001], and the rectal anal pressure gradient was lower than that of the non-OOC children [-43 (-55, -23) vs 16 (9, 29) mmHg, P<0.001];The initial fecal sensory capacity threshold of the OOC children was higher than that of the non-OOC children [90 (54, 110) vs 60 (50, 91) ml, P=0.024]. Conclusions: Compared with non-OOC children in the same age group, OOC children aged 6 years and above have higher residual anal pressure and initial fecal sensory capacity threshold, and lower rectal anal pressure gradient. There is no statistically significant differences in the rectal sensory function in children under 6 years old with OOC.
{"title":"[Comparative analysis of the characteristics of high-resolution anorectal manometry in children with outlet obstructive constipation of different age groups].","authors":"Q H Li, R F Wang, F M Xue, X Q Li","doi":"10.3760/cma.j.cn112137-20240516-01129","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240516-01129","url":null,"abstract":"<p><p><b>Objective:</b> To compare the characteristics of high-resolution anorectal manometry (HR-ARM) in children with outlet obstructive constipation (OOC) in different age groups. <b>Methods:</b> Retrospective inclusion of clinical data of functional constipation (FC) patients who underwent HR-ARM examination in the Department of Gastroenterology of Children's Hospital Affiliated of Zhengzhou University from January 2019 to September 2023 was conducted. The patients were divided into low age group (4 years old≤age<6 years) and high age group (6 years old≤age≤15 years old) according to age. They were divided into OOC group (the pediatric patients with uncoordinated pelvic floor muscle contractions, insufficient rectal thrust during defecation, or insufficient relaxation of anal sphincter muscles during contraction) and non-OOC group based on HR-ARM results. The rectal motility [rectal resting pressure, maximum squeeze pressure (MSP), rectal pressure during force delivery, residual anal pressure, rectal anal pressure gradient], rectal sensory function (initial rectal sensory capacity threshold, initial fecal sensory capacity threshold, defecation distress capacity threshold, and maximum tolerance capacity threshold) and other indicators were compared between OOC group and non-OOC group in 2 age groups, respectively. <b>Results:</b> A total of 228 children with FC were included, including 146 males and 82 females, with an age [<i>M</i> (<i>Q</i><sub>1</sub>, <i>Q</i><sub>3</sub>)] of 7.5 (6.0, 9.7) years, including 54 in the low age group and 174 in the high age group. There were 131 cases in the OOC group and 97 cases in the non-OOC group. Compared with non OOC children (24 cases), there were no statistically significant differences in rectal resting pressure, anal sphincter resting pressure, MSP, rectal pressure during force delivery, initial rectal sensory capacity threshold, initial fecal sensory capacity threshold, defecation distress capacity threshold, and maximum tolerance capacity threshold among OOC children (30 cases) in the low age group (all <i>P</i>>0.05). In the high age group, the residual anal pressure of the OOC children (101 cases) was higher than that of the non-OOC children (73 cases) [102 (70, 113) vs 41 (24, 58) mmHg (1 mmHg=0.133 kPa), <i>P</i><0.001], and the rectal anal pressure gradient was lower than that of the non-OOC children [-43 (-55, -23) vs 16 (9, 29) mmHg, <i>P</i><0.001];The initial fecal sensory capacity threshold of the OOC children was higher than that of the non-OOC children [90 (54, 110) vs 60 (50, 91) ml, <i>P</i>=0.024]. <b>Conclusions:</b> Compared with non-OOC children in the same age group, OOC children aged 6 years and above have higher residual anal pressure and initial fecal sensory capacity threshold, and lower rectal anal pressure gradient. There is no statistically significant differences in the rectal sensory function in children under 6 years old with OOC.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 39","pages":"3676-3680"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.3760/cma.j.cn112137-20240306-00504
L Xie, X Y Jia, M Z An, Y Z Xi, Z P Li, Q H Zhou
<p><p><b>Objective:</b> To compare the postoperative analgesic efficacy of ultrasound-guided infraspinatus-teres minor interfascial block and interscalene block in shoulder arthroscopic surgery. <b>Methods:</b> A total of 74 patients undergoing shoulder arthroscopic surgery at the Affiliated Hospital of Jiaxing University from December 2023 to February 2024 were prospectively included, whose age ranged from 18 to 80 years and the American Society of Anesthesiologists (ASA) grade were Ⅰ-Ⅲ. Patients were divided into two groups using block randomization: infraspinatus-teres minor interfascial block group (observation group) and interscalene block group (control group), with 37 cases in each group. In the anesthesia preparation room, all patients received nerve blocks under ultrasound guidance with 20 ml of 0.375% ropivacaine. Patient-controlled intravenous analgesia (PCIA) was administered to all patients following surgery. The primary outcome was the area under the curve (AUC) of the numeric rating scale (NRS) for pain within 24 hours postoperatively. Secondary outcome measures included the highest NRS score within 48 hours postoperatively, the amount of sufentanil used via PCIA within 48 hours postoperatively, the incidence of rescue analgesia and rebound pain, QoR-40 scores, and the rate of postoperative nausea and vomiting within 24 hours. The non-inferiority margin for the AUC of NRS scores between the two types of regional nerve blocks was set at "2.6". <b>Results:</b> A total of 35 patients were included in the observation group [17 males, 18 females, aged (58.1±9.1) years], and 36 patients were included in the control group [12 males, 24 females, aged (57.0±9.8) years]. The AUC of the NRS scores at rest within 24 hours post-operation was 51.7±10.9 in the observation group and 62.6±13.6 in the control group. The difference in AUC between the two groups was -10.9 (95%<i>CI</i>:-16.8--5.1), with the upper limit of the 95%<i>CI</i> falling below the predefined non-inferiority margin of "2.6" (non-inferiority <i>P</i><0.001). The highest NRS score [<i>M</i> (<i>Q</i><sub>1</sub>, <i>Q</i><sub>3</sub>)] within 48 hours post-surgery was 3 (3, 4) in the control group, which was significantly higher than the observation group's score of 2 (2, 3) (<i>P</i><0.001). During the postoperative period of 0-12 hours, the observation group received a median dose of 12 (10, 14) μg of sufentanil, which was significantly higher than the control group's dose of 8 (6, 10) μg (<i>P</i><0.001). During the postoperative period of 12-24 hours, the observation group received a median dose of 8 (8, 10) μg of sufentanil, which was significantly lower than the control group's median dose of 12 (10, 14) μg (<i>P</i><0.001). During the postoperative period of 24-48 hours, there was no statistically significant difference in the dose of sufentanil between the two groups of patients (<i>P</i>=0.548). In the observation group, the incidence of rescue analgesia within 48 hours
{"title":"[Comparison of the analgesic effects of infraspinatus-teres minor interfascial block and interscalene block under ultrasound guidance in patients undergoing arthroscopic shoulder surgery].","authors":"L Xie, X Y Jia, M Z An, Y Z Xi, Z P Li, Q H Zhou","doi":"10.3760/cma.j.cn112137-20240306-00504","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240306-00504","url":null,"abstract":"<p><p><b>Objective:</b> To compare the postoperative analgesic efficacy of ultrasound-guided infraspinatus-teres minor interfascial block and interscalene block in shoulder arthroscopic surgery. <b>Methods:</b> A total of 74 patients undergoing shoulder arthroscopic surgery at the Affiliated Hospital of Jiaxing University from December 2023 to February 2024 were prospectively included, whose age ranged from 18 to 80 years and the American Society of Anesthesiologists (ASA) grade were Ⅰ-Ⅲ. Patients were divided into two groups using block randomization: infraspinatus-teres minor interfascial block group (observation group) and interscalene block group (control group), with 37 cases in each group. In the anesthesia preparation room, all patients received nerve blocks under ultrasound guidance with 20 ml of 0.375% ropivacaine. Patient-controlled intravenous analgesia (PCIA) was administered to all patients following surgery. The primary outcome was the area under the curve (AUC) of the numeric rating scale (NRS) for pain within 24 hours postoperatively. Secondary outcome measures included the highest NRS score within 48 hours postoperatively, the amount of sufentanil used via PCIA within 48 hours postoperatively, the incidence of rescue analgesia and rebound pain, QoR-40 scores, and the rate of postoperative nausea and vomiting within 24 hours. The non-inferiority margin for the AUC of NRS scores between the two types of regional nerve blocks was set at \"2.6\". <b>Results:</b> A total of 35 patients were included in the observation group [17 males, 18 females, aged (58.1±9.1) years], and 36 patients were included in the control group [12 males, 24 females, aged (57.0±9.8) years]. The AUC of the NRS scores at rest within 24 hours post-operation was 51.7±10.9 in the observation group and 62.6±13.6 in the control group. The difference in AUC between the two groups was -10.9 (95%<i>CI</i>:-16.8--5.1), with the upper limit of the 95%<i>CI</i> falling below the predefined non-inferiority margin of \"2.6\" (non-inferiority <i>P</i><0.001). The highest NRS score [<i>M</i> (<i>Q</i><sub>1</sub>, <i>Q</i><sub>3</sub>)] within 48 hours post-surgery was 3 (3, 4) in the control group, which was significantly higher than the observation group's score of 2 (2, 3) (<i>P</i><0.001). During the postoperative period of 0-12 hours, the observation group received a median dose of 12 (10, 14) μg of sufentanil, which was significantly higher than the control group's dose of 8 (6, 10) μg (<i>P</i><0.001). During the postoperative period of 12-24 hours, the observation group received a median dose of 8 (8, 10) μg of sufentanil, which was significantly lower than the control group's median dose of 12 (10, 14) μg (<i>P</i><0.001). During the postoperative period of 24-48 hours, there was no statistically significant difference in the dose of sufentanil between the two groups of patients (<i>P</i>=0.548). In the observation group, the incidence of rescue analgesia within 48 hours","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 39","pages":"3661-3668"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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