Medicine

IntroductionInsomnia triggers an enormous burden on peoples physical and mental health, especially for the elderly. Traditional Chinese medicine (TCM) therapies were widely used for curing senile insomnia, while the efficiency among various external treatments of TCM (ETs-TCM) was rarely reported. MethodOur network meta-analysis aims to compare and evaluate the optimal ETs-TCM to cure insomnia in the geriatric population. We systematically searched randomized controlled trials (RCTs) published until April 27, 2023 from nine databases. All participants satisfying the diagnosis criteria were recruited without limiting sex, nationality, or race. ResultFrom the initial 13,846 terms searched, we read 2,936 full-text articles and finally included 85 studies (12,724 participants) in our network meta-analysis. The total effective (TE) rate and Pittsburgh Sleep Quality Index (PSQI) score were selected standards for evaluating the effects of ETs-TCM. Evaluated by TE, Qigong plus acupressure massage has the highest probability (83.5%) of being the most effective treatment from its Surface Under the Cumulative Ranking Curves (SUCRA) at 96.7. Additionally, when evaluated using the PSQI, Acupressure Massage had the highest probability (32.9%) of being the most effective treatment (SUCRA=90.9). ConculsionOur findings suggest that the combination of acupressure massage and Qigong, or either method alone, may be effective treatments for insomnia in the elderly. This study provides valuable insight for future senile insomnia interventions using ETs-TCM, emphasizing the significance of manual therapy and gentle mind-body exercise as an alternative to medication.

BackgroundNowadays, the combination of CAG regimen with targeted therapy and immunotherapy has greatly improved the prognosis of AML patients, but there are controversies about the prognostic factors of CAG regimen alone, especially in AML elders. ObjectiveBy investigating the survival status of elder patients who received induction CAG regimen in our hospital at the beginning of this century and analyzing the factors affecting survival, we aim to provide scientific evidence for improving the survival of current patients. MethodThe AML elder patients treated with induction CAG regimen including low-dose cytarabine (10 mg/m2 per 12 hours, day 1 to 14), aclarubicin(14 mg/m 2 per day, day 1 to 4), and G-CSF priming (200 ug / m2 per day, day 1 to 14) in Fujian Medical University Union Hospital from January 2001 to December 2009 were involved in this research. ResultsAmong 92 elderly AML patients, 44 (47.8%) showed clinical efficacy, while 48 (52.2%) experienced treatment failure (including 12 deaths (13.0%)). The main adverse reactions of chemotherapy were bone marrow suppression, with mild non hematological adverse reactions. The median recurrence time was 7 months. The risk factors related efficacy were high blasts, elevated LDH and HBDH. ConclusionThe CAG regimen is suitable for elderly patients and can be used for the treatment of relapsed refractory AML and secondary AML. The CAG regimen has mild non hematological adverse reactions. After chemotherapy, there is a longer bone marrow suppression period and a higher infection rate; The reason for the improved efficacy of CAG regimen in current patients may be related to the effective reduction of tumor burden during induction combined with target or immunotherapy.

ObjectiveThe main goal of this study is to determine whether engaging in core stability exercises benefits LBP sufferers. BackgroundAs a common exercise therapy, core stability training has gradually become the main treatment for LBP patients to relieve pain. Although many similar researches have showed a significant impact of core stability training on LBP, many scholars still have the opposite experimental conclusion, that is, core stability training has no significant therapeutic effect on LBP patients. MethodsOnly randomized controlled could be included in this study, and we used the Web of Science, Cochrane Library, Embase, CNKI databases, China Science and Technology Journal Database and PubMed for article retrieval. Among them, non-LBP patients, non-core training, and articles with imperfect outcome indicators were not included. ResultsThis analysis incorporated findings from 21 relevant studies in total. The results showed that, although that the overall effect was not significant, core stability training was helpful for LBP patients. The results of two secondary outcomes (generic health and specific function) showed that core stability training had no practical significance for the improvement of generic health and specific function of LBP patients. The specific results are as follows: pain (SMD = 2.74, 95%CI: 1.40-4.08, P < 0.0001), disability (SMD = 2.52, 95%CI: 1.69-3.36, P <0.00001), generic health (SMD = 1.08, 95%CI: 0.07-2.08, P = 0.04), specific function (SMD = 1.99, 95%CI: -0.04-4.02, P = 0.05). ConclusionsWe recommend that core stability training be used for short-term therapy, but not for long-term therapy.

BackgroundPercutaneous endoscopic lumbar discectomy (PELD), a minimally invasive spinal technique for lumbar disc herniation (LDH), has gained popularity globally and yielded satisfying results. However, PELD is often performed on awaking patients to avoid nerve injury, thus the intraoperative analgesia of PELD is sometimes insufficient. The effect of intrathecal morphine (ITM) has been well proved in various surgical specialties, and this study aims to investigate the effectiveness and safety of ITM on PELD. MethodsThe intrathecal morphine for percutaneous endoscopic lumbar discectomy (IMPELD) trial is a double-blind, randomized, placebo-controlled trial. The 90 eligible LDH patients undergoing PELD will be randomly assigned to receive either ITM or placebo during spinal anesthesia, at a 1:1 ratio, with a one-month follow-up period. Average intraoperative pain intensity will be the primary outcome. Secondary outcome measures include intraoperative pain intensity assessed at each 30 min intraoperatively, postoperative pain intensity, perioperative analgesia requirements, functional evaluation, radiographic characteristics, overall satisfaction, other characteristics and adverse events. DiscussionCurrently, there is a lack of scientific evidence to provide a reliable method to reduce intraoperative pain of PELD. The IMPELD trial was designed to provide evidence regarding whether 100 ug of ITM is an effective and safe coanalgesic approach for PELD procedure. Trial registrationThe trial was registered with the Chinese Clinical Trial Registry (identifier ChiCTR2000039842). Registered on November 11th, 2020.

Chronic post-thoracotomy pain is a common complication that affects 20% to 60% of patients who undergo surgery for lung cancer. The persistent pain affects quality of life and satisfaction with surgery. Intravenous paracetamol and mannitol, known to have analgesic and antipyretic properties, may help relieve moderate-to-severe post-operative pain. This trial aims to assess their effectiveness and safety in managing chronic post-thoracotomy pain in patients with lung cancer. This prospective double-blind randomized controlled clinical trial will be conducted at a single center. A total of 856 patients who will undergo thoracoscopic radical surgery for lung cancer will be enrolled and randomly assigned to test (intravenous paracetamol and mannitol) and control (intravenous normal saline) groups in a 1:1 ratio (428 patients in each group). Efficacy will be evaluated in terms of the incidence of chronic post-thoracotomy pain at 3 months (primary outcome). Secondary outcomes will include the dosage of propofol and remifentanil, numerical rating scale pain scores, number of times the patient-controlled intravenous analgesia button is pressed, occurrence of post-operative nausea and vomiting and respiratory depression, time to first flatus and ambulation after surgery, length of hospital stay, surgeon and patient satisfaction, and incidence of chronic post-thoracotomy pain at 6 and 12 months after surgery. Quality of daily life will be evaluated at 3, 6, and 12 months after surgery. Intention-to-treat analysis will also be conducted. The research protocol has been reviewed and approved by the Medical Thesis Committee of Henan Provincial Chest Hospital and Chest Hospital of Zhengzhou University on April 29, 2023 (reference: [2023] approval number: [04-06]). The results of this trial will be communicated to the participants and subsequently submitted for publication in peer-reviewed journals for wider dissemination. The study has been registered in the Chinese Clinical Trial Registry on June 27, 2023 (registration number: ChiCTR2300072869, available at https://www.chictr.org.cn/). The protocol version number is Version 1.1, dated August 20, 2023.

IntroductionWith the widely used technique of One Lung Ventilation (OLV) in patients throughout thoracic surgery, its unclear whether inhaled or intravenous anesthetics were associated with postoperative complications. The purpose of the current study is to compare the effects of intravenous and inhaled anesthetics on the postoperative complications within the patients suffering OLV. MethodsWe searched the related randomized controlled trials in PubMed\EMBASE\Medline and the Cochrane library up to 09\2021.Inclusive criteria were as follows: We included all the randomized controlled trials which compared the effects of intravenous and inhaled anesthetics on the postoperative complications[listed as: (a) major complications; (b)postoperative pulmonary complications (PPCs); (c) postoperative cognitive function (MMSE score); (d) length of hospital stay; (e) 30-days mortality] for the patients undergoing one lung ventilation. ResultsThirteen randomized controlled trials with 2522 patients were included for analysis. Overall, there were no significant differences in the postoperative major complications between inhaled and intravenous anesthetics groups (OR 0.78, 95%CI 0.54 to 1.13, p=0.19; I2=0%). However, more PPCs were detected in intravenous groups when compared to inhaled groups (OR 0.62, 95%CI 0.44 to 0.87, p=0.005; I2=37%). Both the postoperative MMSE scores (SMD -1.94, 95%CI -4.87 to 0.99, p=0.19; I2=100%) and the length of hospital stay (SMD 0.05, 95%CI -0.29 to 0.39, p=0.76; I2=73%) were comparable between two groups. Besides, the 30-day mortality didnt differ significantly across groups either (OR 0.79, 95%CI 0.03 to 18, p=0.88; I2=63%). ConclusionsIn patients undergoing OLV, generous anesthesia with inhaled anesthetics could reduce PPCs compared with intravenous anesthetics, but no evident advantages were provided over other major complications, cognitive function, hospital stay or mortality.

BackgroundAlthough various types of stent interventions have been found in clinical trials to be effective in treating coronary heart disease, researchers often use heterogeneous outcome measures. This can preclude the comparison of results across studies and prevent effective meta-analyses from answering important clinical questions. The need to standardize outcome measure reporting is urgent. This study aims to produce a core outcome set(COS) for coronary stent implantation research. MethodsWe performed a systematic review via the PubMed and EMBASE databases and then synthesized recommendations from international standardized endpoint definitions and consensus documents to generate a list of potential outcomes. We conducted a two-round Delphi survey, achieving the iterative selection of potential outcomes. A multidisciplinary panel of experts and patients with coronary stent implantation experience rated the importance of candidate outcomes on a 9-point Likert scale. To be provisionally accepted, outcomes needed to be critical important (score 7-9, with 9 being the maximum) by 70% of each stakeholder group. Finally, we held a consensus meeting to discuss and generate the COS. ResultsA total of seventy-two potential outcomes were identified by systematic literature review. We obtained nine key consensus documents to inform the standardized definitions of the outcomes. After duplication and combination of similar outcomes, 26 of the 72 outcomes assigned into five outcome domains were included in the Delphi surveys. Twenty outcomes were provisionally accepted. Following the consensus meetings, the agreement was reached on a twelve-item COS. ConclusionWe developed a COS for coronary stent implantation in coronary heart disease. Its implementation will facilitate the standardization reporting of clinical trials and reduce the heterogeneity in assessment in future research. Further research may help determine the specific, validated measurement instruments to assess each outcome. What is KnownO_LICoronary stent implantation is consider to be the primary method for treating coronary heart disease. C_LIO_LIMany trials use heterogeneous effectiveness and safety outcome measures with different defined and non-patient concerned outcome measures, which would largely prevent meta-analyses and contribute to selective reporting bias. C_LI What the Study AddsO_LIWe initially develop the first core outcome set(COS) of coronary stent implantation intervention for China to facilitate the standardization reporting of clinical trials and enable meta-analysis. C_LIO_LIIn our study, patient concerned outcome measure were thoroughly discussed and included in the COS by extensively involved patient representatives in every step of the project. C_LIO_LIAlthough we used rigorous method to development the COS, it should be updated as new evidence emerges in this rapidly evolving field. C_LI

IntroductionFailure to secure an airway during general anesthesia is a major cause of adverse events (AEs) in children. The safety of peddiatric anesthesia may be improved by identifying the incidence of AEs and their attributed risk factors. However, previous large cohort studies have not been appropriately designed to explore such aspects. Thus, this study aims to deternine the incidence of AEs and the risk factors attributed to airway management under general anesthesia in children. Methods and designThis prospective, multi-center, registry-based, observational study will be conducted in four tertiary care hospitals in Japan from June 2022 to May 2025. Children younger than 18 years of age undergoing surgical and/or diagnostic test procedures under general anesthesia or sedation by anesthesiologists will be enrolled in this study. Data on patient characteristics, discipline of anesthesia providers, and methodology of airway management will be collected through a standardized verification system under monitoring by institutional research leaders among the recruited institutions to minimize the loss of collected data. The primary outcome and exposure are AEs and presence of difficult airway features with potential confounders, which are related to the failure to secure the airway, and the variability in the anesthesia providers levels, adjusted using hierarchical multivariable regression models with mixed effects. DiscussionThis study will determine the incidence of AEs and the risk factors related to airway management under general anesthesia in children. Trial registrationThis study is registered as a prospective observational study in the University hospital Medical Information Network (UMIN) (registration number UMIN000047351, April 1, 2022).

Postoperative pain is the most notable issue after cesarean section (CS). Contributing factors include hyperalgesia, anxiety, depression, sleep disorders, and inflammation. This study explored the effects of esketamine on pain, hyperalgesia, depression, anxiety, sleep disorders, and inflammation after CS. This randomized, double-blind, controlled trial enrolled single-term pregnant women scheduled for elective CS. Participants were randomly included in the esketamine group (group E: intravenous esketamine 0.5 mg/kg + sufentanil 4 g/kg followed by patient-controlled intravenous analgesia [PCIA] with esketamine 0.5 mg/kg) or the control group (C: normal saline + sufentanil 4 g/kg PCIA). The primary outcome was the maximum pain numerical rating scale (NRS) score within 24 h postoperatively. Secondary outcomes included pain NRS scores for moving incision, visceral, and rest incision pain at 0-6 h, 6-12 h and 12-24 h; pressure pain threshold and tolerance at 30 min and 24 h postoperatively; PCIA drug consumption and number of compressions; time to first PCIA compression; serum C-reactive protein (CRP) at 24 h; incidence of drug-related side effects; and rates of anxiety, depression, and sleep disorders on postoperative day 2. Ninety-eight women were randomly included in group E (n=50) or C (n=48). Group E had significantly lower maximum NRS pain scores within 24 h (5 [4-5] vs. 6 [5-6], P=0.000) and relieved rest incision, visceral, and moving incision pain at all time points. The PCIA compression was significantly delayed, and CRP levels, as well as the incidence of postoperative depression, anxiety, and sleep disorders, were lower in group E. There were no statistically significant differences in hyperalgesia or side effects. Intravenous esketamine effectively reduces postoperative pain, psychological disorders, and inflammation after CS. This study was registered in the Chinese Clinical Trial Registry with registration number ChiCTR2300078310.

BackgroundSince December 2019, Coronavirus Disease 2019 (COVID-19) emerged in Wuhan city and rapidly spread throughout China. The mortality of novel coronavirus pneumonia (NCP) in severe and critical cases is very high. Facing this kind of public health emergency, high efficient administrative emergency responsive mode in designated hospital is needed. MethodAs an affiliated hospital of Sun Yat-sen University, our hospital is the only designated one for diagnosis and treatment of COVID-19 in Zhuhai, a medium-sized city. Novel coronavirus pneumonia department, which is administrative led by the president of hospital directly, has been established at early stage of epidemic crisis in my hospital. In NCP department, there are core members of Pulmonary and Critical Care Medicine (PCCM) specialist and multidisciplinary team. Dont stick to national guidelines of NCP, based on professional opinion by respiratory professor and expert group, we focused on individualized treatment and timely adjustment of treatment and management strategies in working about COVID-19 patients. Results1. High working efficiency: By Mar 02, 2020, we have completed 2974 citywide consultations and treatment of 366 inpatients, including 101 patients diagnosed with COVID-19. 2. Excellent therapeutic effect: Among 101 hospitalized patients with confirmed COVID-19, all were cured and discharged, except for one death. No secondary hospital infection, no pipeline infection and no pressure sore were found in all patients. 3. Finding and confirming person-to-person transmission characteristic of COVID-19 prior to official release conference: Strengthened protection is key point to zero infection in healthcare group and medical faculty and lower rate of second generation infectious patients. 4. Timely adjustment management and treatment strategy prior to guideline update: The first evidence of digestive tract involvement in COVID-19 has been found, and the earliest clinical trial of chloroquine in the treatment of COVID-19 has been carried out in our hospital. ConclusionsIn our hospital, establishment of NCP department, which is administratively led by the president of hospital directly and specialized conduct by respiratory professor, is the key to success in management and treatment of COVID-19 patients. This hospital emergency responsive mode could provide reference for other hospitals and cities in epidemic situation.

IntroductionAnterior Cruciate Ligament Reconstruction (ACLR) imposes substantial socioeconomic and healthcare burdens worldwide. In China, Traditional Chinese Medicine (TCM) has emerged as a popular complementary and alternative medicine strategy to relive pain and functional stability. However, the current evidence is insufficient to support the efficacy of TCM in addressing knee pain and improving physical function. This trial aims to assess the clinical effectiveness of TCM. Methods and analysisA total of 132 patients, aged between 18 and 50 years, will be recruited from Shuguang hospital. Eligible participants will be randomly allocated to either the experimental group receiving integrated TCM-Western rehabilitation intervention five sessions or the control group receiving conventional rehabilitation intervention per week. Both groups will undergo a 4-week intervention phase, followed by a 4-week follow-up period. The primary outcome measure is the change from baseline in Lysholm Score, Knee Muscle Strength, the Knee Injury and Osteoarthritis Outcome Score (KOOS), effusion, Muscle Thickness, The modified Star Excursion Balance Test (SEBT), Knee Range of Motion (ROM), Knee Proprioception. All adverse events occurring during the trial will be promptly documented. Ethics and disseminationThis study protocol has been approved by the Ethics Committee of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (Approval Number: 2024-1522-105-01). Prior to enrollment, written informed consent will be obtained from all eligible participants in accordance with ethical guidelines. Upon study completion, findings will be disseminated through peer-reviewed publications in academic journals and presented at relevant scientific conferences to ensure broad knowledge dissemination and contribute to evidence-based clinical practice. Trial registrationThe trial was registered on the Chinese Clinical Trial Platform (Registration No. ChiCTR2400085239) FundingKey Supporting Discipline Construction Projects in Shanghais Health System (2023ZDFC0301)

IntroductionMedulloblastoma (MB) is the most common childhood malignant brain tumor worldwide. Recently, molecular classification was established and started to play a role in the management of MB; however, studies involving molecular defined MB in Southeast Asia have been limited. We aimed to describe, and correlate clinical characteristics and molecular subgroups with therapeutic outcomes of Thai pediatric patients with MB. Materials and MethodsPediatric MB patients treated at King Chulalongkorn Memorial Hospital in Thailand from 2008 to 2018 were recruited. Patients were classified by clinical characteristics into standard- and high-risk groups, which determined treatment regimen. Retrospectively, available tumor tissues were classified into 3 molecular subgroups using immunohistochemistry: 1) WNT, 2) SHH, and 3) non-WNT/non-SHH. The primary outcome was 5-year overall survival (OS). Risk factors associated with OS were analyzed using cox regression analysis. ResultsFifty-three Thai pediatric patients with MB were enrolled. The median follow-up time was 60 months. The 5-year OS for all patients, and patients with standard-risk and high-risk were 74.2%, 76.3% and 71.4%, respectively. Tumor tissues of 24 patients were available, of which 23 could be molecularly classified. Two, one and 20 were in the WNT, SHH and non-WNT/non-SHH subtypes with 5-year OS of 100%, 100% and 78.9%, respectively. Using multivariate analysis, the interval of more than 8 weeks between surgery and radiotherapy was significantly correlated with a decrease in the 5-year OS. ConclusionInterval between surgery and radiotherapy within 8 weeks was associated with good therapeutic outcomes among Thai pediatric patients with MB. Simplified molecular subtyping combined with clinical characteristics is practical in risk classification of patients with MB in institutes with limited resources.

ObjectiveSystematically evaluate the risk prediction model for neonatal necrotizing enterocolitis (NEC) in China, providing reference for clinical work and future research. MethodsWe searched Chinese and English databases were systematically searched to focus on NEC risk prediction modeling studies.The search time ranged from database establishment to 25 August 2023.Two researchers independently screened the literature and extracted information.Then risk of bias and applicability were assessed by using the Prediction Model Risk of Bias Assessment Tool. ResultsA total of 10 papers involving 12 NEC risk prediction models were included, which is focusing on the populations of preterm infants mostly, building the methods of models diversity, predicting factors discrepancy widely. conclusionThe existing NEC risk prediction models in China have good predictive performance, while they often lack external validation, resulting in an overall high risk of bias. In the future, clinicians and nurses should learn from the evaluation criterions based on the PROBAST, then to test and verify them. Or machine learning algorithms usage is to construct models with operationalization and better predictive efficacy. [REGISTRATION: PROSPERO ID: CRD42024503844]

ObjectiveThe WT1 gene is considered as a poor prognostic factor for acute myeloid leukemia (AML) after Allogeneic hematopoietic stem cell transplantation (Allo-HSCT). However, the effect of the expression threshold of WT1 on the prognosisis controversial, which is evaluated in this meta-analysis. MethodsRelevant studies about the expression threshold of WT1 on the prognosis of AML after Allo-HSCT were searched in online databases. Data were extracted from them and analyzed by Stata16.0 software. ResultsFive studies involving 739 patients were screened out, including 433 cases experimental group and 306 cases control group. The experimental group and control group were compared for 1-year disease-free survival rate (DFS) [RR=1.19, 95%CI (1.03, 1.38), P =0.02] and 4-year DFS [RR= 1.18, 95%CI (0.98, 1.42), P =0.09]. The experimental group was lower than the control group in 1-year DFS, and there was no statistical significance in 4-year DFS. 1-year overall survival rate (OS) [RR=1.06, 95%CI (0.92, 1.23), P =0.40] and 4-year OS [RR= 1.16, 95%CI (1.03, 1.32), P =0.02], suggesting that the experimental group had a lower 4-year OS than the control group, and 1-year OS had no statistical significance. ConclusionsHigh WT1 expression is unfavorable to the prognosis of AML patients undergoing Allo-HSCT. A threshold of 250 copies/104ABL of WT1 may be the best value for predicting the poor prognosis in these patients.

PurposeTo investigate the correlation between perioperative oxygen concentration and postoperative organ damage and other adverse reactions in children undergoing neurosurgery. Materials and methodsThis study was a single-center retrospective cohort study that included 512 children undergoing neurosurgery, aged [&le;]14 years old, and with an operative duration [&ge;]2 hours who were transferred to the Postanesthesia Care Unit (PACU) of the Department of Anesthesiology, Beijing Tiantan Hospital, postop eratively during the period of October 2018 to September 2023. The medical records of the included children during hospitalization were meticulously reviewed and systematically collected through the Hospital Information System (His).The area under oxygen concentration-time curve AUCFIO2= the product of intraoperative oxygen concentration (percentage) and duration of anesthesia (minutes) was calculated, and then 512 children were divided into 3 groups according to the trichotomies of the AUCFIO2 (Group1:AUCFIO2<8720%min, Group2: 8720% min [&le;] AUCFIO2 [&le;] 13800% min, Group 3: AUCFIO2 > 13800% min) for inclusion in the data analysis. ResultsThe incidence of Emergency delirium was 24%, 26.9% and 19.4%, and the incidence of acute kidney injury was 0.6%, 2.3% and 0.6% in the three groups, respectively. There was no significant difference between the three groups (P> 0.05). The incidence of postoperative pulmonary complications in the three groups was 20.6%, 20.8% and 31.5%, respectively, and there was a statistically significant difference between the three comparisons (P<0.05). There were no significant differences in nausea, vomiting, hypoxemia, VAS score and PACU residence time among the three groups during PACU (P>0.05), and there was a statistically significant differences between infections and hospital stay during hospitalization (P<0.05). ConclusionsAlthough the oxygen concentration AUCFIO2 was not correlated with the occurrence of both postoperative AKI and ED, the longer the exposure time of conventional oxygen administration strategy, the higher the incidence of postoperative pulmonary complications and postoperative infections, and the longer the hospitalization time of children.

BackgroundIntermittent Pringle Manipulation (IPM) is among the most common methods used for controlling blood loss during hepatectomy. Ischaemia-reperfusion injury has also been associated with IPM. Ischaemic injury exposes the liver cells to hypoxia, adenosine triphosphate depletion, pH changes, and cellular metabolic stress, all of which can lead to cell damage and death. Reperfusion injury is caused by microcirculatory dysfunction, hypoxia, oxidative stress, and apoptosis. The pathophysiological mechanism of ischaemia-reperfusion injury is hyperkalaemia. Hyperkalaemia is closely related to the electrophysiological activity of the myocardium. Acute hyperkalaemia is associated with life-threatening ventricular arrhythmia and sudden cardiac arrest. Therefore, it is necessary to observe changes in patient serum potassium concentrations during IPM to provide a reference for developing a secure anaesthesia management approach. Methods and analysisThis was a single-centre, open, non-interventional, self-controlled study. All eligible consecutive patients were recruited from a regional medical centre and scheduled for elective hepatectomy. There was no control group; all participants were continuously enrolled from 1 October 2023 to 31 May 2025. The primary outcome was the perioperative serum potassium concentration during IPM. Secondary outcomes included perioperative electrocardiogram changes, lactic acid status, postoperative serum potassium concentration, alanine amine transferase, and aspartate amine transferase peaks, adverse events, serious adverse events, and postoperative hospital stay. These parameters were statistically compared. Subgroup analysis will be performed according to liver disease type and duration of IPM. DiscussionOur finding will provide a reference for developing a secure anaesthesia management approach for anesthesiologists. Ethics and disseminationThe Biomedical Ethics Review Committee of the Peoples Hospital of Jianyang City approved the study protocol (ethics reference: JY202383). All relevant ethical guidelines were followed in this study. The findings will be disseminated in peer-reviewed journals, publicly available reports to be published online, and academic conferences. Trial RegistrationThis trial was registered on 25 August 2023 in the Chinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR2300074753.

IntroductionThe optimal dosage of dexmedetomidine (DEX) as an adjuvant combined with ropivacaine for postoperative analgesia in laparoscopic myomectomy is still controversial. The main aim of this prospective clinical trial was to evaluate the analgesic effect and relevant adverse effects of different doses of dexmedetomidine applied locally for ropivacaine-induced bilateral transmuscular quadratus lumborum block (TQLB). MethodsTQLB was conducted using different doses of dexmedetomidine per side (R group: control group; DEX1 group: 0.1g/kg; DEX2 group: 0.3g/kg; DEX3 group: 0.5g/kg). Numeric rating scales (NRS) of pain score, heart rate (HR) and blood pressure (BP) were assessed at different time points after performing TQLB. Dosage of additional analgesics via patient-controlled analgesia pump, recovery time for anal exsufflation, hospital stay and clinical events such as nausea, vomiting and pruritus were also compared among groups. ResultsA total of 200 patients underwent laparoscopic myomectomy were enrolled in this study and divided into 4 groups (R, DEX1, DEX2 and DEX3 group) randomly, 50 for each group. Compared with R group, NRS pain score was significantly lower in DEX2 group and DEX3group (p<0.001) 10 minutes after TQLB. Twenty minutes after TQLB, statistical significance of NRS pain score appeared between DEX1 group and R group (p<0.05) and between DEX2, 3 group and DEX1 group (p<0.001). In comparison to R group and DEX1 group, NRS pain score in DEX2 and DEX3 group were lower within 24 hours postoperatively (p<0.05). HR in DEX2 group and DEX3 group was significantly lower than DEX1 group and R group (p<0.05). 2 patients in DEX2 and DEX3 group were developed severe low HR of which HR was below 50bpm. Even 6 hours after surgery, patients in DEX3 group still remained severe low HR. Patients in DEX2 group and DEX3 group needed fewer PCA bolus deliveries than patients in R group and DEX1 group (p<0.001). Satisfaction score of postoperative analgesia was higher in DEX2 group and DEX3 group in comparison to DEX1 group and R group (p<0.001).group and DEX3 group in comparison to DEX1 group and R group (p<0.001). Conclusion0.3g/kg per side of dexmedetomidine as an adjuvant for TQLB was recommended to effectively relieve postoperative pain after laparoscopic myomectomy. Trial registrationChinese Clinical Trial Registry with registration number ChiCTR1900028509. Date of registration: 24 November 2019. http://www.chictr.org.cn/edit.aspx?pid=42635=htm=4

ObjectiveThis study aims to comprehensively evaluate and compare the effects of various exercise modalities on the control of chronic nonspecific low back pain through a network meta-analysis, in order to identify the most effective interventions. MethodsAdhering strictly to the PRISMA guidelines, this study selected randomized controlled trials from databases including PubMed, Web of Science, Embase, Cochrane Library, and Scopus, up to June 30, 2024. Data were processed using Stata 17.0 software, and the effect sizes were synthesized using standardized mean differences (SMD) with 95% confidence intervals (CI). The SUCRA method was used to rank the effectiveness of the interventions. ResultsA total of 26 studies involving 1,507 participants aged between 20 and 63.5 years were included. The network meta-analysis revealed that yoga [SMD = -1.71 (-2.93, -0.49), P < 0.05] and core stability training [SMD = -0.81 (-1.44, -0.18), P < 0.05] were significantly more effective than the control group. SUCRA probability ranking indicated that Tai Chi (SUCRA = 77.4) might be the best modality for improving control of chronic nonspecific low back pain. ConclusionThis network meta-analysis demonstrates the intervention effects of different exercise modalities on chronic nonspecific low back pain, with Tai Chi potentially being the most effective intervention. This provides an important reference for non-pharmacological interventions in chronic nonspecific low back pain.

BackgroundDegenerative cervical myelopathy (DCM) is a leading cause of spinal cord dysfunction. While cervical laminoplasty (LAMP) is the standard treatment, the optimal fixation technique, specifically between the conventional suture-anchor method and the modern mini-plate system, remains debated. Although mini-plates offer rigid fixation, they are associated with higher costs and even exist potential complications of lamina reclosure by screw dislodgement or hinge fracture. This study aims to verify the non-inferiority of the suture-anchor method compared to the mini-plate method in double-door LAMP. MethodsThis is a multicenter, open-label, non-inferiority randomized controlled trial. A total of 216 patients with DCM (cervical spondylotic myelopathy [CSM] or ossification of the posterior longitudinal ligament [OPLL]) will be recruited from three high-volume spine centers in Japan. Participants will be randomized (1:1) to undergo double-door LAMP using either mini-plates (control group) or suture-anchors (experimental treatment group). The primary endpoint is the recovery rate of the Japanese Orthopaedic Association (JOA) score at 1 year postoperatively. Secondary endpoints include operative time, blood loss, clinical assessments (EQ-5D-5L, visual analog scale [VAS], and neck disability index [NDI]), radiological outcomes (cervical spinal alignment, lamina retention rate, hinge fracture, bone union, and MRI findings), direct medical costs, and perioperative complications. ConclusionsWe hypothesize that the suture-anchor technique is non-inferior to the mini-plate system regarding neurological recovery and laminar stability. By rigorously comparing these techniques, this trial seeks to establish high-level evidence for a surgical strategy that maintains clinical standards while potentially reducing healthcare costs. Name of the registryJapan Registry of Clinical Trials (jRCT). Trial registry numberjRCT1032250437 Registration datahttps://jrct.mhlw.go.jp/latest-detail/jRCT1032250437

Although immune checkpoint inhibitors have illustrated strong benefits in patient survival and have been widely acknowledged in treating lung cancer, they may be subject to increased risk of immune-related adverse effects (irAEs). Although existing literature have studied the mechanisms of irAEs of immunotherapy, it is difficult to quantify such effect, especially at a large-scale real-world population level. In this paper, the autoimmune-related risk of multiple immune checkpoint inhibitors is compared with that of chemotherapy based on Medicaid and CHIP TAF (T-MSIS Analytic File) data of over 100,000 patient samples from 2012 to 2018. Results show that the irAEs of immunotherapy is significantly higher than chemotherapy in both unadjusted and adjusted samples from the dataset. Analysis on subpopulation and specific disease types further shows that certain immunotherapy treatments are associated with higher risk of irAEs, and the risk of certain autoimmune diseases may vary. We also illustrate the robustness of our conclusion through additional sensitivity analysis, confirming the necessity of keeping track of autoimmune side effects of immune checkpoint inhibitors for medicine researchers. Our methods are also available to evaluate effectiveness and side effects of novel therapies at a large-scale population level.