Objectives To evaluate the effectiveness of different antidepressant drugs in addition to standard clinical care in the prevention of postnatal depression. To compare the effectiveness of different antidepressant drugs and with any other form of intervention for postnatal depression i.e. hormonal, psychological or social support. To assess any adverse effects of antidepressant drugs in either the mother or the foetus/infant.Methods The register of clinical trials maintained and updated by the Cochrane Depression, Anxiety and Neurosis Group and the Cochrane Pregnancy and Childbirth Group.Randomised studies of antidepressants alone or in combination with another treatment, compared with placebo or a psychosocial intervention in non-depressed pregnant women or women who had given birth in the previous six weeks (i.e. women at risk of postnatal depression). Data were extracted independently from the trial reports by the authors.Missing information was requested from investigators wherever possible. Data were sought to allow an intention to treat analysis.Results Two trials fullled the inclusion criteria for this review. Both looked at women with a past history of postpartum depression.Nortriptyline (n=26) did not show any benefit over placebo (n=25). Sertraline (n=14) reduced the recurrence of postnatal depression and the time to recurrence when compared with placebo (n=8). Intention to treat analyses were not carried out in either trial.Conclusions It is not possible to draw any clear conclusions about the effectiveness of antidepressants given immediately postpartum in preventing postnatal depression and, therefore, cannot be recommended for prophylaxis of postnatal depression, due to the lack of clear evidence. Larger trials are needed which also include comparisons of antidepressant drugs with other prophylactic treatments to reect clinical practice, and examine adverse effects for the foetus and infant, as well as assess womens’ attitudes to the use of antidepressants at this time.
Evidence-based evidence translated into health care services requires three conversion processes, preclinical research-clinical research-implementation research, which might take a very long time. In order to speed up the process of research results translated into daily medical practice and health policy, an effectiveness-implementation hybrid design combining the effectiveness research of clinical and implementation research was emerging. This paper introduced the concept, classification and application of effectiveness-implementation hybrid design, to provide references for researchers in this area.
ObjectiveTo discuss the effectiveness of operative treatments for different kinds of old injury of extensor tendon in zone II so as to choose the best surgical approach based on the classification of injury. MethodsBetween May 2006 and May 2014, 68 cases of old injury of extensor tendon in zone II were treated. Among them, there were 50 males and 18 females with an average age of 36 years (range, 18-52 years). The causes included contusion injury in 50 cases, avulsion injury in 11 cases, and burn injury in 7 cases. The left side was involved in 21 cases and the right side in 47 cases. The injured finger involved the index finger in 18 cases, the middle finger in 21 cases, the ring finger in 24 cases, and the little finger in 5 cases. The disease duration was 1.5 months to 1 year (mean, 6.75 months). The central slip of extensor was repaired directly in 32 patients who had normal passive motion. Side cross stitch (8 cases) or Littler-Eaton (10 cases) method was used in 18 patients who can not extend actively and passively. Tendon graft was performed in 11 patients with tendon defect. Joint release was given in 7 patients with contracture after burn injury. ResultsPrimary healing of incision was obtained in all cases. Sixty-eight cases were followed up 3-12 months (mean, 6.9 months). Three cases had tendon adhesion in varying degrees and suffered from pain, which was treated conservatively by functional exercise. Recurrence was observed in 2 cases, and extensor tendon was repaired again. According to total active motion (TAM) function assessment, the results were excellent in 52 cases, good in 11 cases, fair in 3 cases, and poor in 2 cases with an excellent and good rate of 92.6%. ConclusionAdaptive operation method for old injury of extensor tendon in zone II should be selected based on the type of injury. The results will be satisfactory if correct method is chosen.
Objective To compare the effectiveness between locking compression plate (LCP) and locked intramedullary nail (IMN) for humeral shaft fractures of types B and C. Methods Between January 2010 and January 2012, 46 patients with humeral shaft fractures of types B and C were treated, and the clinical data were retrospectively analyzed. LCP was used for internal fixation in 22 cases (LCP group), and IMN in 24 cases (IMN group). There was no significant difference in gender, age, injury causes, the side of fracture, the site of fracture, the type of fracture, associated injury, and time from injury to operation between 2 groups (P gt; 0.05). The regular clinical examination and evaluation of radiography were done. Shoulder function was evaluated by Neer grading system and elbow function was evaluated by Mayo elbow performance score after operation. Results The operation time and intraoperative blood loss in IMN group were significantly lower than those in LCP group (P lt; 0.05). There was no significant difference in hospitalization time between 2 groups (t=0.344, P=0.733). All patients were followed up 16.8 months on average (range, 12-24 months). At 6 months after operation, bone nonunion occurred in 1 patient of LCP group and in 2 patients of IMN group; the bone healing rate was 95.5% (21/22) in LCP group and 91.7% (22/24) in IMN group, showing no significant difference (χ2=0.000, P=1.000). Except for nonunion patients, the bone healing time was (11.77 ± 0.75) weeks in LCP group and (11.38 ± 0.82) weeks in IMN group, showing no significant difference (t=1.705, P=0.095). Between LCP and IMN groups, significant differences were found in radial nerve injury (4 cases vs. 0 case) and impingement of shoulder (0 case vs. 6 cases) (P lt; 0.05), but no significant difference in superficial infection (1 case vs. 0 case) and iatrogenic fracture (1 case vs. 2 cases) (P gt; 0.05). There was no significant difference in shoulder function and elbow function at 1 year after operation between 2 groups (P gt; 0.05). Conclusion LCP fixation and IMN fixation for humeral shaft fractures of types B and C can achieved satisfactory results. More attention should be paid to avoiding radial nerve injury by fixation of LCP; nail tail should be buried deeply into the cortex of the greater tuberosity and rotator cuff should be protected to decrease the rate of impingement of shoulder by fixation of IMN.
ObjectiveTo evaluate the safety and efficacy of local sodium citrate anticoagulation for routine hemodialysis in high-risk patients with hemorrhage.MethodsA total of 150 patients who were admitted to West China Hospital from October 2018 to March 2019 for routine hemodialysis treatment with high-risk bleeding were selected as study objects. The patients were divided into without heparin anticoagulation group (group A) and with 4% sodium citrate anticoagulation group (group B) by random number table method, with 75 cases in each group. Biochemical indicators, serum calcium ion concentration, local anticoagulation safety index of citrate and dialysis adequacy index, blood coagulation in dialyzer and tube during dialysis wre observed in the two groups.ResultsThe coagulation events in group B were significantly lower than those in group A (Z=–4.889, P<0.001), and the urea clearance index in group B was higher than that in group A [(1.26±0.12) vs. (0.73±0.13) L/(min·1.73 m2); t=22.418, P<0.05]. There was a significant difference in the changes of urea nitrogen [(3.53±1.05) vs.(3.12±1.11) mmol/L; t=2.323, P=0.021] 24 hours after dialysis; other indicators showed no statistically significant difference (P>0.05). After the filter, serum calcium ion concentrations in group B at different time points were lower than those in group A [2 hours: (0.52±0.07) vs. (0.64±0.08) mmol/L; 4 hours: (0.56±0.09) vs.(0.63±0.09) mmol/L; t=5.198, 0.525, P<0.001], and the coagulation time was higher in group B than that in group A [2 hours: (172.56±14.78) vs. (151.45±19.81) s; 4 hours: (168.45±16.48) vs. (152.88±16.54) s; t=7.396, 5.775, P<0.001]. None of the patients had dialysis-related adverse events.ConclusionFour percent sodium citrate is effective and safe in anticoagulation therapy for hemodialysis patients, and it can reduce the risk of coagulation in dialyzer and ensure the adequacy of maintenance hemodialysis.
Meibomian gland dysfunction (MGD) is a common ocular surface disease, and the pathogenesis of MGD is closely related to the alteration of meibomian gland morphology and (or) function. At present, the treatment strategy for MGD consists of physical therapy, artificial lubricants, topical and systemic antibiotics and anti-inflammatory agents, topical steroids and Ω-3 dietary supplementation. Recently, the thermal pulsation system (LipiFlow) has been used clinically, which allows heat to be applied to the palpebral surfaces of the upper and lower eyelids directly over the meibomian glands, while simultaneously applying pulsatile pressure to the outer eyelid surfaces. Due to its specific design, the cornea and eyeball can successfully avoid the potential damage from overheating and improper expression, which will greatly improve the safety during the clinical application and patients’ compliance. Studies have showed that the effectiveness of LipiFlow when treating MGD is at least as well as twice-daily lid warming and massage for 3 months, which displays a broad application prospect. At present, the application of LipiFlow in China has not been fully developed, and only some hospitals have experimental applications. This paper summarizes the research progress of LipiFlow treatment in MGD.
Objective To study the efficacy and adverse events of adjunctive perampanel in children with refractory epilepsy. Methods A prospective study was carried out in 45 children with refractory epilepsy, who were treated in our hospital from January 2020 to February 2021 using perampanel as an add-on treatment, with a criteria for enrollment and the starting dose of perampanel. Follow-up would be taken at once a month. Afte 3 months would check blood routine, liver function, kidney function and humoral immunity. The EEG was reviewed after 6 months. The initial dose of perampanel was 0.04 mg/(kg·d) (the maximum didn't exceed 2 mg/d), increasing by 0.04 mg/(kg·d) every two weeks, and the maximum maintenance dose didn't exceed 6 mg/d. The efficacy and adverse reactions of perampanel were evaluated by comparing the seizure frequency and EEG results before and after a 6-month add-on therapy.ResultsAmong the 45 children,complete seizure control was achieved in 7 cases after the therapy, and the seizure attacks were reduced in 26 cases, showing a total response rate of 73.3%. After the treatment, the epileptiform discharge of 28 children was reduced, and the effective rate was 62.22%. During the observation period, all the blood routine, liver function, kidney function,and humoral immunity of the children were normal.10 cases of adverse reactions occurred after the additional treatment of perampanel, and the adverse reaction rate was 22.22%. Conclusions Perampanel has good efficacy and safety in the add-on treatment of refractory epilepsy.
Objective To explore the effectiveness and safety of ziprasidone in the treatment of female patients with schizophrenia. Methods A before-after study design with prospective consecutive data collection was adopted. From June 2006 to May 2007, 30 female patients with schizophrenia discharged from the Second Veterans Hospital of Shanxi Province were included. Ziprasidone 60-120 mg/d was orally administered for 6 weeks. Positive and Negative Syndrome Scale (PANSS) and Treatment Emergent Symptom Scale (TESS) were measured before the treatment and at the end of Week 2, 4 and 6 after the treatment, respectively.Results At Week 6, the significant improvement rate and the total improvement rate were 86.67% and 93.33%, respectively; the incidence of side effects was 86.67%. Conclusion Ziprasidone is safe and effective in the treatment of schizophrenia. Since it will not increase body weight or the level of prolactin, it can be especially applied to female schizophrenic patients.
ObjectivesThe primary objectives of this rapid health technology assessment (RHTA) were to assess the safety and effectiveness of Da Vinci surgical system compared with traditional e surgeries, so as to provide the currently-available best evidence for health decision makers and clinical workers. MethodsA comprehensive search of electronic databases (EMbase, PubMed, The Cochrane Library, Web of Science, CNKI, VIP, CBM and WanFang Data) and relevant professional HTA websites were conducted from inceptionto October 9, 2012. Two reviews independently screen literature according to the inclusion and exclusion criteria, extracted data, and assess the quality of included studies. The data based on secondary studies were reported, and a final recommendation and its level was made based on assessment outcome. ResultsA total of 21 studies were included, encompassing 7 HTAs and 14 systematic reviews/metaanalyses. The included studies involved radical prostatectomy, hysterectomy, nephrectomy, coronary artery bypass graft, and gastric fundoplication. Though the included HTAs and systematic reviews/meta-analyses focus on different diseases, the outcomes showed significant differences existed between Da Vinci surgical system and other routine surgery in clinical effectiveness and safety of different diseases. Compared with routine surgery, Da Vinci surgical system shortened hospital stay; decreased operation conversion rates, blood loss and blood transfusion rates during surgery; but it increased operative time. Besides, compared with traditional laparoscopic surgery, Da Vinci surgical system shortened operation time and hospital stay, and decreased operation conversion rates, blood loss and blood transfusion rates during surgery. ConclusionCurrent evidence shows that the clinical effectiveness and safety outcomes of Da Vinci surgical system differ in diseases. Currently, most included HTAs and systematic reviews/meta-analyses are based on observational studies, relevant prospective randomized controlled trials lack, and the evidence is graded as low quality, health decision makers are suggested to apply this evidence with caution on the basis of comprehensive consideration.
Objective To provide the objective basis for the evaluation of the operative results of vascularized greater trochanter bone flap in treating osteonecrosis of the femoral head (ONFH) by three-dimensional gait analysis. Methods Between March 2006 and March 2007, 35 patients with ONFH were treated with vascularized greater trochanter bone flap, and gait analysis was made by using three-dimensional gait analysis system before operation and at 1, 2 years afteroperation. There were 23 males and 12 females, aged 21-52 years (mean, 35.2 years), including 8 cases of steroid-induced, 7 cases of traumatic, 6 cases of alcohol ic, and 14 cases of idiopathic ONFH. The left side was involved in 15 cases, and right side in 20 cases. According to Association Research Circulation Osseous (ARCO) classification, all patients were diagnosed as having femoral-head necrosis at stage III. Preoperative Harris hip functional score (HHS) was 56.2 ± 5.6. The disease duration was 1.5-18.6 years (mean, 5.2 years). Results All incisions healed at stage I without early postoperative compl ications of deep vein thrombosis and infections of incision. Thirty-five patients were followed up 2-3 years with an average of 2.5 years. At 2 years after operation, the HHS score was 85.8 ± 4.1, showing significant difference when compared with the preoperative score (t=23.200, P=0.000). Before operation, patients showed a hip muscles gait, short gait, reduce pain gait, and the pathological gaits significantly improved at 1 year after operation. At 1 year and 2 years after operation, step frequency, pace, step length and hip flexion, hip extension, knee flexion, ankle flexion were significantly improved (P lt; 0.01). Acceleration-time curves showed that negative wave and spinous wave at acceleration-stance phase of front feet and hind feet in affected l imb were obviously reduced at 1 year and 2 years after operation. Postoperative petronas wave appeared at swing phase; the preoperative situation was three normal phase waves. Conclusion These results suggest that three-dimensional gait analysis before and after vascularized greater trochanter for ONFH can evaluate precisely hip vitodynamics variation.