Paradoxical herniation associated with hyperbaric oxygen therapy after decompressive craniectomy: A case report

BACKGROUND Whether hyperbaric oxygen therapy(HBOT)can cause paradoxical herniation is still unclear.CASE SUMMARY A 65-year-old patient who was comatose due to brain trauma underwent decompressive craniotomy and gradually regained consciousness after surgery.HBOT was administered 22 d after surgery due to speech impairment.Paradoxical herniation appeared on the second day after treatment,and the patient’s condition worsened after receiving mannitol treatment at the rehabilitation hospital.After timely skull repair,the paradoxical herniation was resolved,and the patient regained consciousness and had a good recovery as observed at the follow-up visit.CONCLUSION Paradoxical herniation is rare and may be caused by HBOT.However,the underlying mechanism is unknown,and the understanding of this phenomenon is insufficient.The use of mannitol may worsen this condition.Timely skull repair can treat paradoxical herniation and prevent serious complications.

Synergistic chemotherapy/PTT/oxygen enrichment by multifunctional liposomal polydopamine nanoparticles for rheumatoid arthritis treatment

Amultifunctional liposomal polydopamine nanoparticle(MPM@Lipo)was designed in this study,to combine chemotherapy,photothermal therapy(PTT)and oxygen enrichment to clear hyperproliferating inflammatory cells and improve the hypoxic microenvironment for rheumatoid arthritis(RA)treatment.MPM@Lipo significantly scavenged intracellular reactive oxygen species and relieved joint hypoxia,thus contributing to the repolarization of M1 macrophages into M2 phenotype.Furthermore,MPM@Lipo could accumulate at inflammatory joints,inhibit the production of inflammatory factors,and protect cartilage in vivo,effectively alleviating RA progression in a rat adjuvant-induced arthritis model.Moreover,upon laser irradiation,MPM@Lipo can elevate the temperature to not only significantly obliterate excessively proliferating inflammatory cells but also accelerate the production of methotrexate and oxygen,resulting in excellent RA treatment effects.Overall,the use of synergistic chemotherapy/PTT/oxygen enrichment therapy to treat RA is a powerful potential strategy.

Effect of Zangfu ointment and massage therapy on functional constipation:a protocol for a randomised controlled trial

Introduction:Functional Constipation(FC)is a type of functional bowel disease that is in Clinically characterized by dysportia,decreased frequency of bowel movements,or incomplete bowel movements in the absence of irritable bowel syndrome syndrome,at least 6 months before diagnosis,and symptoms within the last 3 months.At present,commonly used drugs include enema and suppositories,laxatives,microecological preparations,gastrointestinal motility drugs and other treatments.However,the effect is limited.Traditional Chinese medicine(TCM)treatment of FC has advantages.Methods:In this randomized controlled study,244 eligible patients were randomly assigned in a 1:1 ratio to a treatment group(Zangfu ointment and massage therapy+Lactulose Oral Liquid)and a control group(Lactulose Oral Liquid)for 14 days.Number of spontaneous defecation per week and First defecation time will be used as primary outcomes,and Traditional Chinese Medicine(TCM)syndrome scores and syndrome scores,PAC-QOL form will be used as secondary outcomes.Blood routine,liver function,and renal function will be used as safety outcomes.The primary and secondary outcomes will be performed at 0th,7th,and 14th day,and the safety outcomes will be performed at 0th and 14th day.Ethics and dissemination:Ethical approval has been obtained from the Committee on Health Research Ethics of the Fangshan Hospital,Beijing University of Chinese Medicine,Beijing,People's Republic of China(FZY LK-2020-010)on September 18,2020.All patients will be provided oral and written information about the trial before screening.The study results will be disseminated by peer-review publications and conference presentations.Trial registration number:ChiCTR2000038754(registered on April 14,2021).This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial license,which permits others to distribute,remix,adapt,build upon this work non-commercially,and license their derivative works on different terms,provided the original work is properly cited,appropriate credit is given,any changes made indicated,and the use is non-commercial.STRENGTHS AND LIMITATIONS OF THIS STUDY(1)The efficacy of the Zangfu ointment and massage therapy is evaluated in a randomised,double-blind 2-week clinical trial in FC patients.(2)Form a complete and generalizable regimen for the treatment of FC(Qi stagnation)with the Zangfu ointment and massage therapy.

The neuroprotective effects of oxygen therapy in Alzheimer’s disease:a narrative review

Alzheimer’s disease(AD)is a degenerative neurological disease that primarily affects the elderly.Drug therapy is the main strategy for AD treatment,but current treatments suffer from poor efficacy and a number of side effects.Non-drug therapy is attracting more attention and may be a better strategy for treatment of AD.Hypoxia is one of the important factors that contribute to the pathogenesis of AD.Multiple cellular processes synergistically promote hypoxia,including aging,hypertension,diabetes,hypoxia/obstructive sleep apnea,obesity,and traumatic brain injury.Increasing evidence has shown that hypoxia may affect multiple pathological aspects of AD,such as amyloid-beta metabolism,tau phosphorylation,autophagy,neuroinflammation,oxidative stress,endoplasmic reticulum stress,and mitochondrial and synaptic dysfunction.Treatments targeting hypoxia may delay or mitigate the progression of AD.Numerous studies have shown that oxygen therapy could improve the risk factors and clinical symptoms of AD.Increasing evidence also suggests that oxygen therapy may improve many pathological aspects of AD including amyloid-beta metabolism,tau phosphorylation,neuroinflammation,neuronal apoptosis,oxidative stress,neurotrophic factors,mitochondrial function,cerebral blood volume,and protein synthesis.In this review,we summarized the effects of oxygen therapy on AD pathogenesis and the mechanisms underlying these alterations.We expect that this review can benefit future clinical applications and therapy strategies on oxygen therapy for AD.

Effects of oxygen therapy on the outcome of patients with acute myocardial infarction:A randomized clinical trial

Objective:To investigate the therapeutic effects of supplemental oxygen on patients with myocardial infarction.Methods:This study was a randomized,double-blind clinical trial.The study population included all patients who were admitted to the emergency room of Ali-ibn-Abitaleb and Khatam-al-Anbia hospitals in Zahedan within six hours of the onset of classic symptoms of myocardial infarction.The patients(n=47)were divided into two groups:the case group(with oxygen therapy)and the control group(without oxygen therapy).The initial follow-up was evaluated after one month and the second follow-up was evaluated after three months in the target population in terms of mortality caused by acute myocardial infarction,mortality caused by any other cause,and re-hospitalization caused by acute myocardial infarction.Results:Out of the 47 patients,27 were male(57.4%).The average age of the patients was(60.9±8.1)years.One month after admission,2 patients(8.7%)in the case group and 2 patients(8.3%)in the control group died due to acute myocardial infarction.A total of 7 patients(14.9%)died three months after admission.There was no significant difference between the control and case groups in terms of mortality caused by acute ischemia within one and three months.After one month,2 patients(8.7%)in the case group and 1 patient(4.2%)in the control group died of other causes.After three months,4 patients(8.5%)in total died for other causes.There was no significant difference between the control and case groups in terms of mortality due to other causes within one and three months.One month after admission,5 patients(21.7%)of the case group and 4 patients(16.7%)of the control group were re-hospitalized due to acute myocardial ischemia.During the next three months,3 patients(13.0%)of the case group and 5 patients(20.8%)of the control group were re-hospitalized.There was no significant difference between the control and case groups regarding the rate of re-hospitalization caused by acute myocardial infarction within one and three months after admission.Conclusions:There is no significant relationship between oxygen therapy and death by acute myocardial ischemia,or any other causes.The relationship between oxygen therapy and the rate of re-hospitalization caused by acute myocardial ischemia is not found within one and three months after admission.The results show that oxygen therapy does not affect patients with acute myocardial ischemia within three months after admission.

Research progress on reactive oxygen species production mechanisms in tumor sonodynamic therapy

In recent years,because of the growing desire to improve the noninvasiveness and safety of tumor treatments,sonodynamic therapy has gradually become a popular research topic.However,due to the complexity of the therapeutic process,the relevant mechanisms have not yet been fully elucidated.One of the widely accepted possibilities involves the effect of reactive oxygen species.In this review,the mechanism of reactive oxygen species production by sonodynamic therapy(SDT)and ways to enhance the sonodynamic production of reactive oxygen species are reviewed.Then,the clinical application and limitations of SDT are discussed.In conclusion,current research on sonodynamic therapy should focus on the development of sonosensitizers that efficiently produce active oxygen,exhibit biological safety,and promote the clinical transformation of sonodynamic therapy.

Effectiveness of topical oxygen therapy in wound healing for patients with diabetic foot ulcer

Objectives:Non-healing wounds have been one of the major challenges in health care because of increased morbidity,especially for those who have diabetes mellitus.Numerous regimens are being innovated to produce an evidence-based practice that would minimize complications and promote healing.Topical oxygen therapy is an innovation in wound care that has been considered influential in the wound healing process.This intervention aims to increase the oxygen concentration in the affected limb to promote wound healing.Methods:This research applied an experimental design that targeted a total of 60 adult patients aged 45–64 years with diabetic foot ulcers.A randomized systematic sampling technique was used to allow equal chances and prevent bias.In total,30 patients in the control group received usual care for diabetic foot ulcers,and the remaining 30 patients in the experimental group received topical oxygen therapy together with standard care for diabetic foot ulcers.Subjects were assessed using the Wagner-Meggitt Wound Classification System.Results:The result proved that there was a significant difference in the wound grade of patients in the experimental group after the application of the usual wound care plus the topical oxygen therapy using Friedman's test.The control and experimental groups were compared using Mann–Whitney statistical analyses,and the results showed that there was a significant difference between the control and experimental groups after the application of topical oxygen therapy.Conclusions:Topical oxygen therapy was demonstrated to be effective to aid in the wound healing process of patients with diabetic foot ulcers.Fur ther research was recommended to improve the application of topical oxygen therapy to patients with chronic wounds and promote the wound healing process.

Effectiveness of cognitive behavior therapy for sleep disturbance and glycemic control in persons with type 2 diabetes mellitus:A community-based randomized controlled trial in China

BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus(T2DM),and often negatively related with glycemic control.Cognitive behavioral therapy(CBT)may improve sleep quality and reduce blood sugar levels in patients with T2DM.However,it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China.Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care.Glycosylated hemoglobin A1c(HbAlc)and sleep quality[Pittsburgh Sleep Quality Index(PSQI)]were assessed.Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.RESULTS The CBT group had 0.64,0.50,and 0.9 lower PSQI scores than the control group at 2 mo,6 mo,and 12 mo,respectively.The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo.The intervention on meanΔHbAlc values was significant at 12 mo(t=3.68,P<0.01)and that meanΔPSQI scores were closely related toΔHbAlc values(t=7.02,P<0.01).Intentionto-treat analysis for primary and secondary outcomes showed identical results with completed samples.No adverse events were reported.CONCLUSION CBT delivered by general practitioners,as an effective and practical method,could reduce glycemic levels and improve sleep quality for patients with T2DM in community.

Randomized control trial of a culturally adapted behavioral activation therapy for Muslim patients with depression in Pakistan

BACKGROUND Behavioral activation therapy(BA)is as effective as cognitive behavior therapy(CBT)in treating depression and can be delivered by practitioners with much less psychological training,making it particularly suitable for low resource settings.BA that is culturally adapted for Muslims(BA-M)is a culturally adapted form of BA that has been found acceptable and feasible for Muslims with depression in the United Kingdom and Turkey;however,this is the first time that its efficacy has been determined through a definitive randomized controlled trial.AIM To compare the effectiveness of BA-M with CBT for Muslim patients with depression in Pakistan.METHODS One hundred and eight patients were randomized 1:1 to treatment arms in a parallel-group randomized controlled trial in hospital or community sites in Lahore,Pakistan.Recruitment followed self-referral or referrals from clinicians,consultants or relevant professionals at each site.Four measures were recorded by blinded assessors:The patient health questionnaire-9(PHQ-9);the BA for depression scale short form(BADS-SF);symptom checklist-revised and the World Health Organization Quality-of-Life Brief Scale.All measures were recorded at baseline and post treatment;PHQ-9 and BADS-SF were also recorded at each session and at three month follow up.The primary analysis was to regress the PHQ-9 score after therapy upon the PHQ-9 score before therapy(baseline)and the type of therapy given,that is,analysis of covariance.In addition,analysis using PHQ-9 scores collected at each therapy session was employed in a 2-level regression model.RESULTS Patients in the BA-M arm experienced greater improvement in PHQ-9 score of 1.95 units compared to the CBT arm after adjusting for baseline values(P=0.006)The key reason behind this improvement was that patients were retained in therapy longer under BA-M,in which patients were retained for an average 0.75 sessions more than CBT patients(P=0.013).Patients also showed significant differences on physical(P<0.001),psychological(P=0.004)and social(P=0.047)domains of Quality of Life(QoL)at post treatment level,indicating an increased QoL in the BA-M group as compared to the treatment as usual group.Some baseline differences were noted in both groups for BA scores and two domains of QoL scale:Physical and environment,which might have influenced the results,though the BA-M group showed more improvement at completion of therapy.CONCLUSION Results proved the efficacy of BA-M in reducing symptoms for depressed patients in Pakistan,indicating BA-M is a promising treatment modality for depression in future,particularly in low resource settings.

Analysis of the Efficacy of Humidified High-Flow Nasal Oxygen Therapy Combined with Alveolar Lavage in the Treatment of Patients with Severe Pneumonia Complicated with Respiratory Failure

Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。

Establishment of NaLuF_(4):15%Tb-based low dose X-PDT agent and its application on efficient antitumor therapy

X-ray excited photodynamic therapy(X-PDT)is the bravo answer of photodynamic therapy(PDT)for deep-seated tumors,as it employs X-ray as the irradiation source to overcome the limitation of light penetration depth.However,high X-ray irradiation dose caused organ lesions and side effects became the major barrier to X-PDT application.To address this issue,this work employed a classic-al co-precipitation reaction to synthesize NaLuF_(4):15%Tb^(3+)(NLF)with an average particle size of(23.48±0.91)nm,which was then coupled with the photosensitizer merocyanine 540(MC540)to form the X-PDT system NLF-MC540 with high production of singlet oxygen.The system could induce antitumor efficacy to about 24%in relative low dose X-ray irradiation range(0.1-0.3 Gy).In vivo,when NLF-MC540 irradiated by 0.1 Gy X-ray,the tumor inhibition percentage reached 89.5%±5.7%.The therapeutic mechanism of low dose X-PDT was found.A significant increase of neutrophils in serum was found on the third day after X-PDT.By immunohistochemical staining of tumor sections,the Ly6G^(+),CD8^(+),and CD11c^(+)cells infiltrated in the tumor microenvironment were studied.Utilizing the bilat-eral tumor model,the NLF-MC540 with 0.1 Gy X-ray irradiation could inhibit both the primary tumor and the distant tumor growth.De-tected by enzyme linked immunosorbent assay(ELISA),two cytokines IFN-γand TNF-αin serum were upregulated 7 and 6 times than negative control,respectively.Detected by enzyme linked immune spot assay(ELISPOT),the number of immune cells attributable to the IFN-γand TNF-αlevels in the group of low dose X-PDT were 14 and 6 times greater than that in the negative control group,respectively.Thus,it conclude that low dose X-PDT system could successfully upregulate the levels of immune cells,stimulate the secretion of cy-tokines(especially IFN-γand TNF-α),activate antitumor immunity,and finally inhibit colon tumor growth.

Efficacy and safety of mild-warm moxibustion in treating diarrhea-predominant irritable bowel syndrome(spleen deficiency and dampness excess syndrome):a study protocol for a randomized controlled trial

1Background:Irritable bowel syndrome(IBS)is a disorder of bowel function,and diarrhea-predominant irritable bowel syndrome(IBS-D)is the most common.The current treatment for IBS-D is focused on improving patients’gastrointestinal-related symptoms,but there are limitations such as unstable effects and adverse drug reactions.Acupuncture and moxibustion exerts advantages in treating IBS-D.They include several forms,of which moxibustion is one of the most commonly used.And moxibustion is a common way used in treating IBS-D,but there is a lack of relevant evidence-based medical research data.This protocol aims to compare the efficacy of moxibustion(mild-warm moxibustion)in treating IBS-D(spleen deficiency and dampness excess syndrome)with the first-line treatment.Methods:In this prospective,parallel,randomized controlled trial(RCT)protocol,patients will be randomly allocated for 4-week treatment or control therapies and then 4-week follow-up in both groups.We will use Irritable Bowel Syndrome-Symptom Severity Scale(IBS-SSS)score,Irritable Bowel Syndrome-Quality of Life(IBS-QOL)score,serum brain-gut peptide levels,and traditional Chinese medicine(TCM)syndrome scale score to produce more evidence on IBS-D treatment with moxibustion.Finally,we will use SPSS 22.0 software to statistically analyze the data.Discussion:Mild-warm moxibustion is a complementary alternative therapy that fits with the pathogenesis of IBS-D.We hope to see more clinical evidence for mild-warm moxibustion against IBS-D that this RCT supported.

Left ventricular thrombosis caused cerebral embolism during venoarterial extracorporeal membrane oxygenation support: A case report

BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%.Embolization in important organs caused by complications of left ventricular thrombosis(LVT)during VA-ECMO is also an important reason.Although the incidence of LVT during VA-ECMO is not high,the consequences of embolization are disastrous.CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d.After excluding the diagnosis of coronary heart disease,we established a diagnosis of“clinically explosive myocarditis”.The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO,with heparin for anticoagulation.On day 4 of ECMO support,a left ventricular thro-mbus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography.Left ventricular decompression was performed and ECMO was successfully removed,but the patient eventually died of multiple cerebral embolism.CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs.Therefore,a"wait and see"strategy should be avoided.

Neoadjuvant chemoradiotherapy for resectable esophageal cancer:an in-depth study of randomized controlled trials and literature review

Surgery following neoadjuvant chemoradiotherapy(NCRT) is a common multidisciplinary treatment for resectable esophageal cancer(EC). After analyzing 12 randomized controlled trials(RCTs), we discuss the key issues of surgery in the management of resectable EC. Along with chemoradiotherapy, NCRT is recommended for patients with squamous cell carcinoma(SCC) and adenocarcinoma(AC), and most chemotherapy regimens are based on cisplatin, fluorouracil(FU), or both(CF). However, taxane-based schedules or additional studies, together with newer chemotherapies, are warranted. In nine clinical trials, post-operative complications were similar without significant differences between two treatment groups. In-hospital mortality was significantly different in only 1 out of 10 trials. Half of the randomized trials that compare NCRT with surgery in EC demonstrate an increase in overall survival or disease-free survival. NCRT offers a great opportunity for margin negative resection, decreased disease stage, and improved loco-regional control. However, NCRT does not affect the quality of life when combined with esophagectomy. Future trials should focus on the identification of optimum regimens and selection of patients who are most likely to benefit from specific treatment options.

Generalized electro-biothermo-fluidic and dynamicalmodeling of cancer growth: state-feedback controlled cesium therapy approach

This paper develops a generalized dynamical model to describe the interactive dynamics between normal cells, tumor cells, immune cells, drug therapy, electromagnetic field of the human cells, extracellular heat and fluid transfer, and intercellular fractional mass of Oxygen, cell acidity and Pancreatin enzyme. The overall dynamics stability, controllability and observability have been investigated. Moreover, Cesium therapy is considered as a control input to the 11-dimensional dynamics using state-feedback controlled system and pole placement technique. This approach is found to be effective in driving the desired rate of tumor cell kill and converging the system to healthy equilibrium state. Furthermore, the ranges of the system dynamics parameters which lead to instability and growth of tumor cells have been identified. Finally, simulation results are demonstrated to verify the effectiveness of the applied approach which can be implemented successfully to cancer patients.

Short term acupressure therapy on weight-reduction in adolescence: A randomized controlled trial

Aim: Common treatment options for obesity include a reduced-calorie diet, increased physical activity, behavioral modification, pharmacotherapy, and surgery. Ear acupressure may also be an effective adjunct therapy. Methods: This study used a randomized controlled design to test the effectiveness of auricular acupressure for weight reduction in young, Taiwan Residents adults with a BMI ≥ 23 kg/m2. Sixty-eight participants aged 18 to 20 years were recruited from Taiwan Residents universities at the beginning of the study. After four weeks of auricular therapy, the total sample included 57 young adults. All participants met one time per week for ten minutes. The treatment group received ear acupressure treatment with Semen Vaccariae sticks on auricular acupoints while the control group had adhesive tape placed on ear acupoints, change in BMI from baseline to trial completion. Results: BMI in controls increased significantly by +0.0133 kg/m2 (P = 0.000) while the intervention group BMI decreased significantly by ?0.8022 kg/m2 (P ≤ 0.0001). Conclusions: Just four weeks of auricular acupressure by Semen Vaccariae, sticks may significantly help to decrease BMI among young adults.

Incisional Negative Pressure Wound Therapy in the Prevention of Surgical Site Infection after Vascular Surgery with Inguinal Incisions: Rationale and Design of a Randomized Controlled Trial (INVIPS-Trial)

Background/Aims: Inguinal incisions are a common route of access in vascular surgery. Due to anatomical challenges and a diverse bacterial flora in this area, surgical site infections (SSI) represent a common, debilitating and sometimes life-threatening complication. The INVIPS-Trial evaluates the role of Negative Pressure Wound Therapy (NPWT) on closed inguinal incisions in elective vascular surgery to prevent SSI and other wound complications. Methods: This randomized controlled trial (RCT) registered at ClinicalTrials.gov (Identifier: NCT01913132) compares the effects of a NPWT dressing (PICO, Smith & Nephew, UK) and the center’s standard wound dressing (Vitri Pad, ViTri Medical, Sweden) on postoperative wound complications, especially SSI. The study includes two distinct vascular procedures with different SSI risk profiles: endovascular aortic repair (EVAR) and open surgical approaches involving the common femoral artery (OPEN). Results: Four hundred ninety-five groin incisions in both treatment arms are anticipated to be included in the EVAR group and 147 inguinal incisions in both treatment arms in the OPEN group. Since a large percentage of inguinal vascular procedures in both groups but especially in the EVAR group are performed bilaterally, many patients can serve as their own control by randomly receiving NPWT on one and the standard dressing on the contralateral inguinal incision. Conclusions: This ongoing RCT attempts to elucidate the potential benefit of NPWT on closed inguinal incisions after different vascular procedures. Outcome and conclusions of this trial could have implications on postoperative wound care of patients in both vascular surgery and other surgical specialties.

A multi-center randomized controlled clinical trial of three-step acupuncture and cupping therapy for cervicogenic headache

目的:观察三步针罐疗法治疗颈源性头痛的临床有效性和安全性。方法:采用随机、单盲、多中心平行对照临床试验方法,收集符合研究标准的颈源性头痛的患者63例,随机分为治疗组32例和对照组31例,治疗组采用三步针罐疗法治疗,对照组采用假针刺治疗。分别于治疗前、首次治疗后即刻、治疗10天后、治疗20天后、治疗结束3个月随访时观察两组患者的简化的McGill疼痛评分,包括三个部分:疼痛等级指数(PRI),视觉模拟评定(VAS)和现有痛强度(PPI)和头颈部僵硬感及颈椎活动度评定(ROM),并进行安全性评价。结果:与治疗前比较,两组治疗后各个观察时间点各项评分均有显著改善,在观察时间点各项评分方面,治疗组明显优于对照组;疗程结束后3个月随访时各项评分与治疗20天后评分比较,治疗组无显著性差异,对照组各项评分均有显著性差异,提示治疗组与对照组相比有较好的远期疗法。结论:三步针罐法与假针刺组比较,治疗颈源性头痛具有一定的近期疗效,见效快,近期疗效和远期疗效上均优于假针刺组,复发率低。

A randomized controlled clinical trial on the treatment of Thymosin-a1 versus interferon-α in patients with hepatitis B

INTRODUCTIONChronic hepatitis B virus (HBV) infection is a serious problem because of its world wide distribution and possible adverse sequelae ,such as cirrhosis and hepatocellular carcinoma .The World Health Organization estimates that HBV has infected mord than 350 million people worldwide ,and up to 20% of them will become chromic carricrs and will be at significant risk for cirrhosis and HCC .The ultimate goal of the therapy for chronic hepatitis B is to prevent progression to cirrhosis and to prevent development of HCC.

Assessment of knowledge, attitude and practice regarding oxygen therapy at emergency departments in Riyadh in 2017: A cross-sectional study

BACKGROUND: Administering oxygen therapy(OT) has an essential role in preventing/managing hypoxemia in both acute and chronic conditions. It should be adjusted to achieve the normal oxygen saturation of 94%–98% in most cases. This study aims to evaluate knowledge, attitude and practice(KAP) of nurses, paramedics, emergency medical technicians(EMTs) and Emergency Medical Services(EMS) physicians working at emergency departments(ED) in Riyadh, Saudi Arabia. METHODS: In this cross-sectional study, a structured questionnaire was used to assess KAP related to OT of nurses, paramedics, EMTs and EMS physicians currently working at an ED of a tertiary care hospital. Knowledge and attitude were assessed using a Likert scale from 1–5, whereas practice was assessed as a yes/no categorical variable.RESULTS: A total of 444 emergency health-care workers(EHCWs) participated, of which 225(50.7%) were male, with the majority(77%) in the age group of 20–35 years. Over half of the sample were nurses(266; 59.9%). The mean score for knowledge about OT was 5.51±1.45, attitude was 26.31±3.17 and for practices 4.55±1.76. The main factors which were associated with poor KAP were workload and lack of local guidelines. The distribution of overall practice score was signifi cantly better among paramedics – nurses group and EMT – nurses group.CONCLUSION: This study demonstrates that there is a gap in EHCWs' KAP, particularly regarding when to provide OT to a patient. This gap can affect patients' safety. Extensive educational and training programs about OT are needed to raise awareness among health-care providers.