Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures

BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.

Study on the timing of intervention of gastrointestinal function recovery in patients after laparoscopic cholecystectomy with acupoint application of traditional Chinese medicine

Objective: To explore the optimal timing of drug application for the recovery of gastrointestinal function in patients after laparoscopic cholecystectomy. Methods: Ninety patients undergoing laparoscopic cholecystectomy were randomly divided into three groups: control group, intervention group 1 and intervention group 2. All three groups received routine perioperative nursing. Intervention group 1 and group 2 were given acupoint application of Chinese medicine at 0.5 h and 6 h after operation, and the waveform was monitored by electrogastrogram on the 1st day before operation and 3 d after operation. The first anal exhaust time, defecation time, abdominal distension and electrogastrogram changes were analyzed and compared in the three groups. Results: Compared with the first exhaust time and defecation time after operation, the intervention group 1 was earlier than the intervention group 2, and the intervention group 2 was earlier than the control group, the difference was statistically significant (P < 0.05). The average frequency, waveform response area and average amplitude of the intervention group 1 were better than those of the intervention group 2, and the intervention group 2 was better than the control group (P < 0.05). Conclusion: Administration of Chinese medicine acupoint application within 0.5 hours after operation can promote the recovery of gastrointestinal function and improve gastric motility in patients undergoing abdominal surgery, and the curative effect is significant and safe.

Significance of fostering the mental health of patients with diabetes through critical time intervention

BACKGROUND Critical time intervention(CTI)is an evidence-based model of practice that is time-limited and aims to provide support for most susceptible individuals during a transition period.AIM To examine the significance of fostering the mental health of diabetes patients through CTI using the scoping review methodology.METHODS As part of the scoping review process,we followed the guidelines established by the Joanna Briggs Institute.The search databases were Google Scholar,PubMed,Scopus,PsycINFO,Reference Citation Analysis(https://www.referencecitation-analysis.com/),and Cochrane Library.From these databases,77 articles were retrieved with the aid of carefully selected search terms.However,19 studies were selected after two reviewers appraised the full texts to ensure that they are all eligible for inclusion,while 54 papers were excluded.RESULTS This study revealed that diabetic patients who had experienced homelessness were at higher risk of being diagnosed with mental illness and that social support services are impactful in the management of the comorbidity of diabetes and mental health problems.In addition,this review reveals that CTI is impactful in enhancing the mental health of homeless patients during the transitional period from the hospital through social support services.CONCLUSION CTI is a promising intervention for alleviating mental health symptoms in homeless patients.Empirical studies are needed across the globe,involving both hospitalized and community-based patients,to determine how clinically effectively CTI is in managing the mental health of diabetics.

Clinical effects of Xingnao Kaiqiao acupuncture on neurological impairment following cerebral infarction

BACKGROUND： Although the curative effects of acupuncture have been confirmed by various treatments of cerebral infarction, few studies have investigated when acupuncture can attain the best clinical effect. OBJECTIVE： Four different time points were selected for acupuncture treatment of cerebral infarction to evaluate the appropriate time course for Xingnao Kaiqiao therapy in terms of improved neurological function. DESIGN： Controlled observation. SETTING： Department of Traditional Chinese Medicine Rehabilitation and Physiotherapy of the Affiliated Hospital of Medical College of Chinese Armed Police Forces. PARTICIPANTS： A total of 120 inpatients with cerebral infarction of different stages, including 75 males and 45 females, aged 41-75 years, were selected from November 2005 to December 2006 at the Department of Traditional Chinese Medicine Rehabilitation and Physiotherapy in Affiliated Hospital of Medical College of Chinese Armed Police Forces. Diagnostic criteria： in accordance with ＂main points of diagnosis on different cerebrovascular disease＂ secondly revised in the Second Cerebrovascular Disease Academic Meeting of Chinese Medicine Association in 1986. All accepted subjects provided confirmed consent, and the experiment received ethical permission from the hospital＇s ethics committee. METHODS： ① Experiment grouping： All inpatients were divided into four groups with non-stochastic concurrent control method according to the disease course： Group Ⅰ （onset within 7 hours）, group Ⅱ （onset from 7 hours to 3 days）, group Ⅲ （onset within 4-7 days）, and group IV （onset within 21-180 days）. On the basis of symptomatic treatment with western medicine, each group received Xingnao Kaiqiao therapy after onset within 7 hours, 7 hours to 3 days, 4 to 7days, and 21 to 180 days. ① The principal acupoints were Neiguan, Renzhong, and Sanyinfiao. ② The auxiliary acupoints were Jiquan, Chize, and Weizhong. ③Acupuncture manipulations： initially, Neiguan （PC6, bilateral） was needled at 0.5-1.0 cun vertically with a reducing technique achieved by rotating-swirling and lifting-inserting for l minute. Subsequently, Renzhong （GV26） was needled at 0.3-0.5 cun obliquely towards the nasal septum, with a heavy bird-pecking method until eyeballs were moist or shed tears. Sanyinjiao （SP6, affected limb） was needled at 1.0-1.5 cun obliquely along the medial border of the tibia with a 45° angle between the needle and skin. The technique of reinforcing was achieved by a lifting-inserting method until the affected lower limb twitched three times. The auxiliary acupoint, Jiquan, was selected when the patient extended the affected upper limb abduction. Jiquan was along the downward channel, l cun from the quondam Jiquan （HT1） acupoint; the armpit hair was avoided. Jiquan （affected limb） was needled vertically at 1.0-1.5 cun. The technique of reduction was achieved by lifting-inserting until the affected upper limb twitched three times. Chize （LU5） was selected when the patient flexed the elbow at 120°. Chize was vertically needled at l cun with a lifting-inserting reducing technique until the affected forearm and fingers twitched three times. Weizhong （BL40） was selected when the patient＇s leg was raised straight in a supine position. Weizhong was vertically needled at 0.5 1.0 cun with a lifting-inserting reducing technique until the affected lower limb twitched three times. ⑤ Acupuncture manipulations were achieved by the doctor who is an associate chief physician and doctor of acupuncture and moxibustion and has aptitude for the post＇s specification. ⑥One course of treatment lasted for 10 days and each group was treated for two courses of treatment. ⑦Experiment evaluation： To apply neurological impairment scores for evaluating clinical curative effects before and after treatment with Xingnao Kaiqiao therapy on day 7, 14, and 21（range of 0 45; decreasing score indicates functional improvement）.To evaluate clinical curative effect by clinical effective power： Basic recovery： equal to or more than 81%; significant improvement： 56% to 81% （including 56%）; Improvement： between 36% to 56% （including 36%）; Slight Improvement： 11% to 36% （including 11%）; No change： less than 11%; Aggravation （including death）： negative value. Total effective rate was computed at the same time. MAIN OUTCOME MEASURES： The total effective rate and amelioration of neurological impairment of the patients after treatment. RESULTS： All 120 patients with cerebral infarction were included in the final analysis, without deletion. ① Comparison of the total effective rate： the total effective rate of group Ⅰ, group Ⅱ, group Ⅲ and group IV was 97%, 93%, 93%, and 67%, respectively. There were significant differences of interclass synthetic curative effects （x^2 = 36.351 7, P 〈 0.01）. ② Amelioration of neurological impairment： A decreased neurological impairment score was observed in group Ⅰ on day 7, 14, and 21 after Xingnao Kaiqiao therapy. The differences between group Ⅳ and the remaining three groups were significant （P 〈 0.05）. CONCLUSION： Xingnao Kaiqiao therapy is helpful for amelioration of neurological impairment in patients during the acute stage cerebral infarction.

Alerting effects of light in healthy individuals: a systematic review and meta-analysis

Light plays an essential role in psychobiological and psychophysiological processes,such as alertness.The alerting effect is influenced by light characteristics and the timing of interventions.This meta-analysis is the first to systematically review the effect of light intervention on alertness and to discuss the optimal protocol for light intervention.In this meta-analysis,registered at PROSPERO(Registration ID:CRD42020181485),we conducted a systematic search of the Web of Science,PubMed,and PsycINFO databases for studies published in English prior to August 2021.The outcomes included both subjective and objective alertness.Subgroup analyses considered a variety of factors,such as wavelength,correlated color temperature(CCT),light illuminance,and timing of interventions(daytime,night-time,or all day).Twenty-seven crossover studies and two parallel-group studies were included in this meta-analysis,with a total of 1210 healthy participants(636(52%)male,mean age 25.62 years).The results revealed that light intervention had a positive effect on both subjective alertness(standardized mean difference(SMD)=-0.28,95%confidence interval(CI):-0.49 to-0.06,P=0.01)and objective alertness in healthy subjects(SMD=-0.34,95%CI:-0.68 to-0.01,P=0.04).The subgroup analysis revealed that cold light was better than warm light in improving subjective alertness(SMD=-0.37,95%CI:-0.65 to-0.10,P=0.007,I2=26%)and objective alertness(SMD=-0.36,95%CI:-0.66 to-0.07,P=0.02,I2=0).Both daytime(SMD=-0.22,95%CI:-0.37 to-0.07,P=0.005,I2=74%)and night-time(SMD=-0.32,95%CI:-0.61 to-0.02,P=0.04,I2=0)light exposure improved subjective alertness.The results of this meta-analysis and systematic review indicate that light exposure is associated with significant improvement in subjective and objective alertness.In addition,light exposure with a higher CCT was more effective in improving alertness than light exposure with a lower CCT.Our results also suggest that both daytime and night-time light exposure can improve subjective alertness.

Multi-centric clinical study of the effect of intervention time on efficacy of gastroparesis external application prescription treatment of gastrointestinal tumor postsurgical gastroparesis

Objective:This intervention has been shown to be clinically efficacious and safe.The aim of this study was to determine the effect of different intervention times on the efficacy of gastroparesis external application prescription versus placebo for the treatment of gastrointestinal tumor postoperative,postsurgical gastroparesis.Methods:A multicenter,randomized,double-blind,placebo controlled phaseⅢclinical trial was designed to demonstrate superiority and conducted at four grade 3A hospitals in Beijing.Patients diagnosed with gastrointestinal tumor postsurgical gastroparesis and local cold syndrome in the abdomen were enrolled and received conventional treatment(nutritional support,gastrointestinal decompression,and prokinetic medication).Treatment and control groups respectively received gastroparesis external application prescription or placebo acupoint application over a treatment course of 14 days or until the primary efficacy endpoint(clinical efficiency)was achieved.Results:A total of 120 patients were enrolled in the treatment and control groups(n Z 60 per group),and 15 patients dropped out of the study because of skin allergies(n Z 7)or poor efficacy(nZ8).The efficacy among patients in Class B of Group A(treatment group)was marginally better than that of Group B(control group)(64.28%vs.55.56%)although the difference between the two groups was not significant.However,the efficacy among patients in Class C of Group A was significantly better than that of Group B(79.49%vs.43.33%).For Group A,the time for patients in the three classes to achieve the efficacy endpoint increased significantly with disease progression(3.00,6.78,and 8.29 days for Class A,B,and C,respectively).Conclusions:Gastroparesis external application prescription can effectively treat gastrointestinal tumor postsurgical gastroparesis and may be more efficacious in progressive disease compared placebo.Patients with gastrointestinal tumor postsurgical gastroparesis should therefore undergo intervention at an earlier stage.

Retrospective analysis of TACE times after primary liver cancer operation

Objective The aim of the study was to probe into the impacts of the times of preventive transcatheter arterial chemoembolization (TACE) after operation treatment for patients with primary liver cancer on their survival.

Is it time for elective left main percutaneous coronary intervention to become 'main stream'?

Left main (LM) stenting is considered by many to be one of the last frontiers of interventional cardiology. Beginning with the VA cooperative study published in 1976 demonstrating a mortality benefit for patients undergoing coronary artery bypass grafting (CABG), i the standard of care for treatment of left main coronary artery disease has been surgical.The most recent 2005 update of the ACC/AHA/SCAI Practice Guidelines on PCI 2 again notes that "CABG using IMA grafting is the 'gold standard' for treatment of unprotected left main disease and has proven benefit on long-term outcomes."……

Mild moxibustion at different intervention times on the levels of ET-1 and NO in the uterine tissues of rats with cold-damp coagulation and stagnation type dysmenorrhea

Objective： To observe the differences in analgesic effect of moxibustion at different intervention times on dysmenorrhea rats and explore its effect mechanism.Methods： Forty-five female Wistar rats were randomly divided into blank control group（group A）, model group（group B）, pre-moxibustion group（group C）, instant moxibustion group（group D） and pre-instant moxibustion group（group E）,with 9 rats in each group. Cold-damp coagulation and stagnation type dysmenorrhea models were established. In group C,mild moxibustion on ＂Shenque（神阙 CV 8） ＂ and＂Guanyuan（关元 CV 4）＂ was carried out from the time after modeling on the 8 th day for 3 consecutive days. In group D, mild moxibustion was given as the same methods with group C after injection with oxytocin on the 11 th day. In group E, mild moxibustion was given as the same methods from the time after modeling on the 8 th day to that after injection with oxytocin on the 11 th day for 4 consecutive days. The writhing behavior and the changes in levels of ET-1 and NO in uterine tissues of rats with dysmenorrhea in each group were observed.Results： Comparison of the latent period： compared with（4.38 ± 1.06） min in group B,the latent period of rats in group C（9.67 ± 1.32） min,group D（11.78 ± 1.30） min and group E（15.00 ± 1.22） min obviously prolonged（all p 0.01）. Compared with group C, the latent period of group E obviously prolonged（p 0.01）. Compared with group D, the latent period of group E obviously prolonged（p 0.01）.Comparison of the writhing times： compared with（4.38 ± 1.06） in group B,the writhing times of rats in group C（9.67 ± 1.32）,group D（11.78 ± 1.30） and group E（15.00 ± 1.22） reduced（all p 0.01）. Compared with group C,the writhing times of rats in group D and group E reduced（both p 0.01）. Compared with group D, the writhing times in group E reduced（p 0.05）. Comparison of the total writhing score：compared with（4.38 ± 1.06） in group B,the total writhing score of rats in group C（9.67±1.32）,group D（11.78 ± 1.30） and group E（15.00 ± 1.22） decreased（all p 0.01）. Compared with group C,the total writhing score of rats in group D and group E decreased（both p 0.01）. Compared with group D,the total writhing score of rats in group E decreased（p 0.05）. Comparison of ET-1 level： compared with（4.80 ± 0.47） in group A,the ET-1 level in uterine tissues of rats in group B（7.57±0.69） significantly increased（P 0.01）. Compared with group B, the ET-1 level in uterine tissues of rats in group C（6.20 ±0.50）,group D（5.67 ±0.29） and group E（5.16±0.33） obviously decreased（all p 0.01）. Compared with group C, the ET-1 level in uterine tissues of rats in group D and group E obviously decreased（p 0.05, p 0.01）. Compared with group D, the ET-1 level in uterine tissues of rats in group Eobviously decreased（p 0.05）. Comparison of NO level： compared with（6.63±1.83） in group A, the NO level in uterine tissues of rats in group B（1.62 ±0.58） significantly decreased（p 0.01）. Compared with group B, the NO level in uterine tissues of rats in group C（3.60±0.59）,group D（4.77 ±0.67） and group E（5.99±0.63） obviously increased（all p 0.01）. Compared with group C,the NO level in uterine tissues of rats in group Dand group E obviously increased（p 0.05, p 0.01）. Compared with group D, the NO level in uterine tissues of rats in group E obviously increased（p 0.01）.Conclusion： The analgesic effect of mild moxibustion at different intervention times on cold-damp coagulation and stagnation type dysmenorrhea rats was different, which was the most significant in pre-instant moxibustion group. One of the mechanisms of action may be related with the adjustment of abnormal levels of ET-1 and NO.

The Analysis of Impact of Brexit on the Post-Brexit EU Using Intervented Multivariate Time Series

The UK is the most important partner of the EU in terms of economic and other fields due to the geographical proximity.It was one of the largest economies in the EU and its per capita income is higher than the EU average,so it is a net contributor to the EU.With UKs membership of the EU ended on 31 January 2019,there are concerns that the Brexit may have a significant impact on the EU,resulting in social,economic,political,and institutional changes,etc.in EU.While the impact of Brexit on the UK has always been the subject of considerable scholarly interest in recent years,there is relatively little literature on the impact of Brexit on the EU.This paper focuses on the evaluation of the impact of Brexit on the EU economy and other relevant aspects along three dimensions:GDP,PPP,Quarterly GDP growth.Employing powerful quantitative analysis technology that includes vector autoregression model,multivariate time series model with intervention variables,and autoregression integrated moving average,this paper obtains the important and novel evidence about the potential impact of Brexit on the EU economy,pointing out that Brexit is of far-reaching significance to the EU.This analysis uses several statistical models to screen out several key influencing factors,which can be used to predict the total GDP of EU in the next five years.The results show that EU economy will react negatively to"no-deal"Brexit,and its growth rate of economy will slow down significantly in next 5 years.Finally,we put forward relevant policy suggestions on how to deal with the negative impact of Brexit on EU.

Timely completion of multiple life-saving interventions for traumatic haemorrhagic shock: a retrospective cohort study

Background:Early control of haemorrhage and optimisation of physiology are guiding principles of resuscitation after injury.Improved outcomes have been previously associated with single,timely interventions.The aim of this study was to assess the association between multiple timely life-saving interventions(LSIs)and outcomes of traumatic haemorrhagic shock patients.Methods:A retrospective cohort study was undertaken of injured patients with haemorrhagic shock who presented to Alfered Emergency&Trauma Centre between July 01,2010 and July 31,2014.LSIs studied included chest decompression,control of external haemorrhage,pelvic binder application,transfusion of red cells and coagulation products and surgical control of bleeding through angio-embolisation or operative intervention.The primary exposure variable was timely initiation of≥50%of the indicated interventions.The association between the primary exposure variable and outcome of death at hospital discharge was adjusted for potential confounders using multivariable logistic regression analysis.The association between total pre-hospital times and pre-hospital care times(time from ambulance at scene to trauma centre),in-hospital mortality and timely initiation of≥50%of the indicated interventions were assessed.Results:Of the 168 patients,54(32.1%)patients had≥50%of indicated LSI completed within the specified time period.Timely delivery of LSI was independently associated with improved survival to hospital discharge(adjusted odds ratio(OR)for in-hospital death 0.17;95%confidence interval(CI)0.03–0.83;p=0.028).This association was independent of patient age,pre-hospital care time,injury severity score,initial serum lactate levels and coagulopathy.Among patients with pre-hospital time of≥2 h,2(3.6%)received timely LSIs.Pre-hospital care times of≥2 h were associated with delayed LSIs and with in-hospital death(unadjusted OR 4.3;95%CI 1.4–13.0).Conclusions:Timely completion of LSI when indicated was completed in a small proportion of patients and reflects previous research demonstrating delayed processes and errors even in advanced trauma systems.Timely delivery of a high proportion of LSIs was associated with improved outcomes among patients presenting with haemorrhagic shock after injury.Provision of LSIs in the pre-hospital phase of trauma care has the potential to improve outcomes.