Random allocation to intervention groups remains the best method of ensuring that the groups being compared are similar at the onset of study and of avoiding removing selection bias between groups of patients. The success of randomization depends on two interrelated processes. First, an unpredictable allocation sequence must be generated based on a random procedure. Second, strict implementation of that sequence must be secured through an assignment mechanism called allocation concealment to prevent those involved in a trial from knowing upcoming assignments. Inadequate allocation concealment can lead to clinicians scheduling patient’s assignment and compromising the unpredictable allocation sequence.
Objective To summarize the injury characteristics of the whole hand degloving injury and to explore its classification and treatment. Methods Between December 1999 and May 2010, 41 cases of the whole hand degloving injury were admitted for treatment. There were 28 males and 13 females with an average age of 35 years (range, 18-58 years). The causesof injury included mangled injury in 28 cases and crush injury in 13 cases. The interval between injury and surgery was 1-10 hours (mean, 3 hours). According to self-made classification standard for whole hand degloving injury, 11 cases were rated as type I, 5 cases as type II, 4 cases as type III, 8 cases as type IV, and 13 cases as type V. Type I injury was treated by replantation surgery with vascular anastomosis, type II by reconstruction with thumb flap and the second toe containing dorsal skin flap, type III by reconstruction with the second toe containing dorsal skin flap of both feet, type IV by replantation surgery with vascular anastomosis, and type V by reconstruction with thumb flap containing dorsal skin flap (8 cases) or repairing with abdominal flap (5 cases). The size of the dorsal flap was between 9 cm × 6 cm and 17 cm × 11 cm and the dorsal donor site was covered with free skin grafting. Results After surgery, partial necrosis occurred at fingers in 6 patients with type I injury, and at fingers and palm skin in 6 patients with type IV injury; the flaps, the reconstructed fingers, and replanted skin all survived in the others. The grafted skin at donor sites successfully healed. Forty cases were followed up from 6 months to 7 years (mean, 14 months). The skin color and texture were close to normal hand in the cases undergoing replantation, who had the best function restoration with S2-S4 sensory recovery; the hand function was basically restored with S2-S3 sensory recovery in the cases undergoing finger reconstruction with thumb and toe flaps; and the restoration of the hand function was not satisfactory with S1-S2 sensory recovery in the cases undergoing abdominal flaps. Conclusion Whole hand degloving injury can be classified into different types according to injury degree and this will help choose the cl inical treatment plan. The appropriate treatment based on these types can obtain better cl inical effectiveness.
Objective To assess the improvement of different resistance training regimens on blood lipid metabolism and insulin resistance in patients with type 2 diabetes mellitus (T2DM). Methods PubMed, ProQuest, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases were searched to collect randomized controlled trials of resistance training intervention to improve blood lipids and insulin resistance in patients with T2DM. The search time range was from the establishment of the databases to May 2023. Two reviewers assessed the risk of bias of the included studies using the Physiotherapy Evidence Database scale, and performed a network meta-analysis of the extracted data using Stata 16.0 software. Results In the end, 24 articles were included, and a total of 983 participants were enrolled. The result of network meta-analysis showed that high-frequency and moderate-intensity resistance exercise significantly improved the levels of insulin resistance [standardized mean difference=−1.71, 95% confidence interval (CI) (−2.75, −0.67)], triglycerides [weighted mean difference (WMD)=−0.27 mmol/L, 95%CI (−0.51, −0.04) mmol/L], and total cholesterol [WMD=−0.16 mmol/L, 95%CI (−0.20, −0.12) mmol/L], but had no significant effect on improving the level of high-density lipoprotein [WMD=0.05 mmol/L, 95%CI (−0.02, 0.11) mmol/L] or low-density lipoprotein [WMD=−0.20 mmol/L, 95%CI (−0.42, 0.03) mmol/L]. The results of cumulative probability ranking showed that high-frequency and moderate-intensity resistance exercise was the best in improving insulin resistance, triglycerides, high-density lipoprotein and low-density lipoprotein levels. Conclusion Based on current evidence, high-frequency and moderate-intensity resistance exercise may be the best resistance exercise regimen to improve insulin resistance and lipid metabolism in patients with T2DM.
Objective To evaluate the impact of the new performance evaluation system in H hospital on clinical rational blood use and provide a basis for optimizing medical resource management. Methods This study employed a self-controlled before-after design to evaluate the effects of a blood management reform implemented in December 2023. The reform integrated key performance indicator (KPI) assessment with objectives and key results (OKR) methodology. Key interventions included enhancing the information system, strengthening clinical blood management quality control, and promoting alternative therapeutic techniques. Clinical blood utilization data were collected for one year both before and after the reform implementation. The impact of the reform was rigorously assessed using interrupted time series analysis (ITSA). Results A total of 1 032 clinical blood transfusion records were collected from 2023 to 2024, with 977 ultimately included in the analysis. In 2024, the qualified rate of hemoglobin of patients receiving red blood cell suspension transfusions in the whole hospital increased from 67.46% to 76.38%, and the per capita consumption of red blood cell suspension decreased by 11.36% year on year. The number of blood transfusion cases in surgical departments decreased by 26.60%, and that in non-surgical specialist departments decreased by 7.53%. The multi factor model showed that the improvement of the qualified rate in non-surgical departments and the main internal medicine subgroups was statistically significant. Conclusion The new performance evaluation system significantly improves the level of rational blood use and reduces resource waste through mechanism optimization and incentive coordination, providing a reference model for blood management reform in medical institutions.
目的:分析脑出血死亡时间及死因,找出脑出血不同死亡时间的主要死因,为制定脑出血不同时间的相应救治措施提供依据。方法:回顾性总结分析２１１ 例脑出血死亡病例的死亡时间、主要死因,找出不同死亡时间对应的主要死因。 结果: (１)死亡时间:≤３ 天 ９１ 例、４~７天 ５２ 例、８~１４ 天 ４２ 例、１５~２１ 天１８ 例、２２~２８ 天 ７ 例、≥ ２９ 天 １ 例。(２)死亡原因:１６９ 例死于脑疝及中枢性呼吸、循环衰竭;20例死于肺部感染;１０ 例死于消化道出血;4 例死于多器官功能衰竭;４ 例死于心脏病变(如心脏猝死、心肌梗塞、心功能衰竭);其它４例(痰窒息、肾功能衰竭、肝功能衰竭)。(３)不同死亡时间主要死亡原因:≤３ 天 ９０ 例死于脑疝及中枢性呼吸、循环衰竭,仅 １ 例死于消化道出血;４～７ 天４７ 例死于脑疝及中枢性呼吸、循环衰竭,３ 例死于肺部感染,死于心脏病变及其它各１例;８~１４ 天 ２９ 例死于脑疝及中枢性呼吸、循环衰竭,８ 例死于肺部感染,２ 例死于消化道出血,死于心脏病变、多器官功能衰竭、其它各 １ 例;１５~２１ 天 ７ 例死于肺部感染,５ 例死于消化道出血,３ 例死于脑疝及中枢性呼吸、循环衰竭,死于心脏病变、多器官功能衰竭、其它各１例;２２～２８天死于消化道出血、肺部感染各２ 例,死于心脏病变、多器官功能衰竭、其它各１ 例,已无死于脑疝及中枢性呼吸、循环衰竭者;２９ 天后死于多器官功能衰竭１ 例。结论: 脑出血死亡时间不同,其主要死亡原因不同。临床应该针对不同死亡时间的主要死因制定相应救治方案,以降低死亡率。
The prevention and control of chronic diseases is a major need that urgently needs to be solved in China. Traditional Chinese medicine has unique advantages in preventing and treating chronic diseases. However, insufficient patient engagement may be found in the selection and evaluation of traditional Chinese medicine for the prevention and treatment of chronic diseases. In recent years, patient-centered clinical research has become a hot topic. A patient-centered methodological framework is proposed for the selection and evaluation of traditional Chinese medicine for preventing and treating chronic diseases. It incorporates some patient-centered studies based on the evidence-based medicine practice model, and will provide a scientific basis for screening traditional Chinese medicine for preventing and treating chronic diseases, improving the efficiency of traditional Chinese medicine services, improving price policies, and updating medical insurance catalogs.
Precision medicine is a personalized medical system based on patients' individual biological information, clinical symptoms and signs, forming a new clinical research model and medical practice path. The basic idea of traditional Chinese medicine and the concept of precision medicine share many similarities. The basket trial developed for precision medicine is also suitable for clinical trials and evaluation of the efficacy of traditional Chinese medicine syndrome differentiation and treatment systems. Basket trials are used to evaluate the efficacy of a drug in the treatment of multiple diseases or disease subtypes. It has the advantages of sharing a master protocol, unifying management of subsidiary studies, simplifying the test implementation process, unifying statistical analysis, saving resources, reducing budgets and accelerating the drug evaluation progress. This is similar to the concept of using the "same treatment for different diseases" found in traditional Chinese medicine. This paper introduced the concept and method of basket trials and explored their application and advantages in clinical research into traditional Chinese medicine. This study is expected to provide references for the methodological innovation of clinical research into traditional Chinese medicine.
In recent years, reports of domestic robot-assisted total knee arthroplasty have gradually increased. In response to problems that may arise during the perioperative period, West China Hospital of Sichuan University has adopted measures such as the establishment of multidisciplinary team, adequate preoperative evaluation, precise intraoperative operations, and whole process optimization management (incision management, pain management, functional exercise and follow-up management). Combined with the actual clinical situation, a domestic robot-assisted total knee arthroplasty management program during the perioperative period was explored and formulated to promote the recovery of patients. This article introduces the above-mentioned program, and aims to provide a reference for the management optimization of domestic robot-assisted total knee arthroplasty during the perioperative period.
Background Hepatitis B is one of the major infectious diseases of mankind, and up to now, there is no effective way to handle it. Recent clinical trials have shown the potential advantages of Kurorinone an extract of Chinese herb, in treament of chronic HBV infection. Objectives Systermically review the safety and efficacy of Kurorinone in treatment of chronic HBV infection. Search strategy With the searching terms including Kurorinone, its products’ name, hepatitis B and chronic carrier status, the trials registers of the Cochrane Hepato- Biliary Group, the Cochrane Complementary Medicine Field, and the central database of the Cochrane Library as well as MEDILINE, EMBASE and Chinese Biomedical CD Database were searched from their date of inception onward. 20 Chinese medical journals and relevant academic conference proceedings have been searched by hand. The reference lists of identified documents were checked as the complementary search. Inclusion Criteria All RCTs that tested Kurorinone for chronic HBV infection were included in this review. Method of the review According the demand of Cochrane systematic review, selection of trial for inclusion, assessment of methodological quality, data extraction and data syntheses would be conducted for each included trial.