[Application of interrupted suture at exercise position in total knee arthroplasty].
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery. 2018;(4):400-405
Objective: To investigate the effectiveness of interrupted suture under exercise position in total knee arthroplasty (TKA). Methods: Eighty-four patients with osteoarthritis who were treated with TKA between July 2015 and July 2016 were enrolled in the study. All patients were randomly divided into control group and observation group with 42 cases in each group. There was no significant difference in gender, age, side, body mass index, and osteoarthritis grading between 2 groups ( P>0.05). The incisions were interrupted sutured at the knee flexion position in control group and at the exercise position in observation group. Preoperative and postoperative treatments of 2 groups were same. The incision length, suture time, total tramadol usage, intraoperative blood loss, stitches removal time, hospitalization time, incidence of postoperative complication, the incision healing score (HWES), and satisfaction score of incisional self evaluation (Liktert score) were recorded and compared between 2 groups. The visual analogue scale (VAS) score was used to evaluate the incision pain at pre- and post-operation. The hospital for special surgery (HSS) score and range of motion (ROM) were also used to assess the knee function. Results: There was no significant difference in incision length, incidence of postoperative complication, HWES score, stitching time, and hospitalization time between 2 groups ( P>0.05). The suture time, intraoperative blood loss, and Likter score were significantly lower in control group than those in observation group ( P<0.05), but the total tramadol usage was significantly higher in control group than that in observation group ( P<0.05). All patients were followed up. The follow-up time ranged from 12 to 24 months (mean, 14.7 months) in control group and from 12 to 23 months (mean, 15.3 months) in observation group. There was no significant difference in VAS scores between 2 groups before operation, before going to bed at the 1st day, and after suture removal ( P>0.05). The VAS score of observation group after flexion and extension exercises at the 1st day was significantly lower than that of control group ( P<0.05). There was no significant difference in HSS score and ROM between 2 groups before operation and at 12 months after operation ( P>0.05). The HSS score and ROM in observation group at discharge and at 1, 3, and 6 months after operation were superior to those in control group ( P<0.05). Conclusion: Compared with interrupted suture at flexion knee position, the application of interrupted suture at exercise positon in TKA had the advantages of less postoperative pain and good incision healing, and can get satisfactory early joint function recovery. But significant difference in the long-term effectiveness of the two methods was not found.
Community walking speed, sedentary or lying down time, and mortality in peripheral artery disease.
Vascular medicine (London, England). 2016;(2):120-9
We studied whether slower community walking speed and whether greater time spent lying down or sleeping were associated with higher mortality in people with lower extremity peripheral artery disease (PAD). Participants with an ankle-brachial index (ABI) < 0.90 were identified from Chicago medical centers. At baseline, participants reported their usual walking speed outside their home and the number of hours they spent lying down or sleeping per day. Cause of death was adjudicated using death certificates and medical record review. Analyses were adjusted for age, sex, race, comorbidities, ABI, and other confounders. Of 1314 PAD participants, 189 (14.4%) died, including 63 cardiovascular disease (CVD) deaths. Mean follow-up was 34.9 months ± 18.1. Relative to average or normal pace (2-3 miles/hour), slower walking speed was associated with greater CVD mortality: no walking at all: hazard ratio (HR) = 4.17, 95% confidence interval (CI) = 1.46-11.89; casual strolling (0-2 miles/hour): HR = 2.24, 95% CI = 1.16-4.32; brisk or striding (>3 miles/hour): HR = 0.55, 95% CI = 0.07-4.30. These associations were not significant after additional adjustment for the six-minute walk. Relative to sleeping or lying down for 8-9 hours, fewer or greater hours sleeping or lying down were associated with higher CVD mortality: 4-7 hours: HR = 2.08, 95% CI = 1.06-4.05; 10-11 hours: HR = 4.07, 95% CI = 1.86-8.89; ⩾ 12 hours: HR = 3.75, 95% CI = 1.47-9.62. These associations were maintained after adjustment for the six-minute walk. In conclusion, slower walking speed outside the home and less than 8 hours or more than 9 hours lying down per day are potentially modifiable behaviors associated with increased CVD mortality in patients with PAD.
Incidence and Prognostic Significance of Depressive Symptoms in Peripheral Artery Disease.
Journal of the American Heart Association. 2016;(3):e002959
BACKGROUND We compared the incidence of depression, defined by a Geriatric Depression Score (GDS) ≥6, between people with versus without peripheral artery disease (PAD). We determined whether depressive symptoms were associated with increased mortality in people with and without PAD. METHODS AND RESULTS Nine hundred and fifty-one PAD patients and 478 non-PAD patients were recruited from Chicago medical centers and followed prospectively. At baseline and annually, participants completed the GDS (0-15 scale, score ≥6=depression) and 6-minute walk. Cause of death was confirmed with death certificates. The prevalence of a GDS ≥6 at baseline was 186/951 (19.6%) among PAD versus 63/478 (13.2%) among non-PAD participants (P=0.003). During a mean follow-up of 2.7±1.2 years, 122/712 (17.1%) of participants with PAD versus 51/403 (12.7%) without PAD developed a GDS ≥6 (P=0.047). Adjusting for age, sex, race, comorbidities, and other confounders, PAD participants had an increased rate of developing a GDS ≥6 compared to non-PAD participants (hazard ratio=1.54 (95% CI=1.05-2.25, P=0.026). This association was not statistically significant after adjusting for 6-minute walk (P=0.258). Among PAD participants, a baseline GDS ≥6 was associated with increased all-cause mortality, adjusting for confounders (hazard ratio=1.57, 95% CI=1.12-2.21, P=0.009). This association was not significant after adjusting for 6-minute walk (P=0.224). CONCLUSIONS People with PAD have a higher incidence of depressive symptoms than people without PAD. In PAD, depressive symptoms are associated with increased all-cause and cardiovascular mortality. These associations are explained in part by poorer 6-minute walk among people with PAD and among depressed people with PAD, respectively.
Probiotics for prevention and treatment of respiratory tract infections in children: A systematic review and meta-analysis of randomized controlled trials.
Plain language summary
Respiratory tract infections (RTIs) are a leading cause of morbidity and mortality among children worldwide. Probiotics are thought to be able to balance the gut microbiota and interact with the immune system, which may promote resistance against pathogens. There are conflicting results from studies investigating the effect of probiotics on RTI infection. The aim of this systematic review and meta-analysis was to provide the latest and convincing evidence of the effect of probiotic consumption on RTIs in children. 32 studies were included in the qualitative analysis, and 23 in the quantitative meta-analysis. All trials were randomised, double-blinded, and placebo-controlled. Probiotic supplementation had a significant effect on the reduction of number of subjects having at least 1 respiratory symptom episode, on the number of days the children were ill and the number of days absent from day care/school. There was no significant statistical difference of illness episode duration. There was statistical heterogeneity among the trials, and subgroup analysis did not highlight the source of this. It was noted, however, that the probiotic strain, the duration of regimens, administration forms, doses, and follow-up times differed across the included studies, as did the age of children. The authors conclude that probiotic consumption may decrease the incidence and illness duration of RTIs, and that further research is needed to establish optimal probiotic strains, dosing, administration form, time of intervention, and long-time follow-up.
BACKGROUND Respiratory tract infections (RTIs) represent one of the main health problems in children. Probiotics are viable bacteria that colonize the intestine and affect the host intestinal microbial balance. Accumulating evidence suggests that probiotic consumption may decrease the incidence of or modify RTIs. The authors systematically reviewed data from randomized controlled trials (RCTs) to investigate the effect of probiotic consumption on RTIs in children. METHODS MEDLINE/PubMed, Embase, Cochrane Library, and Web of Science were systematically searched for RCTs regarding the effect of probiotics on RTIs in children. The outcomes included number of children experienced with at least 1 RTI episode, duration of illness episodes, days of illness per subject, and school/day care absenteeism due to infection. A random-effects model was used to calculate pooled relative risks, or mean difference (MD) with the corresponding 95% confidence interval (CI). RESULTS A total of 23 trials involving 6269 children were eligible for inclusion in the systematic review. None of the trials showed a high risk of bias. The quality of the evidence of outcomes was moderate. The age range of subjects was from newborn to 18 years. The results of meta-analysis showed that probiotic consumption significantly decreased the number of subjects having at least 1 RTI episode (17 RCTs, 4513 children, relative risk 0.89, 95% CI 0.82-0.96, P = 0.004). Children supplemented with probiotics had fewer numbers of days of RTIs per person compared with children who had taken a placebo (6 RCTs, 2067 children, MD -0.16, 95% CI -0.29 to 0.02, P = 0.03), and had fewer numbers of days absent from day care/school (8 RCTs, 1499 children, MD -0.94, 95% CI -1.72 to -0.15, P = 0.02). However, there was no statistically significant difference of illness episode duration between probiotic intervention group and placebo group (9 RCTs, 2817 children, MD -0.60, 95% CI -1.49 to 0.30, P = 0.19). CONCLUSION Based on the available data and taking into account the safety profile of RCTs, probiotic consumption appears to be a feasible way to decrease the incidence of RTIs in children.
[Clinical comprehensive treatment of refractory chronic rhinosinusitis].
Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology, head, and neck surgery. 2015;(9):797-9
OBJECTIVE To study the methods and efficacy of comprehensive treatment on retractory chronic rhinosinusitis(CRS). METHOD Thirty-two cases of patients with refractory rhinosinusitis took part in individualized comprehensive treatment program, that is, a healthy diet and moderate exercise, psychological counseling, and reasonable operation and gauze changing, and rational use of drug therapy. RESULT All patients were followed up for 6 months or more, 26 cases (81.3%) were completely controlled of the disease, 6 cases (18.7%) were partially controlled; the total effective rate was 100%. CONCLUSION In the current situation that CRS etiology and pathogenesis studies have not yet made a breakthrough, and we have not developed a new and effective drug, comprehensive treatment focusing on internal and external factors of refractory rhinosinusitis at the same time, that is, to take a rational healthy diet, moderate exercise, psychological counseling, and reasonable operation and gauze changing, and rational use of drug therapy ect. can obtain better effect.
Unsupervised exercise and mobility loss in peripheral artery disease: a randomized controlled trial.
Journal of the American Heart Association. 2015;(5)
BACKGROUND Few medical therapies improve lower extremity functioning in people with lower extremity peripheral artery disease (PAD). Among people with PAD, we studied whether a group-mediated cognitive behavioral intervention promoting home-based unsupervised exercise prevented mobility loss and improved functional performance compared to control. METHODS AND RESULTS One hundred ninety-four PAD participants were randomized. During months 1 to 6, the intervention group met weekly with other PAD participants and a facilitator. Group support and self-regulatory skills were used to help participants adhere to walking exercise. Ninety-percent of exercise was conducted at or near home. The control group attended weekly lectures. During months 6 to 12, each group received telephone contact only. Primary outcomes have been reported. Here we compare changes in exploratory outcomes of mobility loss (the inability to climb a flight of stairs or walk one-quarter mile without assistance), walking velocity, and the Short Physical Performance Battery. Compared to controls, fewer participants randomized to the intervention experienced mobility loss at 6-month follow-up: 6.3% versus 26.5%, P=0.002, odds ratio=0.19 (95% CI=0.06 to 0.58) and at 12-month follow-up: 5.2% versus 18.5%, P=0.029, odds ratio=0.24 (95% CI=0.06 to 0.97). The intervention improved fast-paced 4-m walking velocity at 6-month follow-up (P=0.005) and the Short Physical Performance Battery at 12-month follow-up (P=0.027), compared to controls. CONCLUSIONS In exploratory analyses, a group-mediated cognitive behavioral intervention promoting unsupervised walking exercise prevented mobility loss and improved functioning at 6- and 12-month follow-up in PAD patients. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov. Unique identifier: NCT00693940.
Comparison of metformin and repaglinide monotherapy in the treatment of new onset type 2 diabetes mellitus in China.
Journal of diabetes research. 2014;:294017
OBJECTIVE This study was designed to compare the effects of metformin and repaglinide on the fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) in newly diagnosed type 2 diabetes in China. METHODS A total of 107 newly diagnosed type 2 diabetic patients (46 women and 61 men) participated in the study. All patients received 3-month treatment of metformin or repaglinide. Fasting blood glucose and HbA1c were determined at baseline and at the end of the 3-month of treatment. RESULTS FPG and HbA1c decreased in both metformin and repaglinide groups after 3 months treatment (P < 0.01). The reduction of HbA1c was significantly greater in the repaglinide group (P < 0.01). Metformin decreases fasting insulin concentration and HOMA-IR (P < 0.01), and repaglinide improves HOMA-β(P < 0.01). Triglycerides (TG) were reduced in both groups (P < 0.01 in metformin group; P < 0.05 in repaglinide group), but total cholesterol (TC) and low-density lipoprotein (LDL) were decreased only after metformin treatment (P < 0.05). CONCLUSIONS Both repaglinide and metformin were effective in glycaemic control in new onset patients with type 2 diabetes in China. Repaglinide had no effect on insulin sensitivity, but it improved β-cell function.
Home-based walking exercise in peripheral artery disease: 12-month follow-up of the GOALS randomized trial.
Journal of the American Heart Association. 2014;(3):e000711
BACKGROUND We studied whether a 6-month group-mediated cognitive behavioral (GMCB) intervention for peripheral artery disease (PAD) participants, which promoted home-based walking exercise, improved 6-minute walk and other outcomes at 12-month follow-up, 6 months after completing the intervention, compared to a control group. METHODS AND RESULTS We randomized PAD participants to a GMCB intervention or a control group. During phase I (months 1 to 6), the intervention used group support and self-regulatory skills during weekly on-site meetings to help participants adhere to home-based exercise. The control group received weekly on-site lectures on topics unrelated to exercise. Primary outcomes were measured at the end of phase I. During phase II (months 7 to 12), each group received telephone contact. Compared to controls, participants randomized to the intervention increased their 6-minute walk distance from baseline to 12-month follow-up, (from 355.4 to 381.9 m in the intervention versus 353.1 to 345.6 m in the control group; mean difference=+34.1 m; 95% confidence interval [CI]=+14.6, +53.5; P<0.001) and their Walking Impairment Questionnaire (WIQ) speed score (from 36.1 to 46.5 in the intervention group versus 34.9 to 36.5 in the control group; mean difference =+8.8; 95% CI=+1.6, +16.1; P=0.018). Change in the WIQ distance score was not different between the 2 groups at 12-month follow-up (P=0.139). CONCLUSIONS A weekly on-site GMCB intervention that promoted home-based walking exercise intervention for people with PAD demonstrated continued benefit at 12-month follow-up, 6 months after the GMCB intervention was completed. CLINICAL TRIAL REGISTRATION URL ClinicalTrials.gov. Unique identifier: NCT00693940.
A pilot randomized controlled trial of a commercial diet and exercise weight loss program in minority breast cancer survivors.
Obesity (Silver Spring, Md.). 2013;(1):65-76
OBJECTIVE Obesity is associated with poorer breast cancer outcomes and losing weight postdiagnosis may improve survival. As Hispanic and black women have poorer breast cancer prognosis than non-Hispanic whites diagnosed at similar age and stage, and have higher rates of obesity, effective weight loss strategies are needed. We piloted a randomized, waitlist-controlled, crossover study to examine the effects and feasibility of the commercial Curves weight loss program among Hispanic, African American and Afro-Caribbean breast cancer survivors. DESIGN AND METHODS Women with stage 0-IIIa breast cancer ≥ 6 months posttreatment, sedentary, and BMI ≥ 25 kg/m(2) were randomized to the immediate arm (IA): 6 months of the Curves program followed by 6 months of observation; or the waitlist control arm (WCA): 6 months of observation followed by 6 months of the Curves program. The Curves program uses a 30-min exercise circuit and a high-vegetable/low-fat/calorie-restricted diet. RESULTS A total of 42 women enrolled (79% Hispanic, 21% black), mean age 51 (range 32-69) and mean BMI 33.2(± 5.9) kg/m(2); 91% were retained at month 12. At month 6, women in the IA lost an average 3.3% (± 3.5%) of body weight (range: 1.7% gain to 10.6% loss), as compared with 1.8% (± 2.9%) weight loss in the WCA (P = 0.04). At month 12, on average women in the IA regained some but not all of the weight lost during the first 6 months (P = 0.02). CONCLUSIONS Minority breast cancer survivors were recruited and retained in a weight loss study. Six months of the Curves program resulted in moderate weight loss, but weight loss was not maintained postintervention. Future interventions should identify methods to increase uptake and maintenance of weight loss behaviors.
Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial.
IMPORTANCE Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease (PAD) to participate in a home-based walking exercise program. OBJECTIVE To determine whether a home-based walking exercise program that uses a group-mediated cognitive behavioral intervention, incorporating both group support and self-regulatory skills, can improve functional performance compared with a health education control group in patients with PAD with and without intermittent claudication. DESIGN, SETTING, AND PATIENTS Randomized controlled clinical trial of 194 patients with PAD, including 72.2% without classic symptoms of intermittent claudication, performed in Chicago, Illinois between July 22, 2008, and December 14, 2012. INTERVENTIONS Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition. MAIN OUTCOMES AND MEASURES The primary outcome was 6-month change in 6-minute walk performance. Secondary outcomes included 6-month change in treadmill walking, physical activity, the Walking Impairment Questionnaire (WIQ), and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey. RESULTS Participants randomized to the intervention group significantly increased their 6-minute walk distance ([reported in meters] 357.4 to 399.8 vs 353.3 to 342.2 for those in the control group; mean difference, 53.5 [95% CI, 33.2 to 73.8]; P < .001), maximal treadmill walking time (intervention, 7.91 to 9.44 minutes vs control, 7.56 to 8.09; mean difference, 1.01 minutes [95% CI, 0.07 to 1.95]; P = .04), accelerometer-measured physical activity over 7 days (intervention, 778.0 to 866.1 vs control, 671.6 to 645.0; mean difference, 114.7 activity units [95% CI, 12.82 to 216.5]; P = .03), WIQ distance score (intervention, 35.3 to 47.4 vs control, 33.3 to 34.4; mean difference, 11.1 [95% CI, 3.9 to 18.1]; P = .003), and WIQ speed score (intervention, 36.1 to 47.7 vs control, 35.3-36.6; mean difference, 10.4 [95% CI, 3.4 to 17.4]; P = .004). CONCLUSION AND RELEVANCE A home-based walking exercise program significantly improved walking endurance, physical activity, and patient-perceived walking endurance and speed in PAD participants with and without classic claudication symptoms. These findings have implications for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00693940.