Systematic Review of Chinese Herbal Medicines for Preventing in-Stent Coronary Restenosis after Percutaneous Coronary Intervention

Percutaneous coronary intervention (PCI) with stent placement is a standard treatment for coronary artery disease (CAD). In-stent restenosis after PCI remains a challenging clinical problem. In China, Chinese herbal medicines (CHMs) are widely used for preventing restenosis. This paper systematically reviewed the literature on the effectiveness and safety of CHMs in preventing restenosis after PCI in patients with CAD. Electronic databases were searched for randomized controlled trials that compared CHMs plus RWM with the same RWM plus placebo in preventing restenosis after PCI. A total of 52 trials (4905 patients) on 34 CHMs met the inclusion criteria and were analyzed. Ten trials had low risk of bias. Methodological quality of included trials was generally poor. Meta-analysis showed that at the end of at least 3 months' followup, CHMs plus RWM could significantly reduce restenosis rate, cardiac mortality, recurrence rate of angina, acute myocardial infarction, numbers of repeat PCI, and numbers of coronary artery bypass graft. Reported adverse events included gastrointestinal upset, granulocytopenia, and increased alanine transaminase (ALT). CHMs may help prevent restenosis, thus reducing cardiac mortality after PCI. Caution should be exercised in drawing a definitive conclusion due to the poor methodological quality of the trials reviewed

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Cupping therapy for acute and chronic pain management: a systematic review of randomized clinical trials

Objective: Cupping as a traditional therapy is used to treat a myriad of health conditions, including pain. This systematic review assessed the effectiveness and safety of cupping for different types of pain. Methods: Thirteen databases and four trial registries were searched for randomized clinical trials. Meta-analysis of data was conducted if there was non-significant clinical and statistical heterogeneity (measured by I2 test) among trials. Results: Sixteen trials with 921 participants were eligible and included. Six trials were assessed as low risk of bias, another six trials were of unclear risk of bias, and the remaining four trials were of high risk of bias. Pain was related to three acute and seven chronic diseases. Meta-analysis showed a beneficial effect of cupping compared to wait-list control (visual analogue scale (VAS), MD −1.85 cm, 95%CI −2.66 to −1.04) and heat therapy (numerical rating scale, MD −2.05 cm, 95%CI −2.93 to −1.17). Cupping combined with acupuncture was superior to acupuncture alone on post-treatment pain intensity (VAS, MD −1.18 cm, 95%CI −1.68 to −0.68), however, no difference was found between this comparison based on changes in pain intensity (difference of VAS, MD 0.16 cm, 95%CI −0.54 to 0.87). Results from other single studies showed significant benefit of cupping compared with conventional drugs or usual care. Hematoma and pain at the treated site, increasing local pain or tingling were reported as mild adverse effects of cupping. Conclusion: This review suggests a potential positive short-term effect of cupping therapy on reducing pain intensity compared with no treatment, heat therapy, usual care, or conventional drugs

Improved Visualization of Cartilage Canals Using Quantitative Susceptibility Mapping

<div><p>Purpose</p><p>Cartilage canal vessels are critical to the normal function of epiphyseal (growth) cartilage and damage to these vessels is demonstrated or suspected in several important developmental orthopaedic diseases. High-resolution, three-dimensional (3-D) visualization of cartilage canals has recently been demonstrated using susceptibility weighted imaging (SWI). In the present study, a quantitative susceptibility mapping (QSM) approach is evaluated for 3-D visualization of the cartilage canals. It is hypothesized that QSM post-processing improves visualization of the cartilage canals by resolving artifacts present in the standard SWI post-processing while retaining sensitivity to the cartilage canals.</p><p>Methods</p><p>Ex vivo distal femoral specimens from 3- and 8-week-old piglets and a 1-month-old human cadaver were scanned at 9.4 T with a 3-D gradient recalled echo sequence suitable for SWI and QSM post-processing. The human specimen and the stifle joint of a live, 3-week-old piglet also were scanned at 7.0 T. Datasets were processed using the standard SWI method and truncated k-space division QSM approach. To compare the post-processing methods, minimum/maximum intensity projections and 3-D reconstructions of the processed datasets were generated and evaluated.</p><p>Results</p><p>Cartilage canals were successfully visualized using both SWI and QSM approaches. The artifactual splitting of the cartilage canals that occurs due to the dipolar phase, which was present in the SWI post-processed data, was eliminated by the QSM approach. Thus, orientation-independent visualization and better localization of the cartilage canals was achieved with the QSM approach. Combination of GRE with a mask based on QSM data further improved visualization.</p><p>Conclusions</p><p>Improved and artifact-free 3-D visualization of the cartilage canals was demonstrated by QSM processing of the data, especially by utilizing susceptibility data as an enhancing mask. Utilizing tissue-inherent contrast, this method allows noninvasive assessment of the vasculature in the epiphyseal cartilage in the developing skeleton and potentially increases the opportunity to diagnose disease of this tissue in the preclinical stages, when treatment likely will have increased efficacy.</p></div

Comparison of QSM, plain GRE, SWI and QSM-WI at 7.0 T <i>in vivo</i>.

<p>Comparison of QSM, GRE, SWI and QSM-WI of a 3-week-old piglet scanned at 7.0 T <i>in vivo</i>. In the first pane, showing an axial plane perpendicular to B0, the datasets appeared visually similar. In the second pane, with views parallel to B0, artifactual splitting of the vessels was observed for the SWI data while both QSM datasets and the unprocessed GRE appeared artifact-free.</p

Quantitative susceptibility values of the cartilage canals.

<p>Relative susceptibility values of the cartilage canals with respect to the surrounding tissue in a 1-month-old human cadaveric distal femur scanned at 9.4 T (A) and at 7.0 T (B), and in a 3-week-old piglet scanned at 7.0 T <i>in vivo</i> (C) as a function of the truncation factor used in the k-space dipole inversion. Inset images in A-C depict single slices from the quantitative susceptibility maps at truncation factor values of 0.5, 5 and 20 at an intensity scale normalized with the intensity of the cartilage canals to facilitate visual comparison of the streaking artifacts. The second row shows the susceptibility histograms acquired for the corresponding cartilage canal ROIs for the respective specimens as a function of the truncation factor (D-F).</p