Effects of perioperative statins on patient outcomes after noncardiac surgery: a meta-analysis

Background: Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. However, controversy remains regarding whether perioperative administration of hydroxymethylglutaryl-CoA reductase inhibitors (statins) has a beneficial effect on patient outcomes.

Objective: We performed a meta-analysis to validate the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.

Methods: Electronic databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) were searched for randomized controlled trials (RCTs) published up to 10 November 2017. RCTs were eligible for inclusion if they compared perioperative statin treatment with control treatment in patients scheduled for noncardiac surgery and reported data pertaining to clinical outcomes.

Results: Twelve RCTs involving 4707 patients (2371 in the perioperative statin group and 2336 in the control group) were ultimately included in this meta-analysis. The incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation were all lower in patients treated with statins than in control group patients, as shown by the fixed-effects model (odds ratio (OR)?=?0.460, 95% confidence interval (CI)?=?0.324–0.653, p?=?0 for myocardial infarction; OR?=?0.617, 95% CI?=?0.476–0.801, p?=?0 for composite of death/myocardial infarction/stroke; OR?=?0.406, 95% CI?=?0.247–0.666, p?=?0 for new atrial fibrillation). No significant differences in the incidences of stroke or transient ischemic attack, all-cause mortality and cardiovascular mortality were observed between the statin and control arms.

Conclusions: This meta-analysis supports the hypothesis that perioperative statins effectively reduce the incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation in patients undergoing noncardiac surgery.

• Key Messages

• Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery.

• We performed a meta-analysis to confirm the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.

     

Effects of Exercise Training on Restless Legs Syndrome,Depression, Sleep Quality,and Fatigue Among Hemodialysis Patients: A Systematic Review and Meta-analysis

Context

Hemodialysis (HD) patients experience a heavy symptom burden that leads to a decreased quality of life. Pharmacological treatment is effective but costly and has adverse effects. Exercise is a promising approach for symptom management, but the effect of exercise on restless legs syndrome (RLS), depression, sleep quality, and fatigue in HD patients is still uncertain.

Nickel-foam-supported β-Ni(OH)2 as a green anodic catalyst for energy efficient electrooxidative degradation of azo-dye wastewater

Electrochemical oxidative degradation (EOD) is a particularly promising technique for removing organic pollutants from wastewater. However, due to the high overpotential of EOD in conventional anode materials, the energy cost of EOD is usually very high, which greatly promotes the search for highly active, stable, and energy-efficient anodic catalysts. Herein, we demonstrated that nickel-foam-supported (NF-supported) β-Ni(OH)₂ (NF/β-Ni(OH)₂) prepared via a facile hydrothermal method could be used as an energy efficient anode for EOD. The as-prepared 3D porous NF/β-Ni(OH)₂ exhibited high activity toward the electrochemical oxidation of methyl orange (MO) in the low potential region (<1.07 V vs. SCE). This property differs greatly from those of the conventional anode materials that require a high positive potential to keep them active for EOD, making NF/β-Ni(OH)₂ an energy-efficient and active anode material for EOD. With an oxidation current density of 0.25 mA cm⁻², the decolorization of MO was completed within 30 min, and the COD removal after 3h of reaction was 63.0%. The normalized energy consumption for the 3 h degradation of MO was 22.2 kW h (kg COD)⁻¹, which is only a fraction of (or even one tenth of) the values reported in the literature. Moreover, NF/β-Ni(OH)₂ had a good stability and recyclability for EOD. No activity decay was observed during 10 h of EOD and the COD removal remained almost unchanged after four consecutive reaction cycles. We demonstrated experimentally that the NF/β-Ni(OH)₂ anode could generate large amounts of hydroxyl radicals and that the oxidation of MO by hydroxyl radicals was the main mechanism during EOD. We believe that this work opens a new avenue for developing highly active and energy-efficient anode materials that can work in the low potential region for EOD.

A novel NF/β-Ni(OH)₂ catalyst for energy efficient electrochemical degradation of methyl orange was fabricated via a facile hydrothermal method.     

Evaluation of Anti-Bacterial and Wound Healing Activity of the Fruits of Amorpha Fruticosa L.

As the traditional Chinese medicine, the fresh fruits of Amorpha fruticosa L. were applied for the treatment of carbuncle, eczema and burn (Das et al., 2007). However, little is known about the functional roles of the fruits of Amorpha fruticosa L. during wound healing progress. In the present study, we evaluated both antimicrobial potential against a wide range of microorganisms and wound healing activity of the seven compounds isolated from the fruits of Amorpha fruticosa L in vitro and in vivo. Our results showed that compounds I (6a,12a-dehydroamorphin), V (dehydrosermundone) and VI (tephrosin) isolated from the fruits of Amorpha fruticosa L. performed dominant antimicrobial potential against microorganisms. Moreover, these compounds significantly enhanced fibroblasts proliferation and migration, leading to promotion of wound healing. Thus, it could be possible for the therapeutic utilization of Amorpha fruticosa L. for wound healing in the future.     

Improving the solubility and bioavailability of anti-hepatitis B drug PEC via PEC–fumaric acid cocrystal

PEC is a new generation of phosphamide ester anti-hepatitis B virus drug. It is a prodrug of tenofovir and can be rapidly metabolized to tenofovir. However, its poor solubility in water (0.219 mg mL⁻¹ at 25 °C) has limited its oral bioavailability. In this study, we aimed to improve the solubility and consequently the oral bioavailability of PEC via a cocrystal. A cocrystal of PEC with fumaric acid (FUA) (PEC–FUA, 1 : 1) was successfully obtained and characterized. The crystal structure of this cocrystal was tested using a single crystal X-ray diffraction method. The intrinsic dissolution rate (IDR) characterization was performed in a pH 6.8 buffer. The solubility of this cocrystal in 0.1 M HCl (pH 1.0) and pH 6.8 phosphate buffers was investigated, and the results showed that the solubility of the cocrystal was 3.8 and 4.0 times that of free PEC, respectively. We also studied the pharmacokinetics of beagle dogs. The mean AUC_{0–24 h} of the cocrystal is about 4.2 times that of free PEC, indicating that the solubility and bioavailability of PEC can indeed be improved by forming the cocrystal. It may become an ideal solid form of an active pharmaceutical ingredient suitable for pharmaceutical preparations, and it can be further studied later.

A cocrystal of PEC with fumaric acid (FUA) (PEC–FUA, 1 : 1) was successfully obtained and characterized. The mean AUC_{0–24 h} of the cocrystal is about 4.2 times that of free PEC.     

符合米兰标准和杭州标准的肝癌肝移植受者预后回顾性分析

目的比较符合米兰标准和符合杭州标准的肝细胞肝癌(HCC)患者行肝移植术后生存和肿瘤复发情况,验证杭州标准的临床应用价值。方法回顾性分析2006年1月至2011年12月中国肝移植注册登记的肝移植手术,并在浙江大学医学院附属第一医院、重庆医科大学附属第一医院两家肝移植中心接受随访调查受者的临床资料,196例肝癌肝移植受者纳入研究。将符合米兰标准的HCC患者作为米兰标准组,共90例(45.9%);超出米兰标准但符合杭州标准者作为杭州标准组,共40例(20.4%);肿瘤结节直径之和8 cm,术前AFP400 ng/m L且组织学分级为低度分化者作为超出杭州标准组,共66例(33.7%)。比较3组受者术后生存率、无瘤生存率,并评判预后。结果米兰标准组受者术后1、3、5年生存率和1、3、5年无瘤生存率分别为88.9%、73.3%、60.0%和84.4%、66.7%、51.1%,杭州标准组受者术后1、3、5年生存率和1、3、5年无瘤生存率分别为80.0%、65.0%、50.0%和75.0%、55.0%、45.0%,超出杭州标准组受者术后1、3、5年生存率和1、3、5年无瘤生存率分别为57.6%、30.3%、18.1%和45.5%、27.3%、18.1%。对3组受者术后累积生存率和无瘤生存率进行比较,米兰标准组和杭州标准组受者术后1、3、5年生存率和1、3、5年无瘤生存率差异均无统计学意义(P均0.05),米兰标准组受者术后1、3、5年生存率和无瘤生存率均显著高于超出杭州标准组受者(P均0.05),杭州标准组受者术后1、3、5年生存率和1、3、5年无瘤生存率均显著高于超出杭州标准组受者(P均0.05)。结论同米兰标准一样,杭州标准也具有很强的科学性,能够显著拓展受益人群,让更多未符合米兰标准的患者能够施行肝移植术。同时杭州标准能有效预测肝移植受者预后,其创新性提出的生物学标准AFP水平和肿瘤分化程度是影响肝癌肝移植受者术后预后的关键性因素。     

D3卵裂期胚胎玻璃化冷冻技术在IVF实验室中的应用

目的探讨玻璃化冷冻技术在人类卵裂期胚胎冻存中的应用价值。方法回顾性分析本中心261个冷冻胚胎复苏周期,比较2种冷冻方法的胚胎存活率、完好率、妊娠率和种植率等数据。结果玻璃化冷冻组的存活率(97.11%)、完好率(89.02%)和种植率(23.12%)显著高于程序化组(91.31%、63.73%、16.31%)(P<0.05),而妊娠率和平均年龄、平均移植胚胎数、平均内膜厚度两组间无统计学差异(40.26%vs40.22%、31.3±5.3vs32.2±5.5、2.25±0.55vs2.27±0.70、8.9±1.1vs9.1±1.6)(P>0.05)。结论玻璃化冷冻是卵裂期胚胎保存的优选方法。