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      Clinical study on improving postoperative symptoms of cervical spondylotic myelopathy by Qishe pill

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          Abstract

          Background:

          Cervical spondylotic myelopathy (CSM) is the most serious type of cervical spondylosis, which is often treated surgically in patients with progressive neurological symptoms following ineffective conservative treatment. However, some patients have residual symptoms such as neck pain, stiffness, and C5 nerve palsy after surgery. The Qishe pill can effectively relieve the symptoms of neck pain and numbness, but there is no evidence showing the efficacy and safety of the Qishe pill in treating symptoms after spinal cord surgery.

          Methods/design:

          A multicenter, randomized controlled clinical trial will be conducted to evaluate the efficacy and safety of the Qishe Pill. A total of 330 patients with CSM who receive surgical treatment will be randomly divided into 2 groups, treated for 12 weeks and with a 1-year follow-up. The primary outcome will be Japanese Orthopaedic Association score from the baseline to 4 weeks, 12 weeks, 24 weeks, and 48 weeks after surgery. Secondary outcomes will include Visual Analogue Scale score, Neck Disability Index, and imaging indicators (including magnetic resonance imaging and X-ray). Additionally, adverse reactions will be observed and recorded as safety indicators.

          Discussion:

          Although the Qishe pill can effectively improve the discomfort of the neck and upper limbs in clinical applications, there is a lack of clinical research on postoperative patients. This study will investigate the efficacy and safety of the Qishe pill in treating postoperative symptoms of CSM.

          Trial registration:

          Clinical Trials.gov ID: ChiCTR1900028173. Registered on 17 December 2019.

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          Most cited references22

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          Researchers’ perceptions of ethical challenges in cluster randomized trials: a qualitative analysis

          Background Cluster randomized trials (CRTs) pose ethical challenges for investigators and ethics committees. This study describes the views and experiences of CRT researchers with respect to: (1) ethical challenges in CRTs; (2) the ethics review process for CRTs; and (3) the need for comprehensive ethics guidelines for CRTs. Methods Descriptive qualitative analysis of interviews conducted with a purposive sample of 20 experienced CRT researchers. Results Informants expressed concern over the potential for bias that may result from requirements to obtain informed consent from research participants in CRTs. Informants suggested that the need for informed consent ought to be related to the type of intervention under study in a CRT. Informants rarely expressed concern regarding risks to research participants in CRTs, other than risks to privacy. Important issues identified in the research ethics literature, including fair subject selection and other justice issues, were not mentioned by informants. The ethics review process has had positive and negative impacts on CRT conduct. Informants stated that variability in ethics review between jurisdictions, and increasingly stringent ethics review in recent years, have hampered their ability to conduct CRTs. Many informants said that comprehensive ethics guidelines for CRTs would be helpful to researchers and research ethics committees. Conclusions Informants identified key ethical challenges in the conduct of CRTs, specifically relating to identifying subjects, seeking informed consent, and the use of gatekeepers. These data have since been used to identify topics for in-depth ethical analysis and to guide the development of comprehensive ethics guidelines for CRTs.
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            Nonoperative management of cervical myelopathy: a systematic review.

            Systematic review.
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              Comparison of 3 reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy.

              A retrospective comparative study was performed in patients with 3-level cervical spondylotic myelopathy (CSM). To compare the clinical outcomes, radiological parameters, and complication incidence of 3 reconstructive techniques after the anterior decompression of multilevel CSM. There has been growing interest in combination of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) for the treatment of multilevel CSM in recent years. However, the clinical efficacy and radiological outcomes of the hybrid decompression and fusion (HDF) have rarely been investigated. A total of 180 consecutive patients with 3-level CSM undergoing the anterior decompression and fusion procedures from January 2003 to July 2010 were retrospectively investigated. According to various reconstructive techniques, the patients were divided into 3 groups: HDF, ACDF, and ACCF groups. The clinical effects and improvements of cervical and segmental lordosis in each group were assessed. In addition, the fusion rate, postoperative complications, and radiographical adjacent-level changes regarding each group were also evaluated. No statistical differences in clinical effects, restoration of cervical lordosis, and incidences of postoperative complications were found between the HDF and ACDF groups (P > 0.05). The ACCF group has achieved clinical effects similar to the ACDF or HDF group (P > 0.05), but it had more bleeding, lower fusion rate, and higher incidences of postoperative complications compared with the ACDF or HDF group (P 0.05). The HDF can be considered an effective and safe alternative procedure compared with ACDF in the treatment of the multilevel CSM, and ACCF should be the last option.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0025-7974
                1536-5964
                04 September 2020
                04 September 2020
                : 99
                : 36
                : e21994
                Affiliations
                [a ]Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
                [b ]Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.
                Author notes
                []Correspondence: Jie Ye, Wen Mo, Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China ( e-mails: yejie1977@ 123456126.com , mw2218@ 123456126.com ); Wen Yuan, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China (e-mail: yuanwenspine@ 123456smmu.edu.cn ).
                Author information
                http://orcid.org/0000-0001-7844-4566
                Article
                MD-D-20-07157 21994
                10.1097/MD.0000000000021994
                7478389
                3f3e7fe3-a4c3-4753-984e-b0ccf44bf314
                Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 30 July 2020
                : 31 July 2020
                Categories
                3700
                Research Article
                Study Protocol Clinical Trial
                Custom metadata
                TRUE

                cervical spondylotic myelopathy,postoperative residual symptoms,qishe pill,randomized controlled trial

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