BackgroundThe management of neuropathic pain (NP) is challenging despite it being the recent focus of extensive research. A number of clinical practice guidelines (CPGs) for the management of NP have been published worldwide over the past 2 decades. This study aimed to assess the quality of these CPGs.MethodsWe performed a systematic review of published CPGs for the management of NP. Three reviewers independently assessed the quality of the CPGs using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) instrument, and recommendations of CPGs were also appraised.ResultsA total of 16 CPGs were included. Thirteen CPGs were developed using an evidence-based approach, and the remaining CPGs were produced by consensus panels. None of CPGs obtained a score greater than 50 % in all six AGREE II instrument domains mainly owing to poor performance in the “Applicability” domain. The highest score of the CPGs was achieved in “Clarity and Presentation” domain, followed by “Scope and Purpose” and “Editorial Independence” domains, and the lowest scores were found the in “Applicability” domain. The majority of the CPG recommendations on the management of patients with NP were relatively consistent, especially regarding the recommendation of stepwise treatment with medication.ConclusionsGreater efforts are needed not only to improve the quality of development and presentation of the CPGs, but also to provide more efficacy evidence for the management of patients with NP.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-015-0150-5) contains supplementary material, which is available to authorized users.

irect version intracardiac surgery on the beating heart is a newly developed technique that does not use aortic cross-clamping or hypothermic cardiac arrest. 1,2 The nearly normal physiological conditions enables continuous coronary artery blood supply and overcomes the deficiencies of traditional methods. However, operating on the beating heart increases the difficulty of maneuvering and sometimes excessive tugging is inevitable. 3 Beta-1-blockers, which have been successfully used in heart disease, not only decrease heart rate and metabolism, but have many beneficial effects on ischemic myocardium. 4-10 Therefore, we hypothesized that using a 1-blocker in direct version intracardiac surgery with beating heart would protect the myocardium as well as facilitate the operation. We used the ultra short-acting and selective 1-blocker, esmolol, and investigated its protective effect on the myocardium. Methods Patient SelectionTwenty-four patients undergoing elective direct version intracadiac surgery were selected (Table 1). Study ProtocolControl Group (n=12) Normorthermia cardiopulmo- Circulation Journal Vol.66, August 2002nary bypass (CPB) with beating heart. In brief, the ascending aorta and superior and inferior vena cavae were catheterized after heparinization. The nasopharynx temperature was maintained at 35-36°C. The superior and inferior vena cavae were snared, but the aorta was kept open during CPB and maintained the mean blood pressure between 50 and 60 mmHg. The heart was beating during the whole operation. Esmolol Group (n=12) Before CPB, 1 mg/kg of esmolol was injected and followed by 0.3% continuous esmolol drip to maintain the heart rate at 30-50 beats/min. Other protocols were the same as for the control group. Hemodynamic ParametersHeart rate, invasive arterial pressure, myocardial extension and the doses of dopamine used were recorded. Myocardial extension was evaluated by the surgeon and recorded as high, low or extremely low. Esmolol Protects the Myocardium and Facilitates Direct Version Intracardiac Operation With a Beating HeartYun-Kun Deng, MD; Fang Wei, PhD*; Zheng-Lun Li, MD**; Da-Guo Zhang, MD**; Shi-Yu Yang, MD**In recent years there has been renewed interest in beating heart surgery using the ultra-active and selective 1-blocker, esmolol. However, there has not been a report of its use in direct version intracardiac surgery with beating heart. Twenty-four patients undergoing elective direct version intracardiac surgery (mitral valve replacement) were divided randomly into 2 groups: control group (normothermia cardiopulmonary bypass (CPB) direct version intracardiac beating heart surgery) and esmolol group (normothermia CPB direct version intracardiac beating heart surgery and intravenous esmolol drip during CPB to maintain heart rate at 30-50 beats/min). Steady hemodynamic parameters were maintained in both groups; however, the doses of dopamine used in control group were larger than those for the esmolol group (p<0.01). The myocardial ultrastructure was well maintained in both group, but...

Yun-kun (g[~;N), LI Zheng-lun (~t~), SHEN Tian-hai (~0~NI), YANG Shi-yu (~flJ:~), VAN Xing-zhi (l~]~), ZHANG Da-guo (~t~)~[~), and LIU Xiu-lun (~l]~)ABSTRACT Objective: To observe the myocardial protecting effects of Ginaton (Ginkgo biloba extract) on ischemic-reperfusion injured myocardium during cardiopulmonary bypass (CPB). Methods: Twenty patients selected undergoing mitral valvular replacement were randomly divided into two groups. Control group: 10 patients, intermittent intra-aortic infusion with cold St. Thomas solution during hypothermic CPB. Ginaton group: 10 patients, intermittent intra-aortic infusion with cold St. Thomas solution containing Ginaton (0.5 mg" kg-1 ). Changes of ultrastructure levels of adenosine triphosphate (ATP), malondialdehyde (MDA) and hemodynamic data were measured. Results: Hemodynamic parameters in the Ginaton group were maintained better than those in the control group. MDA in the control group was significantly elevated during ischemic-reperfusion (P< 0.05), while in the Ginaton group, there were no obvious change. The levels of ATP and energy change in the Ginaton group were obviously higher than those in the control group at declamping aorta (P < 0. 05). The percentage of normal mitochondria and glycogen content were significantly higher in the Ginaton group than that in the control group at declamping aorta ( P < 0.05). Conclusion: Ginkgo biloba extract may provide a beneficial effect on myocardial protection in ultrastructural preservation, prevention of high energy phosphate depletion, reduction in free radicals production and improvement of myocardial function. KEY WORDSGinkgo biloba extract, ischemic-reperfusion injury, myocardial protection Ginaton (Ginkgo biloba extract, GBE) is