Objective To systematically evaluate effectiveness and safety of nerve block therapy for neck pain. Methods Databases including CENTRAL, PubMed, Ovid, ISI, EBSCO, CBM and CNKI were searched from the date of their establishment to November 2011, and relevant references were also retrieved manually to collect both domestic and abroad randomized controlled trials (RCTs) about nerve block therapy for neck pain. According to the inclusion and exclusion criteria, two researchers independently screened literature, extracted data, and assessed the quality of the included studies. Then the meta-analysis was conducted using RevMan 5.0 software. Results A total of 10 studies involving 625 participants were included. The results of qualitative analysis showed that: a) The short-term effectiveness of the nerve block therapy group was markedly superior to the placebo group, the cognitive therapy group and the transcutaneous electric nerve stimulation (TENS) group; and b) The short-term effectiveness of the combined nerve block therapy was markedly superior to the single nerve block therapy. The results of meta-analysis demonstrated that: a) There was no significant difference between the greater occipital nerve (GON) block group and the C2/3 nerve block group in neither short-term (SMD=−0.13, 95%CI −0.58 to 0.32, P=0.58) nor medium-term effectiveness (SMD=−0.01, 95%CI −0.46 to 0.44, P=0.98); and b): There was no significant difference between the injection with steroids group and the injection without steroids group in both short-term (SMD=0.16, 95%CI −0.13 to 0.44, P=0.28) and long-term effectiveness (SMD=0.27, 95%CI −0.02 to 0.55, P=0.07). Conclusion Current evidence shows nerve block therapy for neck pain is safe and especially good in short-term effectiveness. The combined nerve block therapy is probably more effective, but the effectiveness is not obviously improved by injection with or without steroids, and by different block methods. Due to the limitation of quality, quantity and total sample size of the included studies, this conclusion still needs to be proved by conducting more high quality and large scale studies.
Objective To evaluate long-term effectiveness of recombinant human growth hormone (rhGH) for children with idiopathic short stature (ISS). Methods The randomized controlled trials (RCTs) about rhGH in treating ISS published from 1985 to 2010 were searched in PubMed, ScienceDirect, EBSCOHost, EMbase, The Cochrane Library, CBM, CNKI and VIP. According to the Cochrane Handbook, two reviewers independently screened literature, extracted data, assessed methodological quality, and conducted meta-analysis using RevMan 5.0 software. Results A total of 11 RCTs involving 607 ISS children were included. The results of meta-analysis showed that, compared with the blank/placebo control group after 1-year treatment, the rhGH group resulted in a significant increase in height standard deviation score (SDS) (MD=0.29, 95%CI 0.03 to 0.54, P=0.03), growth velocity (MD=2.68 cm/year, 95%CI 1.70 to 3.65, Plt;0.000 01), and adult SDS (MD=0.46, 95%CI 0.29 to 0.63, Plt;0.000 01). Conclusion rhGH can effectively promote the growth of ISS children. But due to the limitation of quality and small sample size of the included studies, its effectiveness still needs to be further proved by more high quality RCTs.
Objective To evaluate the efficiency and safety of laparoscopic hepatectomy (LH) and conventional open hepatectomy (OH) in patients with hepatocellular carcinoma (HCC). Methods We searched The Cochrane Library, MEDLINE (1966~2008.3), EMBASE (1966~2008.3), CBM (1979~2008.3), we also handsearched some Chinese journals. Using a defined search strategy, randomized controlled trails and controlled clinical trials of comparing OH with LH for hepatocellular carcinoma were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trails was evaluated by Deeks JJ’s evaluation criterion. Meta–analysis was done using the Cochrane collaboration’s Revman 4.2.10. Results Seven controlled clinical trials (309 patients) were included, The meta–analysis showed that: (1) Four studies (n=198) reported mortality, the mortality rate of the LH group was not significantly different from that of the OH group [OR=1.14, 95%Cl (0.15, 8.65), P=0.90]; (2) Two studies (n=91) reported blood transfusion. There were no significant differences between the two treatment groups in terms of the blood transfusion [OR=0.20, 95%Cl (0.03, 1.19), P=0.08]; (3) Four studies (n=165) reported operation time. There were significant differences in operating time between the two groups [SMD=1.05, 95%CI (0.72, 1.38), Plt;0.000 01]; (4) Four studies (n=165) reported intraoperative blood loss. There were significant differences in intraoperative blood loss between the two groups [SMD= – 1.56, 95%Cl (– 2.39, – 0.73), P=0.000 2]; (5) Five studies (n=210) reported the duration of hospital stay. There were significant differences in duration of hospital stay between the two groups [WMD= – 3.89, 95%CI (– 5.54, – 2.23), Plt;0.000 01]; (6) Two studies (n=248) reported complications. There were significant differences in complications between the two groups [OR=0.31, 95%Cl (0.13, 0.72), P=0.006]; (7) Two studies (n=97) reported ALT. There were significant differences in ALT between the two groups [SMD= – 1.54, 95%Cl (– 207, – 1.01), Plt;0.000 01]. Conclusion LH is associated with less postoperative complications, operative blood loss, duration of hospital stay and lower ALT, but longer operation time. However, the trails available for this systematic review are limited, so a prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.
Objective To explore the protective effects of liver X receptor-αactivator ( LXRα)T0901317 on rats with acute lung injury ( ALI) . Methods Seventy-two male Wistar rats were randomly divided into three goups, ie. a control group, a LPS group, and a T0901317 group. Artery blood gas analysis,lung tissue wet/dry weight ratio,myeloperoxidase activity, and lung histopathological changes were measured.The expressions of LXRαand TNF-αmRNA in lung tissue were detected by RT-PCR. The protein levels ofTNF-αand LXRαwere examined with ELISA and immunohistochemistry, respectively. Results In the ALI rats, PaO2 decreased, lung W/D weight ratio and myeloperoxidase activity increased significantly compared with the control group ( P lt; 0. 05) . Histopathological examination also revealed obvious lung injury. In theLPS group, the expression of TNF-αmRNA in lung tissue and the level of TNF-αprotein in lung homogenate and serum increased markedly( all P lt; 0. 05) while the expression of LXR-αmRNA declined significantly ( P lt; 0. 05) . Immunohistochemical staining showed that lung tissues of the normal rats expressed LXRαsignificantly but in the LPS group the expression of TNF-αand LXR-αin lung tissue decreased markedly ( P lt;0. 05) . After the treatment with T0901317, the expressions of LXR-αin lung tissues were significantly higher than those in the LPS group both at the mRNA and the protein level ( P lt; 0. 05) . Conclusion T0901317 plays an anti-inflammatory effect through up-regulating the expression of LXR-αand suppressing the expression of TNF-α, thus reduces the infiltration and aggregation of inflammatory cells in lung tissue.
Abstract： Objective To investigate the effects of βreceptor blocker on intraventricular pressure gradient and left ventricle remodeling after valve replacement for critical aortic stenosis. Methods Fifty-six patients with critical aortic stenosis underwent aortic valve replacement surgery from January 2008 to January 2010 in the First Affiliated Hospital of Zhengzhou University. Thirtytwo of them who were followed up were selected to be enrolled in this study. The patients were divided into two groups under the same basis of clinical features. Twelve patients in the experimental group received oral βreceptor blocker (Metoprolol, 6.2525.00 mg once, twice daily). The rest 20 patients in the control group had no βreceptor blocker. The various indicators of ultrasound cardiogram (UCG) shortly after operation (within a week) and long after operation (6-24 months) were compared between the two groups. Results No death occurred in both groups, and chest distress, shortness of breath and other symptoms were obviously alleviated. Although left ventricular endsystolic dimension (LVESD) and left ventricular outflow tract dimension (LVOTD) of both groups increased 6-24 months after operation, compared with the early postoperative period, only the increase of LVOTD in the experimental group showed statistical difference (t=-47.937, P=0.001). In both groups, interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), filament band velocity of left ventricular outflow tract (V), intraventricular pressure gradient (G) and left ventricular mass index (LVMI) of the later period after operation were significantly lower than those of the early postoperative period. All these indicators in the experimental group showed significant differences (t=7.781, P=0.001；t=5.749, P=0.001; t=2.637, P=0.023; t=7.167, P=0.001; t=100.061, P0.001), while only V, G， and LVMI showed statistical differences in the control group (t=4.051, P=0.001; t= 4.759, P= 0.001; t=-0.166,P=0.001). EF in the experimental group also indicated significant difference compared with early period after aortic valve replacement (t=-6.621, P=0.001). EF between two groups indicated no significant difference (t=-0.354,P=0.726). But differences between the two groups in LVEDD, IVS, G， and LVMI were all statistically significant in the later period after surgery (t=-2.494, P=0.018; t=-3.434, P=0.002;t=-2.171,P=0.038; t=-2.316, P=0.028). Conclusion β-receptor blocker is a safe and reliable drug for those patients who have undergone aortic valve replacement surgery for critical aortic stenosis, and can decrease significantly the residual intraventricular pressure gradient and accelerate left ventricular cardiac remodeling.
Objective To summarize the research progress of health care transition (HCT) for pediatric liver transplant recipients. Method The literatures of HCT for pediatric liver transplant recipients were reviewed, and the concept, related factors, interventions and methods of health care transition were summarized. ResultsHCT is the process of moving from a child/family-centered model of care to an adult or patient-centered model of health care, and influenced by health care provider, child and caregivers, and other factors such as medical policy and economic level. Personalized transition program has more benefits for improving the experience and health outcomes of patients. Conclusion problem-oriented and demand-oriented transition program is recommended, early intervention to improve self-management abilities of children, information construction of pediatric medical system and multidisciplinary team building are important for improving health outcomes of patients.
ObjectiveTo summarize the applied research status on the evaluation tools of patient-reported outcome at home and abroad in patients with venous thromboembolism (VTE). MethodBy searching and analyzing the literatures, this paper summarized the concept, evaluation tools and application status of patient-reported outcome in the field of VTE. ResultsThe patient-reported outcomes can more comprehensively and accurately evaluate the disease burden and treatment effect of patients with venous thromboembolism, and can help doctors better understand patients' needs and guide individualized treatment and rehabilitation plans. ConclusionsPatient-reported outcome has a broad application prospect in the field of venous thromboembolism. Further promotion and application of patient-reported outcome can promote the development of medical research and provide reference guidelines for improving the management of patients with venous thromboembolism.
Objective To evaluate the status of asthma control in asthmatic outpatients.Methods We performed an investigation by a questionnaire in a face-to-face setting from Feb 2006 to May 2006 in asthmatic outpatients of China-Japan Friendship Hospital.Results A total of 101 asthmatic patients were investigated with a mean age of 47±14.8 years and course of disease of 9.1±12.8 years.80.2% of the asthmatic patients had various social insurance.40.6% of the respondents had visited emergency department because of asthma exacerbation.The percentage of adults with lost workdays caused by asthma was 61.7% (29/47)，and which of children with lost schooldays was 75% (3/4).37.6% of asthmatic patients were completely controlled.Approximately three fourth of respondents (75.2%) was either well or completely controlled.72.3% of respondents had undergone a lung-function test during the past year.The one third of respondents (36.6%) owned oneself peak flowmeter.Only 12.9% reported kept regular use of peak flowmeter.87.1% of patients use inhaled corticosteroids (ICS) regularly.Conclusion With the implementation of patient education program and asthma guideline，the asthma control level has been further improved.
Objective To analyze retrospectively the overall situation of medical rescue in the First Affiliated Hospital of Guangxi Medical University after the Wenchuan earthquake, so as to provide references for the emergency preparation for the disaster of earthquake. Methods Analysis was based on the data provided by the Department of Information, the Medical Record Library, the Department of Emergency, the Department of Orthopaedics and other related departments of the hospital. The software Microsoft EXCEL was used for data management, and SPSS 13.0 was used for statistical analysis. Results From May 22 to May 26, 91 cases from the disaster area had been treated in the hospital, of which 90 were from Mianyang and 1 from Chengdu. These patients included 44 males with a median age of 38 (27, 53) years old and 47 females with a median age of 51 (33, 62) years old. Most patients were sent to the hospital within the first 10 or 11 days after the earthquake, with 86.8% hospitalized after 10 days and 22.0% after 11 days. The number of outpatients reached its peak of 37.1% of all the outpatients (33 cases) within 34 days after the earthquake. The wounded were mainly admitted into the Department of Orthopaedics, with 34.81% of the patients having lower limb fracture, 18.26% having spine fracture, and 12.59% suffering pelvis fracture. Only 2 out of the 89 patients died. One death was due to 60% burning injury and 1 died of multiple catastrophic injuries. Conclusion Based on the data, it is important to develop an emergent plan for medical rescues after an earthquake disaster and to strengthen the reserve of medical supplies, personnel training, scientific field triage and the construction of information platforms.
Objective To analyze the efficacy of no-touch technique and traditional technique in drawing great saphenous vein during coronary artery bypass grafting. Methods We searched the literatures on no-touch technique versus traditional technique in drawing great saphenous vein during coronary artery bypass grafting in PubMed, Cochrane Library, Chinese Journal Full-text Database, Wanfang database between January 1997 and November 2017. Jadad scale was used for quality verification. RevMan 5.0 was used for analysis. Results Six studies were included. Jadad scale for both 6 randomized controlled trials was 5 points. Meta-analysis showed that there was no statistical difference in postoperative mortality between the two groups with RR=0.68 and 95%CI 0.11 to 4.11(P=0.67). There was no statistical difference in leg wounds with RR=1.46 and 95%CI 0.23 to 9.16 (P=0.68). There was no statistical difference in short-term cardiogenic death with RR=0.33, 95%CI 0.10 to 1.03 ( P=0.06). The no-touch group’s long-term cardiogenic death was significantly lower than the traditional group withRR=0.36, 95%CI 0.16 to 0.79(P=0.01). Postoperative no-touch group’s short-term patency rate was significantly better than that of the traditional group with MD=3.08 and 95%CI 1.58 to 5.99 (P<0.01). The long-term patency rate in the no-touch group was also higher than that of the traditional group withMD=3.08 and 95%CI 1.58 to 5.99 (P<0.01). Conclusion Compared with the traditional group, the no-touch group increases postoperative long-term survival rate, short-term and long-term patency rate.