BACKGROUND:Pain is the significant cause for patients with early rehabilitation after total knee arthroplasty. Continuous epidural analgesia and continuous femoral nerve block are effective analgesic methods after total knee arthroplasty, however, which method has better effects and less complications remains controversial. OBJECTIVE:To compare the efficacy and safety of countious femoral nerve block and continuous epidural analgesia after total knee arthroplasty. METHODS:We searched Cochrane Library, PubMed, EMBASE, Web of Science, CBM, CNKI, VIP, and WangFang. Meanwhile, we also searched conference papers and academic dissertation. The retrieval time was from database establishment to October 1, 2014. Studies of randomized control ed trials on countious femoral nerve block and continuous epidural analgesia after total knee arthroplasty were included. We evaluated the quality of these included studies and analyzed data by Cochrane Col aboration’s RevMan 5.0 software. RESULTS AND CONCLUSION:A total of 12 randomized control ed trials (4 English articles and 8 Chinese articles) involving 680 patients were included. There were 343 patients with countious femoral nerve block and 337 patients with continuous epidural analgesia. Meta-analysis results revealed that no significant differences in visual analog scale scores were detected between the countious femoral nerve block and continuous epidural analgesia groups at 6, 12, 24 and 48 hours after total knee arthroplasty. However, compared with the continuous epidural analgesia group, countious femoral nerve block could decrease the incidences of nausea/vomiting (RR=0.36, 95%CI:0.21-0.63, P=0.003), urine retention (RR=0.08, 95%CI:0.04-0.16, P<0.001) and dizziness (RR=0.24, 95%CI:0.06-0.99, P=0.05). These results indicate that compared with epidural analgesia, countious femoral nerve block after total knee arthroplasty provided a strong analgesia effect, contributed to early functional training, had less adverse reactions, and was a safe and effective analgesic method.

Objective To evaluate the role of necroptosis in liver injury induced by intestinal ischemia-reperfusion (I/R) in rats.Methods Thirty-two healthy adult male Sprague-Dawley rats,weighing 250-300 g,were divided into 4 groups (n=8 each) using a random number table:sham operation group (S group),I/R group,specific necroptosis inhibitor necrostatin-1 group (N group) and dimethyl sulfoxide (DMSO) group (D group).Intestinal I/R was produced by occlusion of the superior mesenteric artery for 1.5 h followed by 6 h of reperfusion.The superior mesenteric artery was only isolated but not ligated in group S.At 30 min before ischemia,necrostatin-1 1 mg/kg (diluted to 200 μl in DMSO) was intraperitoneally injected in group N,while the equal volume of DMSO was given instead in group D.The animals were sacrificed at the end of reperfusion,livers were removed for examination of the pathological changes with a light microscope,and the severity of liver injury was evaluated using the Eckhoff's scale score.Blood samples were collected from the cardiac apex for determination of serum alanine transaminase (ALT) concentrations by enzyme-linked immunosorbent assay.The expression of receptor-interacting protein kinase 1 (RIP1),RIP3 and high-mobility group box 1 protein (HMGB1) in cytoplasm of hepatocytes was detected by Western blot.The location of RIP1 and RIP3 in liver tissues was determined by immunohistochemistry,and the translocation of HMGB1 from nucleus to cytoplasm was tested by immunofluorescence.Results Compared with group S,the Eckhoff's scale score of liver tissues and serum ALT concentration were significantly increased,the expression of RIP1,RIP3 and HMGB1 in liver tissues was up-regulated (P＜0.05),and the hepatocytes in which RIP1 and RIP3 were highly expressed in the portal area were increased in group I/R.Compared with group I/R,the Eckhoff's scale score of liver tissues and serum ALT concentration were significantly decreased,the expression of RIP1,RIP3 and HMGB1 in liver tissues was down-regulated (P＜0.05),and the hepatocytes in which RIP1 and RIP3 were highly expressed in the portal area were decreased in group N,and no significant changes were found in the variables mentioned above in group D (P＞0.05).HMGB1 was expressed in the nucleus of hepatocytes in the portal area in group S;a large number of HMGB1 in hepatocytes in the portal area was translocated to cytoplasm in I/R and D groups;a small number of HMGB1 in hepatocytes in the portal area was translocated to cytoplasm in group N.Conclusion Necroptosis is involved in intestinal I/R-induced liver injury in rats.

Objective To explore the impact of Enalapril-folic acid tablet on development of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in elderly patients with coronary heart diseases(CHD) complicated with mild renal insufficiency. Methods A total of 935 old patients (≥60 years) undergoing selective PCI at our hospital from January 2013 to June 2016 were enrolled in this retrospective study.Based on treatments during the perioperative phase ,the 935 patients were divided into Enalapril-folic acid tablet intervention group (n= 296 ,31.7％ ) ,and other RAS blocker control group with Angiotensin eonverting-enzyme inhibitor (ACEI) or Angiotensin Ⅱreceptor blocker (ARB) (n=639 ,68.3％ ). The levels of serum creatinine for 72 hours after operation were monitored and evaluated.Baseline data and CIN incidence were compared between two groups.The clinical events within 1 month after contrast media application were recorded.Multivariate Logistic regression analysis was used to analyze independent risk factors for CIN after PCI. Results The incidence of CIN after PCI was lower in the intervention group than in the control group with no statistical significance[7.1％ (21/296) vs.11.1％ (71/639) ,χ2 = 3.679 ,P= 0.059].Multivariate regression analysis showed that age (OR=1.103 ,P=0.001) ,hypertension (OR=3.362 ,P=0.017) , and hyper-homocysteinemia (OR=3.528 ,P=0.003) were independent risk factors ,but the treatment with Enalapril-folic acid tablet might be a protective factor for development of CIN after PCI (OR=0.443 ,P=0.042).During the 1-month follow-up ,the rate of recurrent angina pectoris was lower in the intervention group than in the control group ( P < 0.05 ) ,while there were no statistically significant differences between two groups in the rates of rehospitalization due to worsening renal dysfunction ,dialysis/hemofiltration ,acute heart failure ,and new myocardial infarction (all P>0.05). Conclusions The treatment with enalapril-folic acid tablet may prevent the occurrence of CIN after PCI in elderly patients with coronary heart disease and mild renal insufficiency.

Objective:To establish a method for quality evaluation of Myristica fragrans Houtt. Methods:The common peak was determined with Dehydroisoeugenol as the reference peak, and the HPLC fingerprint of Myristica fragrans was established; then the common peaks were analyzed by High Resolution Liquid Chromatography-mass Spectrometry (HPLC-MS). The chemical components of the common peaks were identified through the calculation and data retrieval of the primary and secondary mass spectra of the characteristic peaks. Results:The HPLC fingerprint of Myristica fragrans was established, and the similarity degree of the 10 batches of samples was above 0.9 and 11 common peaks were established. According to the results of HPLC-MS, the components of 11 common peaks were identified as follow: Methyl eugenol (peak 1), Licarin A (peak 2), Myristol (peak 3), OdoratisolA (peak 4), 2-(3,4-Dimethoxyphenyl) butynoic acid (peak 5), Malabaricon D (peak 6), 5'-Methoxydehydroisoeugenol (peak 7), Dehydroisoeugenol (peak 8), Malabaricone C (peak 9), 4-Methoxy-6-{(2S,3S)-7-methoxy-3-methyl-5-[(1E)-1-propen-1-yl]-2,3-dihydro-1- benzofuran-2-yl}-1,3-benzodioxole (peak 10) and Licarin B (peak 11). Conclusions:The quality of Myristica fragrans could be evaluate with HPLC fingerprint method. HPLC-MS was used to analyze the chemical composition of complex components, which will provide reference for the identification and analysis of chemical components of the extracts and preparations of Traditional Chinese Medicine.