Background: Postoperative pain management is crucial for patients undergoing total knee arthroplasty (TKA). There have been many recent clinical trials on post-TKA peripheral nerve block; however, they have reported inconsistent findings. In this meta-analysis, we aimed to comprehensively analyze studies on post-TKA analgesia to provide evidence-based clinical suggestions. Methods: We performed a computer-based query of PubMed, Embase, the Cochrane Library, and the Web of Science to retrieve related articles using neurothe following search terms: nerve block, nerve blockade, chemodenervation, chemical neurolysis, peridural block, epidural anesthesia, extradural anesthesia, total knee arthroplasty, total knee replacement, partial knee replacement, and others. After quality evaluation and data extraction, we analyzed the complications, visual analogue scale (VAS) score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: We included 16 randomized controlled trials involving 981 patients (511 receiving peripheral nerve block and 470 receiving epidural block) in the final analysis. Compared with an epidural block, a peripheral nerve block significantly reduced complications. There were no significant between-group differences in the postoperative VAS score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Conclusions Our findings demonstrate that the peripheral nerve block is superior to the epidural block in reducing complications without compromising the analgesic effect and patient satisfaction. Therefore, a peripheral nerve block is a safe and effective postoperative analgesic method with encouraging clinical prospects.

Background: Postoperative pain management is crucial for patients undergoing total knee arthroplasty (TKA). There have been many recent clinical trials on post-TKA peripheral nerve block; however, they have reported inconsistent findings. In this meta-analysis, we aimed to comprehensively analyze studies on post-TKA analgesia to provide evidence-based clinical suggestions. Methods: We performed a computer-based query of PubMed, Embase, the Cochrane Library, and the Web of Science to retrieve related articles using neurothe following search terms: nerve block, nerve blockade, chemodenervation, chemical neurolysis, peridural block, epidural anesthesia, extradural anesthesia, total knee arthroplasty, total knee replacement, partial knee replacement, and others. After quality evaluation and data extraction, we analyzed the complications, visual analogue scale (VAS) score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: We included 16 randomized controlled trials involving 981 patients (511 receiving peripheral nerve block and 470 receiving epidural block) in the final analysis. Compared with an epidural block, a peripheral nerve block significantly reduced complications. There were no significant between-group differences in the postoperative VAS score, patient satisfaction, perioperative opioid dosage, and rehabilitation indices. Conclusions Our findings demonstrate that the peripheral nerve block is superior to the epidural block in reducing complications without compromising the analgesic effect and patient satisfaction. Therefore, a peripheral nerve block is a safe and effective postoperative analgesic method with encouraging clinical prospects.

OBJECTIVETo describe the distribution changes of the mortality rate for cervical cancer in China between the 1970's and 1990's and provide the scientific evidence for the prevention and control strategies for cervical cancer campaign in China between next century.

METHODSData from two National Surveys for the Causes of Death in 1970's and 1990's in China. The crude and adjusted mortality rates for the cervical cancer and the distributions based on age and area were calculated and described. The comparison of the differences of changes between two mortality rates periods and together with its trends were shown based on the age-standardized.

RESULTSDuring two decades, the mortality rate for cervical cancer was 10.7 per 100,000 in 1970's which declined to 3.89 per 100,000 in 1990's, and from the 3rd ranking among all female malignant tumors to the 6th in 1990's (decreased about 63.64%). But the declination was not evenly. There have still been some high-risk areas, most located in rural countries in the mid-west of China, with rates remain unchanged and even at the highest level in the world, such as Wudu in Gansu and Yangcheng in Shanxi. A big difference was showed between rural country and city, but in both of them, the mortality rates in 1990's were significantly much lower than in 1970's (P = 0.001) at each five-year age group. And in the city, there was a much sharper increased trend in young women in 1990's.

CONCLUSIONSThe mortality rate for cervical cancer campaign in China has been substantially declined during past twenty years, but it's still a major health problem for women, especially in rural China. The focus of the prevention and control for the cervical cancer in the next century should put on rural areas, especially in mid-west of China and young women in the city.

Adult ; Age Factors ; Aged ; Cause of Death ; trends ; China ; epidemiology ; Female ; Humans ; Middle Aged ; Retrospective Studies ; Rural Health ; Uterine Cervical Neoplasms ; mortality ; prevention & control

OBJECTIVETo compare the detection sensitivity of epidermal growth factor receptor (EGFR) mutations between allele specific oligonucleotide PCR (ASO-PCR) and bi-loop probe and specific primer quantitative PCR (BPSP-qPCR).

METHODSA total of 96 non-small cell lung cancer specimens were selected from West China Hospital from September 2009 to December 2010. ASO-PCR was developed to detect the presence of classical EGFR mutations. A total 39 available specimens were also tested by BPSP-qPCR.

RESULTSEGFR mutation detection rate was 30.2% (26/96) by ASO-PCR. The mutation rate was higher in female than in male patients [45.5% (20/44) vs. 17.3% (9/52), P = 0.003], non-smokers than smokers [44.1% (26/59) vs. 8.1% (3/37), P < 0.001] and adenocarcinomas than other subtypes of lung cancer [37.0% (27/73) vs. 8.7% (2/23), P = 0.01]. Among mutation negative cases by ASO-PCR, BPSP-qPCR increased the rate of detection of 19-del and L858R mutation by 10.3% (4/39) in adenocarcinomas and non-smoking subset. Overall, the mutation detection rate of BPSP-qPCR was higher than that of ASO-PCR [66.7% (26/39) vs. 41.0% (16/39), P = 0.02].

CONCLUSIONBPSP-qPCR has a better detection sensitivity than that of ASO-PCR.

Adenocarcinoma ; genetics ; Carcinoma, Non-Small-Cell Lung ; genetics ; DNA Mutational Analysis ; Female ; Genes, erbB-1 ; Humans ; Lung Neoplasms ; genetics ; Male ; Middle Aged ; Mutation ; Polymerase Chain Reaction ; methods ; Receptor, Epidermal Growth Factor ; genetics ; Sensitivity and Specificity ; Sex Factors ; Smoking

OBJECTIVETo analyze and predict the trend in mortality rate of stomach cancer in twenty years in China.

METHODSStomach cancer mortality data collected from the China national survey over the period 1970s - 1990s for the cause of death were analyzed.

RESULTSThe adjusted mortality rate of stomach cancer in 1990s increased by 11.0% and 6.3% for males and females, respectively. The urban mortality in 1970s was slightly higher than the rural mortality, while in 1990s the rural mortality rate was about 60% higher than the urban mortality. In 1990s, the adjusted urban mortality rate decreased by 22.2% and 26.7% for males and females, respectively. In contrast, the rural mortality rate increased by 26.4% and 22.1% for males and females, respectively. The sex ratio of stomach cancer deaths in 1990s, both in cities and rural areas, was slightly greater than that in 1970s, being more marked in the latter areas. In 1990s, the mortality rate decreased in 12 provinces, accounting for 44% in both sexes (12/27), but the decrease was more marked for females than for males except in Kiangs province. In provinces where the increased rates ranked top six positions, the magnitude of increase in rates was higher in males than in females.

CONCLUSIONThe overall mortality rates of stomach cancer in the past 20 years in China presented an increasing trend, despite there were upward and downward changes in 27 provinces and decrease in cities while increase in rural areas. Compared with other countries, the world-adjusted mortality rate of stomach cancer for both sexes in China ranks first. The increasing trend in stomach cancer mortality was seen in the older age groups (> 60 years) while a decreasing trend was seen in the younger age groups (30 - 59 years). Aging of the population could be an important factor responsible for the increase in mortality rates of stomach cancer in China.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Sex Factors ; Stomach Neoplasms ; mortality

OBJECTIVETo assess the effect of blood pressure (BP) changes from childhood to adulthood on hypertension related cardiac and renal function in adulthood.

METHODSThe "Beijing children and adolescents BP study cohort" consists of 2505 subjects 6-18 years of age who were enrolled in the baseline BP investigation in 1987. Among them, 412 individuals aged 23-37 years were successfully followed up in 2005. In this study, clinical examinations and questionnaire survey about risk factors of cardiovascular disease (CVD) were carried out.

RESULTSAmong 412 adults, the prevalence rate of hypertension was 14.8% (61/412); 83.6% of persons with hypertension were overweight or had obesity. Hypertension related cardiac and renal functional abnormalities were relatively common (72.1%) clinical signs among this adult population. With BP level elevation, cardiac and renal functions damage became more severe. The morbidity of cardiac and renal functional abnormalities in those who were hypertensive in childhood and were not hypertensive in adulthood was similar to those who were not hypertensive at both times. The morbidity of microalbuminuria and abnormalities in electrocardiogram (ECG) were higher in those who were hypertensive at both times than those who had appropriate BP levels in childhood and became hypertensive in adulthood. Adjusted for age, gender, BMI and body surface area (BSA) during adulthood, the left ventricular end-diastolic dimension (LVd), the left ventricular mass (LVM), the intraventricular septal thickness (IVST), the left ventricular posterior wall thickness (LVPWT) in the group of hypertension were higher than that in the group which was not hypertensive, and the ejection fraction (EF) was lower in the group of hypertension in adulthood. The LVd, LVM, IVST, LVPWT and EF in those who were hypertensive in childhood and were not hypertensive in adulthood were similar to those who were not hypertensive at both times. Logistic regression analysis showed that persons who were hypertensive in childhood and remained so during adulthood were at an increased risk of cardiac and renal functional damage (OR = 4.072, 95% CI = 1.472 - 11.266). Those who were hypertensive in childhood and became normotensive in adulthood did not have significant abnormalities in cardiac and renal functions (OR = 1.086, 95% CI = 0.514 - 2.298, chi2 = 0.047, P = 0.828).

CONCLUSIONPersons who were hypertensive at both times were at an increased risk of cardiac and renal function damage. Those who were hypertensive in childhood and became normotensive in adulthood did not have significant abnormalities in cardiac and renal functions. Thus prevention and control of hypertension in children and adolescents may have important beneficial effects on prevention of CVD in adulthood.

Adolescent ; Adult ; Blood Pressure ; physiology ; Child ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Hypertension ; epidemiology ; prevention & control ; Kidney Function Tests ; Male ; Young Adult

Objectives To explore the type and subtype distribution of influenza viruses in influenza-like patients and the hemagglutinin(HA)genetic variation of influenza A viruses in Shang- hai and Wuxi during the influenza prevalent season from 2004 to 2006.Methods Throat swabs were collected from the influenza-like patients in the sentinel hospitals and during the outbreaks,and then inoculated into MDCK cells to isolate influenza viruses,which were subsequently identified by direct immunofluorescence(DIF)and reverse transcription-polymerase chain reaction(RT-PCR).HA seg- ments of influenza A viruses were sequenced to analyze the genetic variation of HA.Results One hundred and twenty-six strains of influenza viruses,including 53 H3N2,43 H1N1 and 30 influenza B viruses were isolated from August 2004 to September 2006,and 7 outbreaks.All these outbreaks oc- curred in February or March The pathogens were identified as H1N1 in one outbreak,H3N2 in two outbreaks,B in two outbreaks and mix infections in two outbreaks(1 H1N1 and B,1 H3N2 and B, respectively).By sequencing the HA segment,the H3 and H1 segments were all homologous to the isolates from different countries in the same period.Conclusion H3N2 and H1N1 are the major strains prevalent in Shanghai and Wuxi,which reach the peak from January to March No HA and NA recom- binant strains and new HA and NA subtypes are found in these areas.The variations of H1 and H3 are similar to those found in other countries.

To investigate the role of platelet membrane glycoprotein (GP) Ib/Ⅸ/Ⅴ complex and its subunit GP Ibа in patients with hemorrhagic thrombopathy (HT), the expressions of GP lb/Ⅸ/Ⅴ complex and GP Ibа, defined as mean fluorescence intensity (MFI), were assessed by flow cytometry.The maximum aggregation of platelet was determined by turbidity method. These indicators were compared among 68 HT patients with the presenting complaint of hemorrhage, 33 well-controlled HT patients and 32 normal healthy subjects. The results showed that the MFI of GP lblIX/V complex and GP Ibct was markedly lower in HT patients with current hemorrhage than that in the healthy subjects, with difference being statistically significant (P<0.05). There was no significant difference in the expressions of GP lb/Ⅸ/Ⅴ complex and GP lbа between well-controlled HT patients and normal healthy subjects (P>0.05). It was concluded that the expression of GP Ib/Ⅸ/Ⅴ complex, the receptor of thrombin and yon Willebrand factor, was down-regulated in HT patients with current hemorrhage,which might result in the dysfunction of platelet aggregation and recurrence of HT.

OBJECTIVETo evaluate the effect of Xuezhikang Capsule on the serum levels of inflammatory factors such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in patients with nonalcoholic fatty liver disease (NAFLD) and hyperlipidemia, and to explore whether it has anti-inflammatory effect.

METHODSA total of 84 patients were randomly assigned to two groups with stratified block randomization, the treatment group (42 cases) and the control group (42 cases). They were treated with Xuezhikang Capsule and polyene phosphatidylcholine capsule for twenty-four weeks, respectively. The changes in serum TNF-alpha and IL-6 were measured by enzyme linked immunosorbent assay before treatment and at the 12th and 24th week.

RESULTSCompared with those before treatment, the serum levels of TNF-alpha and IL-6 significantly decreased in both groups after treatment (P<0.01). There was no significant change between the two groups for the treatments at different time points (P>0.05) and between the two groups for treatments at the same time points (P>0.05).

CONCLUSIONXuezhikang Capsule can inhibit the serum inflammatory factor in patients with NAFLD and hyperlipidemia.

Administration, Oral ; Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal ; administration & dosage ; pharmacology ; Capsules ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; Fatty Liver ; blood ; complications ; drug therapy ; Female ; Humans ; Hyperlipidemias ; blood ; complications ; drug therapy ; Hypolipidemic Agents ; administration & dosage ; pharmacology ; Interleukin-6 ; blood ; Lipids ; blood ; Liver ; drug effects ; physiopathology ; Liver Function Tests ; Male ; Middle Aged ; Treatment Outcome ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVEHypertension is one of the most common disorders in adults. Although it may be already present in children and adolescents, it does not often have clinical pictures. There is a lack of data on the blood pressure in children in Beijing area. This study was conducted to investigate the present situation of blood pressure of children and adolescents in Beijing area.

METHODSChildren and adolescents aged 3 to 18 years in 4 urban and 3 rural areas of Beijing were involved in the study at random. Blood pressure (BP) was measured three times with the use of mercury sphygmomanometery, and the means of the last two BP value were recorded. Systolic BP (SBP) was determined by the first Korotkoff sound, and diastolic BP (DBP) by the fourth Korotkoff sound.

RESULTSAltogether, 20 780 (99.6%) individuals with complete records were studied, including 10 582 from urban and 10 198 from rural areas; 10 398 were males and 10 382 were females. BP of boys was higher than that of girls [SBP: (106 +/- 12) mm Hg vs. (101 +/- 11) mm Hg, u = 27.14, P < 0.01; DBP: (67 +/- 9) mm Hg vs. (65 +/- 8) mm Hg, u = 14.14, P < 0.01]. BP of both boys and girls increased with age. However, SBP had a larger magnitude of increase than that of DBP. Both SBP and DBP of urban children were lower than those of rural children [SBP: (103 +/- 12) mm Hg vs. (104 +/- 12) mm Hg, u = 2.55, P < 0.05; DBP: (66 +/- 8) mm Hg vs. (67 +/- 9) mm Hg, u = 6.73, P < 0.01]. There was a positive correlation between BP and age, height, weight and BMI. SBP had a stronger relationship with each variable than DBP did. Among children aged 6 - 18 years, about 8.1% were found to have hypertension according to the criteria of blood pressure of children and adolescents by age and by gender of 1987 in Beijing.

CONCLUSIONSThe present study provided with the current information and characteristics of blood pressure of children and adolescents in Beijing area. The blood pressure was correlated with sex, age, body height, body weight and BMI of children and adolescents.

Adolescent ; Blood Pressure ; physiology ; Body Height ; Body Mass Index ; Body Weight ; Child ; Diastole ; Female ; Humans ; Hypertension ; physiopathology ; Hypotension ; physiopathology ; Male ; Rural Population