Epidural neostigmine for labor pain: A meta-analysis / 第二军医大学学报

Objective To evaluate the efficacy and safety of epidural neostigmine in management of labor pain. Methods Randomized controlled trials (RCTs) about epidural neostigmine combined with local anesthetics or opioids (experimental group) versus local anesthetics or opioids alone (control group) in management of labor pain were retrieved from Cochrane Library, PubMed, EMbase, Wanfang Database, CNKI, and CBMdisc from the date of their establishment to September 2011. The methodological quality of included RCTs was evaluated by two reviewers independently, and meta-analysis was conducted with the included RCTs using RevMan 5. 1. 4 software. Continuous variables were dealt with mean difference and 95% confidence interval(CI), and the dichotomous variables were dealt with odd ratio and 95% CI. Results We identified 4 RCTs including 282 patients. The results of meta-analyses showed that the values of visual analogue scale (VAS) were significantly lower in the experimental group compared with the control group[low dose(l-2 μg/kg or 250 μg): MD= - 1. 45, 95%CI(-2. 84,-0. 07), P=0. 04; median dose(4 μg/kg or 500 μg): MD=-2. 35, 95%CI (-3. 69, -1.02), P = 0. 000 6; high dose(6-7 μg/kg or 750 μg): MD= -21,95%CI(36. 31,-5. 69),P = 0. 007]. The adverse reactions such as nausea and vomiting were not significantly different between the two groups. Moreover, epidural neostigmine seemed to have no influence on the total duration of labor or the mode of delivery (cesarean section rate or instrumental delivery rate). Apgar scores of the neonates were similar in the two groups. Conclusion The results of our analysis show that epidural neostigmine combined with local anesthetics or opioids has a stronger analgesic effect in managing labor pain whithout increasing the incidence of adverse events.

Diisopropylamine dichloroacetate in the treatment of nonalcoholic fatty liver disease: a multicenter random double-blind controlled trial / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of diisopropylamine dichloroacetate in the treatment of nonalcoholic fatty liver diseases (NAFLD).</p><p><b>METHODS</b>A randomized, double-blind, dose-paralleled control trial was carried out with NAFLD patients. The patients were randomly assigned to 2 groups treated with either a high dosage (120 mg/d) or a low dosage (60 mg/d) of diisopropylamine dichloroacetate for 8 weeks and the efficacy and safety of the drug were examined.</p><p><b>RESULTS</b>127 cases were recruited for the trial, 63 in the high dosage group, and 64 in the low dosage group. No case dropped out in the trial but four cases were eliminated (4/127, 3.1%). The final number in this trial was 123, with 61 in the high dosage group and 62 in the low dosage group. After 8 weeks of treatment, the overall improvement of clinical symptoms in the high dosage and in the low dosage group was 87.8% and 79.6%, respectively. ALT normalization was found in 55.7% and 69.4% of the cases in the two groups, serum lipids were lowered in 67.2% and 67.7% and ultrasound grading of the liver alteration severity was lowered in 51.7% and 43.5% in the two groups. The differences found between the two groups were of no statistical significance. One case from each group was found having an adverse drug reaction of dryness of the mouth (1.6%). No severe adverse drug reactions were found.</p><p><b>CONCLUSION</b>Diisopropylamine dichloroacetate could be used as a safe and effective drug in the treatment of nonalcoholic fatty liver diseases.</p>

Outpatient varicocelectomy performed under local anesthesia / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To report a series of varicocelectomy performed under pure local anesthesia.</p><p><b>METHODS</b>From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal spermatic vein for treatment of a varicocele testis under a regional block in which a precise injection of 0.8 % lidocaine solution was delivered to involved tissues after exact anatomical references were made. A 100-mm visual analog scale (VAS) was used to assess whether the pain level was acceptable.</p><p><b>RESULTS</b>The surgeries were bilateral in 52 cases, and unilateral in 523 cases. All were successfully performed on an outpatient basis except in the case of two patients, who were hospitalized because their surgeries required general anesthesia. Overall, 98.6 % (567/575) of men could go back to work by the end of the first post-operative week and only 8 (1.4 %) men reported feeling physical discomfort on the eighth day. The VAS scores varied from 11 mm to 41 mm with an average of (18.5+/-11.3) mm that was regarded as tolerable.</p><p><b>CONCLUSION</b>This study has shown varicocelectomy under local anesthesia to be possible, simple, effective, reliable and reproducible, and a safe method with minimal complications. It offers the advantages of more privacy, lower morbidity, with no notable adverse effects resulting from anesthesia, and a more rapid return to regular physical activity with minor complications.</p>