Improving endotracheal tube tolerance with intracuffiidocaine： a meta-analysis of randomized controlled trials

Objective： The aim of this study was to compare the efficacy in alleviating the endotracheal tube related discomfort and the safetyof intracufflidocaine （in different forms） with air and/or normal saline （NS） during general anesthesia with tracheal intubation. Methods： Cochrane Central Register of Controlled Trials, PubMed and Embase were searched for relevant studies. Thirteen randomized, controlled trials involving 1 010 patients were ultimately identified. A meta-analysis of all randomized controlled trials fulfilling the predefined criteria was performed. Random-effect model and subgroup studies were used when significant heterogeneity existed among those trials. Results： Compared with air and NS, intracufflidocaine could significantly alleviate the severity of sore throat at different time points （15min, 30min, lh, 2h, 3h, 6h, 12h and 24h aiter extubation） and the occurrence of cough, restlessness, postoperative nausea and vomiting, dysphonia and hoarseness. Besides intracufflidocaine brought about a significant prolongation of spontaneous ventilation time. It was worth mentioning that, compared withlidocaine or its hydrochloride form, alkalinized lidocainewas much more efficient in reducing the severity of sore throat and prolonging spontaneous ventilation time. Conclusion： The present meta-analysis indicates that intracuttlidocaine can significantly improve endotracheal tube tolerance and this improvement can be strengthened by alkalinization of lidocaine.     

Effects of cinnamon on perineal pain and healing of episiotomy： a randomized placebo-controlled trial

BACKGROUND： Analgesic and wound-healing effects of cinnamon, a widely used spice, have been shown in laboratory rats. However, we found no human studies in this area. OBJECTIVE： The aim of this study was to assess the effect of cinnamon on perineal pain and healing of episiotomy incision. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： In this double-blind, randomized, placebo-controlled trial, 144 postpartum women were allocated into two groups, using stratified block randomization, 1 h after completion of episiotomy repair. They received cinnamon or placebo ointment, 2 mL every 12 h for 10 d. MAIN OUTCOME MEASURES： Perineal pain and wound healing were assessed using visual analogue scale （0-10）and Redness, Edema, Ecchymosis, Discharge, Approximation scale （0-15）, respectively. General linear model was used to compare the groups on the outcomes adjusted for baseline values and stratified factors. RESULTS： Follow-up rate was 100% up to the 8 h time point in both groups, and 86% （62 of 72） in the cinnamon group and 85% （61 of 72） in the placebo group at day 10-11 after delivery. Pain score in the cinnamon group was significantly lower than that in the placebo group at （4±1） h （adjusted difference： -0.6, 95% confidence interval： -1.0 to -0.2） and （8＋1） h （-0.9, -1.4 to -0.3） after intervention, and on the 10-11th day after delivery （-1.4, -2.0 to -0.7）. Also the cinnamon group showed significantly more improvement than the control group in healing score at （8±1） h （-0.2, -0.4 to -0.04） and the 10-11th day after delivery （-1.6, -2.0 to -1.1）. CONCLUSION： Cinnamon can be used for reducing perineal pain and improving healing of episiotomy incision.     

Reduced dose of Bacillus Calmette-Guérin versus full dose of Bacillus Calmette-Guérin for non-muscle-invasive bladder cancer after transurethral resection bladder tumor： a meta-analysis of randomized controlled trials

Background Bladder cancer is widely known as the most common malignant tumor in the urinary tract,with 75％-85％ of patients suffering from nonmuscle invasive bladder cancer （NMIBC）.However,the optimal dose of Bacillus Calmette-Guérin （BCG） remains controversial.The aim of this study was to compare the therapeutic efficacy of full dose （FD） with the reduced dose （RD） of BCG.Methods Randomized controlled trials （RCTs） were selected through the Cochrane Library,PubMed and Embase and were supplemented by hand searching of bibliographies.The end points include overall survival rate,recurrence rate,progression rate and side effects.Results Five RCTs that included a total of 1 473 patients （727 in the reduced dose group vs 746 in the full dose group）,with a median follow-up period from 33.5 month to 7.1 year.Disease in 80 of 687 （11.6％） patients assigned to the RD group progress to the muscular layer or distant metastasis,compared with 81 of 698 （11.6％） patients assigned to the FD group （RR=1.02; 95％ CI,0.77-1.36; P=0.89）.The incidence of recurrence at three year was reported in all five studies to be 41.1％ （299 of 727） and 36.1％ （269 of 746） in the RD and FD groups,respectively （RR=1.13; 95％ CI,1.00-1.29; P=0.05）.The 5-year survival rate was 75.9％ （502 of 662） in the RD group,and 75.8％ （510 of 673） in the FD group.In the RD group 41 of 655 （6.3％） patients and 56 of 663 （8.7％） patients in the FD group did not complete the treatment due to systemic or local side effects （RR=0.75; 95％ CI,0.51-1.10; P=0.14） Conclusions In general,the results of our study demonstrate a trend towards a reduction of the toxicity in reduced dose group without affecting the efficacy of treatment when compared with full dose.More trials with large sample size are still necessary to explore the prognosis of the patients with high risk of tumor in different dose group.