A randomised controlled trial of epidural compared with non-epidural analgesia in labour

Objectives To investigate possible short and long term side effects of epidural analgesia, compared with non-epidural analgesia for pain relief in labour.
Design Randomised controlled study, with long term follow up by questionnaire. Analysis by intention-to-treat.
Setting Busy maternity unit within a district general hospital in England.
Participants Three hundred and sixty nine primigravid women in labour were included (randomised allocation: epidural   n = 184  , non-epidural   n = 185  ).
Main outcome measures Backache at three and twelve months after delivery, instrumental delivery rates and maternal opinion of pain relief in labour.
Results No significant differences were found in the reported incidence of backache between the groups at three months: middle backache [  22% vs 20%, χ ²= 0.057, P = 0.81; odds ratio (95% CI) 1.4(0.9-2.3)  ]; low backache [  35% vs 34%, χ ²= 0.009, P = 0.92  ; odds ratio  (95% CI) 1.0(0.6-1.6)  ]. Nor were there significant differences at 12 months: [middle backache 16% vs 16%,   χ ²= 0.013, P = 0.91; odds ratio (95% CI) 1.0(0.5-1.8)  ]; or low backache [  35% vs 27%, χ ²= 1.91, P = 0.17; odds ratio (95% CI) 1.4(0.9-2.3)  ]. The incidence of instrumental delivery was somewhat higher in the epidural group [30% vs 19%, odds ratio (95% CI) 1.77 (1.09-2.86)]. Maternal satisfaction was not significantly different between the groups.
Conclusions This study provided no evidence to support the suggestion of a direct association between the use of epidural anaesthesia in labour and the incidence of long term backache. Despite a significant proportion of women in each group not receiving their allocated analgesia, a significant difference in terms of instrumental delivery rates remained. Satisfaction in both groups of women was high.     

Rarity of colon cancer in Africans is associated with low animal product consumption, not fiber

OBJECTIVE: To investigate whether the rarity of colon cancer in black Africans (prevalence, < 1:100,000) can be accounted for by dietary factors considered to reduce risk, and by differences in colonic bacterial fermentation. METHODS: Samples of the adult black South African population were drawn from several rural and urban regions. Food consumption was assessed by home visits, food frequency questionnaires, computerized analysis of 72-h dietary recall, and blood sampling. Colonic fermentation was measured by breath H2 and CH4 response to a traditional meal, and to 10-g of lactulose. Cancer risk was estimated by measurement of epithelial proliferation indices (Ki-67 and BrdU) in rectal mucosal biopsies. Results were evaluated by comparison to measurements in high-risk white South Africans (prevalence, 17:100,000). RESULTS: Epithelial proliferation was significantly lower in rural and urban blacks than whites. The diets of all the black subgroups were characterized by a low animal product and high boiled maize-meal content, whereas whites consumed more fresh animal products, cheese, and wheat products. Blacks consumed below RDA quantities of fiber (43% of RDA), vitamin A (78%), C (62%), folic acid (80%) and calcium (67%), whereas whites consumed more animal protein (177% of RDA) and fat (153%). Fasting and food-induced breath methane production was two to three times higher in blacks. CONCLUSIONS: The low prevalence of colon cancer in black Africans cannot be explained by dietary "protective" factors, such as, fiber, calcium, vitamins A, C and folic acid, but may be influenced by the absence of "aggressive" factors, such as excess animal protein and fat, and by differences in colonic bacterial fermentation.     

Spontaneous ambulatory activity as a quantifiable outcome measure for rheumatoid arthritis

OBJECTIVE: To validate the objective monitoring of ambulatory activity as an outcome measure for rheumatoid arthritis (RA). METHODS: We have compared ambulatory activity to a range of currently favoured outcome measures, ranging from subjective opinions to X-ray damage, in a population of 93 RA sufferers. RESULTS: Correlations were stronger with measures of joint damage and disability, and less strong with measures of disease activity. Sensitivity to change was good. Three different interventions were compared for the quantity of the response, and the results agree with clinical experience, with steroid injection of the knee and use of non-steroidal anti-inflammatory drugs (NSAIDs) having a similar response and the provision of surgical shoes producing a more modest increase in ambulation. CONCLUSION: The measurement of ambulatory activity has validity for RA assessment. It provides different but related data to the currently used measures. It is objective, relevant, quantifiable and of unlimited scale. It could be used to quantify interventions aimed at increasing ambulation, in carefully constructed studies.     

Assay of topically administered ibuprofen using a model of post-injury hypersensitivity

Objective: To develop a reliable assay for quantifying the analgesic efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) using a model that is accepted as a paradigm of clinical pain. Subjects: Fifteen normal subjects, all of whom were volunteers from medical school staff, took part in the study. Methods: Capsaicin (20 μl) in solution (0.03 mg/ml) was applied to the volar surface of the forearm, and the skin was maintained at a constant temperature using a thermal stimulator. The magnitude of the surrounding area of mechanical allodynia to a brush stimulus (i.e. a clinical correlate of tenderness to touch) was assessed. Under double-blind, placebo-controlled conditions, the test was repeated using skin previously treated with ibuprofen gel or placebo. Results: A close linear relationship was observed between skin temperature over a range of 30 °C to 40 °C and the area of capsaicin-induced allodynia. Ibuprofen gel significantly reduced (P < 0.004) the area of touch-evoked allodynia at a constant skin temperature of 40 °C. Conclusions: The thermal-facilitated adaptation of the capsaicin model described in this study represents an inexpensive and reliable assay for the effects of topical formulations of NSAID upon mechanical sensitivity. As such, it is a potential alternative to many clinical studies in which inherent confounding and bias can preclude a meaningful conclusion. Received: 13 September 1999 / Accepted in revised form: 14 March 2000     

Global survey of haplotype frequencies and linkage disequilibrium at the RET locus

We have constructed haplotypes based on normal variation at six polymorphic sites-five single nucleotide polymorphisms (SNPs) and one short tandem repeat polymorphism (STRP)-at the RET locus for samples of normal individuals from 32 populations distributed across the major continental regions of the world. The haplotyped system spans 41.6 kilobases and encompasses most of the coding region of the gene. All of the markers are polymorphic in all regions of the world and in most individual populations. Expected heterozygosities for the six-site haplotypes range from 82 to 94% for all populations studied except for two Amerindian groups from the Amazon basin at 61 and 76%. Individual populations had from four to eight haplotypes with frequencies exceeding 5%. In general, African, southwest Asian and European groups have the highest numbers of total and of commonly occurring haplotypes; the lowest numbers are observed in Amerindian populations. Overall linkage disequilibrium (LD) for the five SNP sites was very significant (P相似文献   

Head injury in child abuse: evaluation with MR imaging

To evaluate the usefulness of magnetic resonance (MR) imaging in the diagnosis of head injury in child abuse, the authors compared the findings at head MR imaging and computed tomography (CT) in 19 abused children. Subdural hematomas (15 cases), cortical contusions (six cases), and shearing injuries (five cases) were demonstrated to particular advantage with MR imaging. CT remained superior in the detection of subarachnoid hemorrhage. MR imaging appears to be valuable in the assessment of patients with suspected intracranial injury due to child abuse.