Analysis on synergistic cocontraction of extrinsic finger flexors and extensors during flexion movements: A finite element digital human hand model.

Fine hand movements require the synergistic contraction of intrinsic and extrinsic muscles to achieve them. In this paper, a Finite Element Digital Human Hand Model (FE-DHHM) containing solid tendons and ligaments and driven by the Muscle-Tendon Junction (MTJ) displacements of FDS, FDP and ED measured by ultrasound imaging was developed. The synergistic contraction of these muscles during the finger flexion movements was analyzed by simulating five sets of finger flexion movements. The results showed that the FDS and FDP contracted together to provide power during the flexion movements, while the ED acted as an antagonist. The peak stresses of the FDS, FDP and ED were all at the joints. In the flexion without resistance, the FDS provided the main driving force, and the FDS and FDP alternated in a "plateau" of muscle force. In the flexion with resistance, the muscle forces of FDS, FDP, and ED were all positively correlated with fingertip forces. The FDS still provided the main driving force, but the stress maxima occurred in the FDP at the DIP joint.

Effects of labour analgesia with different concentrations of ropivacaine on maternal body temperature and inflammatory factor: A randomised controlled study.

PURPOSE: To investigate the effect of different concentrations of ropivacaine on maternal temperature and inflammatory factors during epidural analgesia. METHOD: One hundred and forty healthy term nulliparas were randomly assigned to receive epidural analgesia with either 0.1% ropivacaine (group H) or 0.068% ropivacaine (group L). Epidural sufentanil 0.3 µg/mL was added in both groups. Maternal tympanic temperature was measured at initiation of epidural analgesia (baseline temperature) and each hour thereafter. Maternal blood samples were taken at the time of epidural placement and 4 hours after analgesia to detect IL-6 and IL-1ß serum concentrations. Visual analog scale pain scores, labour events and neonatal outcomes were recorded. RESULTS: Epidural analgesia using 0.1% or 0.068% ropivacaine both achieved satisfactory pain relief. Increases in maternal body temperature and in IL-6 levels were observed in both groups, but there was no significant difference between the two groups. The incidence of maternal fever was similar between the two groups. CONCLUSION: Maternal body temperature and serum inflammatory factors are similarly affected by 0.1% or 0.068% ropivacaine used during epidural analgesia use for labour pain relief.

Ultrasonographic measurement of antral area for estimating gastric fluid volume in pregnant women.

STUDY OBJECTIVE: To calculate the stomach volume according to the antral area in pregnant women. DESIGN: Prospective observational study. SETTING: One of the maternity units in our hospital. PATIENTS: 24 singleton pregnancy women, over 18-year-old, non-laboring, gestational age ≥ 36 weeks, ASA physical status I to II were involved in our study. INTERVENTIONS AND MEASUREMENTS: An ultrasound assessment of the antrum was performed to the pregnant women after 8 hours fasting for the first time. Those lacking of visualization of any gastric contents in the antrum in both the supine and the right lateral decubitus positions were included in our study. Thereafter 50 ml of water was ingested, 4 times, 200 ml in total. The antrum area was examined 2mins after each 50 ml ingest of water. MAIN RESULTS: A high correlation between CSA and volume of liquid ingested (r = 0.90,P < 0.01) was found. We can construct a formula for the prediction of volume values based on the measured CSA values and demographic variables. The equation is: Volumeml=270.76+13.68∗CSA-1.20∗gestationalage CONCLUSIONS: Bedside antrum area examination by ultrasonography can provide quantitative information for the assessment of the gastric content and volume in the pregnant women. We can calculate the actual stomach capacity according to the CSA of the gastric antrum.

Androgen receptor induces EPHA3 expression by interacting with transcription factor SP1.

Erythropoietin­producing hepatocellular carcinoma cell surface type­A receptor 3 (EPHA3) has been found to promote the proliferation and survival of prostate cancer (PCa) cell lines and prostate tumor development in nude mice. However, the regulation of EPHA3 in PCa remains largely unknown. This study is aimed to investigate the association between EPHA3 expression and androgen receptor (AR) signaling and the potential mechanism. We determined mRNA and protein levels of EPHA3 and AR signaling­related genes in the PCa cell line 22Rv1 by reverse transcription­polymerase chain reaction (RT­PCR) and western blotting, respectively. The EPHA3 mRNA and protein levels were both found to be elevated by dihydrotestosterone (DHT) hormone in a dose­ and time­dependent manner, as AR and prostate­specific antigen (PSA) expression were increased. Similarly, EPHA3 protein levels were also increased in the PCa cell line LNCaP stimulated with DHT or mibolerone (Mib). Overexpression of pEGFP­AR in 22Rv1 cells significantly increased the EphA3 level, while AR knockdown with small interfering RNA (siRNA) for AR (siAR) markedly decreased the expression of EPHA3. The key EPHA3 promoter region associated with AR regulation was evaluated by co­transfection of various pGL3­basic­luciferase reporter plasmids, containing EPHA3 core promoter fragments differing in length, with the AR plasmid or siAR into 22Rv1 cells. AR overexpression in 22Rvl cells raised the EphA3 promoter transcription activity of pGL3­EPHA3­Luc (EPHA3­Luc)­789, and vice versa. Similarly, luciferase activity of EPHA3­Luc­317 was also clearly affected. However, truncated EPHA3­Luc­237 without the transcription factor specific protein 1 (SP1) binding sites or EPHA3­Luc­789ΔSP1 with modified SP1 binding sites clearly decreased EPHA3 promoter activity regardless of whether AR was overexpressed or blocked. Treatment of 22Rv1 cells with 10 and 100 nM of the SP1 inhibitor mithramycin A for 24 and 48 h significantly reduced EPHA3 mRNA and protein levels. Additionally, selective inhibition of SP1 with siRNA SP1 (siSP1) at various concentration from 25 to 75 nM, reduced the EPHA3 protein level in PCa LNCaP cells, accordingly. Co­immunoprecipitation (co­IP) and chromatin IP (ChIP) assays were performed to determine whether AR forms a transcription factor complex with Sp1 that binds the EPHA3 core promoter region to sense androgen induction. The result suggests that the interaction of AR and SP1 contributes to regulate EPHA3 expression, and the SP1 binding sites (­295~­261) in the EPHA3 core promoter region is crucial to the regulation of EPHA3 expression in response to androgen hormone stimuli.

Persistent cauda equina syndrome after cesarean section under combined spinal-epidural anesthesia: a case report.

A 29-year-old pregnant woman was delivered by cesarean section under a combined spinal-epidural anesthesia. Thirty hours after an uneventful surgery, she complained of weakness in her lower extremities and developed fecal and urinary incontinence. Lumbosacral magnetic resonance imaging showed thickening and clumping of cauda equina nerve roots at L2-3 level, consistent with the diagnosis of arachnoiditis. The patient was included in an intense rehabilitation program with a diagnosis of cauda equina syndrome. Most of the symptoms resolved within a few days, but right side foot drop persisted for 2 years after the procedure. Because there was no other etiologies being noticed, we hypothesized that the hyperbaric bupivacaine neurotoxicity was likely to be the cause for this neurologic deficit.

Intracranial pure yolk sac tumor in the anterior third ventricle of an adult: A case report.

A 45-year-old female patient presented with symptoms of polydipsia and polyuria, menopause, headache, gait disturbance and deteriorated mental state. Brain magnetic resonance imaging (MRI) showed an irregular mass in the anterior third ventricle. The tumor was excised using a transfrontal approach from the anterior section of the third ventricle. The histological diagnosis was of an intracranial pure yolk sac tumor. The patient underwent radiotherapy and suffered no tumor recurrence one year after the surgery. Overall, when heterogeneous enhancement and an irregular mass with surrounding invasion and ventricular dilation are observed in the anterior third ventricle of an adult, a yolk sac tumor should be considered, and MRI may aid the differential diagnosis. A combination of surgical resection and radiotherapy is recommended for the yolk sac tumor.

A comparison of remifentanil parturient-controlled intravenous analgesia with epidural analgesia: a meta-analysis of randomized controlled trials.

BACKGROUND: Epidural analgesia is generally accepted as the most effective form of pain relief during labor. Remifentanil patient-controlled IV analgesia (PCIA), which is less invasive than epidural analgesia, may be an attractive alternative. In this meta-analysis, we compared the efficacy and safety of the 2 analgesic techniques for labor pain. METHODS: Databases of PubMed, EMBASE, and Cochrane Library were searched independently by 2 reviewers to retrieve eligible randomized controlled clinical trials. The primary end points were pain scores at 1 and 2 hours, and the secondary end points were nausea, vomiting, pruritus, and umbilical artery pH values. Mean difference (MD) or risk ratio with 95% confidence intervals (CIs) were calculated for each end point. GRADE profiler was applied to assess the quality of evidence. RESULTS: Five eligible trials were retrieved and analyzed. We found that parturients with remifentanil PCIA had higher visual analog scale (10-cm scale) pain scores than those who received epidural analgesia at 1 hour (MD = 1.9 cm; 95% CI, 0.5-3.3; I = 94%) and 2 hours (MD = 3.0 cm; 95% CI, 0.7-5.2; I = 89%) after initiation of analgesia. There was no statistical difference between epidural analgesia and remifentanil PCIA in the incidence of nausea, vomiting, pruritus, or umbilical artery pH values. However, the CIs are quite wide and contain clinically significant differences. According to GRADE profiler, most end points had moderate quality except that pain scores at 1 hour were of low quality. CONCLUSIONS: This meta-analysis suggests that remifentanil PCIA is not superior to epidural analgesia in analgesic efficacy during labor. Given the wide CIs of the pooled results for secondary maternal and neonatal outcomes, definite conclusions cannot be drawn for those outcomes. Further studies are still warranted to validate these conclusions.

Solid phase extraction and spectrophotometric determination of Au(III) with 5-(2-hydroxy-5-nitrophenylazo)thiorhodanine.

A new chromogenic reagent, 5-(2-hydroxy-5-nitrophenylazo)thiorhodanine (HNATR) was synthesized. A highly sensitive, selective and rapid method for the determination microg l(-1) level of Au(III) based on the rapid reaction of Au(III) with HNATR and the solid phase extraction of the colored complex with a reversed phase polymer-based C(18) cartridge have been developed. The HNATR reacted with Au(III) to form a red complex of a molar ratio 1:2 (Au(III) to HNATR) in the presence of 0.05 - 0.5 mol l(-1) of phosphoric acid solution and emulsifier-OP medium. This complex was enriched by the solid phase extraction with a polymer-based C(18) cartridge. The enrichment factor of 100 was achieved. The molar absorptivity of the complex is 1.37 x 10(5) l mol(-1) cm(-1) at 520 nm in the measured solution. The system obeys Beer's law in the range of 0.01 - 3 microg ml(-1). The relative standard deviation for eleven replicates sample of 0.5 microg l(-1) level is 2.18%. The detection limit, based on the three times of standard deviation is 0.02 microg l(-1) in the original sample. This method was applied to the determination of gold in water and ore with good results.