Ultrasound evaluation of gastric emptying of high-energy semifluid solid beverage in parturients during labor at term: a randomized controlled trial.

PURPOSE: What to intake during labor is controversial. The purpose of this study was to compare the gastric emptying of high-energy semifluid solid beverage (HESSB) versus that of carbohydrate (CHO) solution of equal calories and volume by evaluating the gastric antral cross-sectional area (CSA) using ultrasonography in parturients during labor at term. METHODS: The study was conducted at a maternity and infant hospital between June and October 2020. Forty parturients scheduled for epidural labor analgesia during labor at term were randomly assigned to receive HESSB (300 mL, n = 20) or CHO (300 mL, n = 20). Gastric antral CSA was measured at baseline and 5, 30, 60, 90, and 120 min after consumption of the drink. The primary outcome was gastric antral CSA at 120 min in the HESSB group and CHO group. RESULTS: The gastric antral CSA between the HESSB group and CHO group at 120 min was not statistically significant (2.73 cm2 ± 0.55 vs. 2.55 cm2 ± 0.72, P = 0.061). All patients returned to baseline at 120 min after intake of 300 mL isocaloric HESSB and CHO, confirmed by evaluation of gastric antral CSA. The visual analog scale score for satiety was higher in the HESSB group (P < 0.001), with better taste satisfaction (7[5-8] vs. 5[4-6], P < 0.001). CONCLUSION: The change of gastric antral cross-sectional area after HESSB is similar to the corresponding calories and volume of CHO and the gastric emptying of HESSB can be emptied within 2 h with better taste satisfaction and satiety in pregnant women under labor analgesia.

Restoring Wnt signaling in a hormone-simulated postpartum depression model remediated imbalanced neurotransmission and depressive-like behaviors.

BACKGROUND: Postpartum depression (PPD) is a prevalent mental disorder that negatively impacts mothers and infants. The mechanisms of vulnerability to affective illness in the postpartum period remain largely unknown. Drastic fluctuations in reproductive hormones during the perinatal period generally account for triggering PPD. However, the molecular mechanism underlying the PPD-like behaviors induced by the fluctuations in hormones has rarely been reported. METHODS: We utilized hormones-simulated pseudopregnancy (HSP) and hormones-simulated postpartum period (HSPP) rat models to determine how drastic fluctuations in hormone levels affect adult neurotransmission and contribute to depressive-like behaviors. The electrophysiological response of CA1 pyramidal neurons was evaluated by whole-cell patch clamping to identify the hormone-induced modulations of neurotransmission. The statistical significance of differences was assessed with One-way ANOVA and t-test (p < 0.05 was considered significant). RESULTS: Reproductive hormones withdrawal induced depressive-like behaviors and disturbed the balance of excitatory and inhibitory transmission in the pyramidal neurons in the hippocampus. Molecular analyses revealed that the blunted Wnt signaling might be responsible for the deficits of synaptic transmission and behaviors. Activation of Wnt signaling increased excitatory and inhibitory synaptic transmission in the hippocampus. Reactivation of Wnt signaling alleviated the anhedonic behaviors and abnormal synaptic transmission. CONCLUSIONS: Restoring Wnt signaling in the hormones-simulated postpartum period rat models remediated depression-related anhedonia symptoms and rebalanced the excitation/inhibition ratio by collectively enhancing the plasticity of GABAergic and glutamatergic synapses. The investigations carried out in this research might provide an alternative and prospective treatment strategy for PPD.

Role of IL-33-ST2 pathway in regulating inflammation: current evidence and future perspectives.

Interleukin (IL)-33 is an alarmin of the IL-1 superfamily localized to the nucleus of expressing cells, such as endothelial cells, epithelial cells, and fibroblasts. In response to cellular damage or stress, IL-33 is released and activates innate immune responses in some immune and structural cells via its receptor interleukin-1 receptor like-1 (IL-1RL1 or ST2). Recently, IL-33 has become a hot topic of research because of its role in pulmonary inflammation. The IL-33-ST2 signaling pathway plays a pro-inflammatory role by activating the type 2 inflammatory response, producing type 2 cytokines and chemokines. Elevated levels of IL-33 and ST2 have been observed in chronic pulmonary obstructive disease (COPD). Notably, IL-33 is present in COPD induced by cigarette smoke or acute inflammations. The role of IL-33 in sepsis is becoming increasingly prominent, and understanding its significance in the treatment of sepsis associated with high mortality is critical. In addition to its pro-inflammatory effects, the IL-33-ST2 axis appears to play a role in bacterial clearance and tissue repair. In this review, we focused on the role of the IL-33-ST2 axis in sepsis, asthma, and COPD and summarized the therapeutic targets associated with this axis, providing a basis for future treatment.

Ultrasound Assessment of Gastric Volume in Parturients After High-Flow Nasal Oxygen Therapy.

BACKGROUND: High-flow nasal oxygen (HFNO) therapy is widely used in critical care obstetrics to improve oxygenation. Much of the benefit of HFNO is linked to the creation of modest levels of positive airway pressure. Pregnant women are generally considered to be at high risk of regurgitation and aspiration. It is unknown whether HFNO may cause gas insufflation into the stomach and further increase this risk. Therefore, this study aimed to systematically evaluate the possible safety effects of HFNO on gastric volume in healthy fasted parturients. METHODS: Sixty fasted parturients scheduled for elective cesarean delivery were enrolled in an observer-blinded, prospective, interventional study. We used ultrasonography to assess changes of antral cross-sectional area (CSA) and gastric volume before and after a 20-minute treatment with HFNO at a rate of 50 L·min -1 . The primary outcome was the change in gastric volume from before to after HFNO therapy, and the secondary outcome was the distribution of antral grades. RESULTS: In semirecumbent right lateral position, the antral CSA at baseline and after treatment with HFNO was 3.81 (3.01-4.72) cm 2 and 3.79 (3.03-4.54) cm 2 , respectively. The estimated fluid volume at baseline and after treatment with HFNO was 38.51 (33.39-54.62) mL and 39.71 (32.00-52.82) mL, respectively. All participants had either a grade 0 or grade 1 antrum, and most of them had a grade 0 antrum. There was no significant difference in gastric volume and distribution of antral grades before and after HFNO therapy. Gastric air distension was not shown in any of the parturients either at baseline or after treatment with HFNO. CONCLUSIONS: Treatment with HFNO for 20 minutes at flow rates up to 50 L·min -1 did not increase gastric volume in term pregnant women breathing spontaneously when evaluated by gastric ultrasonography.

Subclavian vein ultrasound-guided fluid management to prevent post-spinal anesthetic hypotension during cesarean delivery: a randomized controlled trial.

BACKGROUND: Hypotension frequently occurs after spinal anesthesia during cesarean delivery, and fluid loading is recommended for its prevention. We evaluated the efficacy of subclavian vein (SCV) ultrasound (US)-guided volume optimization in preventing hypotension after spinal anesthesia during cesarean delivery. METHODS: This randomized controlled study included 80 consecutive full-term parturients scheduled for cesarean delivery under spinal anesthesia. The women were randomly divided into the SCVUS group, with SCVUS analysis before spinal anesthesia with SCVUS-guided volume management, and the control group without SCVUS assessment. The SCVUS group received 3 mL/kg crystalloid fluid challenges repeatedly within 3 min with a 1-min interval based on the SCV collapsibility index (SCVCI), while the control group received a fixed dose (10 mL/kg). Incidence of post-spinal anesthetic hypotension was the primary outcome. Total fluid volume, vasopressor dosage, changes in hemodynamic parameters, maternal adverse effects, and neonatal status were secondary outcomes. RESULTS: The total fluid volume was significantly higher in the control group than in the SCVUS group (690 [650-757.5] vs. 160 [80-360] mL, p < 0.001), while the phenylephrine dose (0 [0-40] vs. 0 [0-30] µg, p = 0.276) and incidence of post-spinal anesthetic hypotension (65% vs. 60%, p = 0.950) were comparable between both the groups. The incidence of maternal adverse effects, including nausea/vomiting and bradycardia (12.5% vs. 17.5%, p = 0.531 and 7.5% vs. 5%, p = 1.00, respectively), and neonatal outcomes (Apgar scores) were comparable between the groups. SCVCI correlated with the amount of fluid administered (R = 0.885, p < 0.001). CONCLUSIONS: SCVUS-guided volume management did not ameliorate post-spinal anesthetic hypotension but reduced the volume of the preload required before spinal anesthesia. Reducing preload volume did not increase the incidence of maternal and neonatal adverse effects nor did it increase the total vasopressor dose. Moreover, reducing preload volume could relieve the heart burden of parturients, which has high clinical significance. CLINICAL TRIAL REGISTRATION: The trial was registered with the Chinese Clinical Trial Registry at chictr.org.cn (registration number, ChiCTR2100055050) on December 31, 2021.

Recovery of Siniperca chuatsi rhabdovirus from cloned cDNA.

Siniperca chuatsi rhabdovirus (SCRV) is an important pathogen that infects mandarin fish. A reverse genetics system is an important technical platform for virus research. In this study, the minigenome in which the enhanced green fluorescent protein gene is flanked by the viral genomic ends of SCRV and transcribed using a T7 promoter-terminator cassette was constructed. Co-transfection of the minigenome construct with SCRV-supporting plasmids of N, P, and L in BSRT7 cells resulted in the expression of the reporter gene. Transcription of a positive-strand RNA copy from cDNA of the SCRV genome along with the viral N, P, and L proteins resulted in the recovery of infectious SCRV in cells. Viral titre up to 108 PFU/ml was achieved. Recombinant SCRV was verified by the detection of a unique restriction site engineered into the SCRV genome. The phenotypes of the recombinant SCRV and the parental virus were evaluated by plaque size, replication kinetics in vitro, and pathogenicity in vivo. The recovered SCRV from cDNA showed similar phenotypes compared to the parental virus. The established reverse genetics system is of great significance and value for the functional genome study of SCRV and for laying a foundation for the development of the viral vector and SCRV vaccine.

Colorimetric identification of miRNA-195 sequence for diagnosing osteosarcoma.

Improving biosensing performance is mandatory for biomolecular recognition and disease identification. Gold nanoparticle (GNP)-based colorimetric assay is the easy and cost-effective identification method by a naked eye detection. In this research, osteosarcoma biomarker (miRNA-195) was identified by citrate-capped GNP-colorimetric assay. As salt-induced aggregation was used to observe the color changes of GNP, sodium chloride (NaCl) and capture DNA were optimized as 50 mM and ∼20 pmol, respectively. The capture DNA only on GNP could not stabilize under high NaCl, and the color of GNP turned into purple. At the same time, when capture DNA was hybridized with target, the condition can stabilize the GNP under higher NaCl, which retains the GNP color as red. This simple assay reaches the limit of detection of target miRNA-195 as ∼40 fmol. Control experiments with noncomplementary DNA turned the solution into purple, indicating the specific detection of target. The mixture of target in diluted serum retains the color of the GNP solution to be red, indicating the selective detection of target DNA. This simple assay helps to quantify the level of miRNA-195 target DNA and to diagnose the osteosarcoma.

Effect of Dural Puncture Epidural Technique Combined With Programmed Intermittent Epidural Bolus on Labor Analgesia Onset and Maintenance: A Randomized Controlled Trial.

BACKGROUND: The dural puncture epidural (DPE) technique is associated with faster onset than the conventional epidural (EP) technique for labor analgesia. The programmed intermittent epidural bolus (PIEB) mode for maintaining labor analgesia allows for lower anesthetic drug consumption than the continuous epidural infusion (CEI) mode. Whether DPE technique with PIEB mode offers additional benefits for analgesia onset, local anesthetic drug consumption, and side effects versus EP or DPE techniques with CEI mode remains unclear. METHODS: Nulliparous women with a visual analog scale (VAS) pain score >50 mm and cervical dilation <5 cm were randomly assigned to receive EP + CEI, DPE + CEI, or DPE + PIEB for labor analgesia. A 25-gauge needle was used for dural puncture. Analgesia was initiated with 10 mL of 0.1% ropivacaine with 0.3 µg/mL of sufentanil and maintained with the same solution at 8 mL/h in all groups. A 5-mL patient-controlled epidural analgesia (PCEA) bolus was programmed with a 20-minute lockout. Breakthrough pain not amendable by PCEA was treated with provider boluses of 5 mL of 0.125% ropivacaine. The primary outcome was "time to adequate analgesia," defined as a VAS pain score ≤30 mm during 2 consecutive contractions, and was analyzed using Kaplan-Meier curves and a Cox proportional hazard model. Secondary outcomes included the VAS scores, ropivacaine consumption, sensory block level to ice, PCEA and provider boluses intervention, mode of delivery, duration of labor, Bromage scores, Apgar scores, occurrence of side effects, and maternal satisfaction with the anesthesia. RESULTS: A total of 116 women were included (38 in the EP + CEI group, 40 in the DPE + CEI group, and 38 in the DPE + PIEB group). Adequate anesthesia was achieved faster in the DPE + CEI and DPE + PIEB groups than in the EP + CEI group (hazard ratio = 1.705; 95% confidence interval [CI], 1.039-2.800; P = .015; and hazard ratio = 1.774; 95% CI, 1.070-2.941; P = .012, respectively). DPE technique with PIEB mode was associated with the fewest PCEA boluses and the lowest hourly ropivacaine consumption (both P < .001). There were no differences in the duration of labor, mode of delivery, Bromage scores, newborn Apgar scores, incidence of side effects, and maternal satisfaction scores among the groups. CONCLUSIONS: The use of DPE technique for neuraxial analgesia was associated with faster onset than the use of the EP technique. DPE technique with PIEB mode achieved the greatest drug-sparing effect without increasing maternal or neonatal side effects.

Association between epidural analgesia and indications for intrapartum caesarean delivery in group 1 of the 10-group classification system at a tertiary maternity hospital, Shanghai, China: a retrospective cohort study.

BACKGROUND: In this study, we aimed to determine whether epidural analgesia affects the indications for intrapartum caesarean delivery, such as foetal distress, dystocia, or maternal request, in nulliparous term women with spontaneous labour (Group 1 in the 10-Group Classification System). METHODS: We conducted a retrospective cohort study and collected data from the electronic medical records of deliveries performed in our institution between 1 January 2017 and 30 June 2017. Women conforming to the criterion of Group 1 according to the 10-Group Classification System were enrolled. We compared labour outcomes between women with and without epidural analgesia and analysed the association between epidural analgesia and indications for caesarean by using multivariate logistic regression analysis. RESULTS: A total of 3212 women met the inclusion criteria, and 2876 were enrolled in the final analyses. Women who received epidural analgesia had a significantly lower intrapartum caesarean delivery rate (16.0% vs. 26.7%, P < 0.001), higher rates of amniotomy (53.4% vs. 42.3%, P < 0.001) and oxytocin augmentation (79.5% vs. 67.0%, P < 0.001), and a higher incidence of intrapartum fever (≥38 °C) (23.3% vs. 8.5%, P < 0.001) than those who did not receive epidural analgesia. There were no significant differences between the groups for most indications, except a lower probability of maternal request for caesarean delivery (3.9% vs. 10.5%, P < 0.001) observed in women who received epidural analgesia than in those who did not. Epidural analgesia was revealed to be associated with a decreased risk of maternal request for caesarean delivery (adjusted odds ratio [aOR], 0.30; 95% confidence interval [CI], 0.22-0.42; P < 0.001); however, oxytocin augmentation was related to an increased risk of maternal request (aOR, 2.34; 95%CI, 1.47-3.75; P < 0.001). Regarding the reasons for the maternal request for caesarean delivery, significantly fewer women complained of pain (0.5% vs. 4.6%, P < 0.001) or had no labour progress (1.3% vs. 3.6%, P < 0.001) among those who received analgesia. CONCLUSIONS: Among the women in Group 1, epidural analgesia was associated with a lower intrapartum caesarean delivery rate, which may be explained by a reduction in the risk of maternal request for an intrapartum caesarean delivery.

The efficacy of high flow nasal oxygenation for maintaining maternal oxygenation during rapid sequence induction in pregnancy: A prospective randomised clinical trial.

BACKGROUND: High-flow nasal oxygenation (HFNO) for pre-oxygenation in rapid sequence induction (RSI) has only been assessed in volunteer parturients without intubation. OBJECTIVES: To evaluate the efficacy of HFNO in comparison with the conventional facemask for oxygenation during RSI for caesarean section under general anaesthesia. SETTING: Operating room in a tertiary hospital. DESIGN: Prospective randomised, controlled study. PARTICIPANTS: Thirty-four healthy parturients undergoing general anaesthesia for caesarean section. INTERVENTIONS: Parturients were randomly assigned to HFNO or standard facemask (SFM) group. MAIN OUTCOME MEASURES: The primary outcome measure was the PaO2 immediately after intubation. Secondary outcomes included lowest saturation throughout the intubation procedure, end-tidal oxygen concentration (EtO2) on commencing ventilation, blood gas analysis (pH, PaCO2), fetal outcomes and intubation-related adverse events. RESULTS: PaO2 in the HFNO group was significantly higher than that in SFM group (441.41 ±â€Š46.73 mmHg versus 328.71 ±â€Š72.80 mmHg, P < 0.0001). The EtO2 concentration in the HFNO group was higher than that in the SFM group (86.71 ±â€Š4.12% versus 76.94 ±â€Š7.74%, P < 0.0001). Compared to baseline, PaCO2 immediately after intubation also increased significantly in both groups (HFNO group: 30.87 ±â€Š2.50 mmHg versus 38.28 ±â€Š3.18 mmHg; SFM group: 29.82 ±â€Š2.57 mmHg versus 38.05 ±â€Š5.76 mmHg, P < 0.0001), but there was no difference in PaCO2 between the two groups. There was no difference in lowest saturation, intubation times, duration of apnoea, pH value or fetal outcomes. CONCLUSIONS: Compared with SFM, HFNO provided a higher PaO2 and EtO2 immediately after intubation in parturients. HFNO is safe as a method of oxygenation during RSI in parturients undergoing general anaesthesia for caesarean section. TRIAL REGISTRATION: Clinical trial ChiCTR1900023121.

Accuro ultrasound-based system with computer-aided image interpretation compared to traditional palpation technique for neuraxial anesthesia placement in obese parturients undergoing cesarean delivery: a randomized controlled trial.

PURPOSE: Recently, a new handheld ultrasound-based device, called Accuro, has been commercialized with a real-time automated interpretation of lumbar ultrasound images. We hypothesized that the handheld ultrasound device would improve the efficacy and safety of combined spinal-epidural anesthesia (CSEA) for cesarean delivery in obese parturients. METHODS: Eighty parturients with a body mass index > 30 kg∙m-2 scheduled for elective cesarean delivery were randomly allocated equally (palpation group and ultrasound group). The primary outcome was the first insertion success rate. Secondary outcomes were the time taken to identify the needle puncture site, duration of CSEA procedure, the total time, the rate of parturients who require needle redirections, the number of skin punctures, changes in the intended interspace, and the incidence of complications. RESULTS: Compared to the palpation group, the first insertion success rate was significantly higher (72.5% vs. 40.0%; P = 0.003), and time taken to identify the needle puncture site was less (30 [26-36] vs. 39 [32-49] seconds; P = 0.001) in the ultrasound group. The rate of parturients who required needle redirections (40.0% vs. 72.5%; P = 0.003) and the incidence of paresthesia were both lower (7.5% vs. 45.0%; P < 0.001). The other outcomes had no significant difference between groups. The mean difference between the epidural depth measured by the handheld ultrasound and needle depth was - 0.29 cm [95% limit of agreement, - 0.52 to - 0.05]. CONCLUSIONS: Our study suggests using the Accuro ultrasound device can enhance the efficacy and safety of CSEA in obese parturients when executed by experienced anesthesiologists, and its automated estimation of epidural depth is accurate.

Propofol affects mouse embryonic fibroblast survival and proliferation in vitro via ATG5- and calcium-dependent regulation of autophagy.

Propofol is a commonly used intravenous anesthetic agent, which has been found to affect cell survival and proliferation especially in early life. Our previous studies show that propofol-induced neurodegeneration and neurogenesis are closely associated with cell autophagy. In the present study we explored the roles of autophagy-related gene 5 (ATG5) in propofol-induced autophagy in mouse embryonic fibroblasts (MEF) in vitro. We showed that ATG5 was functionally related to propofol-induced cell survival and damage: propofol significantly enhanced cell survival and proliferation at a clinically relevant dose (10 µM), but caused cell death at an extremely high concentration (200 µM) in ATG5-/- MEF, but not in WT cells. The dual effects found in ATG5-/- MEF could be blocked by intracellular Ca2+ channel antagonists. We also found that propofol evoked a moderate (promote cell growth) and extremely high (cause apoptosis) cytosolic Ca2+ elevation at the concentrations of 10 µM and 200 µM, respectively, only in ATG5-/- MEF. In addition, ATG5-/- MEF themselves released more Ca2+ in cytosolic space and endoplasmic reticulum compared with WT cells, suggesting that autophagy deficiency made intracellular calcium signaling more vulnerable to external stimuli (propofol). Altogether, our results reveal that ATG5 plays a crucial role in propofol regulation of cell survival and proliferation by affecting intracellular Ca2+ homeostasis.

Evaluating coagulation status with thromboelastography in a woman with antiphospholipid syndrome and sepsis: a case report.

This study presents the case of a pregnant woman with antiphospholipid syndrome (APS) who developed septic shock after labor induction. Prolonged coagulation times suggested a hypocoagulable state and contraindication to anticoagulation. Thromboelastography (TEG) similarly indicated hypocoagulation. To exclude the impact of lupus anticoagulant on the coagulation assays, a mixing test of prolonged activated partial thromboplastin times was conducted. The mixing test confirmed that prolongation of coagulation times in vitro was affected by antiphospholipid antibodies (aPL), such as lupus anticoagulant. The patient was administered human immunoglobulin and low-molecular weight heparin to neutralize antibodies and for anticoagulation, respectively. The patient's coagulation state significantly improved. Based on these findings, anesthesiologists and obstetricians should be aware that TEG might not be a reliable method of correcting coagulation parameters in patients with sepsis in the presence of aPL. If necessary, a mixing test can be performed to correctly define a patient's coagulation status.

Ultrasound-Assisted Technology Versus the Conventional Landmark Location Method in Spinal Anesthesia for Cesarean Delivery in Obese Parturients: A Randomized Controlled Trial.

BACKGROUND: Spinal anesthesia, which is commonly used in cesarean deliveries, is often difficult to perform in obese parturients because of poorly palpable surface landmarks and positioning challenges. This study aimed to evaluate the benefits of ultrasound-assisted technology for performing spinal anesthesia in obese parturients. METHODS: Parturients with a body mass index (BMI) ≥30 kg/m scheduled for elective cesarean delivery were randomized to undergo spinal anesthesia using the conventional landmark location technique (landmark group, n = 40) or prepuncture ultrasound examination (ultrasound group, n = 40). All participants underwent spinal anesthesia in the lateral position. The primary outcome was the first-attempt success rate. Secondary outcomes were the number of skin punctures and needle passes, procedure times, patient satisfaction, changes in the intended interspace, and incidence of complications. RESULTS: The ultrasound group had a significantly higher first-attempt success rate (87.5% vs 52.5%; P = .001), fewer cases requiring >10 needle passes (1 vs 17; P < .001), and fewer skin punctures and needle passes (P < .001 for both). There was no statistically significant difference in the time taken to identify the needle insertion site between the 2 groups (202.5 vs 272.0 seconds; P = .580). Both the spinal injection time and total procedure time were significantly longer in the landmark group (P < .001). Patient satisfaction scores were significantly higher in the ultrasound group (P = .001). Among patients with BMI between 30 and 34.9 kg/m, there was no statistically significant difference in the first-attempt success rate (P = .407), number of cases with >10 needle passes (P = .231), spinal injection time (P = .081), or total procedure time (P = .729); however, more time was required to identify the needle insertion site in the ultrasound group (P < .001). For patients with BMI between 35 and 43 kg/m, the ultrasound group had a significantly higher first-attempt success rate (P ≤ .041), fewer cases with >10 needle passes (P ≤ .01), and shorter procedure times, including the time required to identify the needle insertion site (P < .001). CONCLUSIONS: Prepuncture ultrasound examination can facilitate spinal anesthesia in the lateral position in obese parturients (35 kg/m ≤ BMI ≤ 43 kg/m) by improving the first-attempt success rate, reducing the number of needle passes and puncture attempts, shortening the total procedure time, and improving patient satisfaction.

A case of anosmia and hypogeusia as a complication of propofol.

Anesthetics represent an uncommon cause of taste and smell disorders. We describe a case of anosmia and hypogeusia for 6 weeks after recovery from a uterine curettage operation in a 32-year-old woman. The case is unusual because propofol was the only anesthetic used during surgery and anesthesia. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed no abnormality. This case may highly suggest that propofol could induce smell and taste disorders.

Propofol Affects Neurodegeneration and Neurogenesis by Regulation of Autophagy via Effects on Intracellular Calcium Homeostasis.

BACKGROUND: In human cortical neural progenitor cells, we investigated the effects of propofol on calcium homeostasis in both the ryanodine and inositol 1,4,5-trisphosphate calcium release channels. We also studied propofol-mediated effects on autophagy, cell survival, and neuro- and gliogenesis. METHODS: The dose-response relationship between propofol concentration and duration was studied in neural progenitor cells. Cell viability was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and lactate dehydrogenase release assays. The effects of propofol on cytosolic calcium concentration were evaluated using Fura-2, and autophagy activity was determined by LC3II expression levels with Western blot. Proliferation and differentiation were evaluated by bromodeoxyuridine incorporation and immunostaining with neuronal and glial markers. RESULTS: Propofol dose- and time-dependently induced cell damage and elevated LC3II expression, most robustly at 200 µM for 24 h (67 ± 11% of control, n = 12 to 19) and 6 h (2.4 ± 0.5 compared with 0.6 ± 0.1 of control, n = 7), respectively. Treatment with 200 µM propofol also increased cytosolic calcium concentration (346 ± 71% of control, n = 22 to 34). Propofol at 10 µM stimulated neural progenitor cell proliferation and promoted neuronal cell fate, whereas propofol at 200 µM impaired neuronal proliferation and promoted glial cell fate (n = 12 to 20). Cotreatment with ryanodine and inositol 1,4,5-trisphosphate receptor antagonists and inhibitors, cytosolic Ca chelators, or autophagy inhibitors mostly mitigated the propofol-mediated effects on survival, proliferation, and differentiation. CONCLUSIONS: These results suggest that propofol-mediated cell survival or neurogenesis is closely associated with propofol's effects on autophagy by activation of ryanodine and inositol 1,4,5-trisphosphate receptors.

Combined spinal-epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section.

AIM: Maternal position during induction of combined spinal-epidural anesthesia (CSEA) may affect hemodynamics and block characteristics. This study aimed to assess whether the sitting position is more likely to induce hypotension and higher block level than the lateral position in CSEA with hypobaric ropivacaine. METHODS: Ninety American Society of Anesthesiologists physical status I and II parturients undergoing elective cesarean section were randomized into three groups: the sitting, left-lateral, and right-lateral position groups. The L3-4 interspace was selected as the puncture site, and subarachnoid injection of 2.5 mL 0.5% hypobaric ropivacaine was administered. After the epidural catheter was inserted and fixed, the patient's position was changed to the left-leaning supine position. The blood pressure was measured once every 1 min followed by once every 3 min after the delivery. The sensory block level was regularly measured. RESULTS: A total of 88 parturients were included in this study. The incidences of hypotension in the sitting, left-lateral, and right-lateral position groups were 72%, 38%, and 40%, respectively, P = 0.012. Incidence and total dose of the phenylephrine supplement in the sitting position group were significantly higher than in the other two groups. The sitting position group showed a significantly higher block level (T4 [T3, T4]) as compared to the left-lateral (T6 [T5, T6]) and right-lateral position groups (T6 [T4, T6]), P < 0.01. The Apgar scores of neonates at 1 min and 5 min, and the pH values of the umbilical arterial and venous blood were similar among the three groups. CONCLUSION: As compared to the lateral positions, CSEA with hypobaric ropivacaine in the sitting position is more likely to cause hypotension and excessively high block level.

Microplastics in maternal amniotic fluid and their associations with gestational age.

Microplastics (MPs) pollution is a growing global concern due to its potential threat to human health, particularly concerning fetal health. Nevertheless, few studies have examined the sources of fetal MPs exposure and its impact on fetal development. In this study, MPs levels in maternal amniotic fluid (AF) and their associations with measures of fetal growth were investigated. Specifically, 40 human AF samples were collected to determine the presence and characteristics of MPs using laser direct infrared (LD-IR) spectroscopy. MPs were found in 32 out of 40 AF samples, with an average abundance of 2.01 ± 4.19 particles/g. Polyethylene (PE, 38.80 %) and chlorinated polyethylene (CPE, 26.98 %) were the most prevalent polymers. The majority of MPs (87.56 %) were 20-100 µm in size, and fragments (71.23 %) evidently prevailed in morphology. Additionally, a questionnaire was designed to explore the associations between MPs levels in the AF and maternal dietary habits, aiming at unveiling the potential sources of MPs in AF. The MPs levels in the AF were positively associated with the frequency of seafood consumption (r = 0.781, P < 0.001) and bottled water intake (r = 0.386, P = 0.014). Moreover, the associations between MPs levels in maternal AF and measures of fetal growth were evaluated. The abundance of total MPs in maternal AF were significantly negatively associated with gestational age (ß = -0.44, 95 % CI, -0.83, -0.05). This study confirms the presence of MPs in human AF and provides compelling evidence linking them to gestational age, while highlighting the potential risks associated with dietary habits. These findings underscore the need for further investigation into the mechanisms of MPs transmission from mother to fetus and the potential health implications during fetal development, offering valuable insights for future policies aimed at safeguarding maternal and fetal health.

Preoperative Prediction of Meningioma Subtype by Constructing a Clinical-Radiomics Model Nomogram Based on Magnetic Resonance Imaging.

OBJECTIVE: We sought to investigate the value of a clinical-radiomics model based on magnetic resonance imaging in differentiating fibroblastic meningiomas from non-fibroblastic meningiomas. METHODS: Clinical, imaging, and postoperative pathologic data of 423 patients (128 fibroblastic meningiomas and 295 non-fibroblastic meningiomas) were randomly categorized into training (n = 296) and validation (n = 127) groups at a 7:3 ratio. The Selectpercentile and LASSO were used to selected the highly correlated features from 3376 radiomics features. Different classifiers were used to train and verify the model. The receiver operating characteristic curves, accuracy (ACC), sensitivity (SEN), and specificity (SPE) were drawn to evaluate the performance. The optimal radiomics model was selected. Calibration curves and decision curve analysis were used to verify the clinical utility and consistency of the nomogram constructed from the radiomics features and clinical factors. RESULTS: Thirteen radiomics features were selected from contrast-enhanced T1-weighted imaging and T2-weighted imaging after dimensionality reduction. The prediction performance of random forest radiomics model is slightly lower than that of the clinical-radiomics model. The area under the curve, SEN, SPE, and ACC of the clinical-radiomics model training set were 0.836 (95% confidence interval, 0.795-0.878), 0.922, 0.583, and 0.686, respectively. The area under the curve, SEN, SPE, and ACC of the validation set were 0.756 (95% confidence interval, 0.660-0.846), 0.816, 0.596, and 0.661, respectively. CONCLUSIONS: The diagnostic efficacy of the clinical-radiomics model of fibroblastic meningioma and non-fibroblastic meningioma was better than that of the radiomics prediction model alone and can be used as a potential tool for clinical surgical planning and evaluation of patient prognosis.