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BACKGROUND@#No convincing modalities have been shown to completely prevent postdural puncture headache (PDPH) after accidental dural puncture (ADP) during obstetric epidural procedures. We aimed to evaluate the role of epidural administration of hydroxyethyl starch (HES) in preventing PDPH following ADP, regarding the prophylactic efficacy and side effects.@*METHODS@#Between January 2019 and February 2021, patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital. The development of PDPH, severity and duration of headache, adverse events associated with prophylactic strategies, and hospital length of stay postpartum were reported.@*RESULTS@#A total of 105 patients experiencing ADP received a re-sited epidural catheter. For PDPH prophylaxis, 46 patients solely received epidural analgesia, 25 patients were administered epidural HES on epidural analgesia, and 34 patients received two doses of epidural HES on and after epidural analgesia, respectively. A significant difference was observed in the incidence of PDPH across the groups (epidural analgesia alone, 31 [67.4%]; HES-Epidural analgesia, ten [40.0%]; HES-Epidural analgesia-HES, five [14.7%]; P <0.001). No neurologic deficits, including paresthesias and motor deficits related to prophylactic strategies, were reported from at least 2 months to up to more than 2 years after delivery. An overall backache rate related to HES administration was 10%. The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP (OR = 0.030, 95% confidence interval: 0.006-0.143; P < 0.001).@*CONCLUSIONS@#The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP. This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES, respectively, on and after epidural analgesia. The efficacy and safety profiles of this strategy have to be investigated further.
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Pregnancy , Female , Humans , Post-Dural Puncture Headache/epidemiology , Anesthesia, Obstetrical/adverse effects , Retrospective Studies , Punctures , Starch , Blood Patch, EpiduralABSTRACT
Objective To evaluate the effects of different administration routes of lipid emulsion on bupivacaine-induced cardiotoxicity in rats.Methods Forty-eight clean healthy adult male Sprague-Dawley rats,weighing 300-350 g,were divided into 6 groups (n=8 each) using a random number table:Ⅳ infusion of normal saline (NS) group (group VN),Ⅳ infusion of lipid emulsion group (group VL),duodenal infusion of NS group (group DN),duodenal infusion of lipid emulsion group (group DL),intraperitoneal intusion of NS group (group PN) and intraperitoneal infusion of lipid emulsion group (group PL).In VN and VL groups,preheated NS and 20％ lipid emulsion 3 ml · kg-1 · min-1 were infused via the femoral vein for 5 min,respectively,and then 0.75％ bupivacaine was infused at the rate of 2 mg · kg-1 · min-1 until cardiac arrest happened.Preheated NS and 20％ lipid emulsion 15 ml/kg were infused via the duodenum (over 1 min,at a constant rate) in DN and DL groups,respectively,and were intraperitoneally infused in PN and PL groups,respectively,followed by an infusion of 0.2 ml/min for 15 min in DN,DL,PN and PL groups.Then 0.75％ bupivacaine was infused via the left femoral vein at a rate of 2 mg · kg-1 · min-1 until cardiac arrest happened.The time to ventricular arrhythmia,mean arterial pressure (MAP) decreasing to 50％ of the baseline and cardiac arrest was recorded.The amount of bupivacaine consumed was calculated immediately after ventricular arrhythmia occurred (T0),immediately after MAP decreased to 50％ of the baseline (T1) and immediately after occurrence of cardiac arrest (T2).Arterial blood samples were collected at T0-2 for determination of the concentration of bupivacaine in plasma by high-performance liquid chromatography.Results Compared with group VN,the time to ventricular arrhythmia,MAP decreasing to 50％ of the baseline and cardiac arrest was significantly prolonged,and the amount of bupivacaine consumed was increased at T0-2 in group VL (P＜0.01).There was no significant difference in the parameters mentioned above between group DN and group DL,and between group PN and group PL (P＞0.05).Compared with group VL,the time to ventricular arrhythmia,MAP decreasing to 50％ of the baseline and cardiac arrest was significantly shortened,and the amount of bupivacaine consumed was decreased at T0-2 in DL and PL groups (P＜0.01).Compared with group DL,the time to ventricular arrhythmia,MAP decreasing to 50％ of the baseline and cardiac arrest was significantly prolonged,and the amount of bupivaeaine consumed was increased at T0.2 in group PL (P＜0.05).There was no significant difference in the concentration of plasma bupivacaine between six groups (P＞0.05).Conclusion Ⅳ infusion of lipid emulsion can decrease bupivacaine-induced cardiotoxicity when compared with duodenal and intraperitoneal infusion in rats.
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Objective To investigate the value of elasticity score and elasticity strain ratio (SR) in predicting the central lymph nodes metastasis of papillary thyroid microcarcinoma (PTMC). Methods This study conducted a retrospective analysis of ultrasonography ifndings of 236 thyroid lesions from 208 patients. All of them underwent surgery in Ruijin Hospital of Shanghai Jiao Tong University from June 2012 to March 2013. Totally 82 PTMC from 82 patients were included in this study. Among them 12 patients with 12 PTMC had central lymph nodes metastasis. The elasticity score and SR were compared between metastasis and non-metastasis groups, and the receiver operating characteristic (ROC) curve of SR was calculated. Results The differences of PTMC elasticity score between two groups showed no statistical signiifcance (χ2=5.00, P=0.08). The average SR of the group with central lymph nodes metastasis is 2.44±0.61, which is higher than the group without lymph nodes metastasis whose average SR is 1.67±0.42. Differences are statistically signiifcant (t=5.5, P=0.00). The area under curve of SR-ROC curve was 0.847. Using 2.01 as cutoff of SR, the sensitivity, speciifcity, accuracy of predicting central lymph nodes metastasis was 83.3%, 81.4%, 78.6%respectively. Conclusion The SR but not elasticity score could be a meaningful indicator for predicting lymph nodes metastasis.
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Objective To express virus-like particles(VLP) of enterovirus 71 (EV71) in Han-senula polymorpha.Methods The coding sequences of P1 and 3CD genes of EV71 were optimized accord-ing to codon usage bias of Hansenula polymorpha for achieving high expression , and then cloned into the ex-pression vector PMV of Hansenula polymorpha .The recombinant expression vector PMV-P1-3CD was trans-formed into Hansenula polymorpha AU 0501 .The transformants were stably cultured in selective medium (Yeast Nitrogen Base) and screened for strains with positive P1 and 3CD genes by PCR.Then an induced cultivation on the recombinant strains were performed in a medium supplemented with methanol to a final concentration of 1.0%and the expressed products were analyzed by SDS-PAGE and Western blot assays to select high expression strains .The high expression strains were cultured in 30 L fermentor and its fermenta-tion products were analyzed by electronic microscope after purification .Results EV71 recombinant expres-sion strains were successfully constructed .The results of SDS-PAGE showed that the expressed products had obvious VP3, VP1, VP0 protein bands with molecular weights of 26×103, 33×103 and 35×103, respective-ly, which were consistent with the expected molecular weight of the fusion proteins .Western blot demonstra-ted that the expressed products could be specifically recognized by the polyclonal antibody against EV 71-VP1 at 33 ×10 3 , indicating its high immunoreactivity .ELISA confirmed that the expression level of EV 71 fermen-tation products was reached to 200 mg/L.Electronic microscope analysis showed that the VLP of recombi-nant EV71 were 24-30 nm in diameter with normal structure .Conclusion The virus-like particles of human enterovirus 71 are successfully expressed in Hansenula polymorpha , which provides a foundation for the fur-ther development of EV 71 VLP vaccine .
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Objective To discuss the relationship between Hp eradication effect and TCM syndrome types, and provide basis for improving clinical Hp eradication rate of TCM. Methods TCM syndrome types of 922 Hp-positive patients were distinguished. After treatment by the quadruple chemotherapy, the effect of Hp eradication of different TCM syndrome type was analyzed. Results In 922 Hp infectors, Hp eradication effect in different TCM syndrome type from low to high was as follows:spleen-stomach deficiency-coldness, cold-heat complication, stomach-yin deficiency, congestion of stomach collaterals, hyperactive liver-qi harmful to stomach, liver-stomach heat, spleen-stomach dampness-heat, with significant difference (P0.05). Conclusion The eradication rate of Hp infection was different in patients with different TCM syndrome types, which in deficient syndrome is obviously lower than in excessive syndrome.
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Objective To determine the factors contributing to the development of deep vein thrombosis (DVT) in the lower extremity in patients after hip or knee arthroplasty and hip fracture internal fixation.Methods One hundred and forty-seven consecutive patients receiving hip or knee arthroplasty and hip fracture internal fixation from 2004 to 2005 were included in this study. Their age ranged from 33 to 92 years. Duplex color ultrasonic inspection was performed on veins of the bilateral lower extremities before operation and 2 weeks after operation for detection of DVT. The patients were divided into a DVT group and a DVT-free group based on the development of DVT after operation. Detailed perioperative clinical information about the patients, surgery and anesthesia was collected.Results Lower extremity DVT was found in 42.2% of the patients after operation, while the incidence of proximal DVT was 2.7%. Compared with the DVT-free group, the usage rate and dosage of ephedrine increased significantly, the duration of anesthesia was significantly longer, and the white blood cell count (WBC) on the 1st postoperative day and the highest WBC count were significantly higher in the DVT group(P＜0.05). Logistic regression analysis indicated that the above factors were closely related to DVT.Conclusion Duration of anesthesia ＞ 3 h, ephedrine administration and a marked increase in WBC count after operation are the risk factors for DVT in the lower extremities in patients after hip or knee arthroplasty and hip fracture internal fixation.
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Objective: To evaluate the clinical profile of target controlled infusion based anesthesia using remifentanil and propofol. Methods: 16 ASA I II patients undergoing elective laparoscopic cholecystectomy were enrolled. Remifentanil was set at 7?g?L -1 as target and propofol at 3 mg?L -1 throughout the whole procedure. The hemodynamics during induction of anesthesia and recovery profiles were recorded. Arterial blood samples for analysis of remifentanil were taken 15min after infusion, 20 min after infusion and at time of emergence. Results: After induction of anesthesia, systolic blood pressure (SBP) decreased from (144?27) mm Hg to (101?18) mm Hg ( P 0.05). SBP, MBP and HR remained stable after intubation for 3min. No patient showed haemodynamic stress to tracheal intubation. Times from stopping administration of anesthetics until full spontaneous respiration, eye opening, tracheal extubation, orientation and discharging from the postanesthetic care unit (PACU) were (12?6), (9?4), (13?6), (15?5) and (19?7) min respectively. Measured drug values of remifentanil were (4.6?9.5) ?g?L -1 , (6.6?11.5) ?g?L -1 , (1.2?8.7) ?g?L -1 respectively. Conclusion: Remifentanil/propofol TCI based anesthesia achieved the optimal hemodynamic stability during anesthesia induction and maintenance, and better recovery profile from anesthesia. Measured drug values of remifentanil showed a considerable interindividual variation and more lower than the set target.
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Objective To compare the degree of inflammatory response and changes in pulmonary function in patients undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) Methods Elective CABG was performed in twenty-two patients with CPB (n = 11) or off-pump (n = 11). The patients were premedicated with oral midazolam 7.5 mg and intramuscular morphine 10 mg. Anesthesia was induced with fentanyl 5-10 ?g?kg-1 , midazolam 0.05 mg?kg-1 , etomidate 0.15 mg?kg-1 and rocuronium 0.6 mg?kg-1 and maintained with intermittent i.v. boluses of fentanyl and rocuronium. All patients had pulmonary artery catheter and arterial line placed. ECG, SpO2, PET CO2 , body temperature and urine output were monitored. In CPB group aprotinin was given. The patients were transferred to ICU after operation and mechanically ventilated. Extubation was performed when standard extubation criteria were met. The length of ICU stay and hospitalization were recorded. CI, PVRI, SVRI, PA-aO2 , PaO2/FiO2 and QS/QT were measured and calculated before and at the end of operation and 4, 12, 24, 36 h after operation. Blood samples were taken from radial artery and pulmonary artery (mixed venous blood) before and at the end of operation and 4, 12, 36 h after operation for determination of plasma levels of IL-6, IL-8 and neutrophil elastance, the numbers of WBC and neutrophil, the numbers of WBC and neutrophil segregated in the lungs (the number of WBC/neutrophil in mixed venous blood - the number of WBC/neutrophil in arterial blood) .Results The two groups were comparable with respect to age, sex, duration of anesthesia and surgery and the number of grafts. CI was significantly increased while SVRI significantly decreased after operation as compared to the baseline values before operation. There was no significant difference in CI and SVRI after operation between the two groups. The postoperative PVRI and PA-a O2 were significantly lower while postoperative PaO2/FiO2 was significantly higher in the off-pump group than in the CPB group ( P
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Objective To compare the induction of and emergence from anesthesia with target-controlled infusion (TCI) of propofol-remifentanil/fentanyl and isoflurane inhalation. Methods Sixty ASA Ⅰ -Ⅱ patients (26 male, 34 female) aged
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0.05).There were no significant differences in thrombus-associated indexes except a slight change of plasminogen activator antigen.CONCLUSIONS:The incidence of DVT after tumor removal of urinary system is mainly associated with malignant tumor itself, operation wound, postoperative immobilization and the risk factors of thrombus,the administration of reptilase does not increase the incidence of DVT,but might promote the fibrinolytic activity of patients.