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1.
Mater Sci Eng C Mater Biol Appl ; 107: 110311, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761197

RESUMO

In this study, a small-diameter, double-layered eggshell membrane/thermoplastic polyurethane (ESM/TPU) vascular graft with a wavy structure was developed. The avian eggshell membrane, a fibrous structure similar to the extracellular matrix (ECM), has the potential to yield rapid endothelialization in vitro. The dopamine and heparin modification of the ESM surface not only promoted human umbilical vein endothelial cell (HUVEC) proliferation via cytocompatibility assessment, but also improved its anticoagulation properties as verified in platelet adhesion tests. The biomimetic mechanical properties of the vascular graft were provided by the elastic TPU fibers via electrospinning using a wavy cross-section rotating collector. The advantage of combining these two materials is to make use of the bioactivity of ESM as the internal membrane and the tunable mechanical properties of TPU as the external layer. The circumferentially wavy structure of the vascular graft produced a toe region in the non-linear section of the stress-strain curve similar to that of natural blood vessels. The ESM/TPU graft's circumferential ultimate strength was 2.57 MPa, its strain was 339% mm/mm, and its toe region was found to be around 20% mm/mm. Cyclical tension tests showed that the vascular graft could maintain good mechanical properties and showed no structural damage under repeated extension tests.

2.
Mater Sci Eng C Mater Biol Appl ; 107: 110212, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761208

RESUMO

A critical challenge to the development of tissue engineering small-diameter vascular grafts is to achieve rapid endothelialization and long-term anticoagulation. It is necessary to graft both adhesion and antithrombus factors onto the surface of polycaprolactone without burst release to promote endothelial cell affinity and antithrombogenicity. A bionic structure with a nanocoating that allows a biologically responsive, long-term release was employed in this work to enable the grafting of various bioactive molecules such as gelatin, polylysine, and heparin. This approach involved orienting the biomimetic vascular structures; the self-assembly grafting of gelatin, polylysine, and heparin nanoparticles; and genipin crosslinking to form a multiphase crosslinked nanocoating. In this biologically inspired design, vascular endothelialization and long-term anticoagulation were successfully induced through a matrix metallopeptidase 2 regulative mechanism by delivering both adhesion and antithrombus factors with a responsive, long-term release without burst release. The method provided a simple and effective approach for delivering dual factors for tissue engineering small-diameter vascular grafts.

3.
Nature ; 575(7784): 618-621, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31776491

RESUMO

All stellar-mass black holes have hitherto been identified by X-rays emitted from gas that is accreting onto the black hole from a companion star. These systems are all binaries with a black-hole mass that is less than 30 times that of the Sun1-4. Theory predicts, however, that X-ray-emitting systems form a minority of the total population of star-black-hole binaries5,6. When the black hole is not accreting gas, it can be found through radial-velocity measurements of the motion of the companion star. Here we report radial-velocity measurements taken over two years of the Galactic B-type star, LB-1. We find that the motion of the B star and an accompanying Hα emission line require the presence of a dark companion with a mass of [Formula: see text] solar masses, which can only be a black hole. The long orbital period of 78.9 days shows that this is a wide binary system. Gravitational-wave experiments have detected black holes of similar mass, but the formation of such massive ones in a high-metallicity environment would be extremely challenging within current stellar evolution theories.

4.
J Diabetes ; 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31778286

RESUMO

BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with a higher fracture risk. Sex hormones are important for maintaining skeletal health. It is not clear which sex hormone(s) contribute(s) to bone mineral density (BMD) and fracture risk in males with T2DM. This study investigated the relationships of these parameters in males with T2DM. METHODS: This study involved 482 men with T2DM. BMD at the lumbar spine (L2-4), femoral neck (FN) and total hip (TH) were measured by dual-energy X-ray absorptiometry (DXA). The 10-year probability of fractures was assessed using the modified Fracture Risk Algorithm (FRAX) tool. Serum levels of sex hormones were measured. RESULTS: Follicle-stimulating hormone (FSH) and estradiol (E2) were associated with BMDs at L2-4 (FSH, ß = -0.162, P < 0.05; E2, ß = 0.176, P < 0.001), and E2 was associated with BMD at FN (ß = 0.137, P < 0.05) and TH (ß = 0.140, P < 0.05). FSH was associated with major osteoporotic fractures (MOFs) (ß = 0.288, P < 0.001) and hip fractures (HFs) (ß = 0.235, P < 0.001). Higher FSH was a risk factor for osteoporosis/osteopenia (OR = 2.92, 95% CI = 1.66-5.14, P < 0.001), whereas higher E2 was a protective factor (OR = 0.37, 95% CI = 0.22-0.60, P < 0.001). Patients in the higher tertile of FSH and lower tertile of E2 had an increased risk of osteoporosis/osteopenia (OR = 5.05, 95% CI = 1.37-18.65, P < 0.05). CONCLUSIONS: For males with diabetes, FSH and E2 are significantly associated with BMD, osteoporosis/osteopenia and fracture risk. This article is protected by copyright. All rights reserved.

5.
J Photochem Photobiol B ; 202: 111644, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31770706

RESUMO

Management of degenerative spine pathologies frequently leads to the need for bone growth. Rehmanniae Radix (RR), a Chinese herbal formulation was found to exhibit numerous therapeutic properties including its potent effect against cancer cell lines. However, the underlying mechanism through which the Zinc oxide nanoparticles (ZnONPs) synthesized from Rehmanniae Radix exerts its anti-cancer activity against osteosarcoma cell line MG-63 needs to be explored. Therefore, the study was performed to evaluate the anticancer, cytotoxicity and apoptotic effectiveness of ZnONPs from RR against MG-63 cells. Characterization studies such UV-vis spectroscopy, FTIR, TEM and XRD analysis were performed. Cytotoxicity assay, mitochondrial membrane potential (MMP), morphological examination of cells and formation of reactive oxygen species (ROS), and apoptosis inducing ability of RR were evaluated by various procedures. Western blot analysis of apoptotic markers such as Bax, caspase-3 and caspase-9 were also performed. RR was found to inhibit growth of MG-63 cells at increasing dose. AO/EB staining confirmed the apoptotic efficacy of ZnONPs induced by RR in MG-63 cells. ZnONPs was also found to initiate increased generation of ROS and decreased MMP. Decreased MMP has resulted in increased levels of apoptotic proteins Bax, caspase-3 and caspase-9 and induction of apoptosis was substantiated by western blot analysis. The outcomes of the work propose that ZnONPs from RR exhibits strong anticancer action and inducing apoptosis on MG-63 cells via stimulating increased generation of ROS. Thus, ZnONPs from RR might be used as a hopeful drug target against several types of cancer cell lines.

6.
Ann Pharmacother ; : 1060028019888853, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31729256

RESUMO

Background: No previous studies exist examining 2 inhaled epoprostenol formulations in an acute respiratory distress syndrome (ARDS) patient population. Objective: The study aim was to evaluate a formulary conversion from inhaled Flolan to Veletri to determine the impact on effectiveness, safety, and cost in patients with ARDS. Methods: This was a single-center, retrospective, matched cohort observational study at a tertiary care academic medical center. Patients included were mechanically ventilated, adult patients with ARDS receiving inhaled Flolan or Veletri for ≥1 hour in the intensive care unit. Results: A total of 132 patients were included in the matched cohort. There was no difference detected in change in partial pressure of arterial O2/fraction of inspired O2 (PaO2/FiO2) ratio after 1 hour of therapy between the inhaled Flolan and Veletri groups (27.2 ± 46.2 vs 30 ± 68 mm Hg, P = 0.78). Significant differences in secondary outcomes included incidence of hypotension (83% vs 95.5%, P = 0.04) and thrombocytopenia (9.1% vs 29.5%, P < 0.01) in the inhaled Flolan and Veletri groups, respectively, with no difference in cost per duration of therapy (P = 0.29). Conclusions and Relevance: There was no difference in the change in PaO2/FiO2 ratio after 1 hour of therapy between inhaled Flolan and Veletri in an ARDS patient population. The formulary conversion from inhaled Flolan to Veletri was likely justified.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31761326

RESUMO

Ferroptosis is a form of regulated cell death that is triggered by iron accumulation and lipid peroxidation. Although plasma membrane injuries represent an important event in cell death, the impact of membrane repair mechanisms on ferroptosis remains unidentified. Here, we provide the first evidence that membrane repair dependent on endosomal sorting complexes required for transport (ESCRT)-III negatively regulates ferroptotic cancer cell death. The accumulation of ESCRT-III subunits (e.g., CHMP5 and CHMP6) in the plasma membrane are increased by classical ferroptosis activators (e.g., erastin and RSL3), which relies on endoplasmic reticulum stress and calcium influx. Importantly, the knockdown of CHMP5 or CHMP6 by RNAi sensitizes human cancer cells (e.g., PANC1 and HepG2) to lipid peroxidation-mediated ferroptosis in vitro and in vivo. These findings suggest that ESCRT-III confers resistance to ferroptotic cell death, allowing cell survival under stress conditions.

8.
Nanotoxicology ; : 1-18, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31684790

RESUMO

Copper oxide nanoparticles (CuO NPs) have severe nano-toxic effects on organisms. Limited data is available on influence of CuO NPs on plant cells. Here, the molecular mechanisms involved in the toxicity of CuO NPs are studied. Exposure to CuO NPs significantly increased copper content in roots (0.062-0.325 mg/g FW), but CuO NPs translocation rates from root to shoot were low (1.1-2.8%). Presented data were significant at p < 0.05 compared to control. CuO NPs inhibited longitudinal growth and promoted transverse growth in root tip cells. However, CuO NPs did not affect the leaf cells, implying that the transfer ability of CuO NPs was weak, and toxicity mainly affected roots. CuO NPs can conjugate with actin protein. The actin cytoskeleton experienced reorganization in the presence of CuO NPs. The longitudinal filamentous actin (F-actin) decreased, and the transverse F-actin increased. CuO NPs inhibited actin polymerization and promoted depolymerization. The behavior of individual F-actin was at steady state with time-lapse under CuO NPs treatment by time-lapse reflection fluorescence (TIRF) microscopy. The growth rate of actin filaments was weakened by CuO NPs. CuO NPs disturbed the subcellular localization of PINs and the gradient of auxin distribution in root tips in an actin-dependent manner. In conclusion, CuO NPs conjugated with actin and disturbed F-actin dynamics, triggering abnormal cell growth in the root tip, and findings provide theoretical basis for further study nano-toxicity in plants.

9.
Artigo em Inglês | MEDLINE | ID: mdl-31683029

RESUMO

BACKGROUND: ß-Adrenergic blockers (BBs) have been associated with increased risk for severe anaphylactic reaction (AR) from contrast media; however, this was shown with intravenous contrast media, before widespread use of low osmolar contrast media, angiotensin-converting enzyme-inhibitors (ACE-Is), and cardioselective BBs. OBJECTIVE: To assess the risk for AR during cardiac catheterization (CC) associated with BB or ACE-I exposure. METHODS: Patients who experienced adverse reactions during CC from January 2004 to December 2013 were identified; 1 to 2 matched controls were assigned for each case. We analyzed AR rates in association with demographic variables, medication exposures (BBs, ACE-Is, angiotensin-receptor blockers, aspirin), and comorbidities: cardiovascular disorders, asthma, and atopy. RESULTS: We analyzed 71,782 CCs. Of these, severe 70 reactors were identified-46 (0.06%) fulfilled AR criteria. There were 35 cases of mild to moderate AR and 11 cases of severe AR (0.015%). There were no significant differences in age (61.3% vs 61.5%), sex (63% vs 64% males), cardiovascular disorder rate (78% vs 93%), and exposure to BBs (46% vs 51%; cardioselective: 77% vs 80%) and ACE-Is (37.0% vs 37.2%) in cases versus controls. Via multivariate logistic regression, BB exposure was not associated with greater AR frequency (P = .35) or severity (P = .40). Neither cardioselective BBs (P = 0.2) nor noncardioselective BBs (P = .5) influenced AR severity. ACE-Is had no effect on AR frequency (P = .35) or severity (P = .14). Lower AR frequency was associated with cardiovascular disorder (P = .01). CONCLUSIONS: In this case-control study, severe AR was rarely observed. Exposure to BBs or ACE-Is did not significantly influence AR frequency or severity; however, most BBs were cardioselective. Our findings imply that cardioselective BB or ACE-I suspension is not warranted in association with CC.

10.
Phys Chem Chem Phys ; 21(40): 22563-22568, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31588937

RESUMO

We fabricated a chlorophyll (Chl)-based biosolar cell with H2Chl-sensitized TiO2 as an acceptor and (ZnChl)n as a donor. This solar cell gives a relatively high quantum yield from the absorption spectral contribution from both the donor and acceptor species. We employed subpicosecond time-resolved absorption spectroscopy (TAS) to study the excited state dynamics at the Chl interface. A charge transfer (CT) state between TiO2-H2Chl and (ZnChl)n was observed at 640 nm after excitation at the Qy peaks, 680 nm and 720 nm. This CT state is entirely different from the CT states observed for either TiO2-H2Chl (TiO2-H2Chl/spiro-OMeTAD) or TiO2-(ZnChl)n systems. Due to the slower charge transfer process from H2Chl+ to TiO2 as compared to that from (ZnChl)n+ to H2Chl, the CT lifetimes of H2Chl--(ZnChl)n+ (τ1 = 0.1 ps, τ2 = 1.4 ps) excited at 720 nm are slightly shorter than that excited at 680 nm (τ1 = 0.2 ps, τ2 = 5.6 ps). The TAS results suggest that the interface of TiO2-H2Chl and (ZnChl)n not only transfers holes as spiro-OMeTAD does, but also provides a built-in field for charge dissociation between the two Chl species.

11.
J Mol Graph Model ; 93: 107454, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31581063

RESUMO

Prediction of binding affinity of proteins and small molecules is a key step in drug design, and the location of binding sites is crucial for affinity prediction and molecular docking. In order to improve the accuracy of binding site prediction, a method called FRSite which improves the Faster R-CNN for protein binding site prediction is proposed in this paper. Multi-channel descriptors for proteins are generated to three dimensional (3D) girds and fed into the proposed Region Proposal Network (RPN-3D) network for potential proposals detection. Moreover, a 3D classifier is used to predict the bounding box of the binding site for a protein, and could also predict the center and size of the site. It can be seen from our comparative experiments that the proposed method can assist drug design.

12.
Artigo em Inglês | MEDLINE | ID: mdl-31609512

RESUMO

To efficiently capture the toxic uranyl ions (UO2 2+ ), a new hierarchical micro-macroporous metal-organic framework was prepared under template-free conditions, featuring interconnected multi-nanocages bearing carbonyl groups derived from a semi-rigid ligand. The material exhibits an unusually high UO2 2+ sorption capacity of 562 mg g-1 , which occurs in an intriguing two-steps process, on the macropore-based crystal surface and in the inner nanocages. Notably, the latter is attributed to the cooperative interplay of the shrinkage of the host porous framework induced by uranyl accommodation and the free carbonyl coordination sites, as shown by both single-crystal X-ray diffraction and a red-shift of the infrared [O=UVI =O]2+ antisymmetric vibration band.

13.
Chest ; 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31622591

RESUMO

BACKGROUND: Initial fluid resuscitation volume for sepsis is controversial, particularly in patients at high baseline risk for complications. This study was designed to assess the association between 30 mL/kg crystalloids and intubation in patients with sepsis or septic shock and heart failure, end-stage renal disease, or cirrhosis. METHODS: This propensity score-matched retrospective cohort study included patients with sepsis or septic shock admitted to a large medical ICU. Primary exposure was IV fluid volume in the first 6 h following sepsis diagnosis, divided into two cohorts: ≥ 30 mL/kg (standard group) and < 30 mL/kg (restricted group). The primary outcome was need for mechanical ventilation within 72 h following initiation of fluid resuscitation. Secondary outcomes were length of stay, ventilator days, and time to intubation. RESULTS: A total of 208 patients were included, with 104 (50%) in the restricted group (< 30 mL/kg) and 104 in the standard group (≥ 30 mL/kg). No difference in intubation incidence was detected between the two groups, with 36 patients (35%) in the restricted group and 33 (32%) in the standard group (adjusted OR, 0.75; 95% CI, 0.41-1.36; P = .34) intubated. There was no difference between standard and restricted groups in alive ICU-free days (17 ± 11 days vs 17 ± 10 days; P = .64), duration of mechanical ventilation (10 ± 12 days vs 11 ± 16 days; P = .96), or hours to intubation (16 ± 19 h vs 14 ± 15; P = .55). CONCLUSIONS: No differences were detected in the incidence of intubation in patients with sepsis and cirrhosis, end-stage renal disease, or heart failure who received guideline-recommended fluid resuscitation with 30 mL/kg compared with patients initially resuscitated with a lower fluid volume.

14.
J Org Chem ; 84(22): 14949-14956, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31622097

RESUMO

A direct and practical metal-free N-H phosphorylation has been achieved via the TBHP/NH4I-mediated cross-dehydrogenative coupling (CDC) reactions between imines/imidates and P(O)H compounds. This transformation provides an efficient synthetic route to the construction of P-N bonds with good functional group compatibility, leading to the formation of N-phosphorylimines and N-phosphorylimidates in up to 95% yield (33 examples) under mild conditions.

15.
Oncogene ; 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31659258

RESUMO

Gastric cancer (GC) is characterized by extensive local invasion, distant metastasis and poor prognosis. In most cases, GC progression is associated with aberrant expression of cytokines or activation of signaling cascades mediated by tumor-stroma interactions. However, the mechanisms by which these interactions contribute to GC progression are poorly understood. In this study, we find that IL-33 and its receptor ST2L are upregulated in the human GC and served as prognostic markers for poor survival of GC patients. In a co-culture model with GC cells and cancer-associated fibroblasts (CAFs), we further demonstrate that CAFs-derived IL-33 enhances the migration and invasion of GC cells by inducing the epithelial-mesenchymal transition (EMT) through activation of the ERK1/2-SP1-ZEB2 pathway in a ST2L-dependent manner. Furthermore, the secretion of IL-33 by CAFs can be induced by the proinflammatory cytokines TNF-α that is released by GC cells via TNFR2-NF-κB-IRF-1 pathway. Additionally, silencing of IL-33 expression in CAFs or ST2L expression in GC cells inhibits the peritoneal dissemination and metastatic potential of GC cells in nude mice. Taken together, these results characterize a critical role of the interaction between epithelial-stroma mediated by the TNF-α/IL-33/ST2L signaling in GC progression, and provide a rationale for targeting this pathway to treat GC metastasis.

16.
Chemosphere ; 241: 125081, 2019 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-31622890

RESUMO

To take an insight into the long-term accumulation of chromium (Cr) and cadmium (Cd) in school-age children living near an MWI and to assess their early renal impairment, we conducted a cross-sectional study in 2015. A total of 116 children from the exposure area and 122 from the control area were recruited. We measured the urinary levels of Cr (U-Cr) and Cd (U-Cd) by inductively coupled plasma mass spectrometry (ICP-MS), and detected three classic renal tubule indicators, including N-acetyl-ß-d-glucosaminidase (NAG), ß2-microglobulin (BMG), and retinol binding protein (RBP). The U-Cd and U-Cr levels in children living near the MWI were 0.11 and 1.57 µg/g creatinine, respectively. Both the U-Cd and U-Cr levels in the exposure group were lower than those in the control group, although only U-Cd showed a statistical difference (p < 0.01). The U-NAG and U-RBP levels in the exposure group were also statistically lower than those in the control group (0.80 vs. 1.74 IU/g creatinine, 0.26 vs. 0.48 mg/g creatinine, respectively). The U-Cd level in this study was positively correlated with the U-NAG level (r = 0.26, p < 0.01), as the U-Cr level was also positively correlated with the levels of U-NAG, U-RBP, and U-BMG (r = 0.21, 0.33, 0.18, p < 0.01, respectively). This study indicates that children living close to this particular MWI may not suffer considerable long-term accumulation of Cd or Cr, nor early renal impairment.

17.
ChemSusChem ; 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31612622

RESUMO

Biomass-based hierarchical porous carbon (SCPC) exhibits excellent electrochemical performance in electric double layer capacitors, prepared by carbonization and activation of straw cellulose. To investigate the potential applications of SCPC in supercapacitors, the effect of aqueous and organic electrolytes on the electrochemical performance of SCPC was studied in detail. In H2 SO4 , the SCPC electrode exhibits higher specific capacitance (358 F g-1 ) and outstanding cycling stability with 95.6 % capacitance retention over 10 000 cycles. The SCPC electrode shows superior rate capability with 90.7 % capacitance retention in KOH, and higher energy density of 17.9 Wh kg-1 in Na2 SO4 . The SCPC electrode exhibits ideal capacitance characteristics, superior rate capability with capacitance retention of 95.8 %, and high energy density of 36.0 Wh kg-1 in tetraethylammonium tetrafluoroborate/propylene carbonate (Et4 NBF4 /PC). The significant difference of capacitive performance of SCPC electrode in various electrolytes is mainly attributed to the difference in the electrolyte ion size, ionic conductivity, matching between the electrolyte ions and pore structure, and matching between anions and cations adsorbed on the positive and negative electrodes. This work not only establishes the relationship between the structure of SCPC and its electrochemical performance in different electrolytes, but also provides a reference for the high value-added utilization of SCPC.

18.
Biomed Pharmacother ; 118: 109394, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31545259

RESUMO

The renin-angiotensin system (RAS) plays an important role in scar formation. We have previously shown that oral administration of ramipril and losartan could inhibit scarring. For easier application, here we developed a series of topical ramipril and losartan creams in different concentrations and formulations to explore the effect on scar formation in a C57BL/6 mouse scar model. The harvested scar tissues were analyzed with H&E staining, Masson staining and immunohistochemical staining. We found the group treated with 0.2% losartan urea cream (Prep. 1) or 0.1% ramipril cream (Prep. 2) had significantly smaller scars compared to the negative control, while the proliferation of fibroblasts was less active and the collagen fibers were more regular; both groups showed similar efficacy with the positive control (triamcinolone acetonide urea). We also found that drug transdermalness couldn't directly determine the efficacy. Our findings indicate that local application of angiotensin converting enzyme inhibitor drugs (ACEIs) and angiotensin receptor blocker drugs (ARBs) can reduce scarring by reducing the expression of collagen I, collagen III, phosphorylated small mothers against decapentaplegic 3 (p-Smad3) and transforming growth factor-ß 1 (TGF-ß1). This may provide new insight on scar treatment in clinic.

19.
Reg Anesth Pain Med ; 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31541011

RESUMO

BACKGROUND: Various interventions have shown promise in reducing complications following accidental dural puncture. However, these have yet to be studied as a single, comprehensive protocol. The aim of this study is to compare outcomes associated with the use of a continuous spinal protocol for labor pain relief versus resiting the epidural catheter following accidental dural puncture. METHODS: We reviewed the charts of patients managed via our continuous spinal protocol and compared this group with patients for whom the epidural was resited following accidental dural puncture during the 5-year period prior to implementing our protocol. We assessed incidence of postdural puncture headache, epidural blood patch, frequency of catheter replacement, use of pressors, verbal pain scores at 0, 1, 2, 3, 4 hours following catheter placement, infection rates (meningitis/epidural abscess) and mode of delivery. RESULTS: There were 129 women in the continuous spinal protocol group and 52 in the resited epidural group. The incidence of postdural puncture headache was lower in the continuous spinal group versus the resited epidural group (21.7% vs 67.3%, p<0.001), and the incidence of epidural blood patch was lower in the continuous spinal group versus the resited epidural group (12.4% vs 50.0%, p<0.001). Verbal pain scores were consistently lower in the continuous spinal group compared with the resited epidural group at all time intervals studied. CONCLUSION: Patients managed via this continuous spinal protocol had significantly lower incidence of postdural puncture headache and epidural blood patch with more effective labor analgesia following accidental dural puncture.

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