Effects of delivery with epidural anesthesia on peripartum serum inflammatory factors and hemodynamics in women with gestational hypertension.

To explore the associations of changes in serum inflammatory factors, matrix metalloproteinase-3 (MMP-3), 25-hydroxy vitamin D [25(OH)D], and intestinal flora with osteoporosis and disease activity in rheumatoid arthritis (RA) patients, so as to provide references for clinical diagnosis and treatment. A total of 98 RA patients were selected as the objects of study (RA group), and divided into active-stage group (n = 56) and remission-stage group (n = 42) according to the disease activity score (DAS28). Another 50 healthy people receiving physical examination in our hospital during the same period were selected as the control group. The changes in serum inflammatory factors, MMP-3, 25(OH)D, and intestinal flora were compared among the three groups, and the osteoporosis of the subjects was analyzed in each group. Moreover, the associations of changes in serum inflammatory factors, MMP-3, 25(OH)D, and intestinal flora with osteoporosis and disease activity in RA patients were analyzed using the Pearson's method. Compared with those in the control group, the levels of serum MMP-3, interleukin-6 (IL-6), IL-10, and C-reactive protein (CRP). The Escherichia coli count were significantly increased, while the level of serum 25(OH)D, bone mineral density (BMD), and Lactobacillus and Bifidobacterium counts were significantly decreased in the active-stage group and remission-stage group, more obviously in active-stage group (p < 0.05). The osteoporosis and disease activity in RA patients were positively correlated with serum IL-6, IL-10, CRP, MMP-3, Escherichia coli and BMD, but negatively correlated with 25(OH)D, Lactobacillus and Bifidobacterium (p < 0.05), and not correlated with the sharp score (p > 0.05). There are certain associations of changes in serum inflammatory factors, MMP-3, 25(OH)D, and in-testinal flora with osteoporosis and disease activity in RA patients, showing certain value in clinical application.

Objective To investigate the effect of continuous epidural labor analgesia on stages of labor and delivery outcomes. Methods A total of 360 cases of primipara of single fetus, cephalic presentation, without obstetrical complications, and the ASA grade was Ⅰ-Ⅱ were selected. All cases were divided into analgesia group(n=102) and control group(n=258) according whether using continuous epidural labor analgesia. The time of active phase of labor, the second stage and third stage of labor, and the oxytocin usage, the eutocia rate, the obstetric forceps usage, the cesarean section rate and the neonatal one and five minute apgar scores were observed and compared between the two groups. Results The time of active phase of analgesia group[(170±44)min] was longer than(149±39)min of the control group, the difference was significant(P 0.05). Conclusions The use of continuous epidural labor analgesia can prolong the time of active phase of labor, but reduce the cesarean section rate markedly without harmful impact on neonate. The analgesic method can be used safely and effectively in clinical practice. Key words: Labor analgesia; Cesarean section rate; Apgar score; Stage of labor

Objective To investigate the relationship between the changes of serum inflammatory factors and the postoperative restenosis after carotid endarterectomy. Methods From January 2010 to May 2015, 80 randomly selected patients with severe carotid stenosis admitted to the Department of Neurosurgery, Dalian Municipal Central Hospital were analyzed retrospectively. Their stenosis degree was 70%-99%. They all received eversion carotid endarterectomy (eCEA). The levels of serum high sensitive C- reactive protein, soluble intercellular adhesion molecule-1, monocyte chemokine-1were monitored at 24 h, 48 h, 72 h, 1, 2, 4, 8, 16 and 32 weeks, respectively before and after procedure, and the surgical side carotid artery ultrasonography was conducted by the professional ultrasound doctors at the same time points. Six patients with postoperative restenosis were divided into group A, and others were divided into group B. Results The levels of serum high sensitive C-reactive protein, soluble intercellular adhesion molecule-1, and monocyte chemokine-1 in group A and B after procedure increased significantly compared with those before procedure. There were significant differences (P<0.05). At 4, 8, 16 and 32 weeks after procedure, the above detection indices of group A increased significantly compared with those of group B. There were significantly differences (P<0.01). Conclusions Surgery may result in the increased serum inflammatory factors. Restenosis after carotid endarterectomy may begin to occur from the fourth weeks after carotid endarterectomy. The increased level of serum inflammatory factors may be one of the reasons of restenosis. Key words: Carotid endarterectomy; Inflammatory factors; Restenosis

Feasibility study on continuous spinal analgesia in all stages of labor.

The aim of this study was to analyze the changes of interleukin-6 (IL-6), C-reactive protein (CRP), blood lipids and myocardial indexes after treatment of patients with acute myocardial infarction (AMI) with intensive atorvastatin and interventional therapy, and its clinical significance. A total of 78 patients diagnosed with AMI in our hospital from March 2016 to February 2017 were selected and divided into treatment group (N.=39) and control group (N.=39). Patients in treatment group were treated with intensive atorvastatin based on conventional therapy before and after percutaneous coronary intervention (PCI), while those in control group were treated with conventional therapy before and after PCI. The levels of serum IL-6, CRP, blood lipids (total cholesterol [TC], triglyceride [TG], high-density lipoprotein cholesterol [HDL-C] and low-density lipoprotein cholesterol [LDL-C]) and myocardial enzyme indexes (troponin T [TnT] and creatine kinase-MB [CK-MB]) at different time points were detected. The correlations among serum CRP, TC, and TnT in treatment group before treatment were detected using the linear regression analysis, and changes in serum inflammatory factors, blood lipids and myocardial enzyme indexes in treatment group before and after treatment were analyzed. There were no statistically significant differences in demographics and clinical data between treatment group and controls (P>0.05). There were no significant differences, either, in levels of serum IL-6 and CRP before treatment between treatment group and control group, but they were decreased after treatment, and the curative effect in treatment group was significantly superior to that in control group. The differences were statistically significant (P<0.05). There were no significant differences in serum TC, TG, HDL-C and LDL-C levels before treatment between the two study groups. TC, TG and LDL-C were significantly decreased and HDL-C was significantly increased after treatment compared to before treatment. TnT and CK-MB were significantly increased at 24 hours after treatment (P<0.05). At 1 week, TnT was still higher, whereas CK-MB has returned to normal; at 2 weeks, they were both decreased. The curative effect in the treatment group was significantly superior to that in control group. CRP (r=0.793, P<0.001) and TC (r=0.668, P<0.001) were found to be positively correlated with TnT. The levels of serum inflammatory factors and blood lipids in the treatment group before treatment and at 24 hours, 1 week, and 2 weeks showed a decreasing trend, and TnT was increased at first, and then decreased. The application of intensive atorvastatin for AMI patients, especially before PCI, has high safety, which can effectively reduce levels of serum inflammatory factors and blood lipids, protect myocardial cells after PCI and avoid injury.

The authors tested the hypothesis that central hemodynamic parameters in women with hypertensive disorders of pregnancy (HDP) change between before and after delivery. A total of 137 pregnant women were studied: 72 with HDP, 42 with chronic hypertension (CH), and 23 with white-coat hypertension (WCH; control group). Aortic augmentation index adjusted by heart rate 75 beats per minute (AIx@75), central pulse pressure (PP), total peripheral resistance (TPR), and cardiac output (CO) before and after delivery were recorded. AIx@75 and central PP were higher in the HDP group than in the control group, but both parameters declined after delivery until they were similar to the controls. AIx@75 and central PP, but not TPR or CO, were significantly decreased after delivery in the HDP group, but no such effects were seen in the other groups. These findings suggest that increased wave reflection caused by the stiffened aorta could be a key factor in the pathophysiology of HDP.

To observe the effect of transcutaneous electrical acupoint stimulation (TEAS)combined with epidural analgesia on postpartum depression and to explore its underlying mechanism. One hundred and twenty cases of full-term primiparous women with singleton pregnancy were selected from May 2018 to November 2018 in Jinzhong Maternal and Child Health Hospital. The parturients with labor analgesia requirement were randomly divided into the epidural group and the combination group, and the parturients without labor analgesia requirement were used as the control group, with 40 cases in each group. Patients in the control group did not receive labor analgesia and were treated according to the routine procedures of natural delivery; patients in the epidural group received epidural labor analgesia; patients in the combination group received TEAS at bilateral Hegu(LI4), Sanyinjiao(SP6) and Zusanli(ST36) (2 Hz/100 Hz, the current intensity is gradually increased from 15 mA, and the treatment was performed every 2 h, 20 min each time) combined with epidural labor analgesia. The visual analogue scale (VAS) scores were recorded when the uterine orifice opened to 3, 6, 8, 10 cm. Plasma glutamate was measured using high-performance liquid chromatography before analgesia, at the end of the third stage of labor and 42 days after delivery, and Edinburgh postnatal depression scale (EPDS) score was measured at 42 days after delivery. In comparison with the control group, the VAS score, EPDS score and the incidence of postpartum depression of the epidural group and the combination group were significantly lower(P<0.05), and the combination group had significant decrease than those in epidural group (P<0.05). Immediately before analgesia, there was no statistically significant difference in glutamate levels among the 3 groups (P>0.05). Compared with the control group, at the end of the third stage of labor and 42 days postpartum, the glutamate levels of the epidural group and the combination group were significantly reduced(P<0.05), and the combination group decreased more significantly than the epidural group (P<0.05). TEAS combined with epidural analgesia can reduce the incidence of postpartum depression, possibly by down-regulating plasma glutamate level and relieving of labor pain.

Objectives:To study the effect of ultrashort wave combined with loxoprofen sodium on serum inflammatory factors in patients with acute gouty arthritis.Methods:Records of patients with acute gouty arthritis who were treated in The Fourth Hospital of Changsha from May 2018 to September 2020, were reviewed. Of them, 77 cases were selected and divided into two groups based on the received treatment. The control group (n=39) was treated with loxoprofen sodium, and the treatment group (n=38) was treated with an ultrashort wave combined with loxoprofen sodium, for 10 continuous days. The clinical efficacy of the treatment in two groups was analyzed.Results:After treatment, the quality of life of patients in both groups was improved (P < 0.05), but there was no significant difference in the degree of improvement between the two groups (P > 0.05). After treatment, the VAS score of the treatment group was lower than that of the control group (P < 0.05), the improvement of symptoms and signs of the treatment group was better than that of the control group (P < 0.05). Serum CRP and ESR levels in the treatment group were lower than those in the control group (P < 0.05), and the serum IL-1 β, IL-8, TNF-a and MMP-3 levels of the treatment group were lower than those of the control group (P < 0.05). The total effective rate of the treatment group (94.87%) was higher than that of the control group (87.18%), the difference was statistically significant (P < 0.05). No adverse reactions occurred in all patients during the treatment.Conclusion:An ultrashort wave combined with loxoprofen sodium in the treatment of acute gouty arthritis can reduce the inflammatory reaction, improve the degree of joint pain and swelling, improve the curative effect, and do not increase the adverse reactions. The results may be related to the regulation of IL-1 β, IL-8, TNF-a and MMP-3.

Objective To observe and compare the efficacy and safety of chloroprocaine and ropivacaine for epidural labor analgesia.Methods 86 cases of voluntary acceptance of maternal painless natural childbirth were selected in the study.43 cases were given chloroprocaine epidural analgesia (chloroprocaine group),and the other 43 cases were given ropivacaine epidural analgesia (ropivacaine group).The pain (VAS score),lower limb motor block degree(MBS score),fetal heart rate(FHR) and contractions duration of maternal prenatal and medication immediately after 10min,20min,40min,80min were compared between two groups.The first,second and third stage of labor and fetal output after 1 min,5min,10min Apgar score were compared.The incidence of adverse events were observed.Results In the chloroprocaine group,the 10min VAS score was (2.10 ± 1.02),which was significantly lower than (4.31 ± 1.13) in the ropivacaine group (t =4.565,P ＜ 0.05).In the chloroprocaine group,analgesia 20min MBS score was (0.24 ± 0.03),which was significantly higher than (0.11 ± 0.04) in the ropivacaine group (t =4.126,P ＜ 0.05).In the chloroprocaine group,4 cases occurred nerve injury,which was more than the ropivacaine group (1 case),the difference was statistically significant (x2 =4.263,P ＜ 0.05).Conclusion Chloroprocaine and ropivacaine for epidural labor analgesia have superior efficacy and the clinical efficacy is similar.Chloroprocaine has the advantage of quick results,but the medication about 20min time period that the drug might lead to a greater degree of lower limb motor block,and has the risk of nerve injury,pregnant women can choose according to their medication. Key words: Chloroprocaine ; Ropivacaine; Analgesia, patient-controlled ; Analgesia, epidural

Background:In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery.Methods:Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group (Group A, n=16) and the control group (Group B, n=14). After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO2 levels and the calculation of regional–arterial CO2 difference (ΔPCO2). Additional measurements included mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), and arterial lactate levels.Results:There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping.Conclusions:Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results.

To examine the therapeutic efficacy of Lianhua Qingwen granule combined with peramivir sodium chloride injection in treating influenza and level changes of serum inflammatory factors. The clinical data of 100 influenza sufferers enrolled in our infirmary from January 2018 to January 2020 retrospectively analyzed and they were randomized in the contrast group (n=50) and the experience group (n=50). The former was provided with peramivir sodium chloride injection, while the latter was medicated with Lianhua Qingwen granule after peramivir sodium chloride injection. The clinical efficacy, serum inflammatory factor, C-reactive protein, interleukin-6 level and procalcitonin level of both groups of sufferers were compared. The overall response rate of the injected group was 80 %, lower compared with 96 % of the injected and medicated group (p<0.05). The antipyretic time and sore throat disappearance time, cough disappearance time and general ache disappearance duration in the medicated group were remarkably shorter than those without Lianhua Qingwen powder (p<0.05). The differences in interleukin-6, C-reactive protein and procalcitonin levels before treatment between both groups were not statistically remarkable (p>0.05) and the levels of interleukin-6, C-reactive protein and procalcitonin of both groups of sufferers decreased after treatment. The levels of interleukin-6, C-reactive protein and procalcitonin of patients got injection and took medicine were remarkably lower than those who had no granule (p<0.05). Lianhua Qingwen granule combined with peramivir sodium chloride injection shows a remarkable potency in the treatment of influenza. It can shorten the treatment time and reduce the level of serum inflammatory factors. It is worthy of clinical promotion and application.

The advantages of patient-controlled epidural analgesia (PCEA) for delivery compared with continuous epidural analgesia (CEA) have been a point of interest in research obstetric anaesthesia for more than two decades. The aim of this single blind randomized controlled study was to evaluate the incidence of motor block and ability to perform partial knee flexion in women who received CEA or PCEA. Fifty-one healthy nulliparous women were included in this study. After an initial dose and established sensory block at Th 10, parturients were randomized into two groups: group CEA (10 ml/h), and group PCEA (bolus - 5 ml, lockout interval - 15 minutes, basal rate - 0 ml) with bupivacaine 0.08% and fentanyl 2 µg/ml. The motor function of the lower limbs was evaluated by modified Bromage scale at regular hourly intervals until full cervical dilatation. The quality of analgesia was assessed using a visual analogue pain scale (VAPS) and maternal satisfaction. Mode of delivery, the total number of additional rescue boluses, foetal and neonatal outcomes were recorded. Motor block was significantly lower in the third (33.3% vs. 4.35%; p = 0.008), fourth (57.9% vs. 6.3%; p = 0.003) and fifth hour (75.0% vs. 18.2%; p = 0.001) in the PCEA group. Ambulation occurred in 18% in the CEA and 46% in the PCEA group (p = 0.036). VAPS was with borderline significance in the second (p = 0.076) and significantly lower in the fourth hour (p = 0.034). Compared with CEA, PCEA provided less motor block and better first-stage analgesia, which leads to the conclusion that patient-controlled analgesia techniques are the preferred model in obstetric anesthesia.

Objective To investigate the effect of sufentanil combined with low concentration of ropivacaine anaesthetizing in spinal epidural for labor analgesia on pregnancy outcome. Methods Using the prospective design method, we selected 200 cases of primipara from December 2014 to December 2015 for the study. 200 cases of primipara were randomly divided into observation group (100 cases) and control group (100 cases). The observation group received sufentanil combined with low concentration of ropivacaine combined spinal and epidural anesthesia. The stage of labor, VAS, postpartum hemorrhage, delivery status, the incidence of adverse reactions, the levels of cortisol and nitric oxide (NO) in the two groups were compared. Results In the observation group, the first stage of labor was (364.7±187.6)min, the second stage of labor was (53.6±10.7)min, the third stage of labor was (10.15±4.83)min; the VAS score at T1 time point, T2 time point were (6.23±1.19) and (1.25±0.39); the postpartum hemorrhage was (264.8±74.6) ml. In the control group, the first stage of labor was (323.2±104.7)min, the second stage of labor was (55.9±8.5)min, the third stage of labor was (10.27±5.04)min; the VAS score at T1 time point, T2 time point were (6.04±1.36) and (7.84±1.63); the postpartum hemorrhage was (281.9±80.5) ml. The VAS score of the observation group was significantly lower than that of the control group, with statistically significant difference (P 0.05). The natural delivery rate of the observation group was 79%, the vaginal midwifery rate was 7%, the cesarean section rate was 14%; those of the control group were 50%, 10%, and 40%; the natural delivery rate of the observation group was higher than that of the control group, the cesarean section rate was lower than that of the control group, with statistically significant differences (P 0.05). The incidences of neonatal jaundice, low-birth weight infant, and macrosomia of the observation group were 3%, 1%, and 1%, those of the control group were 5%, 3%, and 2%, there were no statistically significant differences between the two groups (P>0.05). The incidence of skin itch of the observation group was 14%, the incidences of hypotension and respiratory depression were 0%, the incidence of nausea and vomiting was 7%, the incidence of lower limb numbness was 3%, the incidence of urinary retention was 4%; the incidences of skin itch, hypotension, respiratory depression, and lower limb numbness of the control group were 0%, the incidence of nausea and vomiting was 1%, the incidence of urinary retention was 6%; the incidences of skin itch, nausea and vomiting of the observation group were higher than those of the control group (P<0.05), which all disappeared after the end of delivery. The levels of cortisol at T1 time point, T2 time point, T3 time point of the observation group were (817±146), (742±105), (703±124) ng/ml, those of the control group were (825±103), (859±117), (914±138) ng/ml; the levels of NO at T1 time point, T2 time point, T3 time point of the observation group were (92.6±17.5), (93.5±18.7), (96.4±10.3)μmol/L, those of the control group were (91.7±13.2), (82.7±17.2), (80.6±12.7)μmol/L; the level of cortisol of the observation group significantly decreased, the level of cortisol of the control group significantly increased, the level of NO of the control group significantly decreased (P<0.05). Conclusions Sufentanil combined with low concentration of ropivacaine anaesthetizing in spinal epidural can significantly reduce maternal childbirth pain, raise the natural delivery rate and reduce the rate of cesarean section with no security risks of maternal and newborn, which has good application value in clinical practice. Key words: Sufentanil; Ropivacaine; Spinal epidural anesthesia; Labor analgesia; Pregnancy outcome

A comprehensive analysis of continuous epidural analgesia's effect on labor and neonates in maternal hypertensive disorder patients.

Objectives:To investigate the effect of azithromycin on the levels of serum inflammatory factors and T lymphocyte subsets in patients with gynecological mycoplasma infection.Methods:Records of 250 patients with gynecological mycoplasma infection, treated in our hospital from May 2020 to June 2021, were retrospectively divided into two groups based on the received treatment. Patient (n=120) that were treated with levofloxacin tablets comprised the control group, and patients (n=130) treated with levofloxacin tablets (250mg) and azithromycin tablets comprised the observation group. Changes of serum inflammatory factors and T lymphocyte subsets in the two groups after two weeks of treatment with corresponding drugs were analyzed retrospectively.Results:After the treatment, the levels of C-reactive protein(CRP), interleukin-6(IL-6) and tumor necrosis factor α Tumor necrosis factor α TNF- α in the observation group were significantly lower than those in the control group (P<0.05). Levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were lower than those in the control group (P<0.05). The total clinical efficacy in the observation group was 93.08%, significantly higher than 80.00% in the control group, and the total incidence of adverse drug reactions was 6.15%, significantly lower than 14.17% in the control group (P<0.05).Conclusion:Azithromycin used in clinical treatment of patients with gynecological mycoplasma infection can effectively improve anti-inflammatory and immune response, improve the clinical efficacy of the treatment and reduce adverse reactions.