non-EA Group Research Articles

Decision Analysis for Epidural Labor Analgesia With Multiattribute Utility (MAU) Model

Epidural analgesia (EA) is an effective and safe method to relieve labor pain. Little is known about the factors associated with decision on EA. We applied Multiattribute Utility (MAU) theory to ascertain possible factors on which we based to predict whether parturients would receive EA or not (non-EA) during their labor. A hierarchical questionnaire on the basis of MAU theory was designed by experts to include individual attributes, knowledge and attitude toward EA and cue factors. Items in the questionnaire were compared between the EA and the non-EA groups. Receiver operating characteristics curve was used to assess predictive validity of the MAU model. Of 167 parturients responding to the questionnaire, 151 participants (75 EA and 76 non-EA groups) completed all questions. Parturients in the EA group had significantly higher education level (rate of junior college or above: 88% vs. 67%, P=0.002). There were also more primiparae in the EA group compared with non-EA group (76% vs. 46%, P<0.001). For items in MAU model, 12 out of 20 items revealed significant differences between the 2 groups. Among them, "fear of side effects," "fear of severe complications," and "fear of needle" had the most remarkable differences. The area under receiver operating characteristics equaled to 0.91 (95% confidence interval=0.86, 0.96) for pre-labor decision and 0.83 (95% confidence interval=0.76, 0.89) for final decision. These findings suggest that our MAU model can predict pre-labor decision and final decision of parturients by the incorporation of correlates with respect to knowledge and attitude.

Electroacupuncture Provides a New Approach to Neuroprotection in Rats with Induced Glaucoma

To investigate, using multifocal electroretinogram (mfERG), the effect of electroacupuncture (EA) on retinal function in rats with experimental glaucoma. Glaucoma was induced in the right eyes of 15 adult female Sprague-Dawley rats by laser photocoagulation for three quarters of the perilimbal and episcleral vessels. The left eye of each rat was used as the control. The animals were divided into 3 groups: no treatment (non-EA control group), 2 Hz EA group, and 100 Hz EA group. EA treatment at different frequencies can produce different levels of analgesia and hence the effect of EA with different frequencies on glaucoma treatment was investigated. Both eyes of each rat in the EA experimental groups received 3 EA treatment sessions each week for 4 weeks. The retinal function was measured using mfERG after 4 weeks of EA treatment. There was no significant difference in the amplitude (both N1 trough and P1 peak) of mfERG firstorder kernel response between the treatment and control groups. In determining the waveform characteristics by the ratio of N1 amplitude to P1 amplitude (N/P ratio), obvious differences were found in the N/P ratio between the control eyes and the glaucoma eyes in the non-EA group and the 100 Hz EA treatment group, but similar values in the N/P ratio were observed between the control eyes and the glaucoma eyes in the 2 Hz EA treatment group. The waveform from the eyes with glaucoma was deformed in both the non-EA group and the 100 Hz EA group, but the waveform from the glaucomatous eye was preserved in the 2 Hz EA group. Application of EA at 2 Hz provides neuroprotection by preserving retinal function in rats with experimental glaucoma. Low frequency EA may be an alternative therapy in the treatment of glaucoma.

Endometriosis: Absence of Recurrence in Patients After Endometrial Ablation

Endometriosis, a very common and debilitating illness, has responded to both medical and surgical treatments, but optimal treatment remains unavailable. This study was planned to determine whether patients with and thosewithout eutopic endometrium differ in the risk that ectopic endometriotic implants will recur. Of 28 women 24 to 40 years of age with at least one child who had a surgical diagnosis of endometriosis after uncontrolled dysmenorrhea, 14 underwent hysteroscopic endometrial ablation (EA). For the procedure, a roller ball was used at 50 watts in the hope of avoiding recurrent abdominal dissemination of endometrial debris. The remaining patients had laparoscopic treatment of endometriosis only, using either bipolar instruments or excision of the implants. Laparoscopy was repeated 2 years later. Nine of 14 patients undergoing EA had no dysmenorrhea 3 months later, and 3 others had significantly less bleeding. Symptoms were appreciably lessened in only 3 of the 14 non-EA group. No retrograde bleeding was seen in EA patients at follow-up laparoscopy, but 9 of the 14 not having EA had significant recurrences. Stromal and epithelial endometrial cells were found within debris in the cul-de-sac in eight patients not having EA. These results support a critical role for removing eutopic endometrium to prevent recurrent endometriosis. The therapeutic key may be to stop the retrograde uterine contractility during menstruation that may be the major cause of recurrence through ectopic endometrial dissemination. Recurrences may result from treatments that are mainly directed to deleting endometriotic implants and to reducing or antagonizing promoters.