Comparison of two vasopressor protocols for preventing hypotension post-spinal anesthesia during cesarean section: a randomized controlled trial / 中华医学杂志(英文版)

BACKGROUND@#Norepinephrine infusion decreases hypotension after spinal anesthesia during cesarean section. This study aimed to compare the efficacy of norepinephrine infusion and ephedrine bolus against post-spinal hypotension in parturients.@*METHODS@#In this double-blinded, randomized controlled clinical trial, parturients scheduled for elective cesarean section were randomly allocated to receive norepinephrine infusion (0.05 μg·kg-1·min-1) just before spinal anesthesia continuing for 30 min or ephedrine bolus (0.15 mg/kg) just before spinal anesthesia. A rescue bolus (5 μg norepinephrine for the norepinephrine group, and 5 mg ephedrine for the ephedrine group) was administered whenever hypotension occurred. Our primary outcome was the incidence of hypotension within 30 min of spinal anesthesia administration. Secondary outcomes included maternal and neonatal outcomes 30 min after spinal block, and neonatal cerebral oxygenation 10 min after birth.@*RESULTS@#In total, 190 patients were enrolled; of these patients, 177 were included in the final analysis. Fewer patients suffered hypotension in the norepinephrine group than in the ephedrine group (29.5% vs. 44.9%, odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.28-0.95, P = 0.034). Moreover, the tachycardia frequency was lower in the norepinephrine group than in the ephedrine group (OR: 0.22, 95% CI: 0.11-0.44, P < 0.001), and patients suffered less nausea and vomiting (OR: 0.28, 95% CI: 0.11-0.70, P = 0.004). There was no difference in Apgar scores and umbilical arterial blood gas analysis between the two groups. However, neonatal cerebral regional saturations were significantly higher after birth in the norepinephrine group than in the ephedrine group (mean difference: 2.0%, 95% CI: 0.55%-3.45%, P = 0.008).@*CONCLUSION@#In patients undergoing elective cesarean section with spinal anesthesia, norepinephrine infusion compared to ephedrine bolus resulted in less hypotension and tachycardia, and exhibited potential neonatal benefits.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT02542748; https://clinicaltrials.gov/ct2/show/record/NCT02542748.

Effect and Mechanism of Jiaotaiwan on Cognitive Impairment in Diabetic Mice / 中国实验方剂学杂志

Objective: To explore effect and mechanism of Jiaotaiwan (JTW) on cognitive impairment in diabetic mice. Method: The 40 db/db mice of spontaneous diabetes were randomly divided into model group, JTW 1 group (1.68 g·kg-1), JTW 2 group (3.36 g·kg-1), and JTW 3 group (8.40 g·kg-1), with 8 mice in each group, and 8 C57BL/6J mice were included into normal group. After 8 weeks of treatment, behavioral test,fasting blood glucose (FBG), fasting insulin (Fins), insulin resistance index (HOMA-IR), total triglyceride (TG), total cholesterol (TC), free fatty acids (FFA), high density lipoprotein (HDL), and low density lipoprotein (LDL) were detected. Western blot was used to detect protein expressions of pSer199, pSer202, pSer214, p-Akt, glycogen synthase kinase-3β(GSK-3β), phospho-GSK-3β(p-GSK-3β). Result: Compared with model group, FBG, Fins, HOMA-IR, TG, TC, HDL, FFA in JTW group decreased significantly (P0.01), with a significant improvement in cognitive function (P0.01), protein expressions of taupSer199, pSer202, pSer214 and GSK-3β in hippocampus of mice decreased significantly (PP0.01), and expressions of p-Akt and p-GSK3 beta significantly increased (P0.01). Conclusion: JTW 3 (Coptidis Rhizoma-Cinnamomi Cortex 10:1) can alleviate insulin resistance and cognitive impairment. The mechanism may be related to the inhibition of over-phosphorylation of tau protein, the down-regulation of GSK-3β protein expression and the up-regulation of p-Akt and p-GSK-3β expressions.

Endoscopic endonasal transsphenoidal approach for pituitary adenomas / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the clinical curative effect of the endonasal transsphenoidal approach for removing pituitary adenoma (PA) under neuroendoscope-assisted.</p><p><b>METHODS</b>There were 215 patients who had undergone neuroendoscopic transsphenoidal surgery. Each patient received CT or MRI examination which showed the size and surrounding structural of tumor.</p><p><b>RESULTS</b>Among the 215 patients, 190 cases (88.4%) had total removal, 17 cases (7.9%) achieved subtotal removal and the remaining 8 cases (3.7%) with fibrous tumor was carried out partial removal. Two patients (0.9%) died after operation. Postoperative follow-up period was 1 to 10 months (the average was 3.5 months). In 182 patients, 150 cases (90.9%) got vision recovered rapidly compared with their preoperative symptoms, such as diminished acuities and visual field defects, and 15 cases (9.1%) had gotten improvements to some extend among 165 who diagnosed as pituitary macroadenoma (PMaA); There were 17 patients who diagnosed as microadenoma (PMiA) showed that the pituitary dyshormonism recovered gradually.</p><p><b>CONCLUSIONS</b>The endonasal transsphenoidal surgery under the neuroendoscope-assisted appears to be a safe, effective and micro-invasive method for PA.</p>

Cranioplasty of skull vault defect and skull base reconstruction: diagnosis and management / 中华创伤杂志

Objective To discuss and analyze the diagnosis,management and surgical techniques for cranioplasty of skull vault defects and skull base reconstruction in order to raise the therapeutic effect. Methods The clinical data of 169 cases of skull vault and skull base defects treated with cranioplasty of skull vault defect and skull base reconstruction were retrospectively analyzed.Results Overlay tech- nique or inlay technique with imported titanium alloy mesh was used in 160 cases,and homologous bone was used in 9 cases.The surgical time ranged from 3 months to 8 years after injury.Eight cases presented with complications such as hematoma,subcutaneous effusion,infection and epilepsy postoperatively,but no operative death occurred.Conclusion For patients with skull vault defect with the diameter≥3 cm the best operative time is 3 months after injury,and for patients with intracranial and extracranial communica- ting tumors,skull base reconstruction can be performed when tumors are removed.Much attention should be paid to perioperative management and surgical skills.