Attention to pulmonary arteriovenous fistula in a case of transient hypoxemia and cerebral infarction during pregnancy: a case report and literature review.

BACKGROUND: Pulmonary arteriovenous fistula is rare during pregnancy. Pulmonary arteriovenous fistula presents no pulmonary symptoms in most patients but can be exacerbated by pregnancy. If not diagnosed and treated promptly, pulmonary arteriovenous fistula can lead to respiratory failure, stroke, spontaneous hemothorax, or other fatal complications. CASE PRESENTATION: A 29-year-old healthy pregnant woman presented with a transient drop in blood oxygen level of unknown cause during a routine examination at 34 weeks of gestation and during a cesarean section at 38 weeks of pregnancy. The patient's oxygen saturation quickly returned to normal and was not further investigated. On day 3 postpartum, the patient suddenly displayed slurred speech and right limb myasthenia. A head magnetic resonance imaging revealed cerebral infarction in the left basal ganglia. Subsequent computed tomography pulmonary arteriography revealed bilateral pulmonary arteriovenous fistula, which was likely the cause of cerebral infarction. The patient was transferred to the Department of Thoracic Surgery after one month of treatment and successfully underwent percutaneous embolization of pulmonary arteriovenous fistula. CONCLUSION: Pulmonary arteriovenous fistula should not be neglected if a pregnant woman presents with transient hypoxemia and cerebral infarction. A transient decrease in pulse oxygen saturation that cannot be explained by common clinical causes can be an early warning sign of the disease. Early diagnosis and multidisciplinary management could improve the prognosis.

Comparative effectiveness of oseltamivir versus peramivir for hospitalized children (aged 0-5 years) with influenza infection.

OBJECTIVES: The effectiveness of oseltamivir versus peramivir in children infected with influenza remains unclear. This study aimed to evaluate their effectiveness in young children (aged 0-5 years) infected with severe influenza A virus (IAV) or influenza B virus (IBV). METHODS: We analyzed a cohort of 1662 young children with either IAV (N = 1095) or IBV (N = 567) who received oseltamivir or peramivir treatment from January 1, 2018 to March 31, 2022. Propensity score matching methods were applied to match children who were oseltamivir-treated versus peramivir-treated. RESULTS: Children who were IAV-infected and IBV-infected shared similar features, such as influenza-associated symptoms and comorbidities at baseline. Among children infected with IAV with bacterial coinfection, the recovery rate was significantly greater in children treated with oseltamivir than in children treated with peramivir (15.6% vs 4.4%, P = 0.01). The median duration of hospitalization was also shorter in children treated with oseltamivir. Among children infected with IAV without bacterial coinfection, the recovery rate was greater in children treated with oseltamivir than in children treated with peramivir (21.1% vs 3.7%, P = 0.002). However, oseltamivir and peramivir offered similar recovery rates and duration of hospitalization (P >0.05 for both) among children infected with IBV. CONCLUSION: Oseltamivir and peramivir exhibit similar effectiveness in young children with severe influenza B, whereas oseltamivir demonstrated improved recovery and shorter hospitalization in the treatment of severe influenza A in hospitalized children.

Purification and comparison of soluble and membrane-bound polyphenol oxidase from potato (Solanum tuberosum) tubers.

Enzymatic browning greatly affects the quality of potato products. Polyphenol oxidase (PPO) is the enzyme mainly responsible for potato enzymatic browning. PPO has soluble polyphenol oxidase (sPPO) and membrane-bound polyphenol oxidase (mPPO) forms. In this study, the properties of sPPO and mPPO were investigated in potato tubers. The molecular weight of potato sPPO and mPPO were estimated to be 69 kDa in the form of homodimers in vivo. The mass spectrometry results showed that the purified sPPO and mPPO protein in potato tubers was mainly tr|M1BMR6 (Uniprot). The optimum pH for sPPO and mPPO was 6.5, and the optimum temperatures were 20 and 30 °C, respectively. The Michaelis constant (Km) and maximum unit enzyme activity (Vmax) of sPPO were 6.08 mM and 2161 U/S when catechol was used as the substrate, whereas those of mPPO were 2.95 mM and 2129.53 U/S, respectively. The mPPO had stronger affinity to the substrate catechol than sPPO, whereas pyrogallic acid was stronger affinity for sPPO. Ascorbic acid and sodium sulfite were inhibitors of sPPO and mPPO, respectively. After understanding the different binding states of polyphenol oxidase, different inhibitors and treatment methods can be used to treat the enzyme according to different enzymatic properties, so as to achieve a greater degree of Browning control. These results will provide a theoretical basis for regulating PPO activity to reduce enzymatic browning during potato processing.

Can cell salvage be used for resuscitation in a patient with amniotic fluid embolism and hepatic laceration? A case report.

BACKGROUND: Amniotic fluid embolism (AFE) is a rare disease that can lead to profound coagulopathy and hemorrhage, especially when combined with the laceration and bleeding of other organs. Intraoperative cell salvage (ICS) has been widely used for treating obstetric hemorrhage, but it remains unclear whether ICS can be used in the treatment of AFE. CASE PRESENTATION: We report the case of a 27-year-old woman at 39 weeks' gestation who suddenly developed severe abdominal pain, convulsions, loss of consciousness, and decreased vital signs during labor. Despite an emergency cesarean section being performed, the parturient experienced sudden cardiac arrest. Fortunately, the heart rate spontaneously recovered after effective cardiopulmonary resuscitation (CPR). Further abdominal exploration revealed right hepatic laceration with active bleeding. ICS was performed and the salvaged blood was promptly transfused back to the patient. Subsequently, the patient was diagnosed with AFE based on hypotension, hypoxia, coagulopathy, and cardiac arrest. The patient was transfused with 2899 mL salvaged blood during surgery with no adverse effects. At 60- and 90-day follow-ups, no complaints of discomfort or abnormal laboratory test results were observed in the mother or the baby. CONCLUSION: ICS was used to rescue patient with AFE, and ICS did not worsen the condition of patients with AFE. For pregnant women who received CPR, clinicians should explore the presence of hepatic laceration which can be fatal to patients.

Preoperative prolonged fasting causes severe metabolic acidosis: A case report.

RATIONALE: Preoperative prolonged fasting may cause starvation ketoacidosis. Herein, we report of a case of starvation ketoacidosis due to long-term fasting before surgery. PATIENT CONCERNS: We report of a case of metabolic acidosis due to prolonged fasting in a previously healthy 44-year-old woman during a total laparoscopic hysterectomy. Hyperventilation was observed to occur when the surgery was completed. Metabolic acidosis and hypoglycemia were demonstrated by blood gas analysis of the radial artery. DIAGNOSIS: Metabolic acidosis. INTERVENTIONS: The patient received sodium bicarbonate and 5% glucose fluid at the end of the surgery. OUTCOMES: The tracheal tube was successfully removed when the tidal volume of the patient returned to normal after the therapy. However, the patient suffered pulmonary edema when she was transferred to the intensive care unit (ICU). With treatments with furosemide and sodium bicarbonate, acidosis and pulmonary edema were completely corrected at 8 hours after the surgery. On the second day after the surgery, the patient suffered nausea and vomiting. Nausea and vomiting were not completely relieved on the sixth day after the operation; therefore, the patient was transferred to the Department of Gastroenterology for further therapy. LESSONS: This case suggests that although the concept of enhanced recovery after surgery (ERAS) has been adopted by most physicians because of its positive outcomes, the issue of prolonged fasting still exists, and such patients may be exposed to the risk of starvation ketoacidosis.

An aldo-keto reductase, Bbakr1, is involved in stress response and detoxification of heavy metal chromium but not required for virulence in the insect fungal pathogen, Beauveria bassiana.

The aldo-keto reductases (AKRs) belong to the NADP-dependent oxidoreductase superfamily, which play important roles in various physiological functions in prokaryotic and eukaryotic organisms. However, many AKR superfamily members remain uncharacterized. Here, a downstream target gene of the HOG1 MAPK pathways coding for an aldo-keto reductase, named Bbakr1, was characterized in the insect fungal pathogen, Beauveria bassiana. Bbakr1 expression increased in response to osmotic and salt stressors, and oxidative and heavy metal (chromium) stress. Deletion of Bbakr1 caused a reduction in conidiation, as well as delayed conidial germination. ΔBbakr1 displayed increased sensitivity to osmotic/high-salt stress with decreased compatible solute accumulation. In addition, the mutant was more sensitive to high concentrations of the heavy metal, chromium, and to oxidative stress than the wild type cells, with impaired ability to detoxify active aldehyde that might accumulate due to lipid peroxidation. However, over-expressing Bbakr1 in either the wild type strain or a ΔBbhog1 background did not cause any obvious changes in phenotypes as compared to their controls. Little effect on virulence was seen for either the ΔBbakr1 or overexpression strains in insect bioassays via cuticle infection or intrahemocoel injection assays, suggesting that Bbakr1 is not required for virulence.

The C-terminal MIR-containing region in the Pmt1 O-mannosyltransferase restrains sporulation and is dispensable for virulence in Beauveria bassiana.

Protein O-mannosyltransferases (Pmts) belong to a highly conserved protein family responsible for the initiation of O-glycosylation of many proteins. Pmts contain one dolichyl-phosphate-mannose-protein mannosyltransferases (PMT) domain and three MIR motifs (mannosyltransferase, inositol triphosphate, and ryanodine receptor) that are essential for activity in yeast. We report that in the insect fungal pathogen, Beauveria bassiana, deletion of the C-terminal Pmt1 MIR-containing region (Pmt1∆ 311-902) does not alter O-mannosyltransferase activity, but does increase total cell wall protein O-mannosylation levels and results in phenotypic changes in fungal development and cell wall stability. B. bassiana mutants harboring the Pmt1 ∆ 311-902 mutation displayed a significant increase in conidiation with up-regulation of conidiation-associated genes and an increase in biomass accumulation as compared to the wild-type parent. However, decreased vegetative growth and blastospore production was noted, and Pmt1 ∆ 311-902 mutants were altered in cell wall composition and cell surface features. Insect bioassays revealed little effect on virulence for the Pmt1 ∆ 311-902 strain via cuticle infection or intrahemocoel injection assays, although differences in hyphal body differentiation in the host hemolymph and up-regulation of virulence-associated genes were noted. These data suggest novel roles for Pmt1 in negatively regulating conidiation and demonstrate that the C-terminal Pmt1 MIR-containing region is dispensable for enzymatic activity and organismal virulence.

Low-dose spinal-epidural anesthesia for Cesarean section in a parturient with uncontrolled hyperthyroidism and thyrotoxic heart disease.

A 29-year-old woman at 34 weeks' gestation with uncontrolled hyperthyroidism and thyrotoxic heart disease was admitted to urgency Cesarean section. After preoperative sedation and good communication, low-dose spinal anesthesia (7.5 mg 0.5 % bupivacaine) combined with epidural anesthesia (6 ml 2 % lidocaine) was performed through L3-4 inter-vertebral. Opioids were given intravenously to the mother for sedation after delivery of the baby. Satisfactory anesthesia and sedation was provided during surgery. The mother and the neonate were safe and no special complication was found after surgery. Our case demonstrated that low-dose spinal anesthesia combined with epidural anesthesia with intravenous opioids can provide satisfactory anesthesia and sedation, and reduce the risk of heart failure and thyroid storm.

Assessment of tracheal intubation in adults after induction with sevoflurane and different doses of propofol: a randomly controlled trial.

Intubation without prior administration of muscle relaxants is a common practice in children and adults with potential difficult airways. We aimed to investigate the effects of adding different doses of propofol on tracheal intubation and the time to return of spontaneous breathing during inhalation induction of patients. 150 patients undergoing operations were randomly given propofol IV at 1.0, 1.5 and 2.0 mg/kg (namely 1.0-propofol, 1.5-propofol and 2.0-propofol, respectively) after inhalational induction with sevoflurane. Tracheal intubating conditions, time to return of spontaneous breathing, postoperative hoarseness, end-tidal carbon dioxide concentration (PETCO2), and pulse oxygen saturations (SpO2) were assessed. Tracheal intubation was successful in all patients. Intubating conditions were acceptable in 31/50, 42/50 and 47/50 in those subjects given propofol 1.0, 1.5 or 2.0 mg/kg, respectively. Intubation scores were similar in groups 1.5-propofol and 2.0-propofol, and were significantly higher than in group 1.0-propofol (P = 0.013). Time to return of spontaneous breathing in group 2.0-propofol was significantly prolonged compared with groups 1.5-propofol and 1.0-propofol (197.0 ± 49.4 sec vs. 130.4 ± 32.7 sec, P < 0.001; 197.0 ± 49.4 sec vs. 104.8 ± 22.6 sec, P < 0.001, respectively). SpO2 in group 2.0-propofol was significantly lower than group 1.0-propofol and 1.5-propofol. However, PETCO2 in group 2.0-propofol was significantly higher than in groups 1.0-propofol or 1.5-propofol. Propofol at a dose of 1.5 mg/kg provides intubating conditions similar to propofol at 2.0 mg/kg in patients. Time to return of spontaneous breathing followed by a dose of 1.5 mg/kg propofol was significantly shorter than that followed by a dose of 2.0 mg/kg propofol.

Effect of dexmedetomidine on preventing postoperative agitation in children: a meta-analysis.

BACKGROUND: Emergence agitation (EA) is one of the most common postoperative complications in children. The purpose of this meta-analysis is to assess the effect of dexmedetomidine for preventing postoperative agitation in children. METHODS: We searched the Cochrane Central Register of Controlled Trails, MEDLINE, and EMBASE. Randomized controlled trials were included. The following outcome measures were evaluated: incidence of EA, number of patients requiring rescue, time to eye-open, time to extubation, time to discharge from the postanesthesia care unit (PACU). RESULTS: We analyzed 19 trials (1608 patients) that met the inclusion criteria. Compared with placebo, intravenous dexmedetomidine significantly reduced the incidence of EA [risk ratio (RR) 0.34, 95% confidence interval (CI) 0.25-0.44, P<0.00001). Dexmedetomidine also decreased the incidence of severe pain (RR 0.41, 95% CI 0.27-0.62, P<0.0001) and requirement of a rescue drug (RR 0.31, 95% CI 0.18-0.53, P<0.0001). However, compared with placebo, dexmedetomidine increased the time to eye-open by 0.98 min (P = 0.01) and the time to PACU discharge by 4.63 min (P = 0.02). Dexmedetomidine was also compared with midazolam, propofol, ketamine, and fentanyl, among others. No significant difference was found in the incidence of EA for most of these comparisons, with the exception of fentanyl and propofol, where dexmedetomidine was more beneficial. CONCLUSIONS: Dexmedetomidine was proved effective for preventing EA and for reducing severe pain and the requirement of rescue drugs. It slightly increased the time to eye-open and the time to PACU discharge. Dexmedetomidine was also more beneficial than propofol or fentanyl in preventing EA.

Ultrasound-guided epidural anesthesia for a parturient with severe malformations of the skeletal system undergoing cesarean delivery: a case report.

Anesthetic management of patients with preexisting diseases is challenging and individualized approaches need to be determined based on patients' complications. We report here a case of ultrasound-guided epidural anesthesia in combination with low-dose ketamine during cesarean delivery on a parturient with severe malformations of the skeletal system and airway problems. The ultrasound-guided epidural anesthesia was performed in the L1-L2 space, followed by an intravenous administration of ketamine (0.5 mg/kg) for sedation and analgesia. Satisfactory anesthesia was provided to the patient and spontaneous ventilation was maintained during the surgery. The mother and the baby were discharged 5 days after surgery, no complications were reported for either of them. Our work demonstrated that an ultrasound-guided epidural anesthesia combined with low-dose ketamine can be used to successfully maintain spontaneous ventilation and provide effective analgesia during surgery and reduce the risk of postoperative anesthesia-related pulmonary infection.

Improving the anti-ovarian cancer activity of docetaxel with biodegradable self-assembly micelles through various evaluations.

Docetaxel (DOC) produces anti-tumor effects by inducing apoptosis and inhibiting cell growth. However, its clinical application is limited by its hydrophobicity and low biocompatibility. Therefore, improving DOC's water solubility, biocompatibility, and anti-tumor effects are important goals that will improve its clinical utility. In this work, DOC and methoxy poly(ethylene glycol) (MPEG)/polycaprolactone (PCL) (MPEG-PCL) showed good compatibility through computer simulations. We prepared DOC-loaded polymeric micelles (DOC/MPEG-PCL micelles) with drug loading of 6.82% and encapsulation efficiency of 98.36%; these were monodispersed and approximately 30 nm in diameter, and released DOC over an extended period in vitro and in vivo. In addition, DOC/MPEG-PCL micelles inhibited cell growth and induced apoptosis more effectively than free DOC in vitro. Furthermore, DOC/MPEG-PCL micelles inhibited ovarian tumor growth more significantly than free DOC. Immunohistochemical analysis indicated that DOC/MPEG-PCL micelles improved DOC's anti-tumor effect by enhancing tumor cell apoptosis and suppressing tumor cell proliferation. Moreover, in bio-imaging analysis, DOC/MPEG-PCL micelles showed a higher concentration and a longer retention time in ovarian tumor tissue than did free DOC, indicating that the DOC/MPEG-PCL micelles delivered more anti-tumor drug to the tumor. Our data suggest that DOC/MPEG-PCL micelles have the potential to be applied clinically in ovarian cancer therapy.

Optimal dose of succinylcholine for tracheal intubation in patients during inhalation induction with sevoflurane: a randomized controlled trial.

STUDY OBJECTIVE: To determine the dose of succinylcholine during inhalation induction of a patient. DESIGNED: Prospective, double-blind, randomized study. SETTING: Operating room of a university hospital. PATIENTS: 180 adult, ASA physical status 1 and 2 patients with a suspected difficult airway, who were scheduled for surgery. INTERVENTIONS: Nonpremedicated patients were anesthetized with inhalation of 8% sevoflurane, followed by succinylcholine. Group 1 received intravenous (IV) succinylcholine 0.3 mg/kg, Group 2 had IV succinylcholine 0.6 mg/kg, and Group 3 was given IV succinylcholine 1.0 mg/kg. Direct laryngoscopy and tracheal intubation were performed after onset of succinylcholine. MEASUREMENTS: Intubation conditions were scored as excellent, good, or poor. The recovery time of spontaneous respiration, end-tidal carbon dioxide partial pressure (PETCO2), and pulse oxygen saturation (SpO2) were recorded. MAIN RESULTS: Acceptable conditions (excellent and good) for intubation were rated in 80% of Group 1 patients (0.3 mg/kg succhinylcholine), 91.7% of Group 2 patients (0.6 mg/kg), and 93.3% of Group 3 patients (1.0 mg/kg), respectively. Intubation scores were similar in Groups 2 and 3, and were significantly higher than in Group 1 patients (0.3 mg; P < 0.01). Time to recovery of spontaneous respiration in Group 3 was significantly prolonged compared with Groups 1 and 2 (238 ± 59 sec vs 132 ± 43 sec, P < 0.001; 238 ± 59 sec vs 151 ± 47 sec, P < 0.001, respectively). SpO2 in Group 3 did not differ significantly from Group 1 and 2 values. However, PETCO2 in Group 3 was significantly higher than in Groups 1 or 2. CONCLUSIONS: Succinylcholine at a dose of 0.6 mg/kg IV provided intubation conditions similar to succinylcholine at 1.0 mg/kg IV, and recovery of spontaneous respiration following a 0.6 mg/kg dose of succinylcholine was significantly shorter.

Prostasin gene polymorphism at rs12597511 is associated with severe preeclampsia in Chinese Han women.

BACKGROUND: Preeclampsia, characterized by hypertension and proteinuria, is a multifactorial disease associated with shallow invasion of trophoblast cells and inadequate spiral artery remodeling. Trophoblast and tumor cells have similar invasion mechanism. Prostasin is closely related to tumor development, invasion and metastasis and influences blood pressure through activating epithelial sodium channel. The effect of prostasin on the pathogenesis of preeclampsia remains unclear. This study investigated the association of prostasin gene at rs12597511 with severe preeclampsia. METHODS: A single nucleotide polymorphism, rs12597511, was tested with polymerase chain reaction and restrictionfragment length polymorphism analyses in 179 severe preeclampsia patients and 222 normal pregnant women. RESULTS: The frequencies of TC + CC genotypes were significantly higher in severe preeclampsia group compared with in control group (the adjusted odds ratio was 2.030, 95% confidence interval 1.195-3.449, P = 0.009). The C allele of rs12597511 was present significantly more often among women with severe preeclampsia (P = 0.001). Genotyping analysis showed that the C allele of rs12597511 could confer a risk for severe preeclampsia. CONCLUSION: The higher frequency of C allele of prostasin gene at rs12597511 is associated with severe preeclampsia.