Regular intermittent bolus provides similar incidence of maternal fever compared with continuous infusion during epidural labor analgesia.

OBJECTIVES: To compare the effects of regular intermittent bolus versus continuous infusion for epidural labor analgesia on maternal temperature and serum interleukin-6 (IL-6) level. METHODS: This randomized trial was performed in Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China between October 2012 and February 2014. Either regular intermittent bolus (RIB, n=66) or continuous infusion (CI, n=66) was used for epidural labor analgesia. A bolus dose (10 ml of 0.08% ropivacaine + 0.4 ug·ml-1 sufentanil) was manually administrated once an hour in the RIB group, whereas the same solution was continuously infused at a constant rate of 10 ml·h-1 in the CI group. Maternal tympanic temperature and serum IL-6 level were measured hourly from baseline to one hour post partum. The incidences of fever (>/=38 degree celsius ) were calculated. RESULTS: The incidence of maternal fever was similar between the 2 groups. There was a rising trend in mean temperature over time in both groups, but no statistical difference was detected between the groups at respective time points; maternal serum IL-6 showed similar changes. CONCLUSION: Compared with continuous infusion, regular intermittent bolus presents with the same incidence of maternal fever for epidural labor analgesia. Interleukin-6 elevation could be involved in mean maternal temperature increase. 

[Role of macrophage migration inhibitory factor in septic shock-induced cardiovascular dysfunction: experiment with rats].

OBJECTIVE: To investigate the role of macrophage migration inhibitory factor (MIF) in septic shock-induced cardiovascular dysfunction. METHODS: 56 SD rats were randomly divided into 7 equal groups: CLP group (undergoing cecal ligation and puncture so as to cause septic shock), CLP + ISO-1 group (ISO-1, was injected before and after CLP), CLP + MIF antibody group (MIF-Ab was injected before and after CLP), CLP + dexamethasone (DEX)-1, 5, and 20 groups [I, 5, or 20 mg/kg was injected 1 h after CLP), and sham operation group. Echocardiography was performed 6 h after CLP to measure the LVEDD, LVESD, FS%, CO, and PP. Catheters were inserted into the femoral artery and vein to measure the mean arterial pressure (MAP) and to be used as the route of drug administration. Phenylephrine (PE) of the concentrations of 0.5, 1, 2, and 2.5 microg/kg was injected intravenously and then the MAP increase percentage (DeltaMAP%) was calculated. Then the rats were euthanized with their hearts and aortas taken out. The aortas were cut into rings, and bathed in Krebs solution. PE of the concentrations of 1 mol/L to 30 micromol/L was added into the solution cumulatively to produce the dose-reaction curve of PE. The maximum energy (Emax) and median effective concentration (EC50) of PE were calculated. Western blotting was used to examine the protein expression of MIF in the myocardium and aorta. Another 70 SD rats were divided into 7 groups as mentioned above to observe the cumulative survival rates within 72 h. RESULTS: The LVEDD and LVESD of the CLP group decreased by 56% and 54% respectively 6 h after CLP, and the LVEDD and LVESD of the ISO-1, MOF-Ab, and DEX-20 groups were all significantly higher than that of the CLP group (all P < 0.05) The FS% of the CLP group was significantly lower than that of the Sham groups, and the FS% of the ISO-1, MOF-Ab, and DEX-20 groups were all significantly higher than that of the CLP group (all P < 0.05). The PP value of the ISO-1, MIF-Ab, and DEX-20 groups were all significantly higher than that of the CLP group (all P < 0.06). The CO of the CLP group was significantly lower than that of the Sham group, and those of the ISO-1, MIF-Ab, and DEX-20 groups were all significantly higher than that of the CLP group (all P < 0.001). The DeltaMAP% of different group all increased after the addition of PE dose-dependently, however, the DeltaMAP% was significantly lower in the CLP group than in the Sham group (P < 0.05), and t significantly higher in the ISO-1, MIF-Ab, and DEX-20 groups than in the CLP group (all P < 0.05). The values of PE-induced maximum aorta tension of the SO-1 and MIF-Ab groups were both significantly higher than that of the CLP group (both P < 0.05). The values of PE-induced maximum aorta tension of the DEX-20 group were all higher than those of the CLP group when the PE concentration was between 1.0 x 10(-6) - 1.0 x 10(-5) mol/L (all P < 0.05), however, were not significantly different those of the CLP group when the PE concentration was over 1.0 x 10(-5) mol/L. The values of Emax were significantly lower in the 6 experimental groups than in the Sham group (all P < 0.05), however, were all significantly higher in the ISO-1, MIF-Ab, and DEX-20 groups than in the CLP group (all P < 0.05). The values of EC50 were significantly higher in the 6 experimental groups than in the Sham group (all P < 0.05), however, were significantly lower in the ISO-1, MIF-Ab, and DEX-20 groups than in the CLP group (all P < 0.05). The protein expression levels of MIF in the heart and aorta were significantly higher in the 6 experimental groups than in the Sham group (all P < 0.05), however, the DEX-1 and DEX-5 groups showed significantly higher MIF expression than DEX-20 group (both P < 0.05). The 72 h survival rates of the ISO-1 and MIF-Ab groups were both significantly higher than that of the CLP group (0%, both P < 0.05). DEX of different dose failed to increase the survival rate. CONCLUSION: MIF plays a pivotal role in the circulation dysfunction in septic ambience. Antagonism and blockade of MIF improve corresponding hemodynamics, vascular responsiveness, and prognosis. Glycocorticoid of high and low dose are poles apart in effects on septic hemodynamics and vaso-reactivity, however, fails to improve the prognosis of sepsis no matter how high is the dose.

[The effect of acetylcholine on the proliferation and apoptosis of three kinds of cultured human pituitary adenoma cells].

In order to elucidate the effect of acetylcholine (ACh) on the occurrence and development of human pituitary adenoma, it was firstly observed whether there exists choline acetyl transferase (ChAT) which is necessary for the synthesis of acetylcholine in the cells of human pituitary adenoma, and then MTT method, (3)H TdR incorporation, cell cycle analysis and TUNEL were employed to estimate the influence of ACh on the proliferation, DNA synthesis and apoptosis of three kinds of human pituitary adenoma (human prolactinoma, somatotropinoma and non-functional tumor) cells cultured in vitro. The results showed that (1) the positive staining of ChAT was obviously observed in the cells of the three kinds of human pituitary adenoma, however, it was lower than that in normal human pituitary gland; (2) ACh had a similar effect on the proliferation of the three kinds of human pituitary adenoma cells. ACh at 0.1-10 micromol/L decreased the (3)H TdR incorporation and the MTT A value in a dose-dependent manner. At the same time, ACh decreased the ratio of S or G(2) phase pituitary adenoma cells significantly, but increased the ratio of G(1) phase pituitary tumour cells markedly; (3) the effect of acetylcholine on the proliferation of human pituitary adenoma cells was inhibited by atropine, but not by tubocurarine; (4) ACh had no effect on the apoptosis of human pituitary adenoma cells cultured in vitro. These data suggest that ACh may have a significant modulating effect on the proliferation of pituitary adenoma cells by means of paracrine or autocrine, and the effect is mediated by muscarinic receptor.