ABSTRACT
BACKGROUND: Spinal morphine is the mainstay of postcesarean analgesia. Quadratus lumborum block has recently been proposed as an adjunct or alternative to spinal morphine. The authors evaluated the analgesic effectiveness of quadratus lumborum block in cesarean delivery with and without spinal morphine. METHODS: Randomized trials evaluating quadratus lumborum block benefits in elective cesarean delivery under spinal anesthesia were sought. Three comparisons were considered: spinal morphine versus spinal morphine and quadratus lumborum block; spinal morphine versus quadratus lumborum block; and no block or spinal morphine versus quadratus lumborum block. The two coprimary outcomes were postoperative (1) 24-h cumulative oral morphine equivalent consumption and (2) pain at 4 to 6 h. Secondary outcomes included area under the curve pain, time to analgesic request, block complications, and opioid-related side effects. RESULTS: Twelve trials (924 patients) were analyzed. The mean differences (95% CIs) in 24-h morphine consumption and pain at 4 to 6 h for spinal morphine versus spinal morphine and quadratus lumborum block comparison were 0 mg (-2 to 1) and -0.1 cm (-0.7 to 0.4), respectively, indicating no benefit. For spinal morphine versus quadratus lumborum block, these differences were 7 mg (-2 to 15) and 0.6 cm (-0.7 to 1.8), respectively, also indicating no benefit. In contrast, for no block or spinal morphine versus quadratus lumborum block, improvements of -18 mg (-28 to -7) and -1.5 cm (-2.4 to -0.6) were observed, respectively, with quadratus lumborum block. Finally, for no block or spinal morphine versus quadratus lumborum block, quadratus lumborum block improved area under the 48-h pain curve by -4.4 cm · h (-5.0 to -3.8), exceeding the clinically important threshold (3.96 cm · h), but no differences were observed in the other comparisons. CONCLUSIONS: Moderate quality evidence suggests that quadratus lumborum block does not enhance analgesic outcomes when combined with or compared with spinal morphine. However, the block improves postcesarean analgesia in the absence of spinal morphine. The clinical utility of this block seems limited to situations in which spinal morphine is not used.
Subject(s)
Analgesia, Obstetrical/methods , Anesthesia, Spinal/methods , Cesarean Section/methods , Nerve Block/methods , Pain, Postoperative/prevention & control , Adult , Analgesics, Opioid , Female , Humans , Morphine , Pregnancy , SpineABSTRACT
PURPOSE: To determine the reliability and validity of the Chinese version of Expanded and Revised Gross Motor Function Classification System (GMFCS-ER) for cerebral palsy (CP) and to explore if there existed differences between parents and the other raters. METHOD: The GMFCS-ER was translated into Chinese. Children with CP age 6 to 18 years from two special education schools were assessed by 6 physiatrists, 21 physiotherapists, 15 teachers and parents. Inter-rater reliability was analyzed with inter-rater correlation coefficients (ICC). Validity was assessed using Gross Motor Function Measure (GMFM) score as the criterion standard. RESULTS: Mean (SD) age of the 130 children (93 boys, 37 girls) was 11.5 (2.8) years. Overall ICCs ranged between 0.84 and 0.92. Reliabilities between physiatrists, physiotherapists and teachers (ICCs from 0.86 to 0.92) were higher than those between parents and the other raters (ICCs from 0.80 to 0.84) in 6-to-12 year age band. The overall correlation for criterion-related validity was -0.83. CONCLUSION: The Chinese version of the GMFCS-ER is a valid measure of functional ability in school children with CP and reliable enough for use by Chinese healthcare providers and parents. Effects of environmental and personal factors should be considered when practicing GMFCS-ER assessment. Implications for Rehabilitation Cerebral palsy. Research about GMFCS-ER is needed to promote a more extensive use of GMFCS-ER in China for school children with CP. The Chinese version of the GMFCS-ER is a valid measure of functional ability in school children with CP and reliable enough for use by Chinese healthcare providers. Effects of environmental and personal factors should be considered when performing the GMFCS-ER assessment.
Subject(s)
Cerebral Palsy , Disability Evaluation , Motor Skills/classification , Activities of Daily Living , Adolescent , Cerebral Palsy/diagnosis , Cerebral Palsy/psychology , Cerebral Palsy/rehabilitation , Child , China , Education, Special/methods , Education, Special/statistics & numerical data , Female , Humans , Male , Parents/psychology , Physical Therapy Modalities , Physical Therapy Specialty/methods , Reproducibility of Results , Severity of Illness Index , TranslationsABSTRACT
Based on the requirement of culture conditions for hematopoietic stem and progenitor cells (HSPCs) ex vive expansion, we developed a new-type bioreactor by combining superiorities of static and stirred culture models. Stem cell factor (SCF), thrombopoietin (TPO), FLT-3 ligand(Flt-3) were used as the cytokines cocktails. The effects of the static and cyclic culture on the expansion characteristics of CD34+ selected cells were compared in the new-type bioreactor. After 7 d cultures, the expansion of total cells in the static culture was 13.86 +/- 4.26 fold, higher than that in the cyclic culture (7.23 +/- 2.67 fold). The analysis of the fold expansion and the proportion of CD34+ cells showed that there was no marked difference between the static culture and the cyclic culture. However, the fold expansion and the proportion of CD34+CD38- cells were higher in the cyclic culture than those in the static culture (3.90 +/- 0.85 versus 1.82 +/- 0.58), which reflected more primary CD34+CD38- cells were obtained in the cyclic culture. The above results demonstrated that both the static culture and the cyclic culture could be used in ex vive expansion of CD34+ cells with the new-type bioreactor. In static culture hematopoietic stem cells differentiated into progenitor cells, whilst the cyclic culture favored the expansion of primary HSPCs.
