Bibliometric Analysis of Research Studies on Postoperative Pain Management of Cesarean Section.

Purpose: Cesarean section (C-section) is associated with moderate-to-severe postoperative pain. Many studies on pain management after C-section have been published in recent decades, many of which focused on new regional techniques. The purpose of this study is to outline the connections within the dynamic evolution of postcesarean delivery analgesia research publications using retrospective bibliometric analysis. Patients and Methods: Published studies on postoperative pain management of C-section were retrieved from the Science Citation Index Expanded (SCI-E) of Web of Science (WOS) Core collection database. All papers published from 1978 to October 22, 2022 were searched. The research progress and growing trend were quantitatively analyzed by total publications, research institutions, journal impact factors, and author's contribution. Total citations frequency, average citations per item and h-index were used for evaluating literature quantity. Top 20 journals with the highest number of publications were charted. The keywords co-occurrence overlay map was visualized by the VOSviewer software. Results: From 1978 to 2022, a total of 1032 articles in postcesarean delivery analgesia research field were published, with 23,813 times cited, average citations of 23.07 per item, and an h-index of 68. The most high-yield publication year, countries, journals, authors, institutions were 2020 (n=79), the United States (n=288), Anesthesia and Analgesia (n=108), Carvalho B (n=25), and Stanford University (n=33), respectively. The United States had the most cited papers. The future research interest might be "prescription", "quadratus lumborum block", "postnatal depression", "persistent pain", "dexmedetomidine", "enhanced recovery", and "multimodal analgesia". Conclusion: By employing the online bibliometric tool and VOSviewer software, we found that studies on postcesarean analgesia had grown markedly. The focus had evolved to nerve block, postnatal depression, persistent pain, and enhanced recovery.

Circulatory collapse during wound closure in spine surgery with an unknown cause: a possible adverse effect of topical application of vancomycin?

BACKGROUND: Vancomycin (VCM) is effective in fighting Gram-positive bacteria related severe infections, and topical application of VCM powder is widely used in orthopedic surgery to prevent wound infection. However, VCM could lead to infusion rate-dependent antibody-and complement-independent anaphylaxis reaction by inducing direct release of histamine. CASE PRESENTATION: We retrospectively analyzed seven cases of severe hypotension and shock during wound closure or immediately after orthopedic surgery with unidentifiable reasons. We found that these cases were all associated with local application of VCM powder during wound closure process. Two patients experienced sudden cardiac arrest. Most of the cases (6/7) with circulatory collapse were discharged without severe sequelae. While one case with application of 3 g VCM developed cardiac arrest and remained in a coma due to hypoxic-hypoxic encephalopathy. The clinical presentations and the time of the shock onset were considered to be related with a VCM induced anaphylaxis reaction. However, as this was a retrospective study, and there was no laboratory examination performed, the conclusion was made upon differential diagnosis based on clinical manifestations and the timing of the shock. CONCLUSIONS: Local application of VCM may not be as safe as was once believed and may lead to a related anaphylaxis. As VCM induced infusion-rate dependent, non-IgE mediated anaphylaxis is characterized by delayed occurrence, severe hypotension and even circulatory collapse, surgeons and anesthesiologists should be extra vigilant during and after VCM application.

HIV-1 subtype diversity, drug resistance, and genetic transmission networks in men who have sex with men with virologic failure in antiretroviral therapy in Sichuan, China, 2011 to 2017.

This study sought to examine the human immunodeficiency virus type 1 (HIV-1) genetic diversity on drug resistance among men who have sex with men (MSM) with virologic failure in antiretroviral therapy (ART), and investigate linking-associated factors for genetic transmission networks.Seven hundred and thirty-four HIV-positive MSM with virologic failure in ART were recruited into our study from 2011 to 2017. HIV-1 pol gene sequences were used for phylogenetic and genotypic drug resistance analyses. The drug resistance mutations were determined using the Stanford University HIV Drug Resistance Database. The genetic transmission networks were analyzed for CRF01_AE and CRF07_BC sequences by the genetic distance-based method.Of 734 subjects, 372 (50.68%) showed drug resistance, in which CRF01_AE and CRF07_BC were the predominating subtypes. Drug resistance more frequently occurred in non-nucleoside reverse transcriptase inhibitors (NNRTIs) treatment (48.64%), and followed by nucleoside reverse transcriptase inhibitors (NRTIs) (36.51%) and PIs (4.03%). The most common drug resistance-associated mutations in protease inhibitors (PIs), NRTIs and NNRTIs were K20I/R, M184V/I and K103N/KN, respectively. For 283CRF01_AE sequences, 64 (22.61%) fell into clusters at a genetic distance of 0.011, resulting in 17 clusters ranging in size from 2 to 16 individuals. For 230 CRF07_BC sequences, 66 (28.69%) were connected to at least one other sequence with 0.005 genetic distances, resulting in 8 clusters ranging in size from 2 to 52 individuals. Individuals who showed drug resistance to ART were less likely to fall into clusters than those who did not. The genetic linkage was robust by the exclusion of sites associated with drug resistance.CRF01_AE and CRF07_BC were the main strains among MSM with virologic failure in ART, and the drug resistance more frequently occurred in NNRTIs, followed by NRTIs and PIs. Genetic transmission networks revealed a complexity of transmission pattern, suggesting early-diagnosis and in-time intervention among MSM.

Short-term effects of meteorological factors and air pollution on childhood hand-foot-mouth disease in Guilin, China.

BACKGROUND: Previous studies have always focused on the impact of various meteorological factors on Hand-foot-mouth disease (HFMD). However, only few studies have investigated the simultaneous effects of climate and air pollution on HFMD incidence. METHODS: Daily HFMD counts among children aged 0-14 years in Guilin city were collected from 2014 to 2016. Distributed lag nonlinear models (DLNM) were used to assess the effects of extreme meteorological factors and air pollution indicators, as well as the effects of different lag days on HFMD incidence. Furthermore, this study explored the variability across gender and age groups. RESULTS: Extreme temperatures, high precipitation and low-O3 concentration increased the risk of HFMD. Hot effect was stronger and longer lasting than cold effect. Risks of rainy effect and low-O3 effect continued to increase as lag days extended, with the maximum RR values: 1.60 (1.38, 1.86) (90th vs median) and 1.48 (1.16, 1.89) (1th vs median) at 0-14 lag days, respectively. By contrast, extremely high wind speed, low precipitation, low PM2.5 and high O3 exerted a certain protective effect on HFMD incidence. The corresponding minimum RR values were: 0.85 (0.74, 0.98) (90th vs median) at 0-14 lag days, 0.98 (0.97, 0.99) (10th vs median) at 0-14 lag days, 0.73 (0.61, 0.88) (1th vs median) at 0-14 lag days and 0.81 (0.73, 0.90) (99th vs median) at 0-7 lag days, respectively. Male children and children aged 0-1 years (followed by 1-3 years) were the most susceptible subgroups to extreme climatic effects and air pollution. CONCLUSIONS: Our results indicated that daily meteorological factors and air pollution exert non-linear and delayed effects on pediatric HFMD, and such effects vary depending on gender and age. These findings may serve as a reference for the development of an early warning system and for the adoption of specific interventions for vulnerable groups.

Determining correct tracheal tube insertion depth by measuring distance between endotracheal tube cuff and vocal cords by ultrasound in Chinese adults: a prospective case-control study.

OBJECTIVES: Unrecognised malposition of the endotracheal tube can lead to severe complications in patients under general anaesthesia. The purpose of this study was to verify the feasibility of using ultrasound to measure the distance between the upper edge of saline-inflated cuff and the vocal cords. DESIGN: Prospective case-control study. SETTING: A tertiary hospital in Beijing, China. METHODS: In this prospective study, 105 adult patients who required general anaesthesia were enrolled. Prior to induction, ultrasound was used to identify the position of the vocal cords. After intubation, the endotracheal tube (ETT) was fixed at a depth of 23 cm at the upper incisors in men and 21 cm in women. The depth of intubation was verified by video-assisted laryngoscopy. The distance between the upper edge of the saline-inflated cuff and the vocal cords was measured by ultrasound; the ideal distance was considered to be 1.9-4.1 cm. RESULTS: Among the 105 cases, two cuffs were too close to the vocal cords and one too far away from the vocal cords. These diagnoses were made by ultrasound and were in agreement with results from direct laryngoscopy. The overall accuracy of ultrasound in identifying malposition of the cuff was 100.0% (95% CI: 96.6% to 100%). The sensitivity, specificity, positive predictive value and negative predictive value of ultrasound were, respectively, 100% (95% CI: 96.5% to 100%), 100% (95% CI: 29.2% to 100%), 100% (95% CI: 96.5% to 100%) and 100% (95% CI: 29.2% to 100%). CONCLUSION: Identification of the upper edge of the saline-inflated cuff and the vocal cords by ultrasound to assess the location of the ETT is a reliable method. It can be used to avoid malposition of the ETT cuff and reduce the incidence of vocal cords injury after intubation. TRIAL REGISTRATION NUMBER: ChiCTR-DDD-17011048.

Spatial, temporal, and spatiotemporal analysis of mumps in Guangxi Province, China, 2005-2016.

BACKGROUND: The resurgence of mumps around the world occurs frequently in recent years. As the country with the largest number of cases in the world, the status of mumps epidemics in China is not yet clear. This study, taking the relatively serious epidemic province of Guangxi as the example, aimed to examine the spatiotemporal pattern and epidemiological characteristics of mumps, and provide a scientific basis for the effective control of this disease and formulation of related health policies. METHODS: Geographic information system (GIS)-based spatiotemporal analyses, including spatial autocorrelation analysis, Kulldorff's purely spatial and space-time scan statistics, were applied to detect the location and extent of mumps high-risk areas. Spatial empirical Bayesian (SEB) was performed to smoothen the rate for eliminating the instability of small-area data. RESULTS: A total of 208,470 cases were reported during 2005 and 2016 in Guangxi. Despite the fluctuations in 2006 and 2011, the overall mumps epidemic continued to decline. Bimodal seasonal distribution (mainly from April to July) were found and students aged 5-9 years were high-incidence groups. Though results of the global spatial autocorrelation based on the annual incidence largely varied, the spatial distribution of the average annual incidence of mumps was nonrandom with the significant Moran's I. Spatial cluster analysis detected high-value clusters, mainly located in the western, northern and central parts of Guangxi. Spatiotemporal scan statistics identified almost the same high-risk areas, and the aggregation time was mainly concentrated in 2009-2012. CONCLUSION: The incidence of mumps in Guangxi exhibited spatial heterogeneity in 2005-2016. Several spatial and spatiotemporal clusters were identified in this study, which might assist the local government to develop targeted health strategies, allocate health resources reasonably and increase the efficiency of disease prevention.

Impact of meteorological factors on mumps and potential effect modifiers: An analysis of 10 cities in Guangxi, Southern China.

BACKGROUND: In the current context of global climate change, understanding the impact of climate on respiratory infectious diseases such as mumps and the potential modified factors is crucial, especially in developing countries. However, research on the climate-related incidence of mumps is rare, inconsistent and mainly limited to a single city or region. METHODS: Daily mumps cases and meteorological variables of 10 cities in Guangxi, Southern China were collected for 2005-2017. Two-stage analyses were performed to assess the relationship between meteorological factors and mumps incidence during two time-periods: 2005-2012 and 2013-2017, separately. First, a Poisson regression model that allows over-dispersion was used to estimate the city-specific climate-related morbidity after controlling for temporal trends, day of week, and national statutory holidays. Then, we used a multivariate meta-analytical model to pool the city-specific effect estimates and conducted subgroup analyses. Multivariate meta-regression was applied to detect potential effect modifiers. RESULTS: Non-linear relationships were observed among mean temperature, wind speed, and mumps incidence in 2005-2012. The impact of high temperature on mumps incidence was short and rapid, whereas the impact of low temperature was long and slow. The total cumulative relative risk (RR) associated with hot temperature was 1.18 [95% Confidence Interval (CI): 0.93, 1.48], which was calculated by comparing the incidence of mumps above the 90th percentile of temperature with its incidence at the median temperature at lag of 0-30 days. Meanwhile, the RR associated with cold temperature was calculated to be 1.50 (95% CI: 1.08, 2.10) by comparing the incidence of mumps below the 10th percentile of temperature with its incidence at the median temperature. Similarly, the RRs associated with windless and windy conditions for the total population were 1.23 (95% CI: 1.04, 1.46) and 0.83 (95% CI: 0.67, 1.02), respectively. Effects based on extreme temperature and wind speed conditions were more prominent in males than in females. Compared with children and adults, adolescents (5-14 years old) were more sensitive to extreme weather conditions. Geographical latitude, Population density, GDP per capita, Number of health institutions, Highly educated population and Inoculation rate were considered the most likely associated modifiers. In addition, the correlation between meteorological factors and the incidence of mumps and modification of socioeconomic factors after 2013 showed similar curves compared with results in 2005-2012, but the cumulative effect was not statistically significant. CONCLUSIONS: Meteorological factors, such as temperature and wind speed, exert a significant impact on the incidence of mumps. The relationship varies depending on gender and age. Socioeconomic factors such as vaccination, GDP, geographical latitude, etc. may substantially affect the weather-related mumps incidence.

Preparation and Quality Evaluation of Salvianolic Acids and Tanshinones Dry Powder Inhalation.

Salvianolic acids and tanshinones both exhibit efficacy in treating idiopathic pulmonary fibrosis (IPF), but their formulation limits their clinical use. This study aimed to prepare the salvianolic acids and tanshinones dry powder for inhalation (SPI) to achieve pulmonary delivery for the treatment of IPF. The variable quantities of salvianolic acids and tanshinones composite powder were optimized using the central composite design-response surface method. Different carriers with various drug-carrier ratios were optimized to prepare SPI. The final optimized formulation of SPI was as follows: InhaLac 230® was selected as the carrier with drug:carrier = 1:6, and the milled lactose InhaLac 400® was added at 5%. The developed SPI characterized with an angle of repose 52.46 ± 1.04°, Carr's index of 34.00 ± 0.50% and showed high lung deposition in vitro, indicating the potential of pulmonary delivery for the treatment of IPF.

Factors associated with HIV infection among Yi minority residents in Liangshan Prefecture, Sichuan Province: A path analysis.

We aimed to evaluate HIV prevalence among residents of Liangshan Prefecture through HIV sentinel surveillance (HSS) data over the period from 2010 to 2016, and investigate risk factors for HIV infection in this population and interactions among them.Two sites (Dechang and Ningnan counties) with majority-Han populations, and 1 site (Butuo) with a majority-Yi population were selected. We used questionnaires to investigate residents' demographic and behavioral characteristics from 2010 to 2016, and performed HIV testing. Multivariate logistic regression and path analysis were undertaken to investigate the interactions and mediating effects among significant risk factors for HIV infection.A total of 5403 community residents in the Yi area and 10,897 community residents in the Han areas were enrolled. HIV prevalence in the Yi area was consistently high, ranging from 9.46% (63/666, 2011) to 2.88% (23/798, 2012) over the period from 2010 to 2016. HIV prevalence in the Han areas ranged from 0.15% (2/1333, 2010) to 0.44% (7/1604, 2011) over the same period. Multivariate logistic regression showed that unprotected casual sexual behavior, male gender, illiteracy, drug use, and injection drug use were positively associated with HIV infection risk in the Yi area. Path analysis of the risk factors revealed that casual sexual behavior (0.051) and injection drug use (0.161) were directly associated with HIV infection. However, marital status (0.004), ethnicity (0.017), education level (-0.004), HIV/AIDS-related prevention knowledge (-0.012), and drug use (0.11) had an indirect influence on HIV infection through casual sexual behavior and injection drug use.The prevalence of HIV is high among residents of majority-Yi areas, and injection drug use and casual sexual behavior are risk factors for infection.

Analysis of HIV prevalence among pregnant women in Liangshan Prefecture, China, from 2009 to 2015.

BACKGROUND: Yi people make up about 50% of the population in Liangshan Prefecture, Sichuan Province, China, but accounted for 88.07% of new HIV cases in the prefecture from 2011 to 2013. This study evaluated HIV prevalence in pregnant women of Liangshan Prefecture using HIV sentinel surveillance (HSS) data over the period of 2009 to 2015. METHODS: Xichang, Zhaojue County, and Butuo County were selected as HSS sites. We investigated the temporal trends in HIV prevalence in these areas, and the association between demographic and behavioral characteristics and risk of HIV infection. RESULTS: Data on a total of 2797 pregnant women in Xichang and 3983 pregnant women in Zhaojue and Butuo was collected for the period 2009 to 2015. There was a fluctuating HIV prevalence among pregnant women of Xichang, with a rate of 0.75% in 2015 (χ2trend = 2.27, P = 0.13). HIV prevalence among pregnant women of Zhaojue and Butuo was consistently high, varying between 3.4% (9/267, 2011) and 10.3% (82/796, 2012) over the period of 2010 to 2015 (χ2trend = 0.12, P = 0.73). In Xichang, we found that Yi ethnicity (OR = 11.37, 95% CI = 2.92-44.25) and a husband who used drugs (OR = 32.13, 95% CI = 5.33-193.67) were significantly associated with HIV risk in pregnant women. For Zhaojue and Butuo, we observed that pregnant women had a higher risk of HIV infection when they were over 30 years old (OR = 1.72, 95% CI = 1.17-2.52), when they had a higher number of previous births, when their husbands had a history of migrating for work (OR = 1.56, 95% CI = 1.16-2.08), and when they had a history of other sexually transmitted infections (OR = 2.19, 95% CI = 1.16-2.08). Compared to those with a primary school education or below, pregnant women with a secondary or high school education level had a lower risk of HIV infection (OR = 0.28, 95% CI = 0.09-0.89). CONCLUSION: Our results indicate that there is a serious HIV epidemic among pregnant Yi women, especially for those with less education, more past births, or a husband with a history of out-migrating for work or STD infection.

Effects of a fixed low-dose ropivacaine with different volume and concentrations on interscalene brachial plexus block: a randomized controlled trial.

BACKGROUND: Ultrasound guidance has reduced the amount of local anesthetics to achieve a successful block. Previous studies of the relationship between the volume or concentration of local anesthetics and the effects of the block were based on relatively high doses of local anesthetics. We tested the hypothesis that providing low dose of ropivacaine at three combinations of volumes and concentrations for ultrasound-guided interscalene brachial plexus block would produce different effects in the aspect of onset time, pain control and the incidence of side effects. METHODS: Ninety-nine patients undergoing elective arthroscopic shoulder surgery were randomized to receive an ultrasound guided combined with nerve stimulator mediated interscalene block with ropivacaine 0.75 % (6.7 ml, Group 0.75), 0.5 % (10 ml, Group 0.5) or 0.25 % (20 ml, Group 0.25). The primary end point was the onset time of the sensory blockade, assessed by using a pinprick in the C5-6 dermatome. The secondary end points included the onset time of the motor blockade, block success rate, postoperative pain rating score, rescue analgesics requirement, sleep quality, strength of the hand on the block side,and the incidence of hemi-diaphragmatic paresis which was evaluated by ultrasonography. RESULTS: There was a statistically significant difference of the sensory block median onset times among Group 0.75 (5 min), Group 0.5 (10 min) and Group 0.25 (20 min). One patient in Group 0.5 and 20 patients in Group 0.25 did not achieve a complete motor block within 30 min, which were also significantly different. No significant difference was observed in postoperative analgesia, decrease of handgrip strength and the incidence of hemi-diaphragmatic paresis among the 3 groups. CONCLUSIONS: This study demonstrates that ropivacaine 50 mg as 0.25, 0.5 or 0.75 % solution for interscalene brachial plexus block before arthroscopic shoulder surgery produces comparable blockade with few side effects, while 0.75 % seems to be more preferable as it is associated with faster onset time. TRIAL REGISTRATION: ChiCTR-TRC-13004058 . Registered 4 December 2013.

[Preparation and characterization of salvianolic acids-tanshinones composite powder for inhalation via co-micronized method].

Salvianolic acids and tanshinones are main hydrophilic and lipophilic extracts from Salvia Miltiorrhiza with significant anti-pulmonary fibrosis effects. The aim of this study was to prepare a co-micronized salvianolic acids-tanshinones composite powder for inhalation using a planetary ball mill. The micronization process parameters were optimized by central composite design (CCD) and response surface methodology (RSM). Treatment time, rotation speed and the ball/sample weight ratio were selected as the independent variables, and the volume fraction of particle size in 1-5 µm was taken as the dependent variable. The powder properties were evaluated by scanning electron microscopy (SEM), laser diffraction and X-ray powder diffraction (XRPD). The powder flow and hygroscopicity were determined with repose angle, compressibility index and critical relative humidity(CRH). According to the results, the salvianolic acids-tanshinones composite powder produced in optimal conditions had a narrow and unimodal particle size distribution and a smaller D50 of 2.33 µm. The volume fraction of particle size in 1-5 µm was 80.82%. The repose angle was (50.60±1.13) °, and the critical relative humidity is about 77%. After being micronized, the particle size significantly reduced, and the number of amorphous substances slightly increased, with no significant changes in powder flow and hygroscopicity. These findings indicate that the grinding method with a planetary ball mill can be used to co-micronize various components with different properties and prepare composite drug powders for dry powder inhalation.

Curcumin-piperine mixtures in self-microemulsifying drug delivery system for ulcerative colitis therapy.

Curcumin (CUR) is a poorly water-soluble drug and its absorption is very low. In this study, CUR and piperine (PIP) were co-encapsulated into the nanoformulation called self-microemulsifying drug delivery system (SMEDDS) to improve the stability and water-solubility of CUR and enhance its anti-colitis activity. The formulation of CUR-PIP-SMEDDS was prepared to encapsulate two hydrophobic components CUR and PIP, and then was characterized by assessing appearance, morphology, particle size, zeta potential and drug encapsulation efficiency. The appearance of CUR-PIP-SMEDDS remained clarified and transparent, and the microemulsion droplets appeared spherical without aggregation. The mean size of microemulsion droplet formed from CUR-PIP-SMEDDS was 15.87 ± 0.76 nm, and the drug encapsulation efficiency of SMEDDS for CUR and PIP were (94.34 ± 2.18)% and (90.78 ± 2.56)%, respectively. The vitro stability investigation of CUR-PIP-SMEDDS in colon tissue suggested that using SMEDDS as a delivery vehicle and co-encapsulated with PIP, CUR was more stable than drug solution in colons site. Meanwhile, the anti-inflammatory activity of CUR-PIP-SMEDDS was evaluated on DSS-induced colitis model. The results showed that CUR-PIP-SMEDDS exhibited definite anti-colitis activity by directing CUR-PIP-SMEDDS to inflammatory colon tissue through retention enema administration. Our study illustrated that the developed CUR-PIP-SMEDDS formulation was a potential carrier for developing colon-specific drug delivery system of CUR for ulcerative colitis treatment.

[Optimization and characterization of curcumin-piperine dual drug loaded self-microemulsifying drug delivery system by simplex lattice design].

The objective of the study was to prepare and evaluate the quality of curcumin-piperinedual drug loaded self-microemulsifying drug delivery system(Cur-PIP-SMEDDS). Simplex lattice design was constructed using optimal oil phase, surfactant and co-surfactant concentration as independent variables, and the curcumin and piperine were used as model drugs to optimize Cur-PIP-SMEDDS formulation. In the present study, the drug loadings of curcumin and piperine, mean particle size of Cur-PIP-SMEDDS were made as indicators, and the experiment design, model building and response surface analysis were established using Design Expert 8. 06 software to optimize and verify the composition of SMEDDS formulation. The quality of Cur-PIP-SMEDDS was evaluated by observing the appearance status, transmission electron microscope micrographs and determining particle diameter, electric potential, drug entrapment efficiency and drug loading of it. As a result, the optimal formulation of SMEDDS was CapryoL 90-Cremophor RH40-TranscutoL HP (10:60:30). The appearance of Cur-PIP-SMEDDS remained clarified and transparent, and the microemulsion droplets appeared spherical without aggregation with uniform particle size distribution. The mean size of microemulsion droplet formed from Cur-PIP-SMEDDS was 15.33 nm, the drug loading of SMEDDS for Cur and PIP were 40.90 mg · g(-1) and 0.97 mg · g(-1), respectively, the drug entrapment efficiency were 94.98% and 90.96%, respectively. The results show that Cur-PIP-SMEDDS can increase the solubility and stability of curcumin significantly, in the expectation of enhancing the bioavailability of it. Taken together, these findings can provide the reference to a preferable choice of the Cur formulation and contribute to therapeutic application in clinical research.