Effects of Combined Spinal-Epidural Analgesia during Labor on Postpartum Electrophysiological Function of Maternal Pelvic Floor Muscle: A Randomized Controlled Trial.

OBJECTIVE: Combined spinal-epidural analgesia (CSEA) is sometimes used for difficult births, but whether it contributes to postpartum pelvic muscle disorder is unclear. This randomized controlled trial examined whether CSEA given during labor affects the electrophysiological index of postpartum pelvic floor muscle function. METHODS: A consecutive sample of primiparous women who delivered vaginally at term were randomly assigned to a CSEA group (n = 143) and control group (n = 142) between June 2013 and June 2014. All were assessed 6-8 weeks later for electrophysiological function of pelvic floor muscle. RESULTS: The two groups were similar in the degree of muscle strength, muscle fatigue, and pelvic dynamic pressure of pelvic floor muscle. The CSEA and control groups showed similar proportions of women with normal muscle strength (score ≥4) in type I pelvic fibers (23.1% vs. 14.1%, P = 0.051) and type II pelvic fibers (28.0% vs. 24.6%, P = 0.524). The groups also contained similar proportions of women who showed no fatigue in type I fibers (54.5% vs. 48.6%, P = 0.315) or type II fibers (88.8% vs. 87.3%, P = 0.699). Similarly low proportions of women in the CSEA group and control group showed normal pelvic dynamic pressure (11.2% vs. 7.7%, P = 0.321). However, women in the CSEA group spent significantly less time in labor than those in the control group (7.25 vs. 9.52 h, P <0.001). CONCLUSIONS: CSEA did not affect the risk of postpartum pelvic muscle disorder in this cohort of primiparous women who gave birth vaginally. A significant shorter duration of labour was observed in the CSEA-group. TRIAL REGISTRATION: ClinicalTrials.gov NCT02334150.

[Effects of LFA-1 costimulation on proliferation and IgG production of PBMCs from lupus nephritis patients].

AIM: To study the effect of lymphocyte function associated antigen-1(LFA-1) costimulation on proliferation and immunoglobin production of peripheral blood mononuclear cells(PBMCs) form lupus nephritis(LN) patients. METHODS: 29 LN patients were enrolled in this study, and 12 healthy persons served as control. PBMCs from LN patients and healthy persons were obtained by Ficoll density gradient centrifugation, and cell proliferation was detected by (3)H-TdR incorporation. IgG content in cultural supermatant was detected by ELISA. RESULTS: Stimulation of anti-CD3 mAb alone could enhance the proliferation and IgG production of PBMCs from 29 LN patients,while the effects on PBMCs from patients in active phase were stronger than those from the patients in the inactive phase (P<0.01). But anti-CD3 mAb had no influenence on PBMCs from healthy persons.The costimulation of anti-CD3 mAb and LFA-1 could increase proliferation and IgG production of PBMCs from LN patients and healthy persons. The effects of this costimulation decreased in turn from active and inactive LN patients to normal persons (P<0.01). The costimulant effects of LFA-1 was inhibited by anti-LFA-1 mAb. CONCLUSION: The effects of enhancing PBMC proliferation and IgG production by LFA-1 may be a mechanism of LN pathogenesis.

[Surgical treatment for pigmented villonodular synovitis].

OBJECTIVE: Pigmented villonodular synovitis(PVS) is a synovial proliferative disorder that remains a diagnostic difficulty. In this retrospective study we evaluated the diagnostic procedures, clinical symptoms and surgical treatment of PVS. METHODS: Six surgically treated cases of PVS were evaluated: five of the lesions were located in the knee joint and one in the hip joint. Diagnosis of PVS was confirmed by histological examination. Operation showed characteristic findings of a joint effusion, and synovial proliferation. RESULTS: Five cases were treated with complete open total synovectomy, and one case received arthoplasty. The followed-up period averaged 3 years and six months (rangeing from 6 months to 6 years). Excellent and good function was seen in all and there was no recurrence. CONCLUSION: PVS diagnosis is frequently delayed due to nonspecific symptoms. Proper treatment includes surgery: extension synovectomy for the diffuse form, and arthoplasty and total joint replacement for the severe bone involvement.