Emergency Cesarean Delivery in a Parturient with Fontan Circulation and Reduced Platelets: A Case Report

NOWADAYS,Fontan circulation always refers to the hemodynamic status after total cavo-pul-monary connection, which was first created in the 1990s. There are two modern surgeryforms, one creating a channel within the right atrium and another making an extra-cardiac channel to connect infe-rior venous cava directly to the right pulmonary artery. Parturients with Fontan circulation are at increased risk of cardiac morbidity and thrombotic complications. We pre-sented a parturient with reduced platelet status of un-known reason undergoing an emergent cesarean delivery.

Construction of meloxicam and bupivacaine co-delivery nanosystem based on the pathophysiological environment of surgical injuries for enhanced postoperative analgesia

Besides peripheral nerve injury,the acute inflammation is one of the pathological features of tissues after surgery,which exacerbates the postoperative pain,especially in the first 48 h after the surgery.Multimodal analgesia(MMA),such as the combination of non-steroidal anti-inflammatory drugs(NSAIDs)with local anesthetics,has shown enhanced potency compared with the usage of local anesthetics alone.However,rare formulations can provide long-term analgesia at a single dose.Herein,bupivacaine(BUP,a local anesthetic)loading poly(lactic-co-glycolic acid)(PLGA)nanoparticles(NPB)were coated with meloxicam(MLX,an NSAID)loading lipid bilayer(LPM),forming a core–shell nanosystem(NPB@LPM)to provide enhanced and long-term analgesia to treat postoperative pain.MLX was encapsulated in the lipid shell,which enabled high dose MLX to be released in the first 48 h after surgery to reduce the acute inflammation induced pain.BUP was encapsulated in the PLGA core to provide a long-term release for the nerve block.This nanosystem provided a 7-day(whole recovery cycle)effective analgesia in the Brennan’s plantar incision rat model.The tissue reactions of NPB@LPM are benign.This work will provide feasible strategies on designing drug delivery systems for postoperative pain management.

Anti-inflammatory effects of diaporisoindole B in LPS-stimulated RAW 264.7 macrophage cells via MyD88 activated NF-κB and MAPKs pathways

Diaporisoindole B(DPB),an isoprenylisoindole alkaloid isolated from the mangrove endophytic fungus Diaporthe sp.SYSU-HQ3,has been proved to inhibit the production of nitric oxide(NO)in lipopolysaccharide(LPS)-challenged RAW 264.7 mouse macrophages,showing potent anti-inflammatory effects.In this study,we further investigated the anti-inflammatory effects of DPB and explored the possible mechanisms in LPS-challenged RAW 264.7 mouse macrophages.The results showed that DPB(3.125,6.2,12.5 and 25μM)could significantly reduce LPS-induced levels of PGE2,and inhibit the expressions of i NOS and COX-2 in a dose-dependent manner.In addition,DPB also inhibited LPS-induced production of inflammatory cytokines,including TNF-α,IL-1β,IL-6.Moreover,we further investigated signal transduction mechanisms by which DPB exerted anti-inflammatory effects.DPB could affect LPS-mediated nuclear factor kappa B(NF-κB)signaling pathway activation via down-regulating the upstream myeloid differentiation protein 88(MyD88)at the protein level.Additionally,DPB also strongly inhibited the phosphorylation of mitogen-activated protein kinases(MAPKs),including extracellular signal-regulated kinase(ERK)1/2,c-Jun N-terminal kinase(JNK)and p38.Therefore,DPB might exert anti-inflammatory effects by suppressing NF-κB activation and MAPKs pathways via down-regulating MyD88 in RAW 264.7 cells.

Transparent exopolymer particles(TEPs)-associated protobiofilm:A neglected contributor to biofouling during membrane filtration

Transparent exopolymer particles(TEPs)are a class of transparent gel-like polysaccharides,which have been widely detected in almost every kind of feed water to membrane systems,including freshwater,seawater and wastewater.Although TEP have been thought to be related to the membrane fouling,little information is currently available for their influential mechanisms and the pertinence to biofouling development.The present study,thus,aims to explore the impact of TEPs on biofouling development during ultrafiltration.TEP samples were inoculated with bacteria for several hours before filtration and the formation of“protobiofilm”(pre-colonized TEP by bacteria)was examined and its influence on biofouling was determined.It was observed that the bacteria can easily and quickly attach onto TEPs and form protobiofilms.Ultrafiltration experiments further revealed that TEP-protobiofilms served as carriers which facilitated and accelerated transport of bacteria to membrane surface,leading to rapid development of biofouling on the ultrafiltration membrane surfaces.Moreover,compared to the feed water containing independent bacteria and TEPs,more flux decline was observed with TEP-protobiofilms.Consequently,it appeared from this study that TEP-protobiofilms play a vital role in the development of membrane biofouling,but unfortunately,this phenomenon has been often overlooked in the literature.Obviously,these findings in turn may also challenge the current understanding of organic fouling and biofouling as membrane fouling caused by TEP-protobiofilm is a combination of both.It is expected that this study might promote further research in general membrane fouling mechanisms and the development of an effective mitigation strategy.