Anesthesia Considerations in Emergency C-Section and Perioperative Neonatal Resuscitation: A Case Report and Review of Literature

Emergency C-sections are performed for various reasons. This is a case report of emergency C-section performed due to fetal distress. This is a classic case report which emphasizes the importance of managing emergency C-sections according to international standards and acknowledges co-operation of obstetrician and anesthesiologist. We reviewed literature about emergency C-sections and discussed sensitive time intervals, types of anesthesia and neonatal resuscitation.

Effects of Meglumine Cyclic Adenylate Pretreatment on Systemic inflammatory Response Syndrome Induced by Lipopolysaccharide in Rats

Studies showed that the use of cyclic adenosine monophosphate(cAMP) substitutes or intracellular c AMP activators increased intracellular cAMP level, causing anti-inflammatory effects. This study was to investigate the effects of pretreatment with meglumine cyclic adenylate(MCA), a compound of meglumine and cAMP, on systemic inflammation induced by lipopolysaccharide(LPS) in rats. Eighteen adult male Sprague-Dawley rats were randomly divided into 3 groups(n=6 each): control group(NS group), LPS group(LPS group) and LPS with MCA pretreatment group(MCA group). Systemic inflammation was induced with LPS 10 mg/kg injected via the femoral vein in LPS and MCA groups. In MCA group, MCA 2 mg/kg was injected via the femoral vein 20 min before LPS injection, and the equal volume of normal saline was given in NS and LPS groups at the same time. Three hours after LPS injection, the blood samples were taken from the abdominal aorta for determination of plasma concentrations of TNF-α, IL-1, IL-6, IL-10, cAMP by ELISA and NF-κBp65 expression by Western blotting. The experimental results showed that inflammatory and antiinflammatory indices were increased in LPS group compared to NS group; inflammatory indices were declined and anti-inflammatory indices were increased in MCA group relative to LPS group. Our study suggested that MCA pretreatment may attenuate LPS-induced systemic inflammation.

Effects of epinephrine on angiogenesis-related gene expressions in cultured rat cardiomyocytes

Epinephrine is often used for the treatment of patients with heart failure, low cardiac output and cardiac arrest. It can acutely improve hemodynamic parameters; however, it does not seem to improve longer term clinical outcomes. Therefore, we hypothesized that epinephrine may induce unfavorable changes in gene expression of cardiomyocyte. Thus, we investigated effects of epinephrine exposure on the mediation or modulation of gene expression of cultured cardiomyocytes at a genome-wide scale. Our investigation revealed that exposure of cardiomyocytes to epinephrine in an in vitro environment can up-regulate the expression ofangiopoietin-2 gene （~ 2.1 times）, and down-regulate the gene expression of neuregulin 1 （-3.7 times）, plasminogen activator inhibitor-1 （-2.4 times） and SPARC-related modular calcium-binding protein-2 （-4.5 times）. These changes suggest that epinephrine exposure may induce inhibition of angiogenesis-related gene expressions in cultured rat cardiomyocytes. The precise clinical significance of these changes in gene expression, which was induced by epinephrine exposure, warrants further experimental and clinical investigations.

Effects of milrinone on inflammatory response-related gene expressions in cultured rat cardiomyocytes

Congestive heart failure(CHF)is defined as a cardiac dysfunction leading to low cardiac output and inadequate tissue perfusion.Intravenous positive inotropes are used to increase myocardial contractility in hospitalized patients with advanced heart failure.Milrinone is a phosphodiesterase Ⅲ inhibitor and used most commonly for inotropic effect.The well-known PROMISE study investigated the effects of milrinone on mortality in patients with severe CHF,and concluded that long-term therapy with milrinone increased morbidity and mortality armong patients with advanced CHF.Previous studies have suggested that phosphodiesterase inhibitors can have potential effects on inflammatory pathways.Hence,we hypothesized that milrinone may alter inflammatory gene expressions in cardiomyocytes,thus leading to adverse clinical outcomes.We used rat cardiomyocyte cell line H9 C2 and studied the impact of exposing cardiomyocytes to milrinone(10 μmol/L)for 24 hours on inflammatory gene expressions.RNA extracted from cultured cardiomyocytes was used for whole rat genome gene expression assay(41 000 genes).The following changes in inflammatory response-related gene expressions were discovered.Genes with increased expressions included:THBS2(+ 9.98),MMP2(+3.47),DDIT3(+2.39),and ADORA3(+3.5).Genes with decreased expressions were:SPP1(-5.28)and CD14(-2.05).We found that the above mentioned gene expression changes seem to indicate that milrinone may hinder the inflammatory process which may potentially lead to adverse clinical outcomes.However,further in vivo and clinical investigations will be needed to illustrate the clinical relevance of these gene expression changes induced by milrinone.

静脉麻醉药物的新进展

咪达唑仑、依托咪酯和丙泊酚是目前常用的静脉麻醉药，静脉麻醉药物的研发都与它们衔尾相随。修饰已知药物的分子结构来改良药性以及发掘新型静脉麻醉药物，始终是过去数十年来并行不悖的制药焦点。静脉麻醉药物的一般作用机制是：通过促进神经元通道开放、易化氯离子内流，

全胚冷冻周期患者不同冻融胚胎移植次数的临床妊娠结局分析

目的探讨同一促排卵周期全胚冷冻患者,冻融胚胎移植(FET)次数与临床妊娠率的关系。方法选择2012年1月至2016年9月在苏北人民医院生殖医学中心实施全胚冷冻后FET的807例患者为研究对象,按照FET累计次数不同,将FET累计1次者纳入A组(n=543),FET累计2次者纳入B组(n=181),FET累计3次者纳入C组(n=63),FET累计4次者纳入D组(n=20)。回顾性分析807例患者的一般临床资料、移植周期资料以及累计临床妊娠率、临床妊娠率。结果 (1)4组患者的年龄、不孕年限、人体质量指数(BMI)、不孕类型构成比、不同因素全胚冷冻率构成比、基础卵泡刺激素(FSH)水平、基础黄体生成素(LH)水平、基础雌二醇水平、基础睾酮水平、基础窦卵泡数(AFC)、获卵数、减数第2次分裂中期(MⅡ)卵母细胞数、正常受精率、同一取卵周期可移植胚胎数等比较,差异均无统计学意义(P>0.05)。(2)各组患者胚胎移植日子宫内膜厚度、移植胚胎数、优质胚胎率及内膜准备方案中人工周期率比较,差异均无统计学意义(P>0.05)。(3)4组患者累计临床妊娠率分别为64.5%、60.0%、58.7%、60.0%,组间比较,差异无统计学意义(χ~2=1.67,P=0.64)。4组患者临床妊娠率依次为64.5%、36.5%、25.1%、18.8%,组间比较,差异有统计学意义(χ~2=143.02,P<0.01)。结论同一促排卵周期增加FET次数,全胚冷冻患者累计临床妊娠率无显著变化。同时首次进行FET未妊娠者,随着FET次数增加,临床妊娠率显著降低。