Effect of exercise during pregnancy on offspring development through ameliorating high glucose and hypoxia in gestational diabetes mellitus

BACKGROUND Gestational diabetes mellitus(GDM)women require prenatal care to minimize short-and long-term complications.The mechanism by which exercise during pregnancy affects organ development and whether glucose transporter(GLUT)1 plays a role in GDM offspring organ development remains unknown.AIM To determine the effect of exercise during pregnancy on the cardiac,hepatic and renal development of GDM mother’s offspring.METHODS Placenta samples were collected from humans and mice.GDM mouse models were created using streptozotocin along with a GDM with exercise group.The hearts,livers and kidneys of 3-and 8-week-old offspring were collected for body composition analysis and staining.The effects of high glucose levels and hypoxia were investigated using HTR8/SVneo.Transwell and wound-healing assays were performed to assess cell migration.Immunofluorescence accompanied with TUNEL and Ki67 staining was used to explore apoptosis and proliferation.RESULTS Exercise during pregnancy downregulated the GLUT1 and hypoxia inducible factor-1αexpression in placenta from individuals with GDM.Cobalt chloride induced hypoxia and high glucose levels also significantly decreased migration and apoptosis of HTR8/SVneo cells.In addition,exercise reduced inflammatory cell infiltration in the liver and decreased the tubular vacuolar area in the kidneys of offspring.CONCLUSION GDM affects the growth and development of organs in offspring.Exercise during pregnancy can reverse adverse effects of GDM on the development of the heart,liver,and kidney in offspring.

Successful treatment of group A streptococcal toxic shock syndrome occurring in late pregnancy:a case report

Streptococcal toxic shock syndrome(STSS)is an acute,life-threatening illness caused by invasive group A Streptococcus(iGAS).The initial manifestations of STSS are atypical,and may progress to shock,multiple organ dysfunction syndrome(MODS),and disseminated intravascular coagulation(DIC)quickly.

Application of prolonging small feeding volumes early in life to prevent of necrotizing enterocolitis in very low birth weight preterm infants

Objective:To study the effects of prolonging small feeding volumes early in life on the incidence of necrotizing enterocolitis(NEC)in very low birth weight(VLBW)preterm infants.Methods:A total of 128 VLBW infants who could not be breastfed were assigned into the experimental group(63 cases)and the control group(65 cases)using a random number table.The experiment group was fed 12 mL/(kg·d)on day 1 which was increased to 24 mL/(kg·d)for the first 10 study days.The control group was fed 12 mL/(kg·d)for the first 14e48 hours.Then,the feeding volume increased by 24-36 mL/(kg·d)up to 140e160 mL/(kg·d)and maintained until the 10th day after birth.The incidence of feeding intolerance and NEC,duration of hospitalization,time to full enteral feedings,incidence of intrahepatic cholestasis,and the levels of gastrin and motilin in serum were assessed.Results:The incidence of feeding intolerance was significantly lower in the experimental group compared with the control group(15.87% vs.33.84%).There was a significant reduction in the incidence of NEC between the experimental and control groups(7.9% vs.16% in the control group).Conclusion:A protocol that prolongs small feeding volumes early in life can reduce the incidence and severity of NEC,but still warrants further study.

Activation of Uterine Smad3 Pathway Is Crucial for Embryo Implantation

Embryo implantation is a complicated physiological process tightly regulated by multiple biological molecules including growth factors.Transforming growth factor-betas(TGF-βs)and their most specific signal transduction factors,Smads,are expressed in the endometrium during the window of implantation.Recent researches indicated that Smad dependent TGF-β signaling may play an important role in the process of embryo implantation.In this study,we measured the expression of TGF-β1,TGF-β receptor type I(TpRI),Smad3 and p-Smad3 in the endometrium of mice and observed their elevation on day 4,5 and 6 of pseudopregnancy.Then we administrated a specific Smad3 inhibitor(Sis3)into the uterine cavity of mice on day 3 of pregnancy.The results showed a reduction in insulin-like growth factor-1(IGFBP-1)expression and the decreased number of implanted embryo after the administration.In addition,Sis3 was found to reduce the IGFBP-1 secretion in decidualized endometrial stromal cells.Taken all together,our findings demonstrated that TGF-β/Smad3 signaling is involved in the process of embryo implantation.

A Systematic Review on Efficacy and Safety of Gasless Laparoscopy in the Management of Uterine Leiomyoma

Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy（GLM） in the management of uterine leiomyoma by comparing GLM with other minimally invasive procedures. Cochrane Library, PubMed, EMBASE, Web of Science, WANFANG database and China National Knowledge Infrastructure（CNKI） were searched for studies published in English or Chinese between January 1995 and May 2015, and related references were traced. Study outcomes from randomized controlled trials and retrospective cohort studies were presented as mean difference（MD） or odds ratio（OR） with a 95% confidence interval（CI）. Seventeen studies（including 1862 patients） meeting the inclusion criteria, including 934 treated with GLM and 928 treated with other minimally invasive procedures were reviewed. The results of meta-analysis revealed that GLM resulted in significantly shorter operating time [MD=–10.34, 95% CI（–18.12, –2.56）, P〈0.00001], shorter hospital stay [MD=–0.47, 95% CI（–0.88, –0.06）], less time to flatus [MD=–2.04, 95% CI（–2.59, –1.48）], less postoperative complications [OR=0.20, 95% CI（0.06, 0.62）] and less blood loss [MD =–30.74, 95% CI（–47.50, –13.98）]. On the other hand, there were no significant differences in duration of post-operative fever [MD=–0.52, 95% CI（–1.46, 0.42）] between the two groups. Additionally, GLM was associated with lower febrile morbidity, lower postoperative abdominal pain, and higher postoperative hemoglobin than other minimally invasive procedures for the treatment of uterine leiomyoma. In conclusion, GLM and other minimally invasive procedures are feasible, safe, and reliable for uterine leiomyoma treatment. However, available studies show that GLM is more effective and safer than other minimally invasive approaches.

Small Extracellular Vesicles Secreted by Peri-urethral Tissues Regulate Fibroblast Function and Contribute to the Pathogenesis of Female Stress Urinary Incontinence

Objective:This study aimed to explore the existence of small extracellular vesicles(sEVs)in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence(SUI).Methods:sEVs were extracted from peri-urethral vaginal wall tissues using differential centrifugation and were observed by transmission electron microscopy(TEM).The number of sEVs and their protein contents were compared between SUI and control groups using nanoparticle tracking analysis(NTA)and bicinchoninic acid(BCA)protein assay.Fibroblasts were cultured separately with SUI(SsEVs group)and normal tissue sEVs(NsEVs group).Proliferation and migration of fibroblasts were compared between groups using CCK-8 and wound healing assays,respectively.Expression levels of collagenⅠandⅢwere compared among blank control(BC),NsEVs,and SsEVs groups using real-time PCR.Protein mass spectrometry was used to test the differentially expressed proteins contained in sEVs between groups.Results:sEVs were extracted and found under the electron microscope.There were significantly more sEVs extracted from the SUI group compared to the normal group.Fibroblasts showed increased proliferative and decreased migratory abilities,and expressed more collagen in the SsEVs group compared to the NsEVs and BC groups.Protein spectrum analysis demonstrated several differentially expressed targets,including components of microfibrils,elastin polymer,and anti-inflammatory factors.Conclusion:sEVs were detected in the peri-urethral tissues.SUI tissues expressed more sEVs than control.The abnormal expression of sEVs and their protein contents may contribute to the pathogenesis and progression of SUI.

Retrorectal mucinous adenocarcinoma arising from a tailgut cyst:A case report and review of literature

BACKGROUND Tailgut cysts are defined as congenital cysts that develop in the rectosacral space from the residue of the primitive tail.As a congenital disease,caudal cysts are very rare,and their canceration is even rarer,which makes the disease prone to misdiagnosis and delayed treatment.We describe a case of caudal cyst with adenocarcinogenesis and summarize in detail the characteristics of cases with analytical value reported since 1990.CASE SUMMARY A 35-year-old woman found a mass in her lower abdomen 2 mo ago.She was asymptomatic at that time and was not treated because of the coronavirus disease 2019 pandemic.Two weeks ago,the patient developed abdominal distension and right waist discomfort and came to our hospital.Except for the high level of serum carcinoembryonic antigen,the medical history and laboratory tests were not remarkable.Magnetic resonance imaging showed a well-defined,slightly lobulated cystic-solid mass with a straight diameter of approximately 10 cm×9 cm in the presacral space,slightly high signal intensity on T2-weighted imaging,and moderate signal intensity on T1-weighted imaging.The mass was completely removed by laparoscopic surgery.Histopathological examination showed that the lesion was an intestinal mucinous adenocarcinoma,and the multidisciplinary team decided to implement postoperative chemotherapy.The patient recovered well,the tumor marker levels returned to normal,and tumor-free survival has been achieved thus far.CONCLUSION The case and literature summary can help clinicians and researchers develop appropriate examination and therapeutic methods for diagnosis and treatment of this rare disease.

Plasmid-based generation of neural cells from human fibroblasts using non-integrating episomal vectors

Differentiation of human fibroblasts into functional neurons depends on the introduction of viral-mediated transcription factors, which present risks of viral gene integration and tumorigenicity. In recent years, although some studies have been successful in directly inducing neurons through sustained expression of small molecule compounds, they have only been shown to be effective on mouse-derived cells. Thus, herein we delivered vectors containing Epstein-Barr virus-derived oriP/Epstein-Barr nuclear antigen 1 encoding the neuronal transcription factor, Ascl1, the neuron-specific microRNA, miR124, and a small hairpin directed against p53, into human fibroblasts. Cells were incubated in a neuron-inducing culture medium. Immunofluorescence staining was used to detect Tuj-1, microtubule-associated protein 2, neuron-specific nucleoprotein NeuN and nerve cell adhesion molecules in the induced cells. The proportion of Tuj1-positive cells was up to 36.7% after induction for 11 days. From day 21, these induced neurons showed neuron-specific expression patterns of microtubule-associated protein 2, NeuN and neural cell adhesion molecule. Our approach is a simple, plasmid-based process that enables direct reprogramming of human fibroblasts into neurons, and provides alternative avenues for disease modeling and neurodegenerative medicine.

Paternal transgenerational glucose intolerance with epigenetic alterations in second generation offspring of GDM

Gestational diabetes mellitus （GDM） has been shown to be associated withhigh risk of diabetes in offspring. In addi tion to intergenerational transmission （F1 offspring）, intrauterine hyperglycemia also has effects on the second generation （F2 off spring）. However, the mechanisms involved and the possibilities of transgenerational transmission are still unclear. In a recent study published in Diabetes, we have uti lized GDM mouse model to identify hyper glycemic intrauterine environment causing a high risk of diabetes in offspring by alter ing epigenetic modification. Furthermore, the results indicate that the abnormality of phenotype and imprinted genes expression are more obvious in male offspring than that of female. The changes of epigenetics in sperm may contribute to transgenera tional transmission. A growing body of research suggests that exposure to the abnormal environment in uterus can lead to chronic health problems later in life.1 Intrauterine hyperglycemia is a major characteristic of GDM and has been suggested as an important determinative fac tor for the risk of diabetes in adulthood, it1 addition to the effects of genetic factors.2 The mechanism involved in the association between intrauterine hyperglycemia and a high risk of diabetes in offspring remains unclear.3 In mammals, epigenetic reprogram ming is involved in germ cells and early embryonic development.4＇5 Because erasure and establishment of the genomic imprints for some imprinted genes begin when migra tory primordial germ ceils enter the embry onic genital ridge through gametogenesis, epigenetic abnormalities that occur duringthis phase may be involved in transgenera tional transmission.6 In the study, Ding et al.7 established a GDM mouse model of intrauterine hypergly cemia. The female （9） and male （or） F1 adults of control and GDM mice were intercrossed to obtain F2 offspring of four groups： （i） C0＂ C9; （ii） CCYGDMg; （iii） GDMCrCg; and （iv） GDMcYGDMg. We found that intrau terine hyperglycemia induced impaired glu cose tolerance （IGT） and abnormal insulin levels in F1 offspring, which are partly due to the deficient islet ultrastructure. IGT of male GDM offspring was more obvious than that of female offspring, suggesting that male fetus might be more sensitive to the intrauterine environment than female. Furthermore, the intrauterine hyperglycemia induced transgenerational transmission of glucose intolerance and abnormal insulin levels. In all F2GDM offspring groups, IGT of male was obvious than that of female, sug gesting the effect of intrauterine hyperglyce mia on F2 males was more obvious than F2 females. Intrauterine environment with mode rate hyperglycemia did not affect birth weight of F1GDM, but increased birth weight of F2 offspring born from F1GDM with IGT. After born from F1GDM with IGT, the birth weight in the GDMcYCC2 and GDMCY GDM9 groups significantly increased when compared with C0＂C9, which showed sex specific characteristics. In previous study, a number of diabetesrelated animal models also show gender differences, with males having a more profound phenotype.8 In the Nagoya ShibataYasuda mice, there is a marked gen der difference with almost all males developing hyperglycemia, but less than a third of females being affected.9 Many genetically induced forms of insulin resistance have a more severe phenotype in males compared with females.1~The gender differences in transmission of phe notypes indicate that epigenetic mechanisms may be involved in transgenerational effect. To define further the potential secretory defects that could contribute to glucose into lerance in offspring exposed to intrauterine hyperglycemia, we assessed glucosestimulated insulin secretion of islets isolated from 8weekold male mice. We found in vitro glu cosestimulated insulin secretion was impaired in both F1GDM and F2GDM offspring. Reduced glucosestimulated insulin secretion may contribute to impaired glucose tolerance in both F1 and F2 offspring from intrauterine hyperglycemia. Many factors are related to ~3cell dysfunction. In our study, we focused on the imprinted genes involved in islet development and the pathogenesis of diabetes, Igf2, H19 and Plagll. Downregulated express ion of Igf2 and H19 exhibited not only in F1GDM but also in F2GDM offspring through both paternal and maternal lines, confirming that dysregulation of Igf2 leads to inappropriate insulin production and secre tion and induces diabetes.11＇12 Moreover, in F2GDM offspring, decreased level of Ig/2 and H19 expression was associated with par ental characteristics. Igfi2 reduced maximum through the maternal line, while H19 was reduced maximum through the patemal line. In accordance with the tendency of phenotype changes, the change of imprinted genes expression was also more obvious in male off spring than that of female.

Acute abdominal pain from ovarian endometriosis

Endometriosis is a common,estrogen-dependent,inflammatory,gynecologic disease process in which normal endometrial tissue is abnormally present outside the uterine cavity.[1]Endometriosis is a common cause of chronic pain,dyspareunia,dysmenorrhea,and infertility.Most commonly,endometriosis is found within the pelvis,specifically on the ovaries.Because of rupture,bleeding,infection,or torsion,ovarian endometriosis(OMA)may cause acute abdominal pain,which is similar to acute abdominal pain caused by other reasons and is not easy to diagnose.[2,3]Determining the clinical and pathological features of OMA is crucial for accurate assessment,diagnosis,and treatment.

A cross-sectional study on nurse turnover intention and influencing factors in Jiangsu Province, China

Background:Nurses'turnover has been a major concern globally,which is strongly influenced by nurses'intent to leave.However,only a few large sample studies on the predictive factors associated with nurses'turnover intention were conducted in Jiangsu Province.This study mainly aims to examine the level and factors that influence nurses to leave their work in Jiangsu Province of Eastern China.Methods:A cross-sectional survey of 1978 nurses was conducted at 48 hospitals in 14 key cities throughout Jiangsu Province.The turnover intention in nurses was measured by the scale of intent to leave the profession.The work environment of nurses was measured by the Chinese version of the Practice Environment Scale.A multiple linear regression model was applied to analyse the factors associated with turnover intention.Results:The resignation rate of nurses in the hospitals of Jiangsu Province ranged from 0.64%to 12.71%in 2016.The mean scores were 15.50±3.44 for turnover intention,and 3.06±0.51 for work environment.Involvement in hospital affairs,resource adequacy,age,professional title,year(s)working,employment type and education level were the predictors of nurse intent to leave(P<0.05).Conclusion:The work environment of nurses in hospitals must be improved in staffing and resource and nurses'involvement in hospital affairs.The current study corroborates that nurses have high turnover intention.Thus,effective measures are needed to improve nurse accomplishment,professional status,participation in hospital affairs and career planning to reduce their turnover intention.

Use of electroacupuncture and transcutaneous electrical acupoint stimulation in reproductive medicine:a group consensus

Abstract： With the rapid development of assisted reproductive technology, various reproductive disorders have been effectively addressed. Acupuncture-like therapies, including electroacupuncture （EA） and transcutaneous electrical acupoint stimulation （TEAS）, become more popular world-wide. Increasing evidence has demonstrated that EA and TEAS are effective in treating gynecological disorders, especially infertility. This present paper describes how to select acupoints for the treatment of infertility from the view of theories of traditional Chinese medicine and how to determine critical parameters of electric pulses of ENTEAS based on results from animal and clinical studies. It summarizes the principles of clinical application of EA/rEAS in treating various kinds of reproductive disorders, such as polycystic ovary syndrome （PCOS）, pain induced by oocyte retrieval, diminished ovarian reserve, embryo transfer, and oligosperrnia/ asthenospermia. The possible underlying mechanisms mediating the therapeutic effects of EA/TEAS in reproductive medicine are also examined.

Mitochondrial DNA haplogroup associated with sperm motility in the Han population

In this study, we aimed to determine whether the main mitochondrial DNA （mtDNA） haplogroups of the Han people have an impact on spermatozoa motility, We recruited 312 men who were consecutively admitted to two affiliated hospitals of College of Medicine, Zhejiang University from May 2011 to April 2012 as part of fertility investigations. Semen and whole blood samples were collected from the men. We determined the mtDNA haplogroups by analysing the sequences of mtDNA hypervariable segment I and testing diagnostic polymorphisms in the mtDNA coding region with DNA probes, No significant differences were found in the clinical characteristics of the mtDNA haplogroup R and non-R （P〉0.05）. Our results suggest that mtDNA haplogroup R is a strong independent predictor of sperm motility in the Han population, conferring a 2.97-fold （95% confidence interval： 1.74-4.48, P〈0.001） decreased chance of asthenozoospermia compared with those without haplogroup R.

Resilience in new nurses:a qualitative study

Objectives:To explore the resilience experience of new nurses and how new nurses develop and apply resilience strategies to cope with the difficulties during the transition period.Methods:A descriptive qualitative research method was on data acquired using data semi-structured interviews with 12 new nurses aged 20-26 years whose working time was more than 12 months but less than 24 months.Results:Analysis of the data could determine participants adopting resilience strategies to withstand difficulties and challenges in transition period.This period consisted of three main phases:"self-protection,""undertaking challenges,"and"planning future."The first-line nurse managers'feedback and flexible shift scheduling paid a vital part in promoting the resilience development of new nurses.Conclusions:Recognizing the importance of understanding and developing the resilience of new nurses in the transition period could greatly reduce the turnover rate and alleviate the shortage of nurses in global nursing workforce.

Analysis of In-hospital Neonatal Death in the Tertiary Neonatal Intensive Care Unit in China： A Multicenter Retrospective Study

Background：Globally,the proportion of child deaths that occur in the neonatal period remains a high level of 37-41%.Differences of cause in neonate death exist in different regions as well as in different economic development countries.The specific aim of this study was to investigate the causes,characteristics,and differences of death in neonates during hospitalization in the tertiary Neonatal Intensive Care Unit （NICU） of China.Methods：All the dead neonates admitted to 26 NICUs were included between January 1,2011,and December 31,2011.All the data were collected retrospectively from clinical records by a designed questionnaire.Data collected from each NICU were delivered to the leading institution where the results were analyzed.Results：A total of 744 newborns died during the l-year survey,accounting for 1.2% of all the neonates admitted to 26 NICUs and 37.6% of all the deaths in children under 5 years of age in these hospitals.Preterm neonate death accounted for 59.3% of all the death.The leading causes of death in preterm and term infants were pulmonary disease and infection,respectively.In early neonate period,pulmonary diseases （56.5%） occupied the largest proportion ofpreterm deaths while infection （27%） and neurologic diseases （22%） were the two main causes of term deaths.In late neonate period,infection was the leading cause of both preterm and term neonate deaths.About two-thirds of neonate death occurred after medical care withdrawal.Of the cases who might survive if receiving continuing treatment,parents＇ concern about the long-term outcomes was the main reason of medical care withdrawal.Conclusions：Neonate death still accounts for a high proportion of all the deaths in children under 5 years of age.Our study showed the majority of neonate death occurred in preterm infants.Cause of death varied with the age of death and gestational age.Accurate and prompt evaluation of the long-term outcomes should be carried out to guide the critical decision.

Women's health and Chinese integrative medicine

Researchers in the fields of obstetrics, gynecology, and Chinese integrative medicine （CIM） were invited to share their perspectives on the most recent studies.

THE USE OF TRADITIONAL CHINESE MEDICINE FOR IN VITRO FERTILIZATION IN CHINA: CLINICAL EVIDENCE

In vitro fertilization(IVF),as an important assisted reproductive technology(ART),is chosen by over l,000,000infertile couples each year,which is linked to over 3,000,000babies bom worldwide.However,an IVF cycle may be unsuccessful.The success of IVF is not guaranteed,and patients often have to undergo more than one cycle of treatment before they are successful.IVF treatment

A simplified method for evaluating the anatomical axis of the upper two-thirds of the vagina on MRI:A hospital-based cross-sectional study

Backgrounds:Pelvic organ prolapse commonly affects the upper two-thirds of the vagina.However,evaluating this region in its normal position presents challenges.This study aimed to assess the anatomical axis of this vaginal segment using pelvic magnetic resonance imaging measurements.Methods:A retrospective study of 614 hospitalized women from two hospitals,who were rigorously screened to exclude those with Pelvic Organ Prolapse or known anatomical variations(median age:43 years,range:17-76 years).Two reference lines were used:the pubococcygeal line(PCL)and a line from the inferior pubic symphysis to the third sacral vertebra(PS3L).Distances between the distal,middle,and apical points of the upper vagina and the reference lines,as well as the angles between the upper vagina and the reference lines,were measured.Comparisons were made among different age groups.Results:The median distances from the distal,middle,and apical vaginal points to the PCL were 0.4 cm(interquartile range[IQR]:0.0-0.7 cm),2.1 cm(IQR:1.7-2.5 cm)and 3.1 cm(IQR:2.5-3.7 cm),respectively.The median PCL-vaginal angle was 29.0°(IQR:23.0-34.0°).The median distances from the distal,middle,and apical vaginal points to the PS3L were-0.5 cm(IQR:-0.9-0.0 cm),0.0 cm(IQR:-0.4-0.6 cm),and-0.2 cm(IQR:-0.9-0.0 cm),respectively.The median PS3L-vaginal angle was 0.0°(IQR:-4.0-7.0°).Women aged 50 years or older had slightly lower vaginal points and slightly larger angles than younger groups in relation to both reference lines(p<.001).The vaginal axis in younger groups appeared parallel to the PS3L.Conclusions:The axis of the upper two-thirds vagina was proximate to a line from the inferior pubic symphysis to the third sacral vertebra,particularly in younger women.It will likely become a simplified method for roughly assessing the vaginal axis in its situ at first glance.

A promising measure to prevent HPV-positive oral squamous cell carcinoma

The article “ HPV and oral squamous cell carcinoma: a review of HPV-positive OSCC and possible strategies for future” provides inspiring insights into the association between human papillomavirus (HPV) infection and oral squamous cell carcinoma (OSCC), as well as the possible strategies that we can adopt in future to minimize its health impact on the population [1]. This association has been widely recognized in recent years, particularly, for the high-risk HPV 16 and 18 strains. The cancer-inducing proteins E6 and E7 of HPV have been identified to be the main factors that in h ib it the tumor suppressors p53 and retinoblastoma protein (pRb), contributing to the development of OSCC. It also has been confirmed that HPV infection is associated with OSCC prognosis. Compared to HPV-negative OSCC patients, HPV-positive OSCC patients have a better prognosis [2].At present, there is no suitable OSCC HPV infection detection method approved by the health adm inistration.Potential methods include immunohistochemical detection of p16 expression, polymerase chain reaction(PCR), or in situ hybridization detection method, which are used to indirectly reflect the HPV infection status. Due to the ineffectiveness of these methods, there are no HPV infection status screening programs for the OSCC high-risk group. Therefore, developing effective HPV detection methods for the early detection and treatment of HPV-induced OSCC is of great significance.

ED50 and ED95 of Intrathecal Bupivacaine Coadministered with Sufentanil for Cesarean Delivery Under Combined Spinal-epidural in Severely Preeclamptic Patients

Background： Spinal anesthesia was considered as a reasonable anesthetic option in severe preeclampsia when cesarean delivery is indicated, and there is no indwelling epidural catheter or contraindication to spinal anesthesia. However, the ideal dose of intrathecal bupivacaine has not been quantified for cesarean delivery for severe preeclamptic patients. This study aimed to determine the ED50 and ED95 of intrathecal bupivacaine for severely preeclamptic patients undergoing elective cesarean delivery. Methods： Two hundred severely preeclamptic patients are undergoing elective cesarean delivery under combined spinal-epidural anesthesia enrolled in this randomized, double-blinded, dose-ranging study. Patients received 4 rag, 6 mg, 8 mg, or 10 mg intrathecal hyperbaric bupivacaine with 2.5 μg sufentanil. Successful spinal anesthesia was defined as a T6 sensory level achieved within 10 minutes after intrathecal drug administration and/or no epidural supplement was required during the cesarean section. The ED50 and ED95 were calculated with a logistic regression model. Results： ED90 and ED95 ofintrathecal bupivacaine for successful spinal anesthesia were 5.67 mg （95% confidence interval [C/]： 5.20-6.10 mg） and 8.82 mg （95% CI： 8.14-9.87 mg） respectively. The incidence of hypotension in Group 8 mg and Group 10 mg was higher than that in Group 4 mg and Group 6 mg （P 〈 0.05）. The sensory block was significantly different among groups 10 minutes after intrathecal injection （P 〈 0.05）. The use of lidocaine in Group 4 mg was higher than that in other groups （P 〈 0.05）. The use of phenylephrine in Group 8 mg and Group 10 mg was higher than that in the other two groups （P 〈 0.05）. The lowest systolic blood pressure before the infant delivery of Group 8 mg and Group 10 mg was lower than the other two groups （P 〈 0.05）. The satisfaction of muscle relaxation in Group 4 mg was lower than other groups （P 〈 0.05）. There was no significant difference in patients＇ satisfaction and the newborns＇ Apgar score and the blood gas analysis of umbilical artery serum （P 〉 0.05）. Conclusion： Our study showed that the EDs0 and ED~ of intrathecal bupivacaine for severely preeclamptic patients undergoing elective cesarean delivery were 5.67 mg and 8.82 mg, respectively. In addition, decreasing the dose of intrathecal bupivacaine could reduce the incidence of maternal hypotension.