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Postoperative Analgesia and Cesarean Section under General anesthesia: Multicenter Study

Open Journal of Anesthesiology 2024年第1期14卷 1-12页

作者： Ghislain Edjo Nkilly Raphael Okoue Ondo Pascal Christian Nze Obiang Stéphane Oliveira Jean-Marcel Mandji-Lawson Romain Tchoua Department of anesthesia and intensive care Omar Bongo Ondimba Army Training Hospital (HIAOBO) Libreville Gabon Department of anesthesia and intensive care Jeanne Ebori Fondation Libreville Gabon Department of anesthesia and intensive care Akanda Army Training Hospital Libreville Gabon

Background: Neuraxial anesthesia with intrathecal morphine is the reference technique in cesarean section anesthesia for the management of postoperative analgesia. If there is a contraindication to this, general anesthesia is required. the objective of the study was to evaluate the analgesic effectiveness of 4 analgesic techniques performed during cesarean section under general anesthesia in two centers with different anesthetic practices (North Franche Comté Hospital and Omar Bongo Ondimba Army Training Hospital). Method: this is a retrospective and descriptive study over 2 years, from January 1, 2019 to December 31, 2020. It involved evaluating the analgesic effectiveness and tolerance of morphine in the epidural catheter, wound infiltration, intravenous analgesia and Transversus Abdominous Plane block (TAP block) from the post-anesthesia care unit (PACU) until the 4th post-operative day. Results: Of the 354 cesarean sections performed, 84 (11.14%) received general anesthesia. the average age was 32.27 years. Acute fetal distress was the first indication for cesarean section (45.2%), followed by hemorrhagic placenta previa (10.7%) and prolapse of the cord (8.33%). Morphine in the epidural catheter was the most used (47.6%) followed by parietal infiltration (36.9%), intravenous analgesia (13.1%) and TAP block (2.38%). the analgesic effectiveness was comparable between the techniques from postoperative day 0 to day 4. No difference in side effects. Postoperative morphine consumption was significantly reduced (p = 0.011) in the infiltration (9 mg) and TAP block (9mg) groups compared to the epidural catheter (16 mg) and intravenous analgesia (17 mg). No difference in 02 rehabilitation criteria (ambulation, first bowel movement). No difference in the occurrence of chronic pain. Conclusion: In the event of a cesarean section under general anesthesia, there are effective and well-tolerated alternatives to neuraxial anesthesia, particularly regional anesthesia techniques (nerve blocks), particularly in count

关键词： Cesarean General anesthesia Morphine Parietal Infiltration Epidural Catheter Transversus Abdominis Plane Block Intravenous Analgesia

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Usefulness of the Surgical Apgar Score to Predict the Occurrence of Major Complications in the Early Post-operative Period of Major Surgeries: Experience of Two Second-Category Hospitals in Cameroon

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Open Journal of Anesthesiology 2024年第3期14卷 51-65页

作者： Charles Emmanuel Toussaint Binam Bikoi Francis Ateba Ndongo Serge Vivier Nga Nomo Édouard Léa Mekoui Ze Fidèle Binam Department of anesthesia and intensive care University of Ebolowa Ebolowa Cameroon Yaounde Mother and Child Center Chantal Biya Foundation University of Garoua Garoua Cameroon Department of anesthesia and intensive care Catholic University of Central Africa Yaounde Cameroon

Objective: the Surgical Apgar Score (SAS) is a tool for intraoperative stratification of the risk of serious complications in the early postoperative period. It varies from 0 to 10 points divided into three risk categories (0 to 4 high, 5 to 7 moderate, 8 to 10 low). the aim of the study was to evaluate its relevance in predicting the appearance of these complications. Material and methods: this descriptive and analytical study was carried out at the “Laquintinie” Hospital in Douala and at the Central Hospital in Yaounde, Cameroon. the main data were collected on a population of patients over 18 years old and recorded on a survey form. they consisted of variables of main interest and exposure variables. Univariate and multivariate statistical analysis using top-down logistic regression models made it possible to evaluate the association of each variable of main interest and each exposure variable. the association was significant at P Results: Of the 88 patients studied, the SAS was 3 hours. In multivariate, this link persisted only and strongly for the SAS OR (IC) 0.1 (0.1 - 0.2) and p = 000. Conclusion: the study found a specific and powerful link between the SAS score the occurrence of complications in the early postoperative period, in favor of its relevance in predicting them.

关键词： Early Postoperative Complications Major Surgeries Surgical Apgar Score

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Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

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World Journal of Clinical Cases 2024年第7期12卷 1235-1242页

作者： Ling Wang Deng-Yan Long intensive care Unit People's Hospital of Qiandongnan Miao and Dong Autonomous PrefectureKaili 556000Guizhou ProvinceChina

BACKGROUND intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.MEthODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.the relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.the most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).the neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION the main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.

关键词： intensive care unit-acquired weakness Risk factors Machine learning Prevention Strategies

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Data driven analysis reveals prognostic genes and immunological targets in human sepsis-associated acute kidney injury

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World Journal of Emergency Medicine 2024年第2期15卷 91-97页

作者： Qing Zhao Jinfu Ma Jianguo Xiao Zhe Feng Hui Liu Department of Diagnosis and Treatment of Cadres the First Medical CenterChinese PLA General HospitalBeijing 100853China intensive care Unit the 305th Hospital of Chinese PLABeijing 100032China Department of Critical care Medicine the First Medical CenterChinese PLA General HospitalBeijing 100853China Nephrology Department the First Medical CenterChinese PLA General HospitalBeijing 100853China

BACKGROUND:the molecular mechanism of sepsis-associated acute kidney injury(SA-AKI)is unclear.We analyzed co-differentially expressed genes(co-DEGs)to elucidate the underlying mechanism and intervention targets of SA-AKI.MEthODS:the microarray datasets GSE65682,GSE30718,and GSE174220 were downloaded from the Gene Expression Omnibus(GEO)database.We identified the co-DEGs and constructed a gene co-expression network to screen the hub genes.We analyzed immune correlations and disease correlations and performed functional annotation of the hub genes.We also performed single-cell and microenvironment analyses and investigated the enrichment pathways and the main transcription factors.Finally,we conducted a correlation analysis to evaluate the role of the hub genes.RESULTS:Interleukin 32(IL32)was identified as the hub gene in SA-AKI,and the main enriched signaling pathways were associated with hemopoiesis,cellular response to cytokine stimulus,inflammatory response,and regulation of kidney development.Additionally,IL32 was significantly associated with mortality in SA-AKI patients.Monocytes,macrophages,T cells,and NK cells were closely related to IL32 and were involved in the immune microenvironment in SA-AKI patients.IL32 expression increased significantly in the kidney of septic mouse.Toll-like receptor 2(TLR2)was significantly and negatively correlated with IL32.CONCLUSION:IL32 is the key gene involved in SA-AKI and is significantly associated with prognosis.TLR2 and relevant immune cells are closely related to key genes.

关键词： Sepsis Acute kidney injury Interleukin 32 Toll-like receptor 2 Bioinformatics analysis

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Identification prognostic features related to sphingolipid metabolism and experimental validation of TRIM47 in hepatocellular carcinoma

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BIOCELL 2024年第4期48卷 639-651页

作者： JIAN TANG CHENQIANG ZHU YUN CHEN YUNLONG WU MING HE YI ZHOU MINGHUA XIE Department of intensive care Unit The First People’s Hospital of Linping DistrictHangzhouChina Department of Pharmacy The First People’s Hospital of Linping DistrictHangzhouChina

Background:the speciﬁc impact of sphingolipid metabolism on developing hepatocellular Carcinoma(HCC)remains unclear.this study aims to explore the relationship between sphingolipid metabolism and HCC prognosis,immune response,and drug sensitivity.Methods:Data were obtained from the Cancer Genome Atlas(TCGA)-Hepatocellular Carcinoma(LIHC)and Gene Expression Omnibus(GEO,GSE14520 datasets).47 sphingolipid metabolism genes were obtained from the Kyoto Encyclopedia of Genes and Genomes(KEGG)database.After classifying HCC samples using the Non-negative Matrix Factorization(NMF)clustering method,differentially expressed genes were screened.then,8 risk genes were obtained by univariate analysis,survival random forest reduction and lasso analysis.the expression of 8 risk genes was veriﬁed in vitro.Results:8 risk genes were used to construct the Sphingolipid score model.High-Sphingolipid score predicted poor prognosis of HCC patients.Sphingolipid score was associated with immune checkpoints(IL-1B,TLR4,TGFB1,and IL-10),immune cells(th2,Treg,MDSC,Neutrophil,Fibroblasts and macrophage),and MAPK Cascade.In the High-Sphingolipid score group,a signiﬁcantly higher proportion of patients with TP53(p53)mutations was signiﬁcantly higher(56%).Furthermore,patients with a high-Sphingolipid score were predicted to have a higher sensitivity to chemotherapy drugs.In vitro validation showed that compared with normal liver cells LX-2,TRIM47,and S100A9 signiﬁcantly increased in liver cancer cells Hep G2,MHCC-97H,and Hep3B2.1-7,while SLC1A7,LPCAT1,and CFHR4 signiﬁcantly decreased.Silencing TRIM47 reduced the proliferation and promoted apoptosis.the levels of ceramide synthesis-related indexes(CERS1,CERS6,CERS5,and SPTLC2)increased,and the ACER3 related to catalytic hydrolysis decreased.Conclusion:We constructed a sphingolipid metabolism-related prognostic signature(Sphingolipid score)based on 8 risk genes.TRIM47 may affect the development of liver cancer by regulating the relevant indicators of ceramide synthesis and catalytic hydrolysis.

关键词： Hepatocellular carcinoma Sphingolipid metabolism TRIM47 Prognosis

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Diagnostic accuracy of ePOS score in predicting DNR labeling after ICU admission:A prospective observational study(ePOS-DNR)

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Journal of intensive Medicine 2024年第2期4卷 216-221页

作者： Omar E.Ramadan Ahmed F.Mady Mohammed A.Al-Odat Ahmed N.Balshi Ahmed W.Aletreby Taisy J.Stephen Sheena R.Diolaso Jennifer Q.Gano Waleed th.Aletreby Department of Critical care King Saud Medical CityRiyadhSaudi Arabia anesthesia Department Faculty of MedicineAin Shams UniversityCairoEgypt anesthesia Department Faculty of MedicineTanta UniversityTantaEgypt Faculty of Medicine Alexandria UniversityAlexandriaEgypt Nursing Department King Saud Medical CityRiyadhSaudi Arabia

Background Resuscitation can sometimes be futile and making a do-not-resuscitate(DNR)decision is in the best interest of the patient.the electronic poor outcome screening(ePOS)score was developed to predict 6-month poor outcomes of critically ill patients.We explored the diagnostic accuracy of the ePOS score in predicting DNR decisions in the intensive care unit(ICU).Methods this study was conducted at the ICU of a tertiary referral hospital in Saudi Arabia between March and May 2023.Prospectively,we calculated ePOS scores for all eligible consecutive admissions after 48 h in the ICU and recorded the DNR orders.the ability of the score to predict DNR was explored using logistic regression.Youden's ideal cut-off value was calculated using the DeLong method,and different diagnostic accuracy measures were generated with corresponding 95%confidence intervals(CIs).Results We enrolled 857 patients,125 received a DNR order and 732 did not.the average ePOS score of DNR and non-DNR patients was 28.2±10.7 and 15.2±9.7,respectively.ePOS score,as a predictor of DNR order,had an area under receiver operator characteristic(AUROC)curve of 81.8%(95%CI:79.0 to 84.3,P17 was associated with a sensitivity of 87.2(95%CI:80.0 to 92.5,Pthis study,the ePOS score performed well as a diagnostic test for patients who will be labeled as DNR during their ICU stay.A cut-off score>17 may help guide clinical decisions to withhold or commence resuscitative measures.

关键词： Do-not-resuscitate(DNR) Resuscitation intensive care unit(ICU) Diagnostic accuracy Sensitivity Specificity

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Prediction of th17/Treg cell balance on length of stay in intensive care units of patients with sepsis

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Journal of intensive Medicine 2024年第2期4卷 240-246页

作者： Yu Wu Guosheng Wu Minyu Li Yongqing Chang Miao Yu Yan Meng Xiaojian Wan Department of intensive care Medicine Changhai HospitalNaval Medical UniversityShanghaiChina Department of Anesthesiology Bethune International Peace HospitalShijiazhuangHebeiChina Department of Burns Changhai HospitalNaval Medical UniversityShanghaiChina Department of Special Needs Clinic Changhai HospitalNaval Medical UniversityShanghaiChina

Background Prolonged length of stay(LOS)of sepsis can drain a hospital's material and human resources.this study investigated the correlations between T helper type 17(th17)and regulatory T(Treg)balance with LOS in sepsis.Methods A prospective clinical observational study was designed in Changhai Hospital affiliated to Naval Medical University in Shanghai,China,from January to October 2020.the patients diagnosed with sepsis and who met the inclusion and exclusion criteria were recruited and whether the levels of cytokines,procalcitonin,subtypes,and biomarkers of T cells in the peripheral blood were detected.We analyzed the correlation between these and LOS.Results Sixty septic patients were classified into two groups according to whether their intensive care unit(ICU)stay exceeded 14 days.the patients with LOS≥14 days were older([72.6±7.5]years vs.[63.3±10.4]years,P=0.015)and had higher Sequential Organ Failure Assessment(SOFA)(median[interquartile range]:6.5[5.0–11.0]vs.4.0[3.0–6.0],P=0.001)and higher Acute Physiology and Chronic Health Evaluation(APACHE)II scores(16.0[13.0–21.0]vs.8.5[7.0–14.0],P=0.001).there was no difference in other demographic characteristics and cytokines,interleukin-6,tumor necrosis factor-α,and interleukin-10 between the two groups.the th17/Treg ratio of sepsis with LOSth LOS≥14 days,the area under the receiver operating characteristic curve for the th17/Treg ratio was 0.766.It improved to 0.840 and 0.850 when combined with the SOFA and APACHE II scores,respectively.Conclusions the th17/Treg ratio was proportional to septic severity and can be used as a potential predictor of ICU stay in sepsis,presenting a new option for ICU practitioners to better care for patients with sepsis.

关键词： Sepsis th17/Treg Length of stay intensive care units

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Effects of traditional Chinese medicine on treatment outcomes in severe COVID-19 patients:a single-centre study

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Chinese Journal of Natural Medicines 2024年第1期22卷 89-96页

作者： XIAO Yongjiu LI Binbin LIU Chang HUANG Xiuyu MA Ling QIAN Zhirong ZHANG Xiaopeng ZHANG Qian LI Dunqing CAI Xiaoqing YAN Xiangyong LUO Shuping XIANG Dawei XIAO Kun Emergency Department the 940th Hospital of Jiont Logistics Support Force of Chinese People’s Liberation ArmyLanzhou 730050China Scientific Research Center the Seventh Affiliated HospitalSun Yat-sen UniversityShenzhen 518000China School of Medicine Nankai universityTianjin 300000China Department of Cardiology the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation ArmyLanzhou 730050China Department of Radiation Oncology Fujian Medical University Union HospitalFuzhou 350000China Department of Traditional Chinese Medicine the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation ArmyLanzhou 730050China Department of Geriatric Diseases the Seventh Medical Center of Chinese PLA General HospitalBeijing 100700China Health and Sport Administration Muskingum UniversityOhioanUSA Laboratory of Vaccine and Antibody Engineering Beijing Institute of BiotechnologyBeijing 100071China Department of Pulmonary and Critical care Medicine the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation ArmyLanzhou 730050China Center of Pulmonary&Critical care Medicine Chinese People’s Liberation Army(PLA)General HospitalBeijing 100853China

As the search for effective treatments for COVID-19 continues,the high mortality rate among critically ill patients in intensive care Units(ICU)presents a profound challenge.this study explores the potential benefits of traditional Chinese medicine(TCM)as a supplementary treatment for severe COVID-19.A total of 110 critically ill COVID-19 patients at the intensive care Unit(ICU)of Vulcan Hill Hospital between Feb.,2020,and April,2020(Wuhan,China)participated in this observational study.All patients received standard supportive care protocols,with a subset of 81 also receiving TCM as an adjunct treatment.Clinical characteristics during the treatment period and the clinical outcome of each patient were closely monitored and analysed.Our findings indicated that the TCM group exhibited a significantly lower mortality rate compared with the non-TCM group(16 of 81 vs 24 of 29;0.3 vs 2.3 person/month).In the adjusted Cox proportional hazards models,TCM treatment was associated with improved survival odds(Pthermore,the analysis also revealed that TCM treatment could partially mitigate inflammatory responses,as evidenced by the reduced levels of proinflammatory cytokines,and contribute to the recovery of multiple organic functions,thereby potentially increasing the survival rate of critically ill COVID-19 patients.

关键词： COVID-19 Pneumonia Novel coronavirus Critically ill Traditional Chinese medicine Clinical outcome

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Neuroanatomical Basis of Postoperative Pain and Assessment of Its Management in a Series of Patients Undergoing Caesarean Sections

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Pain Studies and Treatment 2024年第2期12卷 21-32页

作者： Moustapha Diedhiou Philippe Manyacka Ma Nyemb Ndiamé Sarr Aissatou Sarr Ousmane thiam Mohamed Lamine Fall Health Sciences Training and Research Unit Gaston Berger Saint Louis University Saint Louis Senegal intensive care Unit Saint Louis Regional Hospital Saint Louis Senegal

Introduction: In recent decades, the cost of postoperative pain has been the subject of many studies based on protocols developed by scientific societies for its assessment and optimization. At the Regional Hospital of Saint-Louis (Senegal), several protocols have been developed for pain management, but no study has focused on the assessment of postoperative pain management specifically. We therefore initiated this work, the objectives of which were to remind the neuroanatomical and neurophysiological bases of postoperative pain, and to analyze the assessment and management of this pain in patients who have undergone a caesarean section. Materials and methods: this was a prospective and descriptive study, which took place in the gynecology-obstetrics department, over a period from January 2019 to July 2020. All patients who gave birth by cesarean section were included. the data was collected from a survey sheet written for this purpose. For each of the patients, the information was taken every day throughout the duration of postoperative hospitalization. Results: It appears from our work that after a cesarean section, the pain felt evolves on the first postoperative days with a peak during the second day. As in the data reported in the literature, there does not seem to be a difference in terms of pain intensity and analgesia dosage between scheduled and emergency caesarean sections. However, young age and female gender—for other types of surgeries—are risk factors associated with high postoperative pain scores. this trend is probably related to the low pain experience of tested patients. Our initial hypothesis was that acute post-operative pain after caesarean sections could be linked to defects in the perception and processing of pain by caregivers. Indeed, we have shown that awareness-raising, information, and training actions have made it possible to significantly improve the management of pain after a cesarean section. Conclusion: After a cesarean section the pain is intense, especially when the effects of t

关键词： Postoperative Pain Neuroanatomical Bases Assessment Cesarean Section

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the clinical,radiological,and surgical characteristics of anterior perforated substance glioma:a retrospective study

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Chinese Neurosurgical Journal 2024年第1期10卷 28-34页

作者： Zhiliang Wang Lianwang Li Zheng Wang Xuzhu Chen Zhong Zhang Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityNo.119 South 4th Ring West RoadBeijing 100070People’s Republic of China Department of Molecular Neuropathology Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina Department of Radiology Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina Department of Radiology Beijing Tiantan HospitalCapital Medical UniversityNo.119 South 4th Ring West RoadBeijing 100070People’s Republic of China

Background To explore the clinical,radiological,and surgical characteristics of anterior perforated substance(APS)gliomas.Methods Twenty patients with APS glioma who were treated with surgery between March 2019 and January 2022 from Tiantan hospital were retrospectively reviewed.the clinical,histological and radiological data were collected.Results Twenty patients,including 7 males(55%)and 13 females(45%),with a mean age at diagnosis of 37.9 years(range,28-53 years)underwent operative intervention for APS.Headaches and dizziness were the most common preoperative symptoms in the majority patients(14,70%).Based on radiological features of MRI,the APS was classified into two subtypes,type A and type B.Seven patients(40%)in type A indicated a clear tumor margin,while 13 patients(60%)in type B showed an ill-defined margin.the surgical approach including frontal,temporal,and coronal frontal incisions for type A and type B tumors,respectively.three patients in type A received total resection,while one patient in type B were total resected.Pathologically,12 cases(60%,12/20)were diagnosed as astrocytoma and 8 cases(20%,8/20)were oligodendroglioma.Meanwhile,17 cases(85%,17/20)had MGMT promotor methylation.Conclusion In this study,we performed the first systematic research of patients with APS glioma.Most of patients with APS presented headaches and dizziness symptoms.the APS glioma was further divided into two major radiological subtypes with relevant different surgical approaches.the APS glioma in type A were more likely to receive total resection.

关键词： Anterior perforated substance Glioma Magnetic resonance imaging Operation

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