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Risk factors for postpartum posttraumatic stress disorder after emergency admission

World Journal of Emergency Medicine 2024年第2期15卷 121-125页

作者： Fengxia Du Jun Zha Yan Li Lichao Fang Shuyu Xia Youjia Yu Department of Obstetrics Suzhou Xiangcheng People’s HospitalSuzhou 215131China Department of anesthesiology the Second Affiliated Hospital of Wannan Medical CollegeWuhu 241000China Department of anesthesiology Suzhou Xiangcheng People’s HospitalSuzhou 215131China Department of Emergency and intensive care unit Suzhou Xiangcheng People’s HospitalSuzhou 215131China

BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency *** identification of risk factors for this condition is crucial for developing effective preventive *** retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency ***:Medical records of women who gave birth after emergency admission were collected between March 2021 and April *** patients’general conditions and perinatal clinical indicators were *** puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks *** logistic regression analysis was performed to identify risk ***:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks *** logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum *** pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum ***:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective *** findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.

关键词： Risk factors Posttraumatic stress disorder Emergency Delivery

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Neuroprotective effects of chaperone-mediated autophagy in neurodegenerative diseases

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Neural Regeneration Research 2024年第6期19卷 1291-1298页

作者： Qi Jia Jin Li Xiaofeng Guo Yi Li You Wu Yuliang Peng Zongping Fang Xijing Zhang Department of anesthesiology and Perioperative Medicine and Department of intensive care unit Xijing HospitalThe Fourth Military Medical UniversityXi’anShaanxi ProvinceChina Department of Critical care Medicine Air Force Medical CenterBeijingChina Translational Research Institute of Brain and Brain-Like Intelligence Shanghai Fourth People’s HospitalSchool of MedicineTongji UniversityShanghaiChina

Chaperone-mediated autophagy is one of three types of autophagy and is characterized by the selective degradation of ***-mediated autophagy contributes to energy balance and helps maintain cellular homeostasis,while providing nutrients and support for cell ***-mediated autophagy activity can be detected in almost all cells,including *** to the extreme sensitivity of neurons to their environmental changes,maintaining neuronal homeostasis is critical for neuronal growth and ***-mediated autophagy dysfunction is closely related to central nervous system *** has been shown that neuronal damage and cell death are accompanied by chaperone-mediated autophagy *** certain conditions,regulation of chaperone-mediated autophagy activity attenuates *** this paper,we review the changes in chaperone-mediated autophagy in neurodegenerative diseases,brain injury,glioma,and autoimmune *** also summarize the most recent research progress on chaperone-mediated autophagy regulation and discuss the potential of chaperone-mediated autophagy as a therapeutic target for central nervous system diseases.

关键词： chaperone-mediated autophagy neurodegenerative disease neuronal homeostasis neuroprotection

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Tissue-resident macrophages exacerbate lung injury after remote sterile damage

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Cellular & Molecular Immunology 2024年第4期21卷 332-348页

作者： Hanhui Zhong Jingjing Ji Jinling Zhuang Ziying Xiong Pengyun Xie Xiaolei Liu Jundi Zheng Wangli Tian Xiaoyang Hong Jing Tang The Department of anesthesiology Affiliated Hospital of Guangdong Medical UniversityZhanjiangGuangdongChina The Department of Critical care Medicine General Hospital of Southern Theater Command of PLAGuangzhouChina The Department of Respiratory Medicine Guangdong Provincial Hospital of Integrated Chinese and Western MedicineFoshanChina Pediatric intensive care unit Senior Department of Pediatricsthe Seventh Medical Center of PLA General HospitalBeijingChina

Remote organ injury,which is a common secondary complication of sterile tissue damage,is a major cause of poor prognosis and is difficult to ***,we report the critical role of tissue-resident macrophages in lung injury after trauma or stroke through the inflammatory *** found that depleting tissue-resident macrophages rather than disrupting the recruitment of monocyte-derived macrophages attenuated lung injury after trauma or *** findings revealed that the release of circulating alarmins from sites of distant sterile tissue damage triggered an inflammatory response in lung-resident macrophages by binding to receptor for advanced glycation end products(RAGE)on the membrane,which activated epidermal growth factor receptor(EGFR).Mechanistically,ligand-activated RAGE triggered EGFR activation through an interaction,leading to Rab5-mediated RAGE internalization and EGFR phosphorylation,which subsequently recruited and activated P38;this,in turn,promoted RAGE translation and trafficking to the plasma membrane to increase the cellular response to RAGE ligands,consequently exacerbating *** study also showed that the loss of RAGE or EGFR expression by adoptive transfer of macrophages,blocking the function of RAGE with a neutralizing antibody,or pharmacological inhibition of EGFR activation in macrophages could protect against trauma-or stroke-induced remote lung ***,our study revealed that targeting the RAGE-EGFR signaling pathway in tissue-resident macrophages is a potential therapeutic approach for treating secondary complications of sterile damage.

关键词： tissue-resident macrophage RAGE remote sterile damage

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Low T3 vs low T3T4 euthyroid sick syndrome in septic shock patients:A prospective observational cohort study

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World Journal of Critical care Medicine 2024年第3期13卷 53-62页

作者： Mirza Kovacevic Visnja Nesek-Adam Semir Klokic Ekrema Mujaric Department of anesthesiology Resuscitation and Intensive CareCantonal HospitalZenica 72000Bosnia and Herzegovina Department of anesthesiology Resuscitation and Intensive CareClinical Hospital Sveti DuhZagreb 10000Croatia Gruppenpraxis General Practitioner's OfficeLaufen 4242Switzerland Department of Internal Diseases Cantonal HospitalZenica 72000Bosnia and Herzegovina

BACKGROUND Both phases of euthyroid sick syndrome(ESS)are associated with worse prognosis in septic shock *** there are still no indications for supplementation therapy,there is no evidence that both phases(initial and prolonged)are adaptive or that only prolonged is maladaptive and requires *** To analyze clinical,hemodynamic and laboratory differences in two groups of septic shock patients with *** A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 *** analysis included demographic data,mortality scores,intensive care unit stay,mechanical ventilation length and 28-day survival and laboratory with *** The Simplified Acute Physiology Score II score(P=0.029),dobutamine(P=0.003)and epinephrine requirement(P=0.000)and the incidence of renal failure and multiple organ failure(MOF)(P=0.000)were significantly higher for the low ***(P=0.047),neutrophilia(P=0.038),lymphopenia(P=0.013)and lactatemia(P=0.013)were more pronounced on T2 for the low T3T4 group compared to the low T3 *** blood pressure at T0(P=0.017)and T1(P=0.007),as well as mean arterial pressure at T0(P=0.037)and T2(P=0.033)was higher for the low T3 *** The low T3T4 population is associated with higher frequency of renal insufficiency and MOF,with worse laboratory and hemodynamic *** findings suggest potentially maladaptive changes in the chronic phase of septic shock.

关键词： Septic shock Euthyroid sick syndrome Low T3 Low T3T4 intensive care unit

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Meningeal cryptococcosis in a pancreas transplant recipient requiring grafectomy: A case report

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World Journal of Gastrointestinal Surgery 2024年第9期16卷 3032-3040页

作者： Ileana Lulic Gorana Fingler Dinka Lulic Jadranka Pavicic Saric Danko Mikulic Tajana Filipec Kanizaj Eleonora Goluza Department of Anaesthesiology Intensive Care and Pain MedicineClinical Hospital MerkurZagreb 10000Croatia Immediate Medical care unit Saint James HospitalSliema SLM-1030Malta Department of Surgery Clinical Hospital MerkurZagreb 10000Croatia Department of Gastroenterology Clinical Hospital MerkurZagreb 10000Croatia Department of anesthesiology Intensive Care Medicine and Pain TherapyUniversity Hospital Center ZagrebZagreb 10000Croatia

BACKGROUND Through continuous improvement in transplantation medicine,a wider range of solid organ transplant(SOT)recipients is considered suitable for complex *** advances in modern transplantation practice,transpiring invasive fungal infections pose a substantial threat for SOT *** our knowledge,cryptococcal infection confined amidst sole pancreas SOT recipients has not been described to *** of a multidisciplinary transplant team approach in the management of pancreas SOT recipients presenting with complex cryptococcal complications is fundamental in improving patient *** SUMMARY We present the case of a female pancreas transplant recipient,with confirmed meningeal cryptococcosis,referred to our institution for further evaluation and treatment from the Regional Center for Infectious *** admission,the patient was weaned from the protocolized immunosuppression therapy for two consecutive weeks,in addition to tapering systemic corticosteroid remedial *** novel multidisciplinary transplant team approach embodied exhaustive discussions of possible complex and diverse multiple organ system physiologic and pathologic challenges associated with distinct management strategies in pancreas transplant *** to the potentially devastating impact of invasive cryptococcosis in terms of morbidity and mortality,a definitive surgical intervention of pancreas transplant grafectomy was reinforced,as a pathway towards secure access to early meaningful expertise *** patient was discharged to the Regional Center for Infectious Diseases 2 mo after the admittance further advancing to a clinical *** The precision transplantation approach by tailoring complex medical interventions to individual needs proved indispensable in improving our patient’s outcomes.

关键词： Solid organ transplantation Pancreas transplantation Complications Meningeal cryptococcosis Management Grafectomy Case report

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Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

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Open Journal of anesthesiology 2024年第3期14卷 41-50页

作者： Kunal Tewari Sumanth Pelluru Deepak Mishra Nitin Pahuja Akash Ray Mohapatra Jyotsna Sharma Om Bahadur Thapa Manjot Multani Department of anesthesiology and Critical care Armed Forces Medical College Pune India Department of anesthesiology and Critical care Military Hospital Bhopal India

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

关键词： Chest X ray (CXR) Consolidation Pulmonary edema Pleural effusion Lung ultrasound (LUS) Pneumothorax

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Postoperative Analgesia and Cesarean Section under General Anesthesia: Multicenter Study

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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

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

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Advancing cell-based therapy in sepsis:An anesthesia outlook

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Chinese Medical Journal 2024年第13期137卷 1522-1534页

作者： Hui Ye Xiaoyu Zou Xiangming Fang Department of anesthesiology and intensive care The First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouZhejiang 310003China The Children’s Hospital National Clinical Research Center for Child HealthSchool of MedicineZhejiang UniversityHangzhouZhejiang 312000China

Sepsis poses a health challenge globally owing to markedly high rates of morbidity and *** employing bundle therapy over two decades,approaches including transient organ supportive therapy and clinical trials focusing on signaling pathways have failed in effectively reversing multiple organ failure in patients with *** and appropriate perioperative management for surgical patients with concurrent sepsis is ***,innovative therapies focusing on remedying organ injuries are *** therapy has emerged as a promising therapeutic avenue for repairing local damage to vital organs and restoring homeostasis during perioperative treatment for *** the pivotal role of immune cell responses in the pathogenesis of sepsis,stem cell-based interventions that primarily modulate immune responses by interacting with multiple immune cells have progressed into clinical *** strides made in single-cell sequencing and gene-editing technologies have advanced the understanding of disease-specific immune responses in *** antigen receptor(CAR)-immune cell therapy offers an intriguing option for the treatment of *** review provides a concise overview of immune cell therapy,its current status,and the strides made in the context of sepsis research,discussing potential strategies for the management of patients with sepsis during perioperative stages.

关键词： Sepsis Perioperative Receptors,chimeric antigen Immunotherapy,adoptive Perfusion Tissue repair Multiple organ failure Shock,septic

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Intermediate Hip Arthroplasty in Gabon: Blood Loss and Risk Factor for Transfusion

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Open Journal of anesthesiology 2024年第4期14卷 109-117页

作者： Ghislain Edjo Nkilly Pascal Christian Nze Obiang Raphael Okoue Ondo Arthur Matsanga Stéphane Oliveira Léandre Nguiabanda Jean-Marcel Mandji-Lawson Department of Anaesthesia and intensive care Omar Bongo Ondimba Army Training Hospital (HIAOBO) Libreville Gabon Department of Anaesthesia and intensive care Jeanne Ebori Fondation Libreville Gabon Department of Anaesthesia and intensive care Owendo University Hospital (CHUO) Libreville Gabon Department of Anaesthesia and intensive care Akanda Army Training Hospital Libreville Gabon Orthopedic Surgery Service Omar Bongo Ondimba Army Training Hospital (HIAOBO) Libreville Gabon

Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip hemiarthroplasty in Gabon. Method: It was a retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion and intraoperative data. The primary outcome was intraoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion. Results: Of the 97 patients included, the average age was 74.2 years ± 10, male predominance was 73.2%, the average ASA score was 1.9 ± 0.5, and transfusion incidence was 38.1%. The average number of RBCs transfused was 1.2 ± 0.6. Tranexamic acid was used in 11.3% of patients. The average bleeding was 450 ± 453 ml. Preoperative anemia was predictor of transfusion to be significant. Conclusion: The incidence of transfusion is law compared to total hip arthroplasty. The implementation of a patient blood management protocol is difficult given the urgency of bone repair. However, a better use of tranexamic acid could reduce this transfusion incidence.

关键词： Hip Arthroplasty Risk Factors Patients Hemiarthroplasty Gabon

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Spinal Analgesia with Intrathecal Morphine versus Conventional Analgesia after Laparoscopic Colectomy: A Retrospective Cohort Study

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Open Journal of anesthesiology 2024年第7期14卷 159-174页

作者： Lionel Diyamona Manon Colin Marc Léone Laurent Zieleskiewicz Joseph Nsiala Wilfrid Mbombo Rachel Mbala Bruno Pastene Chris Nsituavibidila Dan Kankonde Gracia Likinda Jean Claude Mubenga Khazy Anga Noelly Mukuna Christel Isengingo Department of Anaesthesia and intensive care University Clinics of Kinshasa University of Kinshasa Kinshasa Democratic Republic of the Congo Department of Anaesthesia and intensive care Marseilles Nord Hospital Marseille France General Hospital of Kinshasa ex Mama Yemo Kinshasa Democratic Republic of the Congo Department of Anaesthesia and intensive care Monkole Hospital Centre Kinshasa Democratic Republic of the Congo

Objective: Postoperative pain (POP) following abdominal surgery can vary from a few hours to several days. This acute, unrelieved pain can become chronic, requiring patients to take analgesics on an almost daily basis for comfort. Analgesia using general opioids has many side effects and intrathecal morphine is a good alternative. This study was conducted to evaluate the efficacy of intrathecal morphine (ITM) versus conventional analgesia in the management of postoperative pain in colectomy performed by laparoscopic surgery. Methods: Cohort study conducted at the Hôpital Nord in Marseille, from 01 January to 31 July 2021 in patients aged at least 18 years undergoing anaesthesia for scheduled colectomy by laparoscopic surgery. The primary endpoint was postoperative pain intensity and the secondary endpoints were morphine consumption, treatment side effects and length of hospital stay. Statistical analysis was performed using XLSTAT software. Results: We included 193 patients: 131 in the control group (conventional analgesia) and 62 in the ITM group. We observed: a significant decrease in pain (assessed by numerical scale) in favour of the ITM group in the post-anaesthetic care room, i.e. 3 (±4) vs 1 (±2), p 0 and H2: 2 (±2) vs. 1 (±2);p Conclusion: These results suggest that intrathecal morphine (ITM) in laparoscopic colectomy provides effective postoperative analgesia with low morphine consumption, and a reduction in morphine side-effects compared with conventional analgesia.

关键词： Intrathecal Morphine Colectomy Laparoscopy Conventional Analgesia

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