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Yunan Lin, Qiang Li, Jinlu Liu, Ruimin Yang, Jingchen Liu Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China Background: This study aims to investigate differences between continuous epidural infusion (CEI) and programmed intermittent epidural bolus (IEB) analgesia for the Chinese parturients undergoing spontaneous delivery and to approach their safety to parturients and neonates.Methods: Two hundred healthy American Society of Anesthesiologists class I or II, term (≥37 weeks’ gestation), nulliparous women who requested analgesia for labor were recruited. Epidural analgesia was initiated with a solution of 0.15% ropivacaine 10 mL and maintained with 0.1% ropivacaine mixed with sufentanil 0.3 µg/mL by CEI at a rate of 5 mL/h combined with a patient-controlled epidural analgesia (PCEA) bolus of 5 mL of ropivacaine sufentanil mixture or IEB of 5 mL of ropivacaine sufentanil mixture combined with a PCEA bolus of 5 mL of ropivacaine sufentanil mixture. The lockout interval was 20 minutes in each arm between the CEI and the IEB group. After 20 minutes of first dosage, visual analog scale (VAS) score was obtained every 60 minutes. The maternal and fetal outcome and total consumption of analgesic solution were compared.Results: There was no difference in demographic characteristics, duration of first and second stages, delivery methods, sensory block, fetal Apgar scores, and the maternal outcomes between the CEI and IEB groups. There was a significant difference in VAS scores and epidural ropivacaine total consumption between the two groups (IEB vs CEI: 51.27±9.61 vs 70.44±12.78mg, P

We evaluated the long-term efficacy and safety of low dose oral desmopressin in elderly patients with benign prostatic hyperplasia with more than nocturnal voids and nocturnal polyuria more than 30% of total daily urine volume.Eligible patients with benign prostatic hyperplasia older than 65 years with nocturia, nocturnal polyuria and International Prostate Symptom Score 14 or greater were included in the study. All patients received placebo or 0.1 mg desmopressin orally at bedtime. Patients were required to visit the outpatient clinic from the first visit, and after 1, 3, 6 and 12 months of treatment. Patients maintained flow volume charts and used diaries to record voiding data throughout the study. During followup urinalysis, urine sodium, urine osmolality, serum electrolytes, prostate specific antigen, International Prostate Symptom Score, quality of life, transrectal ultrasonography of prostate, uroflowmetry and post-void residual urine volume were performed at each visit.A total of 115 patients were enrolled in the study and randomized as 58 in the placebo group and 57 in the desmopressin group. Desmopressin significantly decreased nocturnal urine output and the number of nocturia episodes, and prolonged the first sleep period (p0.01). Compared to before treatment desmopressin gradually decreased serum sodium and induced statistically but not clinically significant hyponatremia after 12 months of treatment. No serious systemic complications were found during medication.Low dose oral desmopressin is an effective and well tolerated treatment for nocturnal polyuria in the lower urinary tract symptoms of patients with benign prostatic hyperplasia. Long-term desmopressin therapy gradually decreases serum sodium and it might induce hyponatremia even in patients without initial hyponatremia. For long-term desmopressin administration serum sodium should be assessed carefully, at least at 1 week after treatment.

Objective: To identify whether programmed intermittent epidural bolus analgesia is effective and safe to the parturients and neonates. Methods: Sixty healthy ASA class I or II, term (?37weeks’ gestation), nulliparous women were recruited in our study. Epidural analgesia was initiated with a solution of 0.15% ropivacaine 10 mL and maintained with 0.12% ropivacaine combined with fentanyl 2ug/mL by continuous epidural infusion at a rate of 5mL/h and combined with a patient-controlled epidural analgesia bolus of 5 mL and intermittent bolus of 5mL and combined with a patient-controlled epidural analgesia bolus of 5 mL, lockout interval was 20 minutes. After 20 minutes of the first dosage the VAS score was obtained in every 60 minutes. The maternal and fetal outcome, total consumption of analgesic solution and were oxytocin compared among the groups. Result: There was no difference of the maternal and fetal outcomes among the groups. The dosage consumption of oxytocin in non-labor analgesia group was significant lower than analgesia groups, the first and second stage of labor in non-labor analgesia group was significant longer than two analgesia groups. There was a significant difference in the epidural ropivacaine total consumption between the two analgesia groups. (51.27±9.61mg vs 70.44±12.78 mg, P=0.00 ) Conclusion: The use of programmed intermittent bolus combined with PECA was more effective than continuous infusion combined with PECA, it could be useful as the mode of maintenance for epidural labor analgesia.

Background Muscle infarction is a rare complication of spontaneous ischemic necrosis occurring in skeletal muscle. It is particularly common in patients with diabetes who have impaired sugar regulation. However, muscle infarction is frequently misdiagnosed due to varied clinical manifestations. Methods We presented 3 cases of muscle infarction reported during April 2009 to April 2014. After a comprehensive literature review, we selected 147 muscle infarction cases from the literature, first investigating the relationships between type of muscle blood supply and infarcted muscle. Results The result indicated that muscle infarction 25.85% belonged to type I vascular supply and 61.21% belonged to type II vascular supply, according to the definition by Mathes and Nahai. Conclusions Poor glucose regulation, intense exercise without adequate hydration, vascular disease, and type I and II muscular blood supply were critical predisposing factors. For preventing muscle infarction, we recommend strict glucose regulation and a gradual increase in exercise with adequate hydration.

The purpose of the study was to determine the effect of ginseng-based steroid Rg1 on TNF-alpha and IL-10 gene expression in human skeletal muscle against exercise challenge, as well as on its ergogenic outcomes. Randomized double-blind placebo-controlled crossover trials were performed, separated by a 4-week washout. Healthy young men were randomized into two groups and received capsule containing either 5 mg of Rg1 or Placebo one night and one hour before exercise. Muscle biopsies were conducted at baseline, immediately and 3 h after a standardized 60-min cycle ergometer exercise. While treatment differences in glycogen depletion rate of biopsied quadriceps muscle during exercise did not reach statistical significance, Rg1 supplementations enhanced post-exercise glycogen replenishment and increased citrate synthase activity in the skeletal muscle 3 h after exercise, concurrent with improved meal tolerance during recovery (P

To investigate the sensory block onset time, duration time, and side effects of adding dexmedetomidine to ropivacaine for cervical plexus block.Forty American Society of Anesthesiologists (ASA) Class I or II adult patients who were scheduled to undergo thyroid surgery were randomly allocated to the following groups to receive cervical plexus block: 30 mL of 0.375% ropivacaine combined with 1 μg kg(-1) of dexmedetomidine; 30 mL of 0.375% ropivacaine combined with saline (control). The sensory block onset time, duration of analgesia, mean arterial pressure (MAP), heart rate (HR), and the incidences of side effects, such as hypotension, bradycardia, and hypoxemia were recorded.The addition of dexmedetomidine to ropivacaine (Group D) shortened the sensory block onset time compared with the ropivacaine group (Group C) (95% confidence interval [CI] 4.18-5.26; p0.05). The duration of analgesia of cervical plexus block in Group D was significantly longer than that in Group C (95% CI 295.96-311.12; p0.05). The Ramsay sedation score at 5, 10, 20, 40, 60, 90, and 120 minutes after local anesthetic administration in Group D was significantly higher than that in Group C (p0.05). MAP level and HR level in Group D were significantly lower than that in Group C (p0.05).The addition of 1 μg kg(-1) dexmedetomidine to ropivacaine for cervical plexus block could shorten the sensory block onset time and extend the duration of analgesia, and increased the quality of analgesia, with the patients being sedated and arousable.