Obstetric analgesia and anaesthesia in SARS-CoV-2-positive parturients across 10 maternity units in the north-west of England: a retrospective cohort study

Since the start of the COVID-19 pandemic, few studies have reported anaesthetic outcomes in parturients with SARS-CoV-2 infection. We reviewed the labour analgesic and anaesthetic interventions utilised in symptomatic and asymptomatic parturients who had a confirmed positive test for SARS-CoV-2 across 10 hospitals in the north-west of England between 1 April 2020 and 31 May 2021. Primary outcomes analysed included the analgesic/anaesthetic technique utilised for labour and caesarean birth. Secondary outcomes included a comparison of maternal characteristics, caesarean birth rate, maternal critical care admission rate along with adverse composite neonatal outcomes. A positive SARS-CoV-2 test was recorded in 836 parturients with 263 (31.4%) reported to have symptoms of COVID-19. Neuraxial labour analgesia was utilised in 104 (20.4%) of the 509 parturients who went on to have a vaginal birth. No differences in epidural analgesia rates were observed between symptomatic and asymptomatic parturients (OR 1.03, 95%CI 0.64–1.67; p = 0.90). The neuraxial anaesthesia rate in 310 parturients who underwent caesarean delivery was 94.2% (95%CI 90.6–96.0%). The rates of general anaesthesia were similar in symptomatic and asymptomatic parturients (6% vs. 5.7%; p = 0.52). Symptomatic parturients were more likely to be multiparous (OR 1.64, 95%CI 1.19–2.22; p = 0.002); of Asian ethnicity (OR 1.54, 1.04–2.28; p = 0.03); to deliver prematurely (OR 2.16, 95%CI 1.47–3.19; p = 0.001); have a higher caesarean birth rate (44.5% vs. 33.7%; OR 1.57, 95%CI 1.16–2.12; p = 0.008); and a higher critical care utilisation rate both pre- (8% vs. 0%, p = 0.001) and post-delivery (11% vs. 3.5%; OR 3.43, 95%CI 1.83–6.52; p = 0.001). Eight neonates tested positive for SARS-CoV-2 while no differences in adverse composite neonatal outcomes were observed between those born to symptomatic and asymptomatic mothers (25.8% vs. 23.8%; OR 1.11, 95%CI 0.78–1.57; p = 0.55). In women with COVID-19, non-neuraxial analgesic regimens were commonly utilised for labour while neuraxial anaesthesia was employed for the majority of caesarean births. Symptomatic women with COVID-19 are at increased risk of significant maternal morbidity including preterm birth, caesarean birth and peripartum critical care admission.     

基于代谢组学探讨艾灸关元穴对老年大鼠肾能量代谢的影响＊

目的 通过UHPLC-Q-TOF-MS代谢组学探讨艾灸关元穴对老年大鼠肾代谢物的影响，进而为艾灸关元穴的作用机制提供参考。方法 将8月龄SD雄性大鼠设为成年对照组（8只），21月龄SD雄性大鼠随机分为老年对照组（8只）、老年金匮肾气丸组（7只）、老年艾灸组（8只）。老年金匮肾气丸组每日按体重给药，老年艾灸组每日艾灸关元穴15 min，均每周5天。实验持续13周后检测大鼠肾组织线粒体呼吸耗氧速率、琥珀酸脱氢酶（SDH）活性以及血清肾功能指标，观察肾脏病理变化，结合UHPLC-Q-TOF-MS技术对大鼠的肾组织进行代谢轮廓分析，筛选代谢差异物并进行鉴定。结果 与老年对照组比较，老年艾灸组大鼠肾线粒体的呼吸耗氧速率和SDH酶的活力显著提高（P<0.01）。代谢组学结果显示，肾组织中筛选出13个共同差异化合物，分别是丁酸十二烷基酯、亚油酰胺、5-甲基四氢叶酸、PC（16∶0/22∶5（7Z，10Z，13Z，16Z，19Z））、6，8-二羟基嘌呤、1，2，3-丙烷三羧酸、3-（4-甲氧基苯基）-2-氧代丙酸、吲哚-3-乙酰甘氨酸、亚麻油酸、9，10-环氧十八烷酸、二十二碳五烯酸（22n-6）、牛磺胆酸、LysoPS （18∶0/0∶0）。结论 艾灸关元穴可通过调控老年大鼠的牛磺酸和亚牛磺酸代谢、α-亚麻酸代谢、亚油酸代谢、甘油磷脂代谢来调节肾的能量代谢。     

双环[1.1.1]戊烷衍生物的合成研究进展

双环[1.1.1]戊烷（BCP）是一种具有三维立体结构的桥环骨架，其作为苯环、叔丁基和炔烃的生物电子等排体，已经在药物化学领域得到广泛的应用。随着BCP应用范围的扩大，BCP及其衍生物的合成日益成为研究的热点。本文对BCP衍生物的主要合成策略和方法进行总结，旨在为新药研发人员提供参考。     

轴向载荷分担比指导外固定器动力化的临床应用

目的:探讨轴向载荷分担比用于胫腓骨骨干骨折术后指导外固定器轴向动力化促进骨折愈合的有效性。方法:选取外固定器治疗的胫腓骨骨干骨折患者100例,随机分为观察组50例,对照组50例。观察组在轴向载荷分担比指导下行外固定器轴向动力化治疗,对照组未行动力化,随访比较两组的治疗效果。结果:所有患者均获随访,随访时间4～12个月,平均6.5个月,治疗期间所有患者均未出现外固定针断裂、松动及再骨折等并发症,观察组1例骨搬移患者轴向载荷分担比5%,X线片显示骨折断端有连续性骨痂通过,拆除外固定器连接杆后发生移位,恢复原数值行轴向加压再动力化,现已愈合。观察组除外1例骨搬移患者,其余49例患者外固定器固定时间为[(24.4±4.7)周],骨折临床愈合时间为[(22.4±4.7)周],与对照组50例患者外固定器固定时间[(29.3±5.6)周],骨折临床愈合时间[(27.3±5.6)周]比较,显著减少(P0.05)。结论:外固定器轴向载荷分担比指导胫腓骨骨干骨折外固定术后轴向动力化可以加速骨折愈合,但不适合骨搬移截骨端已硬化患者。     

刺果甘草全基因组Survey及叶绿体基因组特征分析＊

目的 基于基因组Survey分析对刺果甘草Glycyrrhiza pallidiflora Maxim.基因组大小和杂合率进行估计，并通过叶绿体基因组序列特征对其在甘草属Glycyrrhiza L.中的系统发育位置进行研究。方法 使用二代测序技术对刺果甘草进行测序，采用K-mer方法对测序reads进行分析，估算刺果甘草基因组大小和杂合率，使用生物信息学方法进行叶绿体基因组组装、注释和系统发育分析。结果 Survey分析结果显示其基因组大小约为577.82 Mb，杂合度约为0.31%，重复序列比例约为53.72%。叶绿体基因组长度为127，267 bp，不具有典型的四分体结构，总GC含量为34.32%，包含110个基因，其中76个蛋白质编码基因，30个tRNA基因和4个rRNA基因。系统发育分析表明，刺果甘草与圆果甘草G. squamulosa Franch.亲缘较接近。结论 刺果甘草存在低杂合和重复序列较多的特点，为了更好地对全基因组进行序列拼接和组装，可尝试采用三代测序结合二代测序的分析策略进行基因组组装；刺果甘草叶绿体全基因组比对和系统发育分析，为后续开展甘草属遗传多样性研究和分子鉴定标记筛选提供了重要依据。     

A novel surgical technique to prevent post-enucleation conjunctival cyst:conjunctival staining with methylthioninium

Dear Editor,Conjunctival cyst of the orbit acquired from enucleation is an infrequent but serious complication;which can occur in 3%-7%of patients,more commonly after a secondary procedure;.The most common manifestations are the inability to retain the external prosthesis.     

主动脉窦瘤破裂的外科治疗体会

目的：总结主动脉窦瘤破裂的手术适应症、手术方法和预后。方法：回顾性分析2011年1月至2017年12月因主动脉窦瘤破裂于我院行外科手术治疗的130名患者资料。其中男性58例(44.62%)，女性72例(55.38%)，年龄32～75（52.72±13.87）岁。合并室间隔缺损55例(42.31%)，合并主动脉瓣关闭不全39例(30%)，合并房间隔缺损12例(9.23%)，合并三尖瓣关闭不全8例(6.15%)，合并二尖瓣关闭不全6例(4.62%)，合并主动脉夹层1例(0.77%)，合并其他心脏疾病9例(6.92%)；破裂开口起源于右冠窦119例，起源于无冠窦11例。所有患者均在中低温体外循环下行手术治疗。结果：所有患者中，2例患者围术期死亡，余128例患者随访5个月至5年，术后心功能恢复至I-II级。结论：一旦发现主动脉窦瘤破裂，应积极予以治疗。     

辛味中药在治疗消渴证中的应用价值及中药五味理论现代研究的思考

辛味是中药五味学说中的重要性味之一,通常具有“发散”“行气”和“行血”的作用,且辛味中药在传统医学临床应用中占有较大比例。结合中药辛味的功效内涵及传统中医理论对消渴证的认识,阐述辛味中药与消渴证治疗之间的内在联系,总结辛味中药对“消渴三消”的治疗意义与价值。并在此基础上,对中药五味理论的现代研究趋势和发展方向进行思考,为同行研究提供参考。