Recovery of uterine and ovarian function in patients with complete placenta previa after caesarean delivery: A retrospective study

This retrospective study was designed to explore the recovery of uterine and ovarian function in patients with complete placenta previa (PP) after caesarean delivery (CD). 136 complete placenta previa patients (group completed placenta previa) and 140 patients without complete PP (group non-PP, control group) were included in this study from Jan 2016 to Dec 2018. Subgroup analysis of patients with complete PP was made to determine the impact of different hemostatic methods used during CD on the recovery of uterine function. There were no statistically significant differences between the 2 groups in postpartum menstrual cycle changes, ovarian hormone, and uterine vascular supply as measured by pulsatility index and systolic/diastolic ratio (P > .05). However, the group with complete PP had a reduced endometrial thickness (0.47 ± 0.11 vs 0.50 ± 0.12, P < .001), a lower uterine resistance index at 42nd days (0.84 ± 0.03 vs 0.90 ± 0.03, P < .001), and a delayed resumption menstruation (7.07 ± 2.61 vs 5.31 ± 2.16, P < .001) when compared with control group. Subgroup analysis showed that RI index of all subgroups in completed PP group was lower, endometrial thickness was thinner and the time to menstrual recovery was longer than that of non-PP group. In conclusion, the endometrial thickness and blood supply at 42nd days, not ovarian function, maybe affected after CD in patients with complete PP.     

Tetrodotoxin poisoning caused by Goby fish consumption in southeast China: a retrospective case series analysis

OBJECTIVES:

To investigate an unusual outbreak of tetrodotoxin poisoning in Leizhou, southeast China, a case series analysis was conducted to identify the source of illness.

METHODS:

A total of 22 individuals experienced symptoms of poisoning, including tongue numbness, dizziness, nausea and limb numbness and weakness. Two toxic species, Amoya caninus and Yongeichthys nebulosus, were morphologically identified from the batches of gobies consumed by the patients. Tetrodotoxin levels in the blood and Goby fish samples were detected using liquid chromatography-tandem mass spectrometry.

RESULTS:

The tetrodotoxin levels in the remaining cooked Goby fish were determined to be 2090.12 µg/kg. For Amoya caninus, the toxicity levels were 1858.29 µg/kg in the muscle and 1997.19 µg/kg in the viscera and for Yongeichthys nebulosus, they were 2783.00 µg/kg in the muscle and 2966.21 µg/kg in the viscera.

CONCLUSION:

This outbreak demonstrates an underestimation of the risk of Goby fish poisoning. Furthermore, the relationships among the toxic species, climates and marine algae present should be clarified in the future.     

高龄危重患者手术麻醉方法和管理

目的探讨合并多个脏器功能异常、年龄逾90岁患者手术麻醉方法和管理的特点。方法总结近3年年龄超过90岁手术患者16例次，其中开腹手术6例次，人工髋关节置换术10例次，术前依据病史有针对性检查各重要脏器的功能，并作相应的积极准备，依手术种类和病情特点选择麻醉方法，应用Hemosonic TM100食道超声多普勒监测血流动力学、A-Line自动回归指数（AAL）监测麻醉深度以及4个成串刺激（TOF）指导追加肌肉松弛剂。结果全组患者术前均伴有2～4个脏器功能异常，且以循环、呼吸和内分泌系统改变较为常见；控制血压、营养心肌、抗心律失常、降血糖和抗感染是术前准备常用且有效的方法；开腹手术以全麻为主，追加维库溴铵间隔时间（87±16）min；人工髋关节置换术全部选择硬膜外阻滞，首次剂量1％利多卡因（7．6±0．9）ml，追加间隔时间（63±17）min。用6％羟乙基淀粉按10ml／kg静输后15min，患者每搏输出量、心输出量、心脏指数和主动脉内血流量（ABF）均分别较扩容前平均增加17％、11％、14％和15％，外周血管阻力和心率分别下降16％和9．6％。术中维持AAI 50～60，术毕出现咳嗽（吞咽）和清醒应答时AAI分别为73±9．4和81±7．3，随访术后无知晓。结论重视术前准备和术中监测；硬膜外阻滞应选用低浓度、小容量局麻药，6％羟乙基淀粉适合用于人工髋关节置换术；分次、小剂量应用静脉麻醉药，间隔更长时间再加肌松剂和维持相对较高AAI，是开腹手术实施全麻应遵循的原则。     

固定多粘菌素B的新型吸附剂对血液中细菌内毒素吸附性能的实验研究

研究了固定有多粘菌素B（Polymyxin B,PMB）短肽的聚苯乙烯微球对血浆中细菌内毒素的亲和吸附性能，讨论了不同吸附条件对吸附性能的影响。用纯种大白鼠作为实验动物，建立内毒索血症动物模型。用固定有PMB短肽的聚苯乙烯微球对动物模型进行血液灌流实验，观察该吸附剂血液灌流清除血浆中内毒素的功效，考察了接有PMB短肽的聚苯乙烯微球的血液相容性及其对蛋白的影响。实验结果表明。采用血液灌流吸附疗法成功地清除动物模型血液中的内毒素，而且，固定有多粘菌素B的特异吸附剂具有良好的血液相容性。