Objective To explore the safety of different doses of bupivacaine combined with epidural anes-thesia for delivery women undergoing cesarean operation.Methods A total of 120 cases of parturient women with cesarean section surgery were randomly divided into A,B,C three groups (40 cases in each group).A group was subarachnoidly given 0.5% levobupivacaine 1.5mL(7.5mg),B group was given 0.5% levobupivacaine 2.0mL (10.0mg),C group was given 0.5% levobupivacaine 2.5mL(12.5mg).The anesthesia effect in three groups was recorded.Results 5 min after anesthesia,the central venous pressure,heart rate,blood oxygen saturation in A group were (79.47 ±10.65)mmHg,(83.94 ±8.21)times/min,(98.16 ±1.17)%,which in B group were (76.38 ± 10.15)mmHg,(84.03 ±8.19)times/min,(98.48 ±1.06)%,which in C group were (66.28 ±18.49)mmHg, (76.38 ±5.68)times/min,(95.03 ±0.45)%.10 min after anesthesia,the central venous pressure,heart rate,blood oxygen saturation in A group were (83.54 ±10.03)mmHg,(84.03 ±8.34)times/min,(98.25 ±1.19)%,which in B group were (82.46 ±10.11 )mmHg,(83.95 ±8.24)times/min,(98.04 ±1.15 )%,which in C group were (69.06 ±17.03)mmHg,(74.19 ±5.48)times/min,(94.85 ±0.41 )%,the changes of heart function index in A group and B group had statistically significant differences compared with those in C group(F =5.165,6.487,7.125, 6.145,5.378,6.145,all P <0.05 ).In A group,excellent anesthesia in 9 cases,good in 17 cases,and poor in 14 cases;those in B group were 24 cases,13 cases,3 cases;those in C group were 28 cases,11 cases and 1 case.The anesthesia effect of B group and C group was significantly higher than A group(χ2 =4.887,P <0.05).In A group, hypotension occurred in 1 case,bradycardia in 2 cases,2 cases had nausea and vomiting,shortness of breath 0 case.In B group,hypotension occurred in 2 cases,2 cases of bradycardia,nausea and vomiting 3 cases,difficulty in breathing in 1 case.In C group,15 cases of hypotension,bradycardia in 11 cases,14 cases had nausea and vomiting,dyspnea in 7 cases.The incidence rate of adverse reactions of C group was higher than A group and B group(χ2 =4.168,5.122, 4.784,5.122,all P <0.05).Conclusion The anesthesia effects of levobupivacaine combined spinal and epidural anesthesia in cesarean section surgery is related with dosage,the greater the dosage,the anesthesia effect is stronger, but the circulation disturbance,the greater the use the share such as 10mg dose of levobupivacaine is more suitable, worthy of popularization and application in clinic.

OBJECTIVE:To investigate clinical efficacy and safety of recombinant human tissue type plasminogen activator (rt-PA) intravenous thrombolytic in the treatment of elderly patients (over 75 years old) with acute cerebral infarction (ACI). METHODS:78 elderly ACI patients,on the basis of routine treatment,were divided into thrombolysis group (40 cases) and non-thrombolysis group (38 cases) according to the will of patients or family members. Non-thrombolysis group received aspirin 200 mg,qd;thrombolysis group was given rt-PA 0.9 mg/kg(maximum dose of 90 mg)by intravenous push of 10% dose within 1 min,and intravenous dripping of residue dose within 60 min;receiving aspirin 200 mg,qd,24 h after thrombolytic therapy with-out contraindications. Both groups were treated for 14 days. The effective rate,NIHSS score before treatment and 24 h,7 d and 14 d after treatment,prognosis after 90 d were compared between 2 groups,and the occurrence of ADR was observed in 2 groups. RE-SULTS:The total effective rate was 67.50% in thrombolysis group and 52.63% in non-thrombolysis group,with statistical signifi-cance(P<0.05);there was significant difference in NIHSS score between 2 groups 24 h,7 d,14 d after treatment(P<0.05);90 d prognosis of thrombolysis group was superior to that of non-thrombolysis group,there was statistically significance (P<0.05);there was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:4.5 h time window rt-PA intravenous thrombolytic therapy is safe and effective for elderly patients with ACI,and can reduce disability and fatality,im-prove prognosis.

Objective To evaluate the efficacy and safety of alteplase (rt-PA) thrombolytic therapy on patients with acute ischemic stroke aged over 80 years old.Methods The observational cohort study were conducted.One hundred and thirty-six patients with acute cerebral infarction and received rt-PA thrombolytic treatment were selected as our subjects with incidence time of 4.5 h,and the rt-PA dose of 0.9 mg/kg.The patients were divided into ≥80 years old group(n =34) and ＜80 years old group(n =102).U.S.A national institutes of health stroke scale (NIHSS) score of two groups evaluated before thrombolysis,immediately after thrombolysis 24 h,7 d and 14 d.The incidence and mortality rate of intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH) of two group were compared; and the score of modified Rankin's Scale (mRS) followed-up of 90 d were evaluated.Results NIHSS score after thrombolysis 24 h,7 d and 14 d of two groups were significantly lower than that before thrombolysis,and the differences were statistically significant (t =4.123,9.936,9.679,5.657,8.154,6.956,P ＜0.01).The score after thrombolysis 24 h,7 d and 14 d of two groups were no statistically significant difference.The efficient rate of treatment of two group were 55.88％ and 61.76％ respectively(P =0.54).Mter follow-up of 90 d,the prognosis rate were 47.06％ and 64.71％ respectively(P =0.07),and there were no statistically significant difference.Incidence rate of ICH were 11.76％ and 5.88％ respectively(P =0.07).Occurrence rates of sICH were 5.88％ and 2.94％ (P =0.43).Mortality rate were 11.76％ and 9.80％ (P =0.33),and there were no statistically significant difference.Conclusion This study shows that 80 years of age or older patients with acute ischemic cerebral apoplexy patients using rt-PA intravenous thrombolytic therapy is safe and effective,but RCT need further study.

Objective To observe the clinical effect of tongluozhitong capsule combined with carbamazepine on the treatment of trigeminal neuralgia.Methods94 patients with trigeminal neuralgia from January 2012 to May 2014 in Dongyang people's hospital were randomized double-blindly divided into the control group and the observation group, 47 cases in each group.The control group received carbamazepine treatment, and the observation group received tongluozhitong capsule combined with carbamazepine.VAS score, the effect and adverse reaction were recorded and analyzed before treatment, atwo weeks and four weeks after.Recurrence was followed-up a half and one year after treatment.Results①VAS scores in the observation group 2 weeks and 4 weeks after treatment were (3.78±0.44), (2.01±0.23) points separately, which were lower than those in the control group (5.96±0.53), (4.02±0.38) points separately, and the differences were statistically significant (P<0.05).②The total effective rate in the observation group 4 weeks after treatment was 95.74%, which significantly higher than that in the control group 78.72%, and the difference was statistically significant (P<0.05).③ The adverse reactions in the observation group 4 weeks after treatment was 21.28%, 27.66% in the control group, the difference was not significant;④ The recurrence rate in the observation group six months and one year after treatment were 6.38% and 10.64%, which significantly lower than those in the control group 23.40% and 29.79%, and the differences were statistically significant (P<0.05).ConclusionIt can effectively relieve pain, reduce the recurrence rate, and will not increase the adverse reactions which tongluozhitong capsule combined with carbamazepine were used on the treatment of trigeminal neuralgia.It is a safe and effective treatment program.

Atherosclerosis(As)is a chronic inflammatory disease associated with lipid deposition.Copper is con-sidered to be an important trace element and is closely related to the occurrence and development of As.Excessive accu-mulation of copper ions in cells can induce cell death,a new type of cell death named"cuproptosis".Under normal con-ditions,the body's copper metabolism can control the copper level in a stable range.When the disease occurs,copper ho-meostasis is destroyed,intracellular copper overload produces cytotoxicity,induces oxidative stress,inflammation,cell py-roptosis and cuproptosis,and promotes the occurrence and development of As.This article summarizes the relationship between copper levels and As,and discusses the mechanism of cuproptosis and the pathological mechanism of copper over-load promoting As from the perspective of the body's copper regulation,and reviews the relevant drug intervention,expec-ting to provide a new therapeutic target for As.

AIM:This study aimed to observe the analgesic effects of Hegu acupoint catgut embedding in a rat model of labor and investigate its influence on biomarkers such as calcitonin gene-related peptide(CGRP)signals at the Hegu acupoint.METHODS:Thirty-six pregnant rats were randomly divided into three groups:control group,Hegu acu-puncture group,and Hegu catgut embedding group.Pain threshold changes were assessed using the tail immersion test and paw withdrawal thermal latency at four time points:pre-induction,before the onset of labor,at the onset of labor,and at the mid-stage of labor.Tissue samples from the Hegu acupoint were collected at the mid-stage of labor to detect the ex-pression of CGRP,substance P(SP),and mast cells using immunofluorescence.The concentrations of ATP and ade-nosine were measured using ELISA.RESULTS:Before labor induction,there was no significant difference in tail immer-sion test and paw withdrawal thermal latency among the three groups(P>0.05).Before the onset of labor,both the acu-puncture and catgut embedding groups exhibited significantly higher tail-flick times and paw withdrawal latencies com-pared to the control group(P<0.05).At labor initiation and mid-labor,the catgut embedding group had significantly higher tail-flick times and paw withdrawal latencies compared to both the control and acupuncture groups(P<0.05).During mid-labor,the expression of CGRP,SP,mast cells,ATP,and adenosine concentrations in the catgut embedding group was significantly higher than that in the control and acupuncture groups(P<0.05),with co-expression of CGRP,SP,and mast cells observed.CONCLUSION:Hegu acupoint catgut embedding effectively alleviates labor pain,and its mechanism may involve increased local expression of CGRP and SP,promoting mast cell degranulation,and increasing ATP release and its conversion to adenosine.

Gut microbiota dysbiosis is an avenue for the promotion of atherosclerosis (AS) and this effect is mediated partly via the circulating microbial metabolites. More microbial metabolites related to AS vascular inflammation, and the mechanisms involved need to be clarified urgently. Paeonol (Pae) is an active compound isolated from Paeonia suffruticoas Andr. with anti-AS inflammation effect. However, considering the low oral bioavailability of Pae, it is worth exploring the mechanism by which Pae reduces the harmful metabolites of the gut microbiota to alleviate AS. In this study, ApoE^-/- mice were fed a high-fat diet (HFD) to establish an AS model. AS mice were administrated with Pae (200 or 400 mg·kg^-1) by oral gavage and fecal microbiota transplantation (FMT) was conducted. 16S rDNA sequencing was performed to investigate the composition of the gut microbiota, while metabolomics analysis was used to identify the metabolites in serum and cecal contents. The results indicated that Pae significantly improved AS by regulating gut microbiota composition and microbiota metabolic profile in AS mice. We also identified α-hydroxyisobutyric acid (HIBA) as a harmful microbial metabolite reduced by Pae. HIBA supplementation in drinking water promoted AS inflammation in AS mice. Furthermore, vascular endothelial cells (VECs) were cultured and stimulated by HIBA. We verified that HIBA stimulation increased intracellular ROS levels, thereby inducing VEC inflammation via the TXNIP/NLRP3 pathway. In sum, Pae reduces the production of the microbial metabolite HIBA, thus alleviating the ROS/TXNIP/NLRP3 pathway-mediated endothelial inflammation in AS. Our study innovatively confirms the mechanism by which Pae reduces the harmful metabolites of gut microbiota to alleviate AS and proposes HIBA as a potential biomarker for AS clinical judgment.
Animals ; Mice ; Atherosclerosis/drug therapy* ; Diet, High-Fat ; Endothelial Cells ; Inflammation/drug therapy* ; Mice, Inbred C57BL ; NLR Family, Pyrin Domain-Containing 3 Protein/genetics* ; Reactive Oxygen Species