Neuraxial labor analgesia effectively alleviates maternal pain and enhances pain control dur-ing delivery.However,breakthrough pain(BTP)following labor analgesia may occur in some parturients after neuraxial anesthesia,potentially prolonging labor progression,compromising maternal-fetal safety,and in-creasing the risk of cesarean delivery.Therefore,understanding and managing breakthrough pain are crucial in clinical practice.This review synthesizes current evidence on risk factors,neuraxial anesthesia modalities,ma-intenance techniques,and rational use of analgesic drugs to reduce BTP.

Intestinal ischemia-reperfusion(IIR)injury is a clinical critical disease with high mortality during perioperative period,and the existing prevention and treatment methods are limited.Latest studies have shown that intestinal microbial metabolites are involved in the regulation of IIR injury through epigenetic modification.The existing evidence suggests that the targeted microbial-epigenetic interaction network may provide a new prevention and treatment strategy for IIR injury,but the related clinical transformation research still needs to be deepened.This article reviews the characteristics of intestinal flora imbalance and the change rule of metabolites after IIR,the molecular mechanism of microbial metabolites regulating inflammation and cellular apoptosis through TLR3/NF-κB signaling pathway,non-coding RNA,and the protective effect of his-tone modification on intestinal barrier function and distant organs.

Objective:To introduce the application of 3D printing technology in standardized residency training of percutaneous precise biopsy.Methods:Twenty-two residents were randomly divided into innovative teaching group and traditional teaching group, with 11 ones in each group. Residents in both groups received standardized training of percutaneous biopsy procedure. Innovative teaching group was given 3D printing template combined with guided operation, while traditional teaching group used bare hand operation. The time spent in biopsy, the times of needle adjustment, the frequency of CT scanning during operation, the positive rate of material sampling and the incidence of complications were compared between the two groups.Results:During the percutaneous lung biopsy, two groups of physicians performed the procedure. There was no significant difference between the two groups in operation time [(22.34±3.12) vs. (23.56±4.21)] and the positive rate of sampling (72.73% vs. 90.91%) ( P> 0.05), but there were significant differences in the times of adjusting biopsy needle during operation [(2.11±0.67) vs. (1.02±0.93)], the frequency of intraoperative CT scanning [(4.35±0.76) vs. (3.12±0.84)] and the incidence of complications (54.55% vs. 27.27%) ( P< 0.05). In percutaneous peritoneal organ biopsy, there was no significant difference among the two groups in the operation time [(16.25±2.89) vs. (15.12±2.59)], the number of CT scans [(3.45±0.79) vs. (2.98±0.23)] and the positive rate (78.57% vs. 88.24%) ( P> 0.05), but there were significant differences in times of intraoperative biopsy needle adjustments [(2.43±0.43) vs. (1.84±0.89)] and the incidence of complications (35.71% vs. 5.88%) ( P< 0.05). Conclusion:The application of 3D printing technology combined with the teaching of three-dimensional guided stent can make percutaneous biopsy technique stylized and standardized. It is of great significance to standardize the operation for improving the quality of medical treatment, and it is worth popularizing in clinical teaching.

Objective To investigate the effects of intrathecal morphine remote preconditioning (MRPC) on protein-serine-threonine kinases-endothelial nitric oxide synthase (Akt/eNOS) signaling pathways and cardiac myocyte apoptosis in rats.Methods Male SD rats weighing 280-320 g were used in this study.A needle was inserted through a surgically created hole into the sub-dural space of spinal cord.Thirty-six rats in which intrathecal needle was successfully placed without complication were randomly divided into 3 groups (n =12 in each).In group Ⅰ sham operation was performed (Sham).In group Ⅱ myocardial I/R was produced (I/R).In group Ⅲ morphine was given intrathecally in 3 repeated doses of 1 μg/kg at 5 min intervals before ischemia (MRPC).Myocardial I/R was produced by occlusion of left anterior descending branch (LAD) of coronary artery for 30 min followed by 120 min reperfusion.The animals were then sacrificed and hearts removed for measurement of area at risk (AAR) and infarct size area (IS).IS/AAR ratio was calculated.Myocardial apoptosis was detected by TUNEL and apoptotic index (the number of apoptotic myocardial cells/the total number of myocardial cells) was calculated.The levels of Akt,phosphorylated Akt (p-Akt) and eNOS was determined by Western blot.Results The infarct size,myocardial cell apoptotic index and pAkt level were higher and eNOS level was significantly lower in I/R group than those in group Sham (P ＜ 0.01).MRPC significantly reduced the infarct size and myocardial cell apoptotic index,and pAkt and eNOS level up-regulated in group RMPC compared with group I/R (P ＜ 0.01).Conclusions Akt/eNOS signaling pathways probably participate in the protective effects of intrathecal morphine remote preconditioning against myocardial I/R injury and myocardial cell apoptosis in rats.

Objective Comparing the effect of different anesthetic inductions in pediatric pa-tients undergoing bronchial foreign body removal.Methods Thirty pediatric patients,aged 9-58 months,undergoing emergency bronchial foreign body removal,were randomly into 3 groups (n=10 each):group sevoflurane (group S),group propofol (group P),and group ketamine (group K).Pa-tients in group S were inducted with sevoflurane 8% inhalation,group P with propofol 2.5 mg/kg in-travenous injection,group K with ketamine 5 mg/kg intramuscular injection.Three groups of pa-tients breathed spontaneously during operative period and received topical anesthesia of lidocaine be-fore the placement of rigid bronchoscopy.Combination of intravenous target-controlled infusion of propofol (target plasma concentration of 3-3.5 μg/ml)and remifentanil (target plasma concentration of 2-3 ng/ml)was used for maintenance of anesthesia.The rigid bronchoscopy was inserted after pre-oxygenation for 3 min.Rigid bronchoscopy was performed and the placement time,the first place-ment successfully rate,hypoxemia and side effects as well as postoperative awaking time were recor-ded.Results The first placement successfully rate,group S 90%,group P 70%,group K 40%,with significant difference among three groups (P<0.05).The incidence of side effects were not signifi-cant difference in three groups;In group S and group P,the placement time and the anesthesia awa-king time was significant shorter than that in group K (P<0.05).Conclusion Compared with propo-fol intravenous induction and ketamine intramuscular induction,the high concentration sevoflurane in-duction can provide faster induction,shorter waking time,and reduceside effects in childen undergo-ing bronchial foreign body removal.

ObjectiveTo evaluate the effects of dexmedetomidine on the quality of emergence from general anesthesia in the elderly patients undergoing orthopedic operation.MethodsSixty ASA Ⅰ -Ⅲ patients,aged ≥65 yr,undergoing elective orthopedic operation,were randomly assigned to one of 3 groups ( n =20 each):control group (group C) ; dexmedetomidine 0.25 μg/kg group (group D1 ) and dexmnedetomidine 0.50 μg/kg group (group D2).In groups D1 and D2,15 min befone anesthesia induction,dexmedetomidine 0.25 μg/kg and 0.50 μg/kg were infused over 15 min respectively,while the equal volume of normal saline 15 ml was given instead of dexmedetomidine in group C.After anesthesia induction,tracheal intubation was performed and the patients were mechanically ventilated.General anesthesia was used in the three groups.Flurbiprofen 1 mg/kg was injected intravenously immediately before skin incision.The time for recovery of spontaneous breathing,emergence time,extubation time,and adverse reactions were recorded.Pain was assessed with verbal rating scale (VRS) at 5 min after emergence from anesthesia.ResultsCompared with group C,the incidence of agitation,bucking,and adverse cardiovascular events and VRS score were significantly decreased,and the rate of effective analgesia was significantly increased in groups D1 and D2,and the emergence time and extubation time were significantly prolonged in group D2(P ＜0.05).Compared with group D1,the emergence time and extubation time were significantly prolonged in group D2(P＜0.05).There was no significant difference in VRS score,the rate of effective analgesia and the incidence of adverse renctions between groups D1 and D2(P＞0.05).ConclusionⅣ infusion of dexmedetomidine 0.25 μg/kg before induction of general anesthesia can effectively improve the quality of emergence from general anesthesia in the elderly patients undergoing orthopedic operation.

Objective To investigate the mechanism of the protective effects induced by intrathecally remote morphine preconditioning (RMPC) against myocardial ischemia-reperfusion (I/R) injury in rats.Method Male SD rats weighing 280 ～ 320 g were used in this study. A needle was inserted through a surgically created hole into the spinal cord space. Sixty male SD rats, in which intrathecal needle was successfully placed without complication, were randomly (random number) divided into 10 groups of 6 animals each. In group Ⅰ myocardial I/R was produced (I/R). In group Ⅱ morphine was given intrathecally in 3 repeated doses of 1 μg/kg at 5 mtn intervals before ischemia (RMPC). Antagonists CGRP8-37 (CGRP receptor antagonist), 8-SPT (adenosine receptor antagonist), HOE-140 (bradykinin B2 receptor antagonist) and HEX (autonomic nerve antagonist) were given intrathecally in group Ⅲ , Ⅳ, Ⅴ and Ⅳrespectively at 10 min before RMPC. In group Ⅶ, Ⅷ, Ⅸ and X CGRP8-37, 8-SPT, HOE-140 and HEX were given intrathecally respectively at 40 min before ischemia. Myocardial I/R was produced by occlusion of left anterior descending branch (LAD) of coronary artery for 30 min followed by 120 min reperfusion. At the baseline and the end of 120 min reperfusion venous blood samples were taken for determination of LDH activity. The animals were then killed and hearts removed for measurement of area at risk (AAR) and infarct size area (IS). IS/AAR was calculated. Results The size of infarct area was smaller and IS/AAR ratio lower and significantly less LDH was released at the time of 120 min reperfusion in RMPC group (group Ⅱ) than in group I/R (group Ⅰ). The protective effects of RMPC was abolished by intravenously pretreatment with CGRP8-37, 8-SPT,HOE-140 and HEX. Conclusions CGRP, adenosine, bradykinin and autonomic nerve are involved in the protective effects of intrathecally remote morphine preconditioning against myocardial I/R injury.