This study shows a high prevalence rate of dry eye syndrome in elderly Tibetans, representing an important health problem.

Background:Placenta increta/percreta is an increasingly common and life-threatening obstetric complication. It poses a management challenge to clinicians. The present study aimed to evaluate efficacy and safety of preoperative placement of infrarenal abdominal aorta balloon catheter (IAABC) alone or combined with Bakri tamponade for the management of cases with placenta increta/percreta.Methods:We retrospectively analyzed all cases with placenta increta/percreta at a tertiary referral teaching hospital in China between the year 2014 and 2017. Statistical analysis considered the individual subgroups: IAABC placed group and control group (without IAABC), and compared their maternal–fetal outcomes.Results:The study covered 86 cases with placenta increta. For cases in the IAABC placed group (n = 48), significant reductions were noted in maternal morbidity including estimated blood loss (EBL), EBL ≥ 2000 mL, blood products transfusions, postpartum hemorrhage, operative time, intensive care unit admission, and postoperative days (P < .05 for all). The overall rate of hysterectomy was much lower (4.2%vs 23.7%, P = .018), compared with those in the control group (n = 38). Furthermore, in the IAABC placed group, hysterectomy was avoided in a further 17 cases combined with Bakri tamponade. In the control group, 10 cases were successful in preserving uterus by Bakri tamponade. Four cases failed and needed reoperation (3 uterine arterial embolism, 1 hysterectomy). There were no differences in fetal outcomes between the 2 groups. Eighteen cases were diagnosed with placenta percreta. Almost all the cases (17/18) inevitably underwent caesarean hysterectomy. Only 1 case was treated with a combination of IAABC and Bakri tamponade, and successfully reserved uterus. No differences were observed in any other outcomes, except for a significant less mean operative time (P = .017) in cases with IAABC placed (n = 10), compared with those without IAABC (n = 8). Only 1 case had a femoral artery thrombosis directly related to IAABC placement and recovered after conservative treatment. There was no maternal or neonatal death in this study.Conclusion:Prophylactic insertion of IAABC alone or combined with Bakri tamponade should be safe and effective in controlling intraoperative bleeding due to placenta increta, thus hysterectomy could be avoided. It seems to be less beneficial to women with placenta percreta. Bakri tamponade can be a good choice in the management of placenta increta/percreta before more aggressive surgeries.

BackgroundPrevious studies have shown that electroacupuncture (EA) has a significant effect on acute pain, but it has not solved the clinical problem of the chronification of acute pain. Diffuse noxious inhibitory controls (DNIC) function as a reliable indicator to predict the risk of chronic pain events. DNIC function in knee osteoarthritis (KOA) patients has been demonstrated to gradually decrease during the development of chronic pain. The purpose of this study is to conduct a randomized, controlled clinical trial to determine if EA can repair impaired DNIC function and thus prevent chronification of the acute pain of KOA.Methods/DesignThis is a multicenter, single blind, randomized, controlled, three-arm, large-scale clinical trial. A total of 450 KOA patients will be randomly assigned to three groups. The strong EA group will receive EA with high-intensity current (2 mA < current < 5 mA) at the ipsilateral ‘Neixiyan’ (EX-LE5), ‘Dubi’(ST35), ‘Liangqiu’(ST34) and ‘Xuehai’ (SP10). The weak EA group will receive EA with low-intensity current (0 mA < current < 0.5 mA) on the same acupoints. The sham EA group will receive EA with low-intensity current (0 mA < current < 0.5 mA) with fine needles inserted superficially into the sites 2 cm lateral to the above acupoints. The patients will be treated with EA once a day, 30 minutes per session, in 5 sessions per week, for 2 weeks. In order to determine the best stage of KOA for effective EA intervention, patients within the treatment groups also will be divided into four stages. The primary outcomes are Visual Analog Scale (VAS), DNIC function and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Clinical assessments will be evaluated at baseline (before treatment) and after 5 to 10 sessions of treatment.DiscussionThis trial will be helpful in identifying whether strong EA is more effective than weak EA in reversing chronification of acute pain through repairing the impaired DNIC function and in screening for the best stage of KOA for effective EA intervention.Trial registrationChinese Clinical Trial Registry Number: ChiCTR-ICR-14005411. The date of registration is 31 October 2014.

Background This prospective randomized controlled study was designed to evaluate the effect of S-ketamine with sufentanil given intraoperatively and postoperatively on recovery of gastrointestinal (GI) function and postoperative pain in gynecological patients undergoing open abdomen surgery. Methods One hundred gynecological patients undergoing open abdomen surgery were randomized into an S-ketamine group (group S) or placebo group (0.9% saline; group C). Anesthesia was maintained with S-ketamine, sevoflurane, and remifentanil-propofol target-controlled infusion in group S and with sevoflurane and remifentanil-propofol target-controlled infusion in group C. All patients were connected to patient-controlled intravenous analgesia (PCIA) pump at the end of the surgery with sufentanil, ketorolac tromethamine, and tropisetron in group C and additional S-ketamine in group S. The primary outcome was the time of first postoperative flatus, and the secondary outcome was postoperative pain score of patients. Postoperative sufentanil consumption within the first postoperative 24 h and adverse events such as nausea and vomiting were recorded. Results The time of first postoperative flatus in group S was significantly shorter (mean ± SD, 50.3 ± 13.5 h) than that in group C (mean ± SD, 56.5 ± 14.3 h, p = 0.042). The patient’s visual analog scale (VAS) pain score 24 h after surgery at rest was significantly lower in group S than in group C (p = 0.032). There were no differences in sufentanil consumption within the first postoperative 24 h, postoperative complications related to PCIA between the two groups. Conclusions S-ketamine accelerated postoperative GI recovery and reduced 24 h postoperative pain in patients undergoing open gynecological surgery. Trial registration ChiCTR2200055180. Registered on 02/01/2022. It is a secondary analysis of the same trial.

Without timely discovery and treatment, early live cesarean scar pregnancy (CSP) can cause hemorrhage, uterine rupture or excision, and in extreme cases, loss of fertility or death. This studyexplored the significance of early diagnosis and treatment algorithms for early live CSP. Twenty-three patients with early live CSP who were hospitalized at the Second Xiangya Hospital of Central South University from June 2012 to July 2013 were retrospectively analyzed. The patients were selected according to the number of days since the last menstrual period, the color Doppler ultrasound results, the β-HCG values, and the thickness of the lower uterine myometrium. Ultrasound-guided evacuation and Foley balloon compression hemostasis were conducted directly in the lower uterine segment to stop the bleeding. All 23 patients were cured, and their uteri and fertility were conserved. Timely and proper treatment algorithms can yield satisfactory outcomes in the treatment of CSP.

Background No Pain Labor &Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change in overall cesarean delivery (CD) rate and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service (NA). Methods NA was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia were analyzed from January 2015 to April 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 (p < 0.001); the rate of CD was 48.1% (3577/7360) and stable from January to May 2015 (p>0.05), then decreased from 50.4% in May 2015 to 36.3% in April 2016 (p < 0.001); the rate of MRCD was 11.4% (406/3577) and also stable from January to May 2015 (p>0.05), then decreased from 10.8% in May 2015 to 5.7% in April 2016 (p < 0.001). At the same time, the rate of multiparous women remained unchanged during the 16 month of observation (p>0.05). There was a negative correlation between the rate of NA and rate of overall CD, r = − 0.782 (95%CI [− 0.948, − 0.534], p<0.001), and between the utilization rate of NA and rate of MRCD, r = − 0.914 (95%CI [− 0.989, − 0.766], p<0.001). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women who underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women who underwent CD remained unchanged, and there was no correlation between the rate of NA and anyone of those rates from January 1st 2015 to April 30th 2016 (p>0.05). Conclusions Our study shows that the rates of CD and MRCD in our department were significantly decreased from May 1st 2015 to April 30th 2016, which may be due to the increasing use of NA during vaginal delivery with the help of NPLD.

Background Neuropathic pain severely impacts patients’ life quality. Dezocine can be used for the treatment of pain. The present study intended to explore the effects of dezocine in chronic constriction injury (CCI) induced neuropathic pain as well as the possible responsible molecules in rats. Methods There were 3 subgroups, ie, control group, CCI group and dezocine+CCI group. The values of paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) in rats were determined by a dynamic plantar esthesiometer. The ipsilateral lumbar spinal cords in rats were extracted for the detection of protein levels of phosphorylated-mammalian target of rapamycin (p-mTOR) and p-extracellular signal-regulated kinase 1/2 (p-ERK1/2) by western blot analysis; and the mRNA and protein expression levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, and cyclooxygenase-2 (COX-2) by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA), respectively. Results In comparison with control group, there were lower values of PWT and PWL in CCI group, which were partially reversed by dezocine. In addition, compared to control group, the expression levels of p-mTOR, p-ERK1/2, IL-6, TNF-α and COX-2 were upregulated by CCI, which were attenuated by dezocine. Conclusions In conclusion, the analgesic effect of dezocine on CCI induced neuropathic pain might be correlated with inhibiting of the p-mTOR and p-ERK1/2 signaling pathway.

Background: Individualized pain therapy conforms to the concept of precision medicine and contribute to adequate pain management after surgery. Preoperative biomarkers associated with postoperative pain may instruct anesthesiologists to improve...