简介：AbstractEnhanced recovery after cesarean (ERAC) delivery is an evidence-based, multi-disciplinary approach throughout pre-, intra-, post-operative period. The ultimate goal of ERAC is to enhance recovery and improve the maternal and neonatal outcomes. This review highlights the role of anesthesiologist in ERAC protocols. This review provided a general introduction of ERAC including the purposes and the essential elements of ERAC protocols. The tool used for evaluating the quality of ERAC (ObsQoR-11) was discussed. The role of anesthesiologist in ERAC should cover the areas including management of peri-operative hypotension, prevention and treatment of intra- and post-operative nausea and vomiting, prevention of hypothermia and multi-modal peri-operative pain management, and active pre-operative management of unplanned conversion of labor analgesia to cesarean delivery anesthesia. Although some concerns still remain, ERAC implementation should not be delayed. Regular assessment and process improvement should be imbedded into the protocol. Further high-quality studies are warranted to demonstrate the effectiveness and efficacy of the ERAC protocol.

简介：无

简介：

简介：AbstractObjective:To investigate the effects of spontaneous labor before elective repeat cesarean delivery (ERCD) on short-term maternal and neonatal outcomes.Methods:This was a prospective cohort study. All consecutive ERCDs, occurring at ≥37 weeks of gestation between July 1, 2017 and December 31, 2019 in Makassed General Hospital, were evaluated. The maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery (URCD) group were compared with those of 204 women undergoing cesarean delivery (CD) without spontaneous labor (ERCD) group. Primary outcomes were "composite adverse maternal outcome" and "composite adverse neonatal outcome." Fisher’s exact and Student’s t tests were used to assess the significance of differences in dichotomous and continuous variables, respectively. Two logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal outcomes.Results:"Composite adverse maternal outcome" was significantly more common in women who underwent spontaneous labor ((40/183) 21.9% vs. (19/204) 9.3%, P= 0.001, relative risk (RR): 2.7, 95% confidence interval (CI): 1.50-4.90). Similarly, "composite adverse neonatal outcome" was significantly increased in the URCD group ((24/183) 13.1% vs. (12/204) 5.9%, P= 0.014, RR: 2.4, 95% CI: 1.18-4.98). These adverse effects persisted after adjustment for confounders. Multivariate regression models revealed that, besides labor, CD-order impacted maternal outcome (RR: 1.5, 95%CI: 1.02-2.30, P= 0.036), while CD-order and teenage pregnancy influenced neonatal outcome (RR: 2.1, 95%CI: 1.29-3.38, P= 0.003, and RR: 16.5, 95%CI: 2.09-129.80, P= 0.008, respectively).Conclusion:In our study, spontaneous labor before ERCD, including deliveries at term, was associated with adverse maternal and neonatal outcomes, indicating that it is preferable to conduct ERCD before the onset of labor. Screening women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1-2 weeks earlier. Further large prospective studies to assess the effects of such an approach on maternal and neonatal outcomes are strongly warranted.

简介：AbstractBackground:Nalbuphine has been suggested to be used for post-cesarean section (CS) intravenous analgesia. However, ideal concentration of nalbuphine for such analgesia remains unclear. The present study was conducted to explore an ideal concentration of nalbuphine for post-CS intravenous analgesia by evaluating the analgesic effects and side-effects of three different concentrations of nalbuphine combined with hydromorphone for post-CS intravenous analgesia in healthy parturients.Methods:One-hundred-and-fourteen parturients undergoing elective CS were randomly allocated to one of three groups (38 subjects per group) according to an Excel-generated random number sheet to receive hydromorphone 0.05 mg/mL + nalbuphine 0.5 mg/mL (group LN), hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL (group MN), and hydromorphone 0.05 mg/mL + nalbuphine 0.9 mg/mL (group HN) using patient-controlled analgesia (PCA) pump. Visual analog scale (VAS) for pain, PCA bolus demands, cumulative PCA dose, satisfaction score, Ramsay score, and side-effects such as urinary retention were recorded.Results:The number of PCA bolus demands and cumulative PCA dose during the first 48 h after CS were significantly higher in group LN (21 ± 16 bolus, 129 ± 25 mL) than those in group MN (15 ± 10 bolus, 120 ± 16 mL) (both P < 0.05) and group HN (13 ± 9 bolus, 117 ± 13 mL) (both P < 0.01), but no difference was found between group HN and group MN (both P > 0.05). VAS scores were significantly lower in group HN than those in group MN and group LN for uterine cramping pain at rest and after breast-feeding within 12 h after CS (all P < 0.01) and VAS scores were significantly higher in group LN than those in group MN and group HN when oxytocin was intravenously infused within 3 days after CS (all P < 0.05), whereas VAS scores were not statistically different among groups for incisional pain (all P > 0.05). Ramsay sedation scale score in group HN was significantly higher than that in group MN at 8 and 12 h after CS (all P < 0.01) and group LN at 4, 8, 12, 24 h after CS (all P < 0.05).Conclusions:Hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL for intravenous PCA could effectively improve the incisional pain and uterine cramping pain management and improve comfort in patients after CS.Trial registration number:ChiCTR1800015014, http://www.chictr.org.cn/Chinese Clinical Trial Registry.

简介：AbstractBackground:Obstetric hemorrhage is a major cause of maternal death during cesarean delivery. The objective of this retrospective observational study was to evaluate the efficacy and safety of intra-operative cell salvage (IOCS) in cesarean section.Methods:We included a total of 361 patients diagnosed with central placenta previa who underwent cesarean section from May 2016 to December 2018. In this study, 196 patients received autologous transfusion using IOCS (IOCS group) and 165 patients accepted allogeneic blood transfusion (ABT group). Propensity score matched analysis was performed to balance differences in the baseline variables between the IOCS group and ABT group. Patients in the IOCS group were matched 1:1 to patients in the ABT group.Results:After propensity score matching, 137 pairs of cases between the two groups were successfully matched and no significant differences in baseline characteristics were found between the IOCS group and ABT group. Patients in the IOCS group were associated with significantly shorter length of hospital stay, compared with ABT group (8.9 ± 4.1 days vs. 10.3 ± 5.2 days, t= -2.506, P = 0.013). The postoperative length of hospital stay was 5.3 ± 1.4 days for patients in the IOCS group and 6.6 ± 3.6 days for those in the ABT group (t = -4.056, P < 0.001). The post-operative hemoglobin level in the IOCS group and ABT group was 101.3 ± 15.4 and 96.3 ± 16.6 g/L, respectively, which were significantly different (t= 2.615, P= 0.009). Allogeneic red blood cell transfusion was significantly lower at 0 unit (range: 0–11.5 units) in the IOCS group when compared with 2 units (range: 1–20 units) in the ABT group (P < 0.001).Conclusions:This retrospective observational study using propensity score matched analysis suggested that IOCS was associated with shorter length of postoperative hospital stay and higher post-operative hemoglobin levels during cesarean delivery.

简介：无

简介：INTRODUCTIONSincetheirintroductioninmid-1980s,polyamidoamide(PAMAM)dendrimershaveattractedconsiderableattentionbecauseoftheiruniquestructuresandproperties.Accordingtopreliminarystudiesinanimals,PAMAMdendrimersarenon-immunogenic,verylowinvivotoxicityandcanbeexcretedbyurineandfeces.

简介：AbstractInfectious diseases are an increasing threat to global biosafety. Vaccination is the most effective and cost-efficient method for preventing and controlling infectious diseases. The development of new vaccines is inextricably linked to the advancement of materials that serve as essential components of vaccines, such as antigens, adjuvants, and their carriers. The physicochemical and biological properties of vaccines—such as the kinetics of antigen retention and presentation—are determined by the material compositions of vaccines and carriers, affecting the overall efficacy. The sustained release of antigens prolongs their retention time in germinal centers and improves humoral immune responses. Pulsatile release that imitates clinical dosing regimens can improve patient adherence to vaccination, affording increased vaccine coverage. Herein, we review progress of materials innovation on altering vaccine release kinetics, which affects the overall vaccine efficacy, safety, and compliance.

简介：Colorectalcancer（CRC）isthethirdmostcommoncancerdiagnosedworldwideinhumanbeings.Surgery,chemotherapy,radiotherapyandtargetedtherapiesaretheconventionalfourapproacheswhicharecurrentlyusedforthetreatmentofCRC.Thesitespecificdeliveryofchemotherapeuticstotheirsiteofactionwouldincreaseeffectivenesswithreducingsideeffects.Targetedoraldrugdeliverysystemsbasedonpolysaccharidesarebeinginvestigatedtotargetanddeliverchemotherapeuticandchemopreventiveagentsdirectlytocolonandrectum.Site-specificdrugdeliverytocolonincreasesitsconcentrationatthetargetsite,andthusrequiresalowerdoseandhenceabridgedsideeffects.Somenoveltherapiesarealsobrieflydiscussedinarticlesuchasreceptor（epidermalgrowthfactorreceptor,folatereceptor,wheatgermagglutinin,VEGFreceptor,hyaluronicacidreceptor）basedtargetingtherapy;colontargetedproapoptoticanticancerdrugdeliverysystem,genetherapy.EventhoughgoodtreatmentoptionsareavailableforCRC,theultimatetherapeuticapproachistoaverttheincidenceofCRC.ItwasalsofoundthatCRCscouldbepreventedbydietandnutritionsuchascalcium,vitaminD,curcumin,quercetinandfishoilsupplements.ImmunotherapyandvaccinationareusednowadayswhichareshowingbetterresultsagainstCRC.

简介：

简介：Timelyandcost-efficientmulti-hopdatadeliveryamongvehiclesisessentialforvehicularad-hocnetworks(VANETs),andvariousroutingprotocolsareenvisionedforinfrastructure-lessvehicle-to-vehicle(V2V)communications.Generally,whenapacket(oraduplicate)isdeliveredoutoftheroutingpath,itwillbedropped.However,weobservethatthesepackets(orduplicates)mayalsobedeliveredmuchfasterthanthepacketsdeliveredalongtheoriginalroutingpath.Inthispaper,weproposeanoveltreebasedroutingscheme(TBRS)forultilizingthedroppedpacketsinVANETs.InTBRS,thepacketisdeliveredalongaroutingtreewiththedestinationasitsroot.Andwhenthepacketisdeliveredoutitsroutingtree,itwon'tbedroptimmediatelyandwillbedeliveredforawhileifitcanarriveatanotherbranchofthetree.WeconducttheextensivesimulationstoevaluatetheperformanceofTBRSbasedontheroadmapofarealcitycollectedfromGoogleEarth.ThesimulationresultsshowthatTBRScanoutperformtheexistingprotocols,especiallywhenthenetworkresourcesarelimited.

简介：Thephenomenonofparticleinteractioninvolvedinpulmonarydrugdeliverybelongstoawidevarietyofdisciplinesofparticletechnology,inparticular,fluidization.Thispaperreviewsthebasicconceptsofpulmonarydrugdeliverywithreferencestofluidizationresearch,inparticular,studiesonGeldartgroupCpowders.Drypowderinhalerdevice-formulationcombinationhasbeenshowntobeaneffectivemethodfordeliveringdrugstothelungfortreatmentofasthma,chronicobstructivepulmonarydiseaseandcysticfibrosis.Evenwithadvanceddesigns,however,deliveryefficiencyisstillpoormainlyduetopowderdispersionproblemswhichcausepoorlungdepositionandhighdosevariability.Drugparticlesusedincurrentinhalersmustbe1-5mindiameterforeffectivedepositioninsmall-diameterairwaysandalveoli.Thesepowdersareverycohesive,havepoorflowability,andaredifficulttodisperseintoaerosolduetocohesionarisingfromvanderWaalsattraction.Theseproblemsarewellknowninfluidizationresearch,muchofwhichishighlyrelevanttopulmonarydrugdelivery.

简介：

简介：无

简介：Thearticleisaboutsolvingthelastmiledeliveryprobleminruraltownorvillage.Wewanttotestthedrone’spotentialinparceldelivery.Theobjectivesare1)tointroducetheclusterandtruck-droneintandemdeliverymethod,2)tocomparethenewmethodwiththetraditionalTSPmethodinaspectoftruckrunningdistance,energyusingandtimeoccupation.Theparceldeliverydemandissparse,soitisnotdenseenoughforatrucktocarryondelivery.Wetrytoidentifythebestrouteforthedronetodeliverthegoods.Weusek-meanmethodtocarryonclustering,thenweuseenumerationmethodtofulfillthecentroidsdelivery,whichcomesfromthedepot.Wedesignamodelandcalculatetheenergy,timeanddistancesavingbetweendroneusingmethod(DTSP)andtraditionalTSPmethod.Thedroneattendeddeliverysavestruckdeliverydistance,energyconsumptionandtime.ThetruckrunningdistanceofDTSPmethodsaves91.87%,thetruckrunningdistanceisshortenedfrom189.69kmto15.4252km.TheDTSPmethodsaves90.45%ofenergy.TheDTSPmethodbringsa29.75%cutoffintimeaspectwhentherearetwodroneinrunning.TheresearchintroducestheclusterandTSPcombinationmethod,whichisagoodwaytocarryonlastmiledelivery.Theresultshowsabrightfuturefordronetoattendparceldelivery.Thee-commercecorporationcanapplythismethodinpractice.

简介：

简介：Inordertoinvestigatetheimmtmogenicityofthecontrolled-releasemicroencapsulatedhepatitisBvaccineinmice,polyethyleneglycol-poly-dl-lactide(PELA)microsphereswithentrappedHSsAgwerepreparedbydoubleemulsionW/O/Wbasedonsolventextractionmethods.BALB/cmicewereimmunizedwiththeencapsulatedvaccinebyoralfeedingorinjection.Bloodsampleswerecollectedat8^th,10^th,14^thand24^thweeks,respectively,andthelevelsofantibodyresponseweredetectedbyEI.ISA.Itwasfoundthatthescanningelectronmicroscopyshowedthepreparedmicrosphereshadsmoothandsphericalsurface,suitableforvaccinedelivery.Twogroupsofmiceorallyfedwiththeencapsulatedorconventionalrecombinantvaccines,respectively,theresereshowednoobviousdifferenceintheIgGlevels.At14^thweek,thegroupinjectedwithasingledoseofencapsulatedvaccinehadasimilarlevelofIgGresponsetothegroupinjectedwithtwodosesoftherecombinationvaccine.At24^thweek,theIgGlevelsofthegroupinjectedwithtwodosesofencapsulatedvaccinewerehigherthanthoseofthegroupinjectedwithtwodosesoftherecombinationvaccine.ItconcludesthatControlled-releasemicroencapsulatedhepatitisBvaccinepossessesthefeatureofslowlyreleasinginv/voandlongtimesimmtmogenicity.

简介：无

简介：AbstractObjective:To evaluate the efficacy and safety of a modified cesarean hysterectomy (MCH) procedure in controlling hemorrhage in patients with placenta previa complicated with placenta percreta.Methods:A retrospective analysis was conducted on 23 patients with placenta previa complicated with placenta percreta from January 2016 to December 2018 in the Union Hospital. The patients’ age ranged from 24 to 41 years, and had gestational durations of 32-38 weeks. Nine of them underwent MCH and 14 underwent conventional cesarean hysterectomy (CCH). In the MCH group, the bladder was not mobilized, deliberately. The uterus was excised horizontally above the tourniquet level. Placental tissue around the cervical os was cleaned thoroughly, and hemostatic suturing was performed under direct vision. In the CCH group, the uterus was removed gradually after programmed hemostasis and dissection of adhesions of the vesicouterine peritoneal fold and mobilization of the bladder.Results:There were no significant differences in general conditions between the two groups. The blood loss was significantly less in the MCH group (P < 0.05). The operation time was also decreased dramatically and hospital stay (in days) was shorter than in the CCH group (P < 0.05). There were no bladder or ureter injuries in the MCH group, compared with three cases in the CCH group. There were no statistically significant differences in neonatal birth weight, Apgar score, or intensive care unit admittance rates between the two groups (P > 0.05).Conclusion:This MCH procedure reduced blood loss, avoided bladder injury, and had no long-term complications. It is a safe, rapid, and effective way to control fatal hemorrhage during surgery for women with placenta previa complicated with placenta percreta.