Abstract Background Specialised maternity hospitals respond to over 90% of labour analgesia requests in their localities within China. We administered a questionnaire survey to determine the predictors of labour analgesia use in two of these hospitals, with the aim of further enhancing epidural analgesia utilisation during labour. Methods This prospective case-control multi-centre questionnaire survey included a total of 640 postpartum women with 374 women who received epidural analgesia and 266 women who did not receive epidural analgesia. The questionnaire contained 20 questions and was distributed through WeChat from July 2022 to September 2022. The responses to the questionnaires were uploaded to the cloud storage space, and only the statistician had access to the original data. Multivariate logistic regression analysis was used to screen variables related to the receipt of epidural labour analgesia. Binary logistic regression was used to identify predictors related to the administration of epidural labour analgesia from a set of selected variables. Results Binary logistic regression results of the survey data showed that multi-parity (odds ratio [OR] 2.805, 95% confidence interval [CI] 1.792 to 4.393, P < 0.001), late arrival of anaesthesiologist (OR 2.728, 95% CI 1.180–6.306, P = 0.019), and rapid progress in first stage of labour (OR 11.709, 95% CI 7.449–18.404, P < 0.001) prevented women from receiving epidural labour analgesia, while women’s preference (OR 0.035, 95% CI 0.013–0.097, P < 0.001) and family agreement to epidural analgesia prior to labour (OR 0.091, 95% CI 0.016–0.551, P = 0.006) promoted its use. Conclusions To address the factors that may hinder or promote the use of epidural labour analgesia in maternal specialised hospitals, pregnant women should be screened for the risk of rapid progression in the first stage of labour and be provided latent-phase labour analgesia. Moreover, in cases where anaesthesiologists are unavailable or when women have contraindications to epidural analgesia, inhalation nitrous oxide analgesia and intravenous remifentanil analgesia should be considered as alternative options. It is recommended that hospitals provide professional, comprehensive, and free antenatal education on labour analgesia to pregnant women and their families to further promote the use of epidural analgesia. Trial registration: http://www.chictr.org.cn ChiCTR2200055621; January 15, 2022.
Our previous study showed there was a gender difference in plasma lactate concentrations in subjects with type 2 diabetes. This study investigated the effect of sex hormone levels on plasma lactic acid (LA) levels in type 2 diabetes with and without metformin therapy.Fasting whole blood specimens of 392 type 2 diabetes patients treated with metformin (n=199) or not (n=193) were collected. LA was measured with an enzyme-electrode assay. Levels of sex hormones, including testosterone (T) and estradiol (E(2)), were measured with a chemiluminescence microparticle immunoassay. Spearman's or Pearson's correlation and logistic regression analysis were performed for the factors associated with LA.The LA level in the metformin group was significantly higher than that in the non-metformin group (1.26±0.43 vs. 1.14±0.49 mmol/L, P<0.001), and LA levels of females were significantly higher than those of males (P<0.001). LA concentrations were positively correlated with E(2) level but negatively correlated with metformin and T levels (P<0.01). The logistic regression analysis showed that gender, creatinine, E(2), metformin, and T were independent factors influencing lactate levels. Analysis of subgroups demonstrated that the LA concentrations increased with the elevation of E(2) level (P<0.05) but decreased with the rising of T level (P<0.05).Sex hormones play an important role on regulating plasma lactate levels in diabetes patients treated with metformin. E(2) up-regulates but T tend to down-regulate lactate levels.
Abstract Background: To assess the prognostic role of coronary collaterals in patients with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Methods: Coronary collateralization was graded according to Rentrop scoring system in 198 type 2 diabetic patients and 335 non-diabetics with stable angina undergoing PCI for at least one CTO lesion. Left ventricular ejection fraction (LVEF) was determined and major adverse cardio-cerebral events (MACCE) were recorded during follow-up. Results: Poor collateralization was more common in patients with T2DM than in non-diabetics (40% vs 29%, p=0.008). At 13.5±4.1 months, the rate of composite MACCE (17.3% vs 27.6%, p=0.034) and repeat revascularization (15.2% vs 25.5%, p=0.026) was lower and the increase in LVEF (3.10 % vs 1.80%, p=0.024) was greater in patients with good collaterals than in those with poor collaterals for non-diabetic group. The associations were in the same direction for T2DM group (35% vs 44%; 30% vs 36%; 2.14% vs 1.65%, respectively) with a higher all-cause mortality in diabetic patients with poor collaterals (p=0.034). Multivariable Cox proportional hazards analysis showed that coronary collateralization was an independent factor for time to MACCE (HR 2.155，95%CI 1.290-3.599, P=0.003) and repeat revascularization (HR 2.326, 95%CI 1.357-3.986, p=0.002) in non-diabetic patients, but did not enter the model in those with T2DM. Conclusions: T2DM is associated with reduced coronary collateralization. The effects of the status of coronary collateralization on long-term clinical outcomes and left ventricular function appear to be similar in size in type 2 diabetic patients and non-diabetics after successful recanalization of CTO.
Zoster-associated pain (ZAP) represents an important medical, social, and economic problem. The treatment approach for ZAP continues to be challenging. Tender point infiltration (TPI) with local anesthetic and steroids has been demonstrated to have potential in the treatment of severe pain, but there are rare reports of the efficacy and security of TPI for acute and subacute ZAP.The aim of this study was to retrospectively analyze the efficacy of TPI for pain control in acute and subacute ZAP.Retrospective case series.Medical records of 152 patients who underwent TPI for acute and subacute herpes zoster pain were reviewed. The patients were divided into 2 groups: acute TPI group (TPI within 30 days after zoster onset) and subacute TPI group (TPI between 30 and 90 days after zoster onset). The numeric rating scale (NRS), effective rate, frequency of TPI and rate of medication discontinuation during the follow-up period of 3 months were retrospectively analyzed.The NRS score significantly decreased from 7.80 ± 1.05 before TPIs to 0.97 ± 0.68 in the acute TPI group (P < 0.001) and was decreased from 5.76 ± 1.07 to 1.12 ± 0.70 in subacute TPI group (P < 0.001). The effective rate was 92.2% in acute TPI group and was 90.7% in subacute TPI group (P = 0.734). The rate of medication discontinuation at month 1 and month 3 was higher in the acute TPI group than in the subacute TPI group (P < 0.05). The frequency of TPI in acute TPI group (1.49 ± 0.79) was less than subacute TPI group (3.09 ± 1.02) (P < 0.001). A small proportion of the patients had mild complications, and all resolved over time after TPIs. No severe adverse events occurred during or after TPI procedures.Retrospective design without a control group, short period of follow-up, and the small number of patients.TPI can be a useful and safe option for the control of acute and subacute ZAP with high feasibility. Early application of TPI in the acute phase of herpes zoster pain may show better clinical outcomes.
Introduction: High-density lipoprotein (HDL) functional capacity is markedly impaired in patients with diabetes. The role of HDL in maintaining coronary collateralization in diabetic and non-diabet...
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