and NaV1.9 are involved in different aspects of physiological or pathological pain. Although NaV1.6 in conjunction with the modulatory NaVβ4 subunit has the ability to trigger and maintain high-frequency repetitive firing via mediating persistent and resurgent currents, only very recently has its role in pain disorders been recognized. Summary: The persistent and resurgent currents in sensory neurons are generated predominantly by NaV1.6 in association with NaVβ4. Since spontaneous activity, especially high-fre-quency repetitive and burst firing in damaged peripheral sensory nerve or neurons, is crucial for the development of neuropathic pain, NaV1.6 and/or NaVβ4 may be new therapeutic targets for managing pathological pain conditions. (Funded by the National Institutes of Health.) ABSTRACT
Background: Emergency Manuals (EMs) are valuable tools to guide healthcare professionals during anesthesia-related emergencies that require prompt diagnosis and effective treatment. Its use has been shown to improve simulated and actual patient outcomes in various operating room (OR) critical scenarios. However, integration of EMs into the standard practice of OR crises has been particularly challenging. Methods: The Simulation Wars was a competition created in China to increase awareness of EMs, the use of EMs among multidisciplinary teams, and to promote health care professional participation in EM simulation training. Each participant completed a post-competi-tion questionnaire detailing their opinions about the event. A novel scoring system was created and tested for use in simulation competitions. Results: Ninety-three percent of participants agreed that this competition could enhance the participation of simulation training in multidisciplinary health professionals and that they would continue participating in their hospital simulation training. The novel scoring system exhibited high internal consistency and good reliability. There is a strong positive correlation between the judges ’ score and the participants ’ score as R = 0.862, P = 0.013. Conclusion: The Simulation Wars can increase participants ’ understanding of how and why to use EMs, and enhance participation of multidisciplinary teams. The scoring system created for the competition has shown good reliability and justifies further development and evaluation. ABSTRACT
This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose.To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. From the Cardiology Department, The James Cook University Hospital, Middlesbrough, UK. .
bstetric patients present unique challenges in providing neuraxial (spinal or epidural) blockade. Neuraxial anesthesia offers analgesia and anesthesia for labor, vaginal delivery, cesarean section, and is considered the gold standard because of its limited effects on both the mother and fetus. Neuraxial analgesia/anesthesia relies primarily on the palpation of anatomical landmarks, which can be obscured in the setting of obesity, edema, and anatomical variation (1). Pregnancy is associated with generalized tissue edema, weight gain, and an exaggerated lordosis which can make palpation and identification of anatomic landmarks very challenging. Further-more, the hormonal changes of pregnancy cause ligaments to soften which can alter the tactile sen-sation of the dural ligament making the epidural space harder to identify. These changes narrow the epidural space causing the intrathecal space to become smaller increasing the risk for inadver-tent dural puncture (2). Parturients may also have difficulty achieving and maintaining ade-quate flexion of the lumbar spine for neuraxial insertion because of the gravid uterus and/or severe pain from contractions (2). None-the-less, repeated needle insertions and redirections can further increase the pain and discomfort already experienced by the parturient in labor (1). Ultrasound imaging for clinical procedures popularity decade
lidocaine and one of its less well known neuropharmacological mechanisms of action is examined as one explanation of its effectiveness in this setting.
the molecular mechanism on how systemic HMGB1 neutralization improves POCD is not fully elucidated. Necroptosis could cause sterile inflammation and negatively associates with the cognitive score in Alzheimer ’ s disease. Thus we detected the effects of anti-HMGB1 antibody on the necroptosis-associated protein expressions dur-ing the POCD of aged rats. under sevoflurane anesthesia and analgesia were performed. Immunoglobulin G (1 mg/kg) and HMGB1 neutralizing antibody (1 mg/kg) were injected via tail right before and 6 hours after surgery. The expression of necroptosis-associated proteins (HSP90, CDC37, and RIP3) in the prefrontal cortex of brain was detected by western blot and immunofluorescence. Oxidative stress was measured by dihydroethidium staining. Results: Systemic administration of anti-HMGB1 antibody decreased the levels of reactive oxygen species (ROS) and reduced the expression of HSP90, CDC37, and RIP3 in prefrontal cortex neurons of brains after surgery (P < 0.05, respectively). Moreover, acetylated HSP90 (ACHSP90) which is a negative regulator of necroptosis was significantly decreased by treatments of anti-HMGB1 neutralization antibody (P < 0.05). Conclusion: Systemic administration of anti-HMGB1 antibody may improve POCD through reducing reactive oxygen species and decreasing necroptosis in the prefrontal cortex of the aged brain. (Funded by the National Natural Science Foundation of China and Central South University Postdoctoral Foundation in Changsha, China.) ABSTRACT
This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose.To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. From the Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Department of Anesthesiology, Beijing Jishuitan Hospital, both in Beijing, China.
BACKGROUND:With essentially no drug available to control the infection caused by the extensively drug-resistant Acinetobacter baumannii (XDR-Ab) in infants and young children, this study explored the clinical outcomes of pediatric patients with drug-resistant XDR-Ab who were treated with rifampicin in combination with sulbactam sodium.METHODS:The data for clinical outcomes, microbiological responses, and side effects were collected and evaluated for 12 critically ill infants and young children diagnosed with ventilator-associated pneumonia caused by XDR-Ab following surgical treatment for congenital heart disease in a pediatric cardiac intensive care unit. This study was approved by local institutional review board (IRB).RESULTS:Two patients died from the complex underlining diseases. The other 10 patients were weaned off the mechanical ventilation successfully within 4-15 days after the start of treatment with rifampicin combined with sulbactam sodium and discharged home. Three cases experienced adverse side effects, including severe rash and elevated aminotransferase level.CONCLUSION:The combination of rifampicin and sulbactam sodium appeared to be an effective and safe therapy for severe ventilator-associated pneumonia caused by XDR-Ab in infants and young children. Side effects such as skin rashes and elevated aminotransferase levels can be reversed once rifampicin is discontinued in time. (Funded by the Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Chang-sha, China; the Departments of Anesthesiology and Pain Medicine of University of California Davis Health; and the National Institutes of Health.).
