RESUMEN
BACKGROUND: Labor analgesic interventions, particularly the use of opioids and epidural anaesthesia, have raised concerns regarding their potential impact on postpartum urinary retention (PUR), necessitating a comprehensive investigation into their association with this clinical outcome. METHODS: This retrospective case-control study analysed clinical data from postpartum patients at our hospital from January 2023 to December 2023. Anaesthetic methods, including opioid and non-opioid drug usage, epidural analgesia and non-use of analgesia, were assessed. Logistic regression analysis was also performed to determine important associations with apparent PUR. RESULTS: This study included clinical data from 54 postpartum patients with PUR and 54 without urinary retention. A higher percentage of women with apparent PUR received opioids during labour compared with those without PUR (p = 0.033). Conversely, a lower percentage of women with apparent PUR received non-opioid analgesics compared with those without PUR (p = 0.026). In addition, a higher percentage of women with apparent PUR received epidural analgesia compared with those without PUR (p = 0.041). Logistic regression analysis demonstrated that opioid consumption during labour was significantly associated with apparent PUR (odds ratio (OR) = 2.469, p = 0.022). By contrast, non-opioid consumption during labour was inversely associated with apparent PUR (OR = 0.297, 95% CI = 0.123-0.681, p = 0.005). In addition, the use of epidural analgesia during labour showed a remarkable association with apparent PUR (OR = 2.857, 95% CI = 1.289-6.552, p = 0.011). CONCLUSIONS: Opioid use during labour and the use of epidural analgesia were identified as important risk factors for apparent PUR. These findings emphasise the need for a thoughtful and balanced approach to analgesic management during labour to minimise the risk of PUR in obstetric patients.
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Analgesia Epidural , Analgesia Obstétrica , Analgésicos Opioides , Anestesia Epidural , Retención Urinaria , Humanos , Retención Urinaria/etiología , Femenino , Analgésicos Opioides/administración & dosificación , Embarazo , Estudios Retrospectivos , Estudios de Casos y Controles , Adulto , Factores de Riesgo , Trastornos Puerperales/etiologíaRESUMEN
BACKGROUND: Postpartum urinary retention is a common complication following caesarean section, with significant implications for patient comfort and recovery. Combined spinal and epidural anaesthesia is frequently employed for caesarean section, but postpartum urinary retention remains a clinical concern despite its benefits. This study aimed to investigate the effectiveness of hydromorphone hydrochloride combined with bupivacaine for combined spinal and epidural anaesthesia in reducing postpartum urinary retention. METHODS: A retrospective analysis was conducted on patients who received combined spinal and epidural anaesthesia for caesarean section. The control group received bupivacaine, whereas the hydromorphone hydrochloride combined with bupivacaine spinal-epidural anaesthesia (HB) group received hydromorphone hydrochloride combined with bupivacaine. Data on demographics, anaesthesia, operative characteristics, postoperative urinary retention and adverse events were collected and analysed. RESULTS: The study enrolled 105 patients, with a control group (n = 51) receiving bupivacaine spinal-epidural anaesthesia and an observation group (n = 54) receiving hydromorphone hydrochloride combined with bupivacaine spinal-epidural anaesthesia. The incidence of postoperative urinary retention was significantly lower in the HB group than in the control group (3.70% vs. 17.65%, p = 0.044). Furthermore, the HB group exhibited a shorter time to first voiding after anaesthesia (5.72 ± 1.26 h vs. 6.28 ± 1.35 h, p = 0.029), lower peak postvoid residual volume (168.57 ± 25.09 mL vs. 180.43 ± 30.21 mL, p = 0.032), decreased need for postoperative catheterisation (5.56% vs. 21.57%, p = 0.034) and shorter duration of urinary catheterisation (10.92 ± 2.61 h vs. 12.04 ± 2.87 h, p = 0.039) than the control group. Correlation analysis supported a negative correlation between hydromorphone supplementation and parameters related to postoperative urinary retention. Multivariate regression analysis demonstrated a significant association between the duration of urinary catheterisation and the use of hydromorphone with the occurrence of postoperative urinary retention, providing further insights into the multifactorial nature of this postoperative complication. CONCLUSIONS: The addition of hydromorphone hydrochloride to bupivacaine for combined spinal and epidural anaesthesia was associated with a reduced incidence of postpartum urinary retention and improved postoperative voiding parameters, without significantly increasing the risk of adverse events.
Asunto(s)
Anestesia Epidural , Anestesia Raquidea , Bupivacaína , Hidromorfona , Retención Urinaria , Humanos , Retención Urinaria/prevención & control , Retención Urinaria/etiología , Hidromorfona/administración & dosificación , Hidromorfona/uso terapéutico , Hidromorfona/efectos adversos , Estudios Retrospectivos , Femenino , Anestesia Raquidea/efectos adversos , Bupivacaína/administración & dosificación , Adulto , Anestésicos Locales/administración & dosificación , Cesárea/efectos adversos , Anestesia Obstétrica/efectos adversos , Anestesia Obstétrica/métodos , Embarazo , Trastornos Puerperales/prevención & control , Trastornos Puerperales/etiología , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Resultado del TratamientoRESUMEN
The autophagy-tethering compound (ATTEC) technology has emerged as a promising strategy for targeted protein degradation (TPD). Here, we report the discovery of the first generation of PDEδ autophagic degraders using an ATTEC approach. The most promising compound 12c exhibited potent PDEδ binding affinity and efficiently induced PDEδ degradation in a concentration-dependent manner. Mechanistic studies confirmed that compound 12c reduced the PDEδ protein level through lysosome-mediated autophagy without affecting the PDEδ mRNA expression. Importantly, compound 12c was much more effective in suppressing the growth in KRAS mutant pancreatic cancer cells than the corresponding PDEδ inhibitor. Taken together, this study expands the application scope of the ATTEC approach and highlights the effectiveness of the PDEδ autophagic degradation strategy in antitumor drug discovery.
RESUMEN
OBJECTIVE: To show the involvement of lymphocyte-derived catecholamines in the pathogenesis of rheumatoid arthritis (RA), we investigated the change in expression of tyrosine hydroxylase (TH), a rate-limiting enzyme of catecholamine synthesis, by CD4+ T lymphocytes in lymphoid tissues of DBA/1 mice with collagen-induced arthritis (CIA). METHODS: CIA model was induced by chicken type II collagen in DBA/1 mice. The joints of the mice were observed for clinical score of swelling on and after the 22nd day of primary immunization. Pathological changes of ankles were examined by staining of tissue sections with hematoxylin and eosin on the 35th and 55th day following primary immunization. Immunofluorescent histochemistry was used to identify the number of TH-positive, CD4-positive, and double-labeled cells in the mesenteric lymph nodes and the spleen. RESULTS: Paw-swelling onset was on days 29 - 32 after the first immunization in DBA/1 mice. Clinical score for swelling of the paws reached peak on day 46 after the first immunization. Compared with the ankles of intact or vehicle mice, the joints of CIA mice had these characteristics: increased inflammatory cells in the synovial tissues, proliferated synoviocytes in the multilayers, narrowed articular space, and destructed articular cartilages. Simultaneously, the number of TH-positive, CD4-positive, and double-labeled cells in the mesenteric lymph nodes and the spleen was significantly increased on days 35 and 55 following the first immunization. Between day 35 and day 55 post-immunization, there was no significant difference in the number of these positive cells. CONCLUSION: CD4+ T lymphocytes up-regulate TH expression in the process of CIA and therefore, it is suggested that endogenous catecholamines of lymphocytes involve in the pathogenesis of RA.