Objective To observe the adsorption of fentanyl by different materials of the analgesic pump reservoir. Methods The concentrations of fentanyl in pump reservoirs,which were made by different materials （glass,silica gel,polyvinyl chloride,non polyvinyl chloride） were detected with the time by high-performance liquid chromatography. The measurement was repeated three times.Results Fentanyl concentration in these reservoirs decreased with time,which decreased 6.3% in silica gel reservoir （P0.05）,2.7% in non polyvinyl chloride（P0.05）,1.5% in PVC and 1.2% in glass bottles.Conclusion Fentanyl citrate will be adsorbed by different materials of analgesia pump reservoir within 72 h,and the adsorption sequence was silica capsule,non polyvinyl chloride,polyvinyl chloride,and glass bottles.

Objective To evaluate the application value of elastic index difference (EID) in identifying benign or malignancy masses of breast imaging reporting and data system (BI-RADS) 3-5.Methods Data of 193 lesions in 164 patients with ultrasonic diagnosed as BI-RADS 3-5 breast masses were retrospectively analyzed.All the cases were confirmed pathologically.The EID of masses and normal glands were measured with elastography quantitative analysis software.BIRADS 3-5 breast masses were diagnosed as malignant when EID≥2.5,which was the criteria for BI-RADS reclassification.ROC curve was drawn,and the area under the curve (AUC) was calculated.The diagnostic accuracy and AUC of malignant breast tumors with the methods of BI-RADS and BI-RADS combined with EID were compared.Results Taking pathological results as gold standard,the sensitivity,specificity,accuracy of BI-RADS in detecting malignant tumors were 96.00％ (72/75),67.80％ (80/118),78.76％ (152/193),and those of BI-RADS combined with EID were 97.33％ (73/ 75),83.05％ (98/118),88.60％ (171/193),respectively.The AUC of BI-RADS combined with EID (0.931) was higher than that of BI-RADS (0.875;Z=2.06,P＜0.05).The statistical difference of accuracy was found between BI-RADS and BI-RADS combined with EID methods (x2 =15.21,P＜0.05).Conclusion The combination of BI-RADS and EID is better than simple using BI-RADS in identifying benign or malignancy of breast tumors.

Objective To test the hypothesis that isoflurane-preconditioning (ISO-P) provides added protection of myocardium with hypothermia against ischemia-reperfusion injury through KATP channels. Methods Thirty-two SD rats of both sexes weighing 230-270 g were studied. The animals were anesthetized with intraperitoneal ketamine 100 mg?kg-1 and heparinized. Chest was opened and heart was immediately removed and perfused in a Langendorff apparatus with oxygenated (95% O2, 5% CO2) Krebs-Hensleit buffer (KHB) for 50 min,followed by 150 min of hypothermic-ischemia (perfusion was suspended and heart was immersed in 17℃ KHB) and 60 min of normothermic reperfusion (heart was again reperfused with 37.7℃ KHB and immersed in 37.7℃ KHB) (I/R). The animals were randomly divided into 4 groups of 8 animals:(l) control group; (2) ISO-P group; (3) ISO-P + GLB group and (4) ISO-P + 5-HD group. The control group received no pretreatment before I/R. In ISO-P group the heart was perfused with KHB gassed with 1% isoflurane for 15 min followed by 15 min wash-out before I/R. In group 3 and 4 the heart was perfused with KHB containing glibenclamide 20?mol?L-1 (group 3) or 5-hydroxydecanoate 150?mol ?L-1 (group 4) in addition to 1% isoflurane before I/R. Cardiac function was measured with a fluid filled latex balloon inserted in left ventricle (LVSP, LVDP, LVEDP, dp/dtmax, dp/dtmin). During hypothermic ischemia left ventricle pressure (LVP),S-time (the interval between the beginning of ischemia to the time point when LVP increased by 1 mm Hg from the baseline pressure) and C-time (the interval between the beginning of ischemia to the time point when LVP was lmmHg below the plateau pressure) were measured. Other criteria included coronary flow (CF),infarct size and creatine kinase.Results (l) S-time and C-time were negatively correlated with infarct size.(2)In ISO-P group (group 2) S-time and C-time were significantly longer during ischemia; LVDP and LVDP x HR were significantly higher during normothermic reperfusion and infarct size was significantly smaller than those in control group (groupl) (P

Objective To discuss the presentations, pathologic features, diagnosis and treatment of primary synovial sarcoma of the kidney. Methods One case of primary synovial sarcoma of the kidney was reported and the relevant literature was reviewed. A 55-year-old man was admitted with complaint of right abdomen and flank pain for 5 h. Computerized tomography revealed a 12.5 cm × 11.0 cm × 9. 0 cm mass located at the middle and lower pole of the right kidney. The patient was taken radical nephrectomy. Results The diagnosis of primary synovial sarcoma of the kidney in the patient was confirmed by postoperative pathology. Under microscope, tumor was typically mitotically active, monomorphic spindle cells growing in intersecting fascicles or in solid sheets with epithelial differentiation. In some areas a haemangiopericytoma-like pattern was found. Immunohistochemical staining showed that the tumor cells were positive for the markers Vimentin, CD99 and Bcl-2, but CK was negative. The patient died of local recurrence and multi-metastasis at 8 months after surgery. Conclusions Primary synovial sarcoma of the kidney is extremely rare with a high grade of malignancy,and its prognosis is poor. The diagnosis depends on pathological features, Immunohistochemical studies and RT-PCR detection. Radical resection combined with chemicaltherapy is considered to be the most reliable treatment so far.

Objective To propose SHA.LIN nephrolithometry scoring system for assessing and predicting the stone-free rate of percutaneous nephrolithotomy ( PCNL) and to investigate the clinical value of SHA.LIN scoring system for nephrolithiasis in patients undergoing PCNL .Methods A literature review from 1976 to 2014 was performed to identify clinically relevant and reproducible variables that could affect the outcomes of PCNL. Six reproducible variables available from preoperative noncontrast-enhanced computed tomography were measured , including stone size ( S) , hydronephrosis ( H) , anatomic distribution (A), length of tract(L), indicator of CT(I), number of involved calices(N) and was named as SHA.LIN nephrolithometry scoring system .A retrospective analysis was conducted of clinical data of 116 patients with nephrolithiasis undergoing PCNL from June 2011 to March 2015. The general conditions , preoperative information , stone characteristics and perioperative variables were collected . The correlation of nephrolithometry scores based on SHA.LIN scoring system with stone-free status, operation time, blood loss, length of hospital stay and postoperative complications were analyzed . Receiver operating characteristic ( ROC) curves was drawn to detect sensitivity and specificity of SHA .LIN score in predicting the stone-free rates of PCNL.Results The SHA.LIN score was 9.13 ±2.24 in this cohort.The stone free rate was 75.9%(88/116).Postoperative complications occurred in 32 (27.6%) cases.In those patients with stone
free, the SHA.LIN score was 8.27 ±1.62, significantly lower than that in those patients with residual stones 11.86 ±1.72 ( t =-10.069, P=0.000) .The SHA.LIN score showed significant correlation with the postoperative stone free status, operation time, estimated blood loss (P<0.01).But, it did not correlate with postoperative complications and length of hospital stay (P>0.05).The area under curve of ROC curves for the SHA.LIN scoring system was 0.923 ( 95%CI 0.870 -0.975 ) . Conclusions The SHA.LIN nephrolithometry scoring system can predict postoperative stone-free status of PCNL and can be used for disease related assessment.Further research is required to evaluate its performance in predicting peri-operative variables and postoperative complications .

【Objective】To study the relationship between circulation tumor cell（CTC）and clinicopathological characteristics in early and middlestage colorectal cancer，and to evaluate the diagnostic and prognostic value of peripheral blood CTC through dynamically monitoring the changes of peripheral blood CTC in the patients before and after operation.【Methods】 Prospectively 67 patients with early and middle stage colorectal cancer were included，and 20 healthy volunteers served as contrast during the same period. Peripheral venous blood（7.5 mL）was collected 24 h before radical operation，3 months after radical operation and in control group. SE- iFISH technique was used to isolate and identify CTC. The cutoff value of CTC in diagnosis of colorectal cancer was determined by the receiver operating curve（ROC）and Youden index. Kaplan-Meier and log-rank methods were used for survival analysis and multivariate COX regression analysis for multivariate correction. The value of CTC in the diagnosis of early and middle stage colorectal cancer was evaluated comprehensively，and then the relationship between CTC in peripheral blood and clinicopathological characteristics and prognosis was synthetically evaluated combined with clinicopathological characteristics and postoperative follow- up data. 【Results】The positive rate of CTC in patients with early and middle stage colorectal cancer was significantly higher than that in healthy people（91.0% vs. 5.0% ，P<0.01）. The CTC enumeration was significantly correlated with the depth of invasion and tumor location（P = 0.001，P = 0.044），but not with gender，age，tumor size，lymph node metastasis，TNM stage ，CEA level and CA-199 level. The preoperative CTC enumeration were not correlated with the above-mentioned clinicopathological parameters. Preoperative CTC had no predictive significance for disease free survival（DFS）and total survival（OS）（AUC = 0.359，P = 0.068；AUC = 0.428，P = 0.423），and postoperative CTC critical point of 3/7.5 mL had predictive significance for DFS and OS（AUC = 0.936 ，P < 0.001 ；AUC = 0.863 ，P < 0.001）. It was found that patients with early and middle stage colorectal cancer were divided into two groups ：good prognosis group（CTC < 3 after operation or the number of CTC after operation was equal or decreased with the number of CTC before operation）and bad prognosis group（CTC ≥ 3 after operation or the number of CTC after operation was higher than the number of CTC before operation）. The DFS of the good prognosis group was significantly longer than that of the poor prognosis group （43.7 months vs. 20.4 months，P < 0.001；48.7 months vs. 26.8 months，P < 0.001），and the OS was also significantly longer （54.7 months vs. 43.3 months，P < 0.001；54.8 months vs. 45.1 months，P < 0.001）. Multivariate analysis showed that CTC ≥ 3/7.5 mL was a bad independent factor of DFS and OS.【Conclusions】CTC has high clinical value in patients with early and middle stage colorectal cancer. Preoperative CTC values can not predict the prognosis of early and middle stage colorectal cancer ，but postoperative CTC values and dynamic detection for CTC changes before and after operation can independently predict the prognosis of early and middle stage colorectal cancer.

Objective To evaluate the effect of intelligentized patient-controlled analgesia ( PCA) management on the quality of postoperative analgesia in the patients. Methods A total of 6601 patients who underwent postoperative PCA from January 1, 2015 to December 31, 2017 searched from the intelli-gentized PCA system database were selected as intelligentized PCA management group ( I group) , and then were divided into 3 subgroups according to the year: 2015 subgroup ( n=2221 ) , 2016 subgroup ( n=2152) and 2017 subgroup (n=2228). A total of 1235 patients who underwent PCA which was mainly performed by a department of anesthesiology in the postoperative analgesia-related multi-center questionnaire from April 11, 2016 to April 22, 2016 in 12 grade A tertiary hospitals in Guangdong Province were select-ed as the traditional PCA management group (C group). The development of moderate and severe pain, nausea and vomiting, over-sedation at rest and during activity and patient′s satisfaction were recorded on 1st and 2nd days after operation. Results Compared with C group, the incidence of moderate and severe pain, nausea and vomiting and over-sedation at rest and during activity was significantly decreased, and the rate of patient′s satisfaction was increased at each time point after operation in I group ( P<0. 05 or 0. 01) . Com-pared with 2015 subgroup, the incidence of moderate and severe pain at rest and severe pain during activity was significantly decreased in 2016 and 2017 subgroups ( P<0. 05 or 0. 01) , and the incidence of nausea and vomiting was significantly increased in 2017 subgroup ( P<0. 05) . Compared with 2016 subgroup, the incidence of nausea and vomiting was significantly increased in 2017 subgroup (P<0. 05). Conclusion Intelligentized PCA management can improve the efficacy of PCA, mitigates the occurrence of adverse reac-tions and raise the quality of postoperative analgesia in the patients.

Twenty-three secondary and higher level hospitals in Nantong City were selected from June 3 to June 19, 2019, and the anesthesia safety and quality control surveys were conducted by using "Supervision and Evaluation Scale of Medical Quality Control Index System in a Department of Anesthesiology in Nantong City (2019 edition)" and "Special Supervision and Evaluation Scale of Perioperative Management and Information Construction in a Department of Anesthesiology in Nantong City (2019 edition)" . The results showed that the total score for medical quality control was 90.2±1.3, and the rate of reaching the standard was 87%.The department configuration score was (12.4±0.7), with the rate of reaching the standard 100%, 87% hospitals had anesthesia recovery rooms, but only 2 hospitals had anesthesia clinics.The staffing score was (15.50±0.23), with the rate of reaching the standard 74%, Nantong City had 0.67 anesthesiologists per 10 000 population, the ratio between the number of anesthesiologists and the number of operating rooms was (1.55±0.10), the ratio between the number of nurse anesthetists and the number of operating room was (0.30±0.04), and three hospitals even had no nurses in the department of anesthesiology.The department management and system score was (28.6±0.5), the rate of reaching the standard was 91%, and the operation safety verification system was not implemented in place in 87% hospitals.The medical technique score was (33.6±0.7), the rate of reaching the standard was 83%, and anesthesiology department was not equipped with anesthesia depth monitor, muscle relaxation monitor, body temperature monitor and other equipment in 35% hospitals.The perioperative management and information construction score was (40.2±1.7), the rate of reaching the standard was 48%, standardized post-operative ward round system was not carried out in 43% hospitals, and the surgical anesthesia information system was not used in 65% hospitals.In conclusion, the current status of anesthesia safety and quality control in secondary and higher level hospitals in Nantong City mainly manifests in the urgent need to improve the awareness of anesthesia safety and quality control, lack of doctors and nurses in a department of anesthesiology and lag of anesthesia information construction.

Objective To compare the effectiveness of patient-controlled intravenous analgesia with or without background infusion of dezocine plus flurbiprofen axetil injection in patients undergoing laparoscopic colorectal cancer operation. Methods Sixty patients scheduled for laparoscopic colorectal cancer surgery,35 males and 25 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ,were randomly divided into 2 groups:common-dose background infusion group(Group CB,n = 30),and no background infusion group(Group NB, n = 30). All patients were intravenously administered a PCA pump containing dezocine 0.6 mg/kg,flurbiprofen axetil 3 mg/kg and normal saline in a volume of 120 mL.Patients in Group CB were given background infusion rate of 2 mL/h with PCA bolus dose 2 mL,patients in Group NB were given PCA bolus dose 4 mL only.NRS scores, Ramsay sedation scores,pressing times,consumption of analgesic,supplementary analgesics,incidence of ad-verse reactions,time of first exhaust,time of first leaving bed and patients'satisfaction scores were recorded after surgery. The influence factors of time of first exhaust and time of first leaving bed were also analyzed. Results Compared with group CB,the NRS scores in group NB were higher both at rest and during movement(P<0.05), the Ramsay sedation scores in group NB were lower at 24 and 48 h after surgery(P<0.05),the pressing times in group NB were higher(P < 0.05),the consumption of analgesic in group NB were lower after surgery,and the incidence of using supplementary analgesics was higher(P < 0.05). No statistical difference was found on the in-cidence of adverse reactions between the two groups(P > 0.05). Moreover,the time of first leaving bed in group NB was longer than that in group CB(P<0.05).The satisfaction scores in group NB was lower than that in group CB(P<0.05).The main influence factors of the time of first leaving bed were gender and NRS score during move-ment at 24 h after the operation(P<0.05).The main influence factors of the time of first exhaust were age,BMI and fluid infusion volume(P < 0.05). Conclusion Postoperative patient-controlled intravenous analgesia with background infusion of dezocine and flurbiprofen axetil injection was more efficacious and satisfactory,and more suitable in postoperative pain management.

OBJECTIVE To provide reference for improving the level of hospital pharmaceutical management for operating room drugs. METHODS The operating room pharmacy of our hospital utilized the concept and means of the Internet of Things （IoT） to build an intelligent IoT system for operating room drugs （hereinafter referred to as the “IoT system”）， and optimized and improved it. The quality of drug management in the operating room of our hospital during the initial phase of the IoT system （Q1 2022） and after optimization and improvement （Q1 2023） were compared by setting indicators from four aspects： quality， efficiency， cost， and satisfaction. RESULTS After more than a year of optimization and improvement， our hospital has built a traceable IoT system for the entire drug process that integrated surgical anesthesia systems and hospital information systems， with the direction of drug circulation in the operating room as the axis， using intelligent drug vehicles as the hardware foundation， and anesthesia doctor’s order information system as the software medium. After the optimization and improvement of the IoT system， the standardized score of anesthesia orders in the operating room increased from （68.5±3.5） points in the initial period to （97.0± 2.7） points； the consistency rate between accounts and materials increased from （82.40±8.85）% to （96.50±4.80）%； the time of taking medicine was shortened from （40±8） min to （12±3） min； the frequency of drug withdrawal was reduced from （36.0± 6.5） times/day to （15.5±3.0） times/day； the cost of loss drugs was decreased from （1 292.61±305.90） yuan to （594.24±195.05） yuan； the satisfaction was increased from （80.5±6.5） points to （96.0±3.0） points. All indicators were significantly improved with statistically significant differences （P＜0.05）. CONCLUSIONS The intelligent IoT system constructed by our hospital effectively ensures the accessibility， timeliness， and safety of intraoperative medication， which is conducive to improving the quality of drug management in the operating room.