Objective To investigate the analgesic effect of ultrasound-guided paravertebral nerve block on patients with radical mastectomy. Methods Sixty female patients who underwent unilateral radical mastectomy with general anesthesia in the Second Hospital of Shanxi Medical University from March 2016 to January 2018 were enrolled, and 58 cases were actually studied according to the inclusion and exclusion criteria. According to the random number table method, the patients were randomly divided into simple general anesthesia group (GA group, 30 cases) and paravertebral nerve block combined with general anesthesia group (PG group, 28 cases). In the PG group, 15 ml of 0.4％ ropivacaine was injected into the T2-T6 paraspinal space on the surgical side with ultrasound. All patients received general anesthesia with intravenous propofol induction, and were given a self-controlled intravenous analgesia pump. When the visual analogue scale (VAS) score was ≥7 points, the patient was given intravenous morphine 5-10 mg. The t-test andχ2 test were used to compare the hemodynamic parameters at different time points, the VAS score at different time after operation, the postoperative analgesia pump use, and postoperative adverse reactions. Results There were no significant differences in hemodynamic parameters between the PG group and the GA group at different times (all P>0.05). The static VAS scores of the PG group at different time points were lower than those of the GA group, but the difference was not statistically significant (all P> 0.05). The cough dynamic VAS scores of the patients in the PG group were lower than those in the GA group at 2, 6, 12, and 24 h after surgery, and the difference was statistically significant (all P<0.05). The total amount of sufentanil [(35±10)μg vs. (50±8) μg, t=6.308, P<0.05], the number of remedial analgesia within 48 hours after operation [(550±105) mg vs. (680±128) mg, t=4.240, P<0.05], and the number of effective presses of analgesia pump (3.1±1.5 vs. 10.0± 3.4, t=10.117, P<0.05) in the PG group were significantly lower than those in the GA group. The adverse reactions such as nausea, vomiting and lethargy in the PG group were significantly lower than those in the GA group, and the difference was statistically significant (χ2 values were 3.869 and 2.334, both P< 0.05). The postoperative analgesia comfort rate of the PG group was significantly higher than that of the GA group [96.4％(27/28) vs. 70.0％(21/30)], and the difference was statistically significant (χ2=7.089, P<0.05). Conclusion The combined use of general anesthesia and ultrasound-guided paravertebral nerve block for postoperative analgesia in patients with radical mastectomy is superior to PCIA.

Objective: To investigate the etiology, clinical features, treatment and outcome of nephrotic syndrome associated with chronic mercury poisoning. Methods: From June 2013 to April 2018, Beijing Chaoyang Hospital, Capital Medical University received 33 patients with chronic mercury-neutral nephrotic syndrome. The clinical manifestations, laboratory tests, treatment methods, and outcomes were analyzed. Results: Among the 33 patients, 27 patients had mercury exposure due to daily-life contact and the other 6 patients were caused by iatrogenic mercury. The symptom was characterized by typical nephrotic syndrome such as lower extremity edema and proteinuria at first onset. The treatment was based on mercury-removing treatment, 19 cases were treated with mercury removal alone, 16 cases were completely relieved; 10 cases were treated with mercury removal and glucocorticoids, all of which were completely relieved; 4 cases were treated with mercury removal, glucocorticoids and immunosuppressive agents, all complete remission; clinical complete remission rate is about 90.9% (30 cases in total) . Urinary mercury levels decreased the fastest between the first and second courses of mercury treatment, but the total amount of urine protein increased. As the amount of urinary mercury excreted increased, the total amount of urine protein decreased gradually (Z=2.86, P<0.01) . Conclusion The clinical features of chronic mercury-induced nephrotic syndrome are non-specific, easy to be misdiagnosed and missed. The treatment is mainly treated with mercury removal treatment. The prognosis is good. In severe cases, glucocorticoid therapy can be supplemented.