In order to standardize the postoperative pain management in adults in China, the Chinese Society of Anesthesiology formulated the "Clinical practice guidelines for postoperative pain management in adults (2024 edition)" according to the methods and steps of the "Principles for Formulation/Revision of Clinical Diagnosis and Treatment Guidelines in China (2022 Edition)". This protocol mainly introduced the purpose of guideline formulation, the formation and responsibilities of the working group, the collection and selection of clinical questions, the evaluation and synthesis of evidence, the formation of recommendations and other processes.

Objective: To observe the relationship between hyperthyroidism and vascular endothelial injury. Methods: From 2016 to 2017, data of 60 patients with simple hyperthyroidism, autoimmune thyroid disease, cardiovascular and cerebrovascular diseases were collected from the Second Affiliated Hospital of Harbin Medical University. And 60 healthy subjects were enrolled in the same period as a healthycontrol group. The enzyme-linked immunosorbent assay (ELISA) was used to detect the content of vascular endothelial injury markers (vWF), thrombomodulin (TM), endothelin-1 (ET-1), P-selectin in serum of all subjects, as well as the serum thyroid stimulating hormone (TSH), free triiodothyronine (FT₃), free thyroxine (FT₄), anti-thyroglobulin antibody (TgAb), and anti-thyroid peroxidase antibody (TPOAb) in patients with cardiovascular and cerebrovascular diseases levels. The correlation analysis of vascular endothelial injury in the simple hyperthyroidism group, autoimmune thyroid disease group, cardiovascular and cerebrovascular diseases group and healthy control group was conducted. Results: There were statistically significant differences between the healthy control group, the simple hyperthyroidism group, the autoimmune thyroid disease group and the cardiovascular and cerebrovascular diseases group in the serum levels of vWF, TM, ET-1 and P-selectin, respectively(F = 6.56, 9.19, 7.88, 12.45, P < 0.05), and the simple hyperthyroidism group, autoimmune thyroid disease group, cardiovascular and cerebrovascular diseases group were significantly higher than the healthy control group (P < 0.05). Correlation analysis showed that the vascular endothelial injury in the patients with simple hyperthyroidism, autoimmune thyroid disease, and cardiovascular and cerebrovascular diseases groups was statistically significantly different compared with the healthy control group, respectively(χ² = 5.08, 5.08, 8.16, P < 0.05); the risk of vascular endothelial injury in each diseased group was 2.37, 2.37, and 3.07 times higher than that of the healthy control group, respectively. The abnormal rates of TSH, FT₃, FT₄, TgAb and TPOAb in patients with cardiovascular and cerebrovascular diseases were 18.33% (11/60), 15.00% (9/60), 15.00% (9/60), 10.00% (6/60) and 11.7% (7/60), respectively. Conclusion Simple hyperthyroidism and autoimmune thyroid disease are risk factors of vascular endothelial injury.

Adult ; Anesthesia ; methods ; Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; surgery ; Female ; Humans ; Ovarian Neoplasms ; surgery ; Young Adult

Objective To investigate the MRI and pathological features of different molecular subtypes of breast cancer.Methods The data of 202 patients who underwent primary breast cancer resection were retrospectively reviewed.All of the patients had MRI preoperatively.The molecular subtypes of breast cancer defined by immunohistochemistry were classified as basal-like,luminal and HER-2 overexpression.Morphology (including mass or non-mass like enhancement,shape and margin of masses,unifocal or multifocal masses) and enhancement characteristics on MRI,histologic types and grades of tumors were analyzed with Chi-square test,exact test,Fisher exact test,Kruskal-Wallis H test,and Wilcoxon test.Results Among the 202 patients,34 were basal-like,144 were luminal and 24 were HER-2 overexpression.The number of mass cases in each subtype was 29,133 and 19 respectively,making no significant difference (x2 =4.136,P =0.126).As for the shape of basal-like lesions,8 were round,19 were lobular and 2 were irregular,while this distribution was 23,58,52 in luminal subtype and 1,11,7 in HER-2 overexpression subtype (x2 =13.391,P ＜ 0.05).The margin was also strikingly different among three groups (smooth,spiculated,irregular):20,5,4 respectively in basal-like,27,53,53 respectively in luminal,and 4,7,8 respectively in HER-2 overexpression (x2 =28.515,P ＜ 0.01).52.6％ (10/19) of HER-2 overexpression cases were multifocal,while only 6.9％ (2/29) of luminal and 8.0％ (24/133) of basal-like ones were multifocal (x2 =16.140,P ＜ 0.01).Characteristics in dynamic contrast-enhanced MRI were statistically different,with homogeneous,heterogeneous,and rim enhancement 0,13,16 respectively in basal-like cases,28,93,11 respectively in luminal cases and 2,11,6 respectively in HER-2 overexpression cases (P ＜ 0.01).However,the difference for enhancement curve did not reach significance (P =0.457).Histologic types were significantly different among molecular subtypes (P ＜ 0.01).Luminal breast cancer consisted of various histologic types,32.6％ (47/144) of which were mixed type.The majority of the other two molecular subtypes were invasive ductal carcinoma.Furthermore,invasive ductal carcinomas with different molecular subtypes showed different histologic grades (Hc =30.014,P ＜ 0.01).Basal-like breast cancer was more likely associated with a higher grade of malignancy.Conclusions Different molecular subtypes of breast showed distinct MRI features and pathologic characteristics.MRI might be a useful tool for preoperative prediction of molecular subtypes of breast cancer.

Objective To evaluate the effects of botulinum toxin type A (BTX-A) on spasticity of wrist and hand post stroke. Methods 36 patients accepted BTX-A injection were assessed with modified Ashworth scale (MAS), Upper Extremities Functional Test (UEFT), limbs position at rest, Visual Analogous Scale (VAS) for pain, modified Barthel Index (MBI), and difficulties encountered during 3 upper limb motor tasks: cleaning the affected palm, cutting the affected fingernails, putting the affected arm into the sleeve, before and 2, 4, and 12 weeks after treatment. Results The scores of MAS, VAS, UEFT and accomplishment of those tasks improved after treatment (P<0.05), from 1 week to 12 weeks. No significant improvement was observed in MBI (P>0.05). Conclusion Local BTX-A injection can reduce the spasticity and pain, and improve function of upper limbs for stroke patients.

To investigate the distribution of virulence associated factors of 5 strains of Streptococcus suis type 2 from slaughtered pigs isolated in Fujian province , 7 virulence genes were detected through PCR amplification. They were the glutamate dehydrogenase gene(gdh), the capsular polysaccharides gene(cps), the extracellular factor gene(ef), the muramidate-released protein gene(mrp), the suilysin gene(sly), the fibronectin-binding protein gene(fbps) and the virulence-associated sequence or f2. Among these 5 strains isolated, the virulence genotypes of 4 strains S.suis type 2 and strain SS2PFJ07 was gdh+/cps2J+/mrp+/ef-/sly-/fbps+/orf2+ and the other one strain isolated from slaughtered pigs was gdh+/cps2J+/mrp+/ef+/sly+/fbps+ /orf2+ respectively. This results showed that there are at least 2 virulence genotypes in Streptococcus suis type 2 from slaughtered pigs isolated in Fujian province.

OBJECTIVE To evaluate the efficacy and side effect during target controlled infusion of remifentanil and propofol in elderly patient undergoing nasal-endoscopy surgery.METHODS 60 patients of nasal-endoscopy surgery were devided into two groups based on age(non-elderly group age

Objective: To observe the efficacy of controlled hypotention with nicardipine and influences on endocrine system. Method: Twenty adult patient, ASA grade Ⅰ-Ⅱ, scheduled for bone tumour operation, were selected. After the operation begining, Nicar of 0.01-0.02mg/kg was given at central venous bolus, was infused at 1-4?g?kg?min~(-1). Result: Hemodynamics was very stable during controlled hypotension, regulating frequency of Niear dosage was 1.5?0.7 time/h, reaching time of aim blood pressure was 47?31s, BP recovery time from discontinuating Nicar intusion to pre-hypotention level was 40?11min and no hypertention rebound occurred after discontinuation of Nicar. Fifteen min following controlled hypotension, plasma catecholamine (CA) level increased (P0.05). During mass bleeding and subsequent malignant hypotension, serious arrhythmia and oliguria did not occur. Conclusion: Controlled hypotension with Niear is rapid, stable and easy without hypertension rebound. The influences of Nicar on plasma CA are only very obvious. Nicar has considerable protective effects on heart and kidney during mass bleeding.

Objective To determine perioperative changes of tumor necrosis factor alpha (TNF ?),superoxide dismutase(SOD),lipid peroxides(LPO) and creatine kinase MB (CK MB) in patients undergoing cardiopulmonary bypass (CPB) Methods Thirteen patients undergoing heart valves surgery were studied Blood samples were taken from artery and coronary sinus for measurement of plasma TNF ? and LPO concentrations, and plasma SOD and CK MB activities prior to CPB, 5min,30min after aorta declamping, at the end of operation, 6h and 18h after surgery respectively Blood gas analysis was done at various intervals and alveolar arterial oxygen gradient (P A a DO 2) was calculated The net myocardial release of TNF ? (coronary sinus plasma level minus arterial level) was recorded Results Arterial and coronary sinus TNF? levels increased significantly following aortic declamping as compared with those before CPB and were kept at the higher level till the end of operation (P