Opioid-reduced multimodal analgesia has been used clinically for many years to decrease the perioperative complications associated with opioid drugs. We aimed to assess the clinical effects of opioid-reduced anesthesia during thoracoscopic sympathectomy. Surgical patients (n = 151) with palmar hyperhidrosis were randomly divided into control (Group C, 73 patients) and test (Group T, 78 patients) groups. All patients were administered general anesthesia using a laryngeal mask. In Group C, patients received propofol, fentanyl, and cisatracurium for anesthesia induction, and maintenance was achieved with propofol and remifentanil, along with mechanical ventilation during the operation. In Group T, anesthesia was induced with propofol, dezocine, and dexmedetomidine (DEX) and maintained with propofol, DEX, and an intercostal nerve block, along with spontaneous breathing throughout the operation. Perioperative complications related to opioid use include hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness were observed. To assess the impact of these complications, we recorded and compared vital signs, blood gas indices, visual analogue scale (VAS) scores, adverse events, and patient satisfaction between the two groups. Perioperative complications related to opioid use were similar between groups. There were no significant differences in the type of perioperative sedation, analgesia index, respiratory and circulatory indicators, blood gas analysis, postoperative VAS scores, adverse reactions, propofol dosage, postoperative recovery time, and patient satisfaction. In minimally invasive surgeries such as thoracoscopic sympathectomy, opioid-reduced anesthesia was found to be safe and effective; however, this method did not demonstrate clinical advantages. Chinese Clinical Trial Register: ChiCTR2100055005, on December 30, 2021.

The incidence of breast cancer has exhibited an annually increasing trend, and the disease has become the most common malignant tumour worldwide. Currently, the primary treatment for breast cancer is surgical resection. However, metastatic recurrence is the main cause of cancer-related death in this patient population. Various factors are associated with breast cancer prognosis, and anaesthesia-induced changes in the tumour microenvironment have attracted increasing attention. To date, however, it remains unclear whether anaesthetic drugs have a positive or negative impact on cancer outcomes after surgery. The present article reviews the effects of different anaesthetics on the postoperative prognosis of breast cancer surgery to guide the choice of anaesthetic technique(s) and agents for such patients.

We aimed at exploring the role and mechanism of METTL3-mediated m6A modification in neuropathic pain. Male Sprague-Dawley rats were randomly divided into four groups: Sham operation group (Sham group), chronic constriction injury (CCI) of the sciatic nerve model group (NPP group), intrathecal injection of virus down-regulated METTL3 + CCI model group (M3 + NPP group) and intrathecal injection of negative control virus + CCI model group (Scr + NPP group). The M3 + NPP group and the Scr + NPP group were intrathecally injected with virus nineteen days before operation. The paw withdrawal mechanical thresholds and paw withdrawal latency were respectively recorded one day before operation, three days, five days and seven days after oper-ation. The rats were sacrificed on the seventh day after operation, and their spinal cord tissues were taken. The frozen sections of rats were performed to observe the expression of green fluorescent protein of the virus. The methylation level of RNA, the protein expression of m6A-related enzyme (METTL3) and mu opioid receptor (MOR) in spinal cord tissues of the four groups were measured. Downregulation of METTL3 had no effect on the overall methylation level of the spinal cord, but it could regulate the methylation level of the OPRM1 gene RNA encoding MOR, partially restore the expression of MOR, and relieve pain in rats. In the process of NPP, METTL3 may inhibit the expression of MOR by regulating the methylation level of OPRM1 gene RNA encoding MOR, and ultimately promote the occurrence and development of NPP.

神经病理性疼痛是由中枢神经系统及周围神经系统的原发性损害和功能障碍诱发,常会引起痛觉过敏、异常疼痛、自发性疼痛和感觉异常,而这些变化是如何发生的仍然难以确定.最新研究表明,外周有害刺激改变了 RNA修饰、非编码 RNA、DNA甲基化、组蛋白修饰等表观遗传学修饰,这些变化可能与神经病理性疼痛的痛觉敏感有关.本文综述目前神经病理疼痛表观遗传学作用机制的研究进展,以期为该疾病的诊疗提供潜在靶点.

Objective To study the clinical effects of dexmedetomidine（DEX） on patient controlled intravenous analgesia（PCIA） in patients with acquired immunodeficiency syndrome（AIDS） underwent perianal surgery. Methods Ninety AIDS patients with perianal surgery under combined spinal epidural anesthesia were randomly divided into observation group（Group O） and control group（Group C）. In Group O, sufentanil 1.5 μg/kg + DEX 2.5 μg/kg + flurbiprofen 200 mg + ondansetron 8 mg were diluted to 200 mL with normal saline in PCIA; the background infusion rate was 3 mL/h; an additional dose of 3 mL/h was permitted under a locking time of 15 min; and the total infusion time was 48 h. In Group C, DEX was not used in PCIA, the rest were the same as Group O. The degree of pain, sedation at rest 4, 12, 24 and 48 hours after surgery, and PCIA cumulative additional drugs were recorded. The changes of plasma T lymphocyte subsets in the two groups before anesthesia and 24 and 48 hours after operation were observed, and the occurrence of perioperative adverse reactions and patients′ satisfaction were recorded. Results Compared with Group C, the pain score after surgery and cumulative additional drugs in Group O were significantly reduced; while the patients′ satisfaction was significantly improved（P＜0.05）. However, there was no significant difference in postoperative sedation score, perioperative T lymphocyte subsets or adverse reactions between two groups（P＞0.05）. Conclusion DEX is safe and effective in PCIA of patients with AIDS after perianal surgery. It can reduce the degree of pain and improve patients′ satisfaction, but has no significant effect on T lymphocyte subsets.

目的 探讨低频电刺激联合早期康复训练对社区脑梗死患者NIHSS评分的影响.方法 选取收治的社区脑梗死患者126例,随机分为对照组和研究组各63例.两组均行常规治疗,对照组应用早期康复训练,研究组联合应用低频电刺激.观察对比两组NIHSS评分和FIM评分.结果 治疗后,研究组NIHSS评分显著低于对照组(P<0.05);运动功能及认知功能评分显著高于对照组(P<0.05).结论 应用低频电刺激联合早期康复训练可显著降低患者的NHISS评分,改善其认知功能及运动功能.

目的:探讨社区残疾人心理健康状况调查与干预中Zung焦虑自评量表(SAS)与Zung抑郁自评量表(SDS)的应用价值.方法:随机纳入深圳市福田区残疾人联合会持证肢体残疾人160名作为研究对象,并将纳入的受检者随机分为对照组(n=80)与观察组(n=80).所有受检者均应用Zung SAS与Zung SDS进行心理健康状况调查,对照组未进行干预,观察组针对性予以心理干预,对两组受检者持续随访6个月,比较首次调查与末期随访调查时两组受检者的心理状况变化.结果:首次调查显示,两组受检者SAS、SDS评分比较,差异无统计学意义(P＞0.05);但首次调查的SAS、SDS评分与全国常模评分相比均明显更高,差异具有统计学意义(P＜0.05);末期随访显示,观察组受检者SAS、SDS评分比对照组明显更低,差异具有统计学意义(P＜0.05);观察组受检者末期随访的家庭支持、周围人际关系比对照组受检者有更明显改善,差异具有统计学意义(P＜ 0.05).结论:社区残疾人心理健康状况调查中SAS与SDS的应用,能够明确其心理健康状态,在此基础予以综合心理干预能改变其负性情绪状态,同时提示残疾人家庭的支持,能促进其对周围人际关系的改善.