Pain is the most fearful symptom in cancer patients.The cancer patients suffered refractory pain with the progress of cancer.Not all cancer patients could obtain adequate pain relief by the mefhod of three-step pain relief ladder of WHO.With the reseach and recognition of the mechanisms,the pain can be effectively controlled by the right technique at the right time.It is summarized in this artical about the central and peripheral mechanism and the treatment progress of the terminal cancer pain.

Objective To compare the nursing technique between laparoendoscopic surgery with abdominal wall lift ( LESC) and that with pneumoperitoneum laparoscopic cholecystectomy ( PLC) .Methods Data from 76 patients who underwent LESC and 72 patients who underwent PLC between April 2012 and May 2013 were collected .The operating time , estimated blood loss , shoulder and back pain rate , doctors and patients'satisfaction were observed .Results The mean estimated blood loss was significantly more in the LESC group than that in the PLC group [(298.20 ±47.78) vs (533.22 ±90.29)ml;t=-5.144, P<0.05)], while the shoulder and back pain rate of LESC group was significantly lower than that of PLC group (7 vs 1 cases;χ2 =4.129,P<0.05).The doctors'satisfaction in PLC group was higher than that in LESC group ( P<0.05), especially in property transfer accuracy and instrument proficiency ( t=3.130,3.536,respectively;P<0.05).The patients'satisfaction had no significant difference (t=-1.925,P>0.05), while the posture comfort of patients in LESC group was higher than that in PLC group (t=-2.746,P<0.05).Conclusions Operation nurses should fully master the nursing technique and characters of LESC and PLC in order to improve the surgical nursing quality , and the doctor-nurse cooperation is the key for the success of LESC .

Objective: To understand the awareness of sexual knowledge among primary and secondary school students, as well as their attitudes towards school sex education and to provide a reference for school-based sex education. Methods: A total of 5 531 primary and secondary school students were selected from Beijing, Chongqing, Heilongjiang (Harbin and Jiamusi) and Hubei (Wuhan and Xiaogan) by stratified cluster sampling and were investigated with self-reported questionnaire. Results: Sex-related knowledge scored 62.33±19.35, with a pass rate of 61.9%, and the excellent rate 17.5%. Sexual knowledge of junior high school students scored 64.30±19.07, with the pass rate of 64.7%, and the excellent rate 22.0%. A large proportion of primary students reported unaware of pubertal growth and HIV/AIDS-related knowledge, and a large proportion of junior high students unaware of reproductive physiology. Multivariate Logistic regression analysis showed region, grade, gender, and suburban areas were related to the level of sexual knowledge(P<0.05). More than 76.0% primary students and 85.9% middle school students agreed on the importance of school sexuality education. 59.7% of primary school students and 73.3% of junior high school students hoped to include school sexuality education in compulsory education courses; 59.8% of primary school students and 68.3% of junior high school students felt that school sexuality education should be equipped with specialized teachers. Conclusion Chinese primary and secondary school students are lack of sexual knowledge. As students have strong wills to get more information on sexual knowledge, schools should provide them with more comprehensive and effective sex education through appropriate courses and activities.

Purpose: This study aimed to investigate the clinicopathologic features and mutational landscape of patients with hepatitis B virus (HBV)–related advanced hepatocellular carcinomas (HCC) undergoing transcatheter arterial chemoembolization (TACE). Materials and Methods: From January 2017 to December 2018, 38 patients newly diagnosed with HBV-related advanced HCC were enrolled in the final analysis. Their pathological tissues and corresponding blood samples before TACE treatment were collected for whole-exome sequencing. Response to TACE was evaluated at 1-3 months after two consecutive use of TACE. Predictive factors were analyzed by univariate and multivariate analyses in a bivariate Logistic regression model. Enrichment of related pathways of all driver genes were acquired using the gene set enrichment analysis (GSEA). Results: Among 38 patients, 23 (60.5%) exhibited TACE failure/refractoriness. Patients with TACE failure/refractoriness showed higher frequency of TP53 mutation than their counterparts (p=0.020). Univariate and multivariate analyses showed that only vascular invasion and TP53 mutation were significantly correlated with TACE failure/refractoriness in HBV-related advanced HCC. Of the 16 patients without vascular invasion, eight (50.0%) had TP53 mutations, and TP53 mutation was associated with TACE failure/refractoriness (p=0.041). Moreover, GSEA showed that mitogen-activated protein kinase and apoptosis pathways induced by TP53 mutation were possibly associated with TACE failure/refractoriness. Conclusion Our study suggested that TP53 mutation was independently related with TACE efficacy, which may work via mitogen-activated protein kinase and apoptosis pathways. These findings may provide evidence to help distinguish patients who will particularly benefit from TACE from those who require more personalized therapeutic regimens and rigorous surveillance in HBV-related advanced HCC.