With the development of our understanding of the physiology,pathophysiology and pharmacology of pain,preemptive analgesia has been widely introduced into clinical treatment.This review focuses on the mechanism and application of preemptive analgesia in acute pain therapy.

Objective To investigate the effect of Shufeng Xuanfei and Jiebiao Qingli concoctions on Toll-like receptor (TLR) signal pathway of pneumonia infected with influenza virus in mice.Methods The pneumonia model was reproduced by nasal dropping of influenza virus A in mice.The mice were randomly divided into nine groups:normal group (C),model group (M),tamiflu group (D),Shufeng Xuanfei low-dose (SL),medium-dose (SM) and high-dose (SH) groups,Jiebiao Qingli low-dose (JL),medium-dose (JM) and high-dose (JH) groups,each n =12.Two hours after model-reproduction,the mice in C group and M group received distilled water by gavage.The mice in D group received 2.5 g· mL-1· d-1 oseltamivirphosphate.Shufeng Xuanfei formula in doses of 3.76,1.88,0.94 g· kg1 · d-1 were respectively administered to SH,SM and SL groups by gavage,Jiebiao Qingli formula in doses of 4.37,2.18,1.09 g ·kg-1 ·d-1 was given to JH,JM and JL groups by gavage,respectively.Each group was in equal dose of 0.2 mL daily over a 4-day period.Total RNA was extracted in each group.Then gene chips were used to screen these RNA samples.Some genes that were involved in TLR signal pathways were selected.These candidate genes were verified by real-time reverse transcription-polymerase chain reaction (RT-PCR).Results TLR7,MYD88,CCLS,IFNB1,IL6,IL12a,NFKBIA and IKBKB were up-regulated in model group compared with control group.Compared with model group,down-regulated genes in medium-dose,low-dose Shufeng Xuanfei formula and medium-dose Jiebiao Qingli formula included TLR3,TLR7,MYD88,CCL5,IFNB1,IL6,IL12a,NFKBIA and IKBKB (log2 signal intensity of SM,/M in medium-dose Shufeng Xuanfei formula group were-1.24,-2.02,-1.36,-1.95,-0.63,-1.33,-3.50,-1.33,-1.33,log2 signal intensity of SI/M in low-dose Shufeng Xuanfei group were-1.07,-2.43,-2.63,-2.30,-5.09,-3.19,-3.53,-1.95,-1.95,log2 signal intensity of JM/M in medium-dose Jiebiao Qingli formula group were -1.78,-0.55,-1.35,-1.47,-1.65,-2.03,-3.02,-1.57,-1.57,respectively).The results suggested that the effect of Shufeng Xuanfei formula was better than that of Jiebiao Qingli formula.By RT-PCR,compared with model group,low-dose,medium-dose and high-dose groups of Shufeng Xuanfei formula,medium-dose and high-dose groups of Jiebiao Qingli formula,and tamiflu group,significant decrease in TLR7,nuclear factor-κB (NF-κB),myeloid differential protein-88 (MyD88) mRNA expression were found.Medium-dose and low-dose Shufeng Xuanfei formula group (TLR7 mRNA:3.6 ±0.3,3.5 ± 1.2 vs.7.4 ± 1.6,NF-κB mRNA:1.1 ±0.2,1.0 ±0.2 vs.2.2 ±0.4; MyD88mRNA:1.4 ± 0.4,1.0 ± 0.3 vs.3.4 ± 0.9,all P＜0.01) and medium-dose Jiebiao Qingli formula group (TLR7 mRNA:4.9 ± 0.3 vs.7.4 ± 1.6,NF-κB aRNA:1.3 ± 0.7 vs.2.2 ± 0.4,MyD88 mRNA:1.6 ± 0.8 vs.3.4 ± 0.9,P＜0.05 or P＜ 0.01) were shown statistically significant decreases compared with the model group.Conclusions Medium-dose and low-dose Shufeng Xuanfei formula and medium-dose Jiebiao Qingli formula can inhibit the inflammatory reaction induced by influenza virus by down-regulating the NF-κB through TLR signal pathways dependent on MyD88.The regulation of Shufeng Xuanfci formula in TLR signal pathways was superior to that of Jiebiao Qingh formula.

Purpose:The value of color doppler ultrasonography( CDUS) in monitoring hemodynamic changes was investigated in patients with hyperdynamic circulatory state before and during 730 days after orthotopic liver transplantation.Materials and Methods:83 cases of orthotopic liver transplantation (OLT) were examined by CDUS to assess the hemodynamic changes of portal vein,hepatic artery,splenic artery and longitudinal diameter of the spleen ( LDS).Results:(1) Portal flow velocity ( PFV) was significantly lower in pre-OLT but higher than controls (P < 0.05 ) during 730 days after OLT.Resistance index of the hepatic artery ( HARI) in pre-OLT and within 7 days- after OLT was significantly higher (P<0.05).(2) Resistance index of splenic artery ( SARI) was also significantly higher in pre-OLT (P < 0.05 ).LDS was significantly higher after OLT than in both pre-OLT phase and controls(P<0.05).Conclusions: In early stage after OLT,HARI changed from high to low value and so did PFV,which kept the stability of hepatic blood flow.In late stage,high PFV and large spleen improved,but could not back to normal.

Objective To explore the diagnostic value of spiral CT for the intestinal obstruction of unknown causes.Methods The CT findings of 115 intestinal obstructive patients with unknown causes were analyzed retrospectively.Results Of the 115 patients,the diagnosis of intestinal obstruction was comfirmed by CT in 110 cases patients,the correct diagnostic rate was 95.7%.Conclusions Abdominal CT is a rapid、simple and effective means for diagnosis of the location、cause and degree of obstruction in cases of intestinal obstruction with unknown cause.It can act as an important basis for the treatment program by doctors.

Objective To observe the therapeutic effect of Ziyin Yangxue Qingre Formula (Formula for enriching yin,nourishing blood and clearing heat) on primary Sjogren's Syndrome (pSS).Methods Totally 64 female pSS patients were randomized into a treating group (33 cases),and a control group (31 cases).The control group was administered Hydroxychloroquine Sulfate Tablet.In addition,the treating group was prescribed Ziyin Yangxue Qingre Formula.Three-month treatment was as one course.After one course of treatment,the changes in symptom scores,salivation quantity,tear quantity,and immuno-infective indices were observed to compare the effect between both groups.Results The total effective rate of the treating group(87.88%) was significantly higher than that (64.52%) of the control group (P

Objective To observe the preventive effect of Taohong Siwu decoction on the formation of lower extremity deep vein thrombosis (DVT) in patients with cerebral hemorrhage.Methods Eighty patients with cerebral hemorrhage admitted to the Department of Neurosurgery in Huzhou First People's Hospital from November 2014 to January 2016 were enrolled, and they were divided into an observation group and a control group according to the difference in treatment methods, each group 40 cases. Both groups were given routine treatment and nursing care, the patients of observation group were additionally given Taohong Siwu decoction (composition:Radix Angelicae Sinensis (stir-fried with wine) 10 g,Radix Rehmanniae Preparata 10 g,Radix Paeoniae Alba10 g,Ligusticum Chuanxiong Hort 6 g,Semen Persicae 6 g,Carthami Flos 4 g), once a day for consecutive 2 weeks.Results The D-dimer level in the observation group was significantly lower than that in the control group (mg/L: 1.47±0.91 vs. 1.88±0.79,t = 1.991,P = 0.035); the incidence of DVT in the observation group was obviously lower than that in the control group [5.0% (2/40) vs. 20.0% (8/40), χ2 = 4.114,P = 0.043].Conclusion Taohong Siwu decoction can effectively reduce the incidence of DVT in patients with cerebral hemorrhage.

Objective To investigate rates and clinical associates of combined antipsychotic therapy in hospitalized patients with schizophrenia during 1986 ～ 2006. Methods Hospital charts of schizophrenic inpatients who discharged from six psychiatric hospitals in Tangshan in 1986,1996,2001, and 2006 were reviewed. Demographic and clinical character and prescription information at time of discharged of patients' was coded by trained investigators with a special designed form. Results The rates of combination antipsychotic therapy in the four years mentioned above were 13.2%, 18. 1% ,32.7%, and 28.9% ,respectively and the difference was statistically significant( x2 = 76.431, P ＜ 0.01; linear by linear x2 = 25. 542, P ＜ 0.01 ). Combined antipsychotic therapy in schizophrenic inpatients in Tangshan region show a increasing trend. There is significant difference of rate of combined antipsychotic therapy between hospitals. Combined antipsychotic therapy were associated with duration of illness,numbers of prior psychiatric hospital admission,hospital from which patients discharged,and discharged year.

Background and purpose: Arginase-1 (Arg-1) is an enzyme involved in the urea cycle. Research has shown that changed expression of Arg-1 plays an important role in the cellular metabolism and growth. The purpose of this research was to investigate the expression of Arg-1 in hepatocellular carcinoma (HCC) and to analyze its correlation with clinicopathological features. Methods: The expression of Arg-1 protein and mRNA in 31 samples of HCC, paracancerous liver tissues and 12 samples of normal liver was detected by Western blot and reverse transcription-polymerase chain reaction (RT-PCR). The expression profiles of Arg-1 at protein level in 158 samples of HCC and paracancerous liver tissues were detected with high-throughput tissue microarray technique and immunohistochemistry. The relationships between Arg-1 expression and clinicopathological features were also analyzed. Results:The expression of Arg-1 mRNA and protein was signiifcantly decreased in HCC compared with the paracancerous liver tissues and normal liver tissues (F=57.83, 160.89; all P<0.01). The expression of Arg-1 in HCC was related to differentiation degree (F=10.41, 30.03; all P<0.01). And with tumor differentiation decreased, the expression level down-regulated. Immunohistochemistry revealed that Arg-1 protein was mainly located in the cytoplasm and nuclear. The expression rates of Arg-1 were 88%, 98.7%and 100%in HCC, paracancerous tissues and normal liver tissues, respectively. Statistical analysis revealed that Arg-1 protein staining rate was signiifcantly lower in tumor tissues than that in paracancerous tissues (χ2=14.7416, P<0.01) and normal liver tissues (χ2=4.1415, P<0.05). The Arg-1 expression was correlated with differentiation degree of HCC, vascular invasion and recurrence after operation (χ2=22.8459, 10.2639, 10.6368 respectively;all P<0.05), but not correlated with age, gender, the hepatitis B virus, the level of serum AFP, liver cirrhosis, diameter of tumor and tumor number. Conclusion:The expression level of Arg-1 is much lower in HCC than that in the paracancerous liver and normal liver. Moreover, Arg-1 expression level is closely related to tumor differentiation degree, metastasis and relapse. These data demonstrate that Arg-1 may play a negative role in the development of HCC.

Objective To explore the value of arginase-1(Arg-1) and glypican-3 (GPC-3) combined examination in the differential diagnosis of hepatocellular carcinoma (HCC),metastatic carcinoma (MC) of liver and intrahepatic cholangiocarcinoma (ICC).Methods From January 2005 to December 2011,a total of 54 patients with HCC were selected,including 10 cases with high differentiation,25 cases with moderate differentiation and 19 cases with poor differentiation.At the same time,25 patients with MC of liver and 20 patients with ICC were selected.A total of 31 normal liver specimens were set as control.The expressions of Arg 1 and GPC-3 in the above tissues were detected by immunohistochemistry method.The sensitivity and specificity of the examination in the diagnosis of HCC were analyzed.Chi-square test was performed for count data analysis.Results The positive expression rate of Arg-1 in HCC,MC of liver,ICC and normal liver tissues was 87.0％ (47/54),4.0％ (1/25),5.0％ (1/20) and 100.0％ (31/31),respectively.The Arg 1 positive expression rate in HCC tissues was higher than that in other tumor tissues of non-HCC,and the difference was statistically significant (x2 =66.98,P＜0.05).The positive expression rate of GPC-3 in HCC,MC of liver,ICC and normal liver tissues was 70.4％ (38/54),12.0％ (3/25),5.0％ (1/20) and 0 (0/31),respectively.The GPC-3 positive expression rate in HCC tissues was higher than that in other tumor tissues of non-HCC and the difference was statistically significant (x2=37.98,P＜0.05).The sensitivity and specificity of Arg-1 or GPC-3 positive in HCC diagnosis was 92.6％ (50/54) and 86.7％ (39/45).The sensitivity and specificity of both Arg 1 and GPC-3 positive in HCCdiagnosis was 64.8％ (35/54) and 100.0％ (45/45).Conclusion Arginase-1 and glypican-3 combined examination has an important value in HCC diagnosis and differential diagnosis.

This paper introduced vascular surgery residency program in Northwestern Memorial Hospital including application process,training mode,program content and scientific training.This paper also made comparison in surgical residency program between United States and China and put forward the proposal for the implementation of Chinese main land vascular surgery residency training program.