Bile leak is a commonly complication after biliary tract surgery.In the past,operation was considered priorly to deal with bile leak besides putting a drainage tube in advance.Minimally invasive surgery has gradually become a primary management of bile leak,with the development of minimally invasive surgery such as abdominoscope in the 20th century.

Objective To evaluate the efficacy and safety of gabapentin in preemptive analgesia for hysterectomy after general anesthesia.Methods PubMed, Cochrane, Embase, Ovid, Springer Link, Web of Science, CNKI, Wanfang and Weipu databases were searched for randomized placebo-controlled trials involving the efficacy of gabapentin for preemptive analgesia published from 2000 to 2016.The methodological quality of the included randomized controlled trial (RCT) was assessed and the data were extracted according to the Cochrane Handbook.The meta-analysis was performed using the RevMan 5.3 software.Results A total of 10 RCTs involving 609 patients were included.Compared with the control group, there was a significant decrease in 24-hour cumulative narcotic consumption at 24 hours when gabapentin was administered before surgery (WMD=-8.83 mg, 95%CI-12.70——4.97, P<0.001), there was no significant decrease in VAS score in preemptive analgesia group (WMD=-7.70 mm, 95%CI-18.22-2.82, P=0.15).Compared with the control group, the rate of vomiting was less in the gabapentin group (RR=0.49, 95%CI 0.35-0.69, P<0.001).Compared with the placebo group, there was no significant decrease in nausea (RR=0.73, 95%CI 0.45-1.17, P=0.19) and somnolence (RR=2.08, 95%CI 0.62-6.92, P=0.23).Conclusion Preemptive administration of gabapentin is effective in decreasing accumulation of opium and vomiting.

With the changes in medical model and the enhancement of ethical standard as well as the patients' awareness of right protection,clinical teaching resource shortages have been increasingly prominent.This article analyzes the characteristics and status of clinical medical education and points out that the development of medical simulation education has great significance for building a harmonious clinical training environment centering on the content classification,functional positioning and outstanding advantage of medical simulation education.

Aiming at present situation and difficult position of clinical medical education,and based on the demand goal of modern medicine,this paper put forward constucting the mul-ti-dimensional optimization training pattern for five-year system clinical medicine inter-disciplinary talents by renewing the education idea,adopting the curriculum reform,the quality regulation,the educational reform,the innovation of teaching methods,and the construction of community medi-cal service practice base and so on,which is of great significance to train the high quality tal-ented person with adaptability to social development.

The application of standardized patient SP is the tendency of medical education in China.The applied characteristics of using SP in diagnostics teaching were summarized in this article.We described the recruitment,training and application of SP in the teaching process of diagnostic.The great advantages of SP and its shortage were analysed,and our expectation of deepening SP was brought forward.

According to the characteristics of clinical probation teaching of endocrinology,we established the stage-separated echelon teaching mode that accorded with cognitive law.By inspiring,guiding and other methods,medical students’learning enthusiasm were greatly stimulated,and their understanding and grasping degree to the clinical specialty content was deepened.We focused on training clinical skills and thinking ability of medical students,and achieved satisfactory teaching results.

In recent years,there is an increasing focus on three Dimensional (3D) Technology in medical field.The article summarizes the progress of 3D printing technology such as medical models,implantable prosthetics,biological engineering,est.,analysis application and effects of 3D technology abiding by the characteristics of clinical medical education.Considering the situation of domestic medical education,therefore,it points out that it is of broad application prospects and great practical significance to develop 3D medical education due to establishing a harmonious teaching environment,providing simulated clinical practice opportunities,activating the brain proportionately and stimulating students learning enthusiasm.

Abstract Objective:The effects of both TM-TGFa and S-TGFa on proliferation were compared to explore the biological characteristics of the two forms of TGF-a.Methods:The proliferation of mouse fibroblast cell line NIH3T3 and its expression of PCNA were determined by the methods of MTT and histochemical technique. The level of IL-6 mRNA in HaCaT cell line was tested by in situ hybridization. Results:The two forms of TGFa were able to promote cell proliferation,PCNA expression and IL-6 mRNA transcription.The effects of S-TGFa had been shown stronger than that of TM-TGFa( P

0.05); while 100 ?mol?L-1 and 1 000 ?mol? L-1 bupivacaine reduced IK by 24%) ?4% and 33% ?6% (P