The progress of liver surgery is characterized by precision,minimal invasion and effectiveness in the 21 st century.Establishment of painless liver surgery ward and implementation of pain management in the perioperative period are not only the central content of enhanced recovery after surgery,but also one of the core connotation in precision liver surgery research.Conducting training programs for medical staffs,emphasizing health education of pain,selecting the reasonable pain assessment strategy,combination of preemptive analgesia and multimodal analgesia in the perioperative period and paying attention to individualized analgesia are important contents of construction of painless liver surgery ward.To carry out multicentre clinical study energetically,explore clinical pathway for the construction of painless ward and perioperative analgesic model are the development orientation for the construction of painless liver surgery ward.

Objective To evaluate the clinical efficacy of three chemotherapy regimens and partial excision of the affected vertebrae for spinal tuberculosis. Methods Between December 1998 and November 2003, 76 cases with spinal tuberculosis were treated with chemotherapy and surgical intervention. All pa-tients were divided into three groups randomly to receive one of three different courses of chemotherapy. Among these, 38 cases were selected to receive ultra-short-course chemotherapy regimen with 2SHRZ/ 2.5H2R2Z2, 23 of short-course with 3SHRZ/5H2R2Z2, and 15 of standard with 3SHRZ/9H2R2Z2. The duration of the preoperative chemotherapy of the three groups was about the same with an average of 21 days (15 to 40 days). All patients underwent anterior partial excision of the affected vertebrae, large iliac strut graft and anterior or posterior fixation. Results The mean follow-up time of the ultra-short-course, short-course and standard chemotherapy groups were 23, 28 and 45 months respectively. The observed indices included: 1) Clinical manifestation: disappearance of TB symptoms, the nerve function recovered, life and the work activ-ities. 2) Lab tests: both ESR and CRP data or either of them in normal or near normal status. 3) X-ray, CT and MRI examination: abscesses, new lesion, absorption of the bone grafts, translucent line between bone graft and vertebral body, and correction of kyphotic deformity. 4) Ultrasonic examination: no opaque dark area at the sites where there might be the paravertebral or gravity abscesses. 5) Drug complications: the hepatic and renal function of patients at follow up were normal or close to normal. The follow-up showed that all the three groups achieved excellent results. Conclusion Treatment of spinal tuberculosis with anterior partial excision of pathologic vertebrae, large iliac strut graft and anterior or posterior internal instrumental fixation in either ultra-short-course, short-course or standard chemotherapy all achieved excellent therapeutic effects. There was no difference among three different courses of chemotherapy.

Objective To investigate the clinical distribution of carbapenem-resistant Enterobacteriaceae(CRE)strains separated in this hospital and the situation of its production of carbapenem enzyme.Methods The production of carbapenem enzyme by CRE strains was confirmed by using modified Hodge test,the situation of the production of metallo-beta-lactamases by CRE strains was screened by using imipenem-EDTA double-disk synergy test,and the clinical distribution of CRE strains was retrospectively ana-lysed.Results 37 strains of CRE isolated in this laboratory were screened by using instrument method and verified by using disk diffusion (K-B)method.It showed an increasing trend from 2012 to 2014 in the amount of CRE strains.In terms of bacterial spe-cies,K.pneumonia(1 6 strains)was the main kind of carbopenems-resistant strains,followed by E.coli(6 strains),Ser.marcescens(6 strains)and E.cloacae(4 strains).CRE strains were mainly isolated from geriatric ward and intensive care unit(ICU).Sputum,u-rine and blood specimen were key sources of CRE strains.Modified Hodge test confirmed that 36 strains of CRE were the strains that can produce carbapenemase,including 4 strains of K.pneumonia,3 strains of E.cloacae,and 1 strain of E.asburiae,and strains producing metallo-beta-lactamases were confirmed by using imipenem-EDTA double-disk synergy test.Conclusion Elderly patients with underlying diseases are susceptible population of CRE hospital infection and are primary preventive targets.The principal mechanism of carbapenem-resistant CRE strains in this hospital is the production of carbapenemase and production of metallo-β-lac-tamases in a small number of strains.

Objective To analyze treatment strategies for complications following lumbopelvic fixation for unstable sacral fractures.Methods Between May 2014 and December 2015,20 patients diagnosed with unstable sacral fracture were treated by lumbopelvic fixation.They were 9 males and 11 females,with an average age of 35.5 years (range,from 14 to 59 years).According to the Denis classification,5 fractures were type Ⅰ,7 type Ⅱ and 8 type Ⅲ.Complications related to lumbopelvic fixation were recorded and followed up.Results All the patients were followed up for an average of 18 months (range,from 12 to 31 months).All the fractures healed after an average of 19 weeks (range,from 15 to 32 weeks).Early complications included neural injury in 2 cases,incision infection in one and pressure ulcer in 2;late complications included prominence of internal implants in 7 cases,loosening of internal implants in 5,lumbopelvic pain or discomfort in 3,limited motion of lumbar vertebrae in 4,limb discrepancy in 3 and rotation deformity of lower limb in one.Conclusions Complications related to wound and internal implants are common following lumbopelvic fixation for sacral fractures.Careful planning and correct choice of internal fixators are the key to decreasing complications.Internal implants should be removed as soon as a sacral fracture unites to decrease the risk of long-term complications.

Objective To discuss the diagnostic value of two-dimensional speckle tracking imaging in the evaluation of left ventricular rotation and torsion in pre-apical hypertrophic cardiomyopathy(PAHCM)patients. Methods A total of 26 patients with PAHCM,26 patients with hyperten-sive left ventricular hypertrophy(HLVH)and 26 healthy volunteers were recruited for the study. Two-dimensional echocardiographs were performed carefully. Two-dimensional images were obtained from the left ventricular apical four-chamber section,two-chamber section and two short-axis sec-tions,including mitral valve and apical levels. The peak subendocardial rotation(endo-rot),epicardial rotation(epi-rot),transmural torsion(mural-tor)and bulk rotation(bulk-rot)of each short-axis section were measured and analyzed using QLAB 9.1 software. Results In the mitral level, there was no statistically significant difference in endo-rot,epi-rot,mural-tor and bulk-rot between the PAHCM group and normal control group (P>0.05). There was statistically significant difference in endo-rot,epi-rot,mural-tor and bulk-rot between the PAHCM group and HLVH group (all P<0.05). There was statistically significant difference in endo-rot,epi-rot,mural-tor and bulk-rot between the HLVH group and normal control group(all P<0.05). In the apical level,there was no statistically significant difference in epi-rot among three groups(P>0.05). There was statisti-cally significant difference in endo-rot,mural-tor and bulk-rot between each two groups(P<0.05). There was statistically significant difference in G-tor between each two groups(P<0.05). The receiver operating characteristic curve analysis showed that the accuracy of differential diagnosis of G-tor PAHCM was high(the area under the receiver operating characteristic curve is 0.89),the sensitivity was 73.08%,and the specificity was 92.31%. Conclusion Two-dimensional speckle tracking imaging could accurately and quantitatively measure the left ventricular rotation and tor-sion in PAHCM patients. The G-tor could accurately screen and identify between PAHCM and HLVH.

Objective To evaluate the effect of the high concentration of sevoflurane wash-in in induction of anesthesia on the cardiac function in young infants.Methods ASA Ⅰ young infants,aged 28-60 days,undergoing resection of hemangioma on body surface under general anesthesia,were studied.According to the principle of randomized block design,8 blocks were designed based on the body weight (3.0-3.4 kg,3.5-3.9 g,4.0-4.4 kg,4.5-4.9 kg,5.0-5.4 kg,5.5-5.9 kg,6.0-6.4 kg,6.5-6.9 kg),with 3 infants in each block.The infants were randomly divided into 3 groups (n =8 each):anesthesia induction with 6％,7％ and 8％ sevoflurane groups (groups S1-3).In groups S1-3,the infants inhaled 6 ％,7 ％ and 8 ％ sevoflurane respectively for induction of anesthesia.Transthoracic echocardiographic examinations were performed before sevoflurane inhalation (baseline,T1) and at 4 min of sevoflurane inhalation (T2) to record the stroke volume (SV),left ventricle end-diastolic volume (LVEDV),ejection fraction (EF),stroke volume index (SI),heart rate (HR),cardiac output (CO),cardiac index (CI),peak early diastolic velocity of mitral annulus (Ea),peak late diastolic velocity of mitral annulus (Aa),peak systolic velocity of mitral annulus (Sa),and Tei index.The mitral annulus poteroseptal Ea/Aa (Ea/Aa) was calculated.Results Compared with the baseline value,SV,EF,SI,Ea/Aa and Tei index were significandy increased,HR,Sa,Ea and Aa were significantly decreased (P ＜ 0.05),and no significant change was found in LVEDV,CO and CI at 4 min of sevoflurane inhalation in groups S1-3 (P ＞ 0.05).Tei index was significantly higher in groups S2.3 than in group S1 (P ＜ 0.05).There was no significant difference in the parameters of cardiac function between group S2 and group S3 (P ＞ 0.05).Conclusion 6 ％,7 ％ and 8 ％ sevoflurane wash-in in induction of anesthesia exert no effect on the cardiac function in young infants,and the 3 concentrations can be recommended for clinical use.

Objective To evaluate the effects of sevoflurane anesthesia on the left ventricular function in young infants.Methods Sixteen ASA physical status Ⅰ pediatric patients,aged 28-75 days,weighing 4.0-6.1 kg,undergoing elective resection of hemangioma on the body surface under general anesthesia with sevoflurane were studied.After the pediatric patients inhaled 6 ％ sevoflurane for 4 min,tracheal intubation was performed,and the pediatric patients were mechanically ventilated.Anesthesia was maintained with sevoflurane with the endtidal concentration of 4.48％-5.12％.Transthoracic echocardiographic examinations were performed before induction of anesthesia (baseline,T0),immediately before intubation (T1),at 10 and 30 min after intubation (T2,3),and at 20 min and 1 h after extubation (T4,5) to calculate Tei index.Results Compared with the baseline value at T0,Tei index was significantly increased at T1-4 (P ＜ 0.05 or 0.01),and no significant change was found in Tei index at T5 (P ＞ 0.05).The blood pressure and heart rate were stable and no adverse cardiovascular events were found during surgery.Conclusion Although sevoflurane anesthesia does not induce cardiovascular events,it decreases the left ventricular function to some extent in young infants.

ObjectiveTo investigate the effects of ABI-1 gene knockdown upon the proliferation and migration of human gastric cancer cell NCI-N87 in vitro. MethodsNCI-N87-ABI-I-ShRNA cell model was successfully constructed and validated by Real-time PCR and Western blot. The cellular morphous and skeleton, proliferative and migrative potents, and also AKT expression were compared between NCI-N87-ABI-1-ShRNA and its parents by immunofluorental staining, CCK-8 assay, transwell chamber and Western blotting.ResultsCCK-8 assay showed there was no significant difference in the proliferation rates at different time points between the NCI-N87-Vector and NCI-N87 cells while the proliferation rates at the time points of 36 and 48 hours of the NCI-N87-ABI-1-ShRNA were significantly lower than the NCI-N87( t =2. 85and 4. 166, P ＜ 0. 05 ). Transwell assay showed that migrated cell number were 66 ± 8, 65 ± 8 and 30 ± 4,respectively, and there was significant difference between the NCI-N87-ABI-1-ShRNA and NCI-N87 cells (t =9. 550,P ＜0. 05). Finally, ABI-1- knock-down altered the cellular morphoos and skeleton of 90％NCI-N87 cells and inhibited p-AKT expression.ConclusionABI-1 inhibits proliferation and migration of NCI-N87 cells in vitro probably by PI3K/AKT pathway.

Objective To investigate the occurrence of postoperative pain of hepatectomy and its possible related factors.Methods The clinical data of 555 cases undergoing hepatectomy was analyzed retrospectively,and the related influencing factors on postoperative pain of hepatectomy were analyzed by univariate analysis and multivariate logistic regression.Results Moderate postoperative pain was reported in 255 cases among 555 patients who underwent hepatic resection (with an incidence of 45.95％).Incision pain which was often sharp was most common,followed by postoperative complication caused pain.According to whether the postoperative pain occurred or not,all cases were divided into postoperative pain group (n =255) and non-postoperative pain group (n =300),univariate analysis showed that age (P ＜0.01),surgical history (P ＜ 0.01),surgical approach (P ＜ 0.01),incision length (P ＜ 0.01),xiphoid removal(P ＜ 0.01),the final outcome of incision (P ＜ 0.01),complications (P ＜ 0.01) were significantly different between the two groups.Logistic multiple regression analysis showed that the independent influencing factors of postoperative pain included surgical history (P =0.001),surgical approach (P =0.005),incision length (P =0.000),xiphoid process removal (P =0.001),complications (P =0.000).Conclusions The postoperative pain of hepatectomy has a high incidence.Surgical history,surgical approach,incision length,xiphoid process,removal and postoperative complications are the independent impact factors of postoperative pain.

ObjectiveToinvestigatetheroleofimmuneinflammatoryreactionintheformationof intracranial aneurysm. Methods The intracranial aneurysms in 40 patients of craniotomy ( intracranial aneurysm group) and the vascular specimens in 20 craniotomy patients w ith traumatic brain injury (control group) w ere col ected. Fluorescence quantitative polymerase chain reaction w as used to detect the expression of interleukin (IL)-17 receptor in the arterial w al . Flow cytometry w as used to detect the Th-17 cel s in peripheral blood. Enzyme-linked immunosorbent assay w as used to measure the levels of IL-17, IL-6 in the arterial w al and tumor necrosis factor-α( TNF-α) in peripheral blood. Results There w ere no significant differences in the age (62.6 ±8.7 years vs.61.4 ±7.9 years;t=0.342;P=0.681), proportions of male (60.0%vs.65.0%; χ2 =0.246, P=0.434), hypertension ( 12.5%vs.10.0%; χ2 =0.315, P=0.492), diabetes (75.0%vs.10.0%; χ2 =0.284, P=0.482), and smoking (35.5%vs.30.0%; χ2 =0.224, P=0.413) betw een the intracranial aneurysms group and the control group. The expression of IL -17 receptor in the arterial w al (0.106 ±0.032 vs.0.264 ±0.071; t=5.115, P=0.001) and the proportion of Th17 cels in peripheral blood (2.75%±0.53%vs.7.18%±1.54%; t=8.436, P<0.001) and IL-17 level ( 7.32 ±1.82 μg/L vs.22.64 ±4.51 μg/L; t= 8.357, P< 0.001 ) in the control group w ere significantly low er than those in the intracranial aneurysm group. The levels of IL-6 (1.15 ±0.24 μg/L vs. 19.64 ±4.16 μg/L; t=9.527, P<0.001) and TNF-α(1.43 ±0.31 μg/L vs.26.17 ±4.32 μg/L; t=9.816, P<0.001) in the arterial wal in the control group were significantly lower than those in the intracranial aneurysm group. Conclusions The expression of IL-17 receptor in the arterial w al , the proportion of the Th17 cels and IL-17 level in peripheral blood were increased in patients with intracranial aneurysms. Immune inflammation may be involved in the formation of intracranial aneurysm.