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 safety and efficacy of a fractional microneedle radiofrequency device in the treatment of axillary osmidrosis.Methods A total of 24 patients with moderate to severe axillary osmidrosis were enrolled from Department of Dermatology of Peking Union Medical College Hospital between June 2015 and June 2016,and treated with the Body TiteTM fractional microneedle radiofrequency device for 1 session.Visual analogue scale (VAS) was used to evaluate the intensity of axillary odor in patients,36-item short-form health survey (SF-36) to assess health-related quality of life (HRQoL),and axillary skin tissues were resected for histopathological examination before and after the treatment.Results VAS showed that 22 of 24 patients achieved persistent remission for more than 12 weeks,and rates of decrease in odor score ranged from 50％ to 100％.However,1 patient experienced recurrence at 12 weeks after the treatment,and another 1 patient did not achieve clinical remission.SF-36 revealed that scores of social functioning (SF),role-emotional (RE) and mental health (MH) scales were all significantly increased after the treatment [M (P0-P100):100.00 (62.00-112.50),100.00 (33.30-110.00),68.00 (48.00-80.00),respectively] compared with those before the treatment [77.50 (62.50-100.00),66.67 (33.30-100.00),55.00 (48.88-72.00),respectively,all P ＜ 0.05].Histopathological examination showed obvious degeneration and necrosis of sweat gland cells in 22 cases,and epidermal damages in 2 patients after the treatment.Unilateral upper-limb pain occurred in 1 case,and small-area burn-like skin changes were observed in 2 cases after the treatment.The postoperative recovery time ranged from 7 to 14 days.Conclusion The fractional microneedle radiofrequency device has shown high clinical response rate,good safety,and favorable application prospects in the treatment of axillary osmidrosis.

Objective:To optimize the extraction process of total flavonoids from Chloranthus japonicus sieb by Box-Behnken re-sponse surface methodology. Methods:The independent variables were the ethanol concentration ( X1 ) , liquid-solid ratio ( X2 ) and extraction time ( X3 ) , the dependent variable was the extraction amount of total flavonoids ( Y) , and the extraction process was opti-mized by Box-Behnken response surface methodology. Results: The results showed that the optimal extraction conditions for total fla-vonoids from Chloranthus japonicus sieb were as follows: the ethanol concentration was 54. 8%, the liquid-solid ratio was 13. 6, and the extraction time was 2. 0 h. The verified extraction process parameters of three batches showed that the relative error between the ex-perimental values and those predicted from the regression model was -2. 34%. Conclusion:The optimal extraction process parameters are simple and more convenient with higher precision for the extraction of total flavonoids from Chloranthus japonicus sieb.

OBJECTIVE:To provide reference for promoting the prior usage of essential medicines and scientifically selecting of antitumor medicines in the national and local drug reimbursement list. METHODS:Entering the Human Resources and Social Se-curity Bureau websites in 10 cities(Beijing,Shanghai,Guangzhou,Nanjing,Wuhan,Xi’an,Chengdu,Shenyang,Jinan and Gui-yang),drug reimbursement list was downloaded to statistically analyze the containing of antitumor medicines(including 24 essential medicines). RESULTS:In antitumor medicines,there were 5 cities with more than 100 varieties,of which Shanghai had 255 vari-eties,which was far more than other cities;the numbers of medicines in class A were near 30 in all the cities except Beijing(67 va-rieties),and the number of class B was highest in Shanghai and lowest in Beijing. All the drug reimbursement lists in 10 cities con-tained 24 antitumor essential medicines,however,the classification was different according to the dosage forms,among which, parts of formulations of cytarabine(injections),doxorubicin(injections),busulfan (often release oral dosage forms),fluorouracil (often release oral dosage forms,injections),cyclophosphamide(often release oral dosage forms,injections),methotrexate(often release oral dosage forms,injections)and cisplatin were classified as class A medicines in all cities;oxaliplatin(injections)and pa-clitaxel (injections) were classified as class B medicines;busulfan,fluorouracil,cyclophosphamide and methotrexate were classi-fied as class B in Shanghai only. CONCLUSIONS:There are some differences in the distribution of antitumor essential medicines in drug reimbursement list in each city,the varieties in developed cities are relatively more,and developing cities are less. It is sug-gested to consider the tumor epidemiology characteristics and economic situations,reasonably select antitumor essential medicines into drug reimbursement list and reasonably adjust the proportion of class A and B to ensure the basic medication and drugs’reim-bursement.

Objective To evaluate the effects of dexmedetomidine on the expression of aquaporins 1 (AQP1) and AQP5 during lung ischemia/reperfusion (I/R) in rats in an in vitro experiment.Methods SPF healthy male Sprague-Dawley rats,aged 3-4 months,weighing 250-320 g,were used in this study.Forty-five isolated rat lungs in which the model of isolated lung perfusion was successfully established were divided into 3 groups (n=15 each) using a random number table:sham operation group (S group),I/R group and dexmedetomidine group (D group).The isolated rat lungs were continuously perfused for 150 min in group S.After 15 min of perfusion,the isolated rat lungs were subjected to 60 min of ischemia and apnea followed by 75 min of ventilation and reperfusion to establish the model of isolated lung I/R injury in group I/R.In group D,the isolated rat lungs were perfused for 15 min with K-H perfusion fluid containing 10 nmol/L dexmedetomidine,and then subjected to 60 min of ischemia and apnea followed by 75 min of ventilation and reperfusion with K-H perfusion fluid containing 10 nmol/L dexmedetotnidine.The lung compliance,airway resistance,perfusion flow and partial pressure of arterial oxygen (PaO2) were recorded at 10 min of perfusion and 15,45 and 75 min after restoration of perfusion.Lung tissues were obtained at 75 min after restoration of perfusion for determination of wet/dry weight ratio (W/D ratio) and for examination of the pathological changes and changes in the uhrastructure.The expression of AQP1 and AQP5 protein and mRNA in lung tissues was detected by Western blot and real-time polymerase chain reaction,respectively.Results Compared with S group,the airway resistance was significantly increased and lung compliance,perfusion flow and PaO2 were decreased during reperfusion,and W/D ratio was increased in I/R and D groups (P＜0.05),the expression of AQP1 and AQP5 protein and mRNA in lung tissues was significantly down-regulated in group I/R,and the expression of AQP 1 and AQP5 protein and mRNA in lung tissues was significantly up-regulated in group D (P＜0.05).Compared with I/R group,the airway resistance was significantly decreased and lung compliance,perfusion flow and PaO2 were increased during reperfusion,W/D ratio was decreased,the expression of AQP1 and AQP5 protein and mRNA in lung tissues was up-regulated (P＜0.05),and the pathological changes of lung tissues was significantly attenuated in group D.Conclusion The mechanism by which dexmedetomidine reduces I/R injury may be related to up-regulation of the expression of AQP1 and AQP5 in rats in an in vitro experiment.

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.

Objective To evaluate the effect of problem-based learning (PBL)versus tradi-tional methods in medical statistics. Methods Computer retrieval was conducted to search for con-trolled studies comparing PBL and traditional methods. The quality of included studies was critically evaluated and data were analyzed by using the Cochrane Collaboration's RevMan 5.0 software. Results A total of 21 articles were retrieved,but only 7 were included. The results of Meta analysis showed that there was no significant difference between PBL and traditional methods in both the passing rate of student's score (RR=1.09,95%CI=0.98-1.23,P=0.12>0.05)and the exact score (WMD=0.30, 95%CI=-0.06 -0.67,P=0.10>0.05). Conclusion PBL showed no better learning results in medical statistics compared with traditional methods.

Metastasis is the essential character of biological behaviors in malignancies,which is also the main reason for the death of patients with tumor. So it is very important to research the metastasis for the pre-vention and treatment of carcinomas. Rectal cancer is one of the most common gastrointestinal cancer,and its prognosis is bad. lymphatic metastasis is one important factor in the determination of colon cancer' s progno-sis. More than 50% patients are found lymphatic metastasis when taking operation. The ralationship of lym-phatic metastasis and prognosis is more important than the original tumor's invasiving. So it is meaningful to study the mechanism of tumor metastasis, and to provide a scientific approach to the prediction of tumor me-tastasis, the precise assessment of prognosis and the treatment of tumor metastasis.

Objective To express in prokaryotic system and to analyze the antigenic specificity of EB virus(EBV) latent membrane protein 2(LMP2) multi-epitopes gene rich of T cell and B cell epitopes.Methods Using on-line prediction service, T cell epitopes and B cell epitopes of EB virus latent membrane protein 2 were predicted. The genes rich of CTL and th cell epitopes were selected as the candidate gene sequences, while B cell epitopes around them were taken into account. The finial selected multi-epitope gene was synthesized after being optimized according to prokaryotic codon bias and inserted into prokaryotic expression vector pET32a( + ) to get the recombinant plasmid: pET32a( + )/EBV-LMP2 multi-epitopes. After transformed into E. coli BL21 (DE3) and induced by IPTG, the target multi-epitopes gene can be expressed as Trx-His fusion protein. The expression products can be identified by SDS-PAGE and Western blot. Moreover, rabbit serum antibody to EBV membrane protein and nasopharyngeal carcinoma(NPC) patient serum were used respectively to detect the antigenic specificity of the multi-epitopes. Meanwhile, 6-8 weeks female BALB/c mice were immunized with EBV-LMP2 multi-epitope at 2 week intervals, three times in all, Trx-His protein and PBS were set as the control groups. At the second week after the last immunization, the mice were sacrificed. LDH and indirect ELISA were taken to detect the specific spleen CTL activityand specific IgG in serum, which reflected the immunogenicity of the EBV-LMP2 multi-epitope. Results Two amino acid sequences which locate at the LMP2 (aa195 -232 ) and LMP2 (aa419-436 ) were selected and connected in series to be the target gene. The recombinant plasmid containing EBV-LMP2 multi-epitope gene successfully constructed and the target protein was expressed in E. coli BL21 ( DE3 ). The relative molecular mass(Mr) of The expression products is about 27 × 103 , which matches up to the expected Mr. The antigenic specificity of the multi-epitopes protein was identified by Western blot and the multi-epitopes protein also can be detected by rabbit serum antibody to EBV membrane protein and NPC patient serum respectively. In the result of the animal experiment, EBV-LMP2 multi-epitope was able to induce the specific CTL activity in BALB/c mice. With the increasing of the effector: target ( E: T) 1: 5,1: 10, 1: 25, the CTL activity was also increased wih( 12.52% + 2.59% ), (21.80% + 1.08% ), (23.68% + 3.74% ) respectively; EBV-LMP2 multi-epitope was able to induce LMP2-specific antibody response(A490 =0.258 +0.040) as compared with Trx-His protein(A490 =0.095 +0.011) and PBS(A490 =0.068 +0.014,P＜0.05＝. Conclusion The EBV-LMP2 multi-epitopes gene was designed successfully and expressed precisely in prokaryotic expression system with good antigenicity and immunogenicity.

After health information push service on Internet was investigated ,suggestions were put forward for impro-ving the health information service by making use of the Wechat public platform according to the incomplete and non-professional health information service , rampant advertisements and unaccessible personal information on Internet .