With the transformation in modern medical models and the increasingly diversified needs of patients， building a harmonious and mutually trusting doctor-patient community relationship has become the key to improving the quality of medical services， enhancing patients’ sense of access to medical care， and promoting medical effects. Medical social worker is an indispensable member of the medical team， whose interdisciplinary background knowledge and professional skills provide unique advantages for building a harmonious doctor-patient community relationship. However， the current subjects of research on the doctor-patient community are still limited to the medical staff and patients， and there is a lack of relevant research that uses interdisciplinary thinking and tools to explore the path of building a doctor-patient community. Therefore， under the guidance of the spiral research idea of action research method， by sorting out the action paths of medical social workers in carrying out pediatric neurosurgery specialist services in the past five years， three analytical tools from management， namely the strategic decision-making process model， the organization- stakeholder fit model， and the value proposition canvas， were used to solve the problems and dilemmas in the different stages of building a doctor-patient community. On these foundations， practical knowledge was produced， providing valuable experience and methods for medical social workers to build a doctor-patient community.

The professional development of medical social workers currently faces several dilemmas， such as insufficient professionalism， unbroken professional barriers， and an incomplete policy system. To address these dilemmas， medical social workers should clarify the dimensions of their professional capabilities and strive to improve their professional capabilities， building a professional capability framework focusing on problem-solving. Meanwhile， with the popularization of AI technology， the cross-field integration and development of “AI + medical social workers” have brought new opportunities for the professional capability construction of medical social workers. For example， big data can enhance the optimization of electronic health record services； virtual reality （VR） and augmented reality can facilitate the electronic standardization of social worker training for clients； and machine learning can promote the transformation of the social work service model towards “risk prediction and advance intervention，” assisting in improving direct service capabilities. ChatGPT and VR remote consultation systems can be used for supervision services， big data cloud classrooms and robot teaching assistants can broaden learning channels， and natural language processing technology can assist in professional document writing， aiding in enhancing indirect service capabilities. However， applying AI technology to the professional capacity construction of medical social workers may also lead to the alienation of the professional service relationship of medical social workers from needs assessment and relationship building to service intervention， further causing ethical risks brought by demand bias， relationship alienation， and weakened subjectivity. Therefore， it is necessary to rationally view AI’s “double-edged sword” effect. While enjoying the field transformation brought about by high and new technology， it is also imperative to address the subsequent challenges from the perspectives of social work professional assessment and review， educational supervision， and ethical awareness enhancement.

Objective To evaluate the effect of thoracic paravertebral nerve block (TPVB) on postoperative chronic pain in patients undergoing thoracic surgery.Methods One hundred and forty patients of both sexes,aged 25-64 yr,with body mass index of 18-24 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective thoracoscopic radical resection of lung cancer,were divided into 2 groups (n=70 each) using a random number table method:control group (group C) and TPVB group (group P).Two-point (T4,6) TPVB was performed on the affected side under ultrasound guidance before anesthesia induction,and 0.5％ ropivacaine 20 ml was injected into each puncture site in group P.Sufentanil 0.1 μg/kg was intravenously injected at 10 min before the end of operation in group C.Analgesic pump was connected at the end of operation in two groups,and patient-controlled intravenous analgesia was performed with sufentanil.The patients were followed up after operation.Sufentanil 0.1 μg/kgwas intravenously injected when visual analogue scale score ≥4.The total consumption of sufentanil and the number of requirements for rescue analgesia were recorded at 48 h after operation in both groups.The patients were followed up to 2 months by telephone after operation,the occurrence of postoperative chronic pain was recorded,and the effect of pain on daily life and grade of treatment measures were evaluated.Results Compared with group C,the total consumption of sufentanil and the number of requirements for rescue analgesia were significantly reduced,and the impact of postoperative chronic pain on daily life and grade of treatment measures for pain were decreased in group P (P＜0.05).There was no significant difference in the incidence of postoperative chronic pain between the two groups (P＞ 0.05).Conclusion Although TPVB cannot reduce the incidence of postoperative chronic pain,it can relieve the degree of postoperative chronic pain in patients undergoing thoracic surgery.

PurposeTo investigate the role of diffusion weighted imaging (DWI) in the detection of focal liver lesions (FLL).Materials and Methods T2WI, dynamic contrast enhancement (DCE) and DWI (b=100 s/mm2 and 600 s/mm2 respectively) were performed in 205 patients with 310 FLLs. All images were read by two reviewers to determine the detection of FLLs and score the confidence. The consistency of the results given by the two reviewers was evaluated. The confidence scores between different sequences and the detection rate of different sequences were also compared.Results The consistency of the two reviewers was excellent or good in T2WI, high b value DWI, low b value DWI, and DCE (Kappa=0.71, 0.85, 0.82 and 0.64,P<0.05). As to the confidence score of lesion detection, high b value DWI and low b value DWI were both significantly higher than T2WI (P<0.01), but both were lower than DCE (P<0.01). DWI yielded higher score and detection rate for detecting FLLs than T2WI (86.5%vs. 70.3%,P<0.01), but lower than DCE (91.6%,P<0.05). For small malignant lesions (≤2 cm in diameter), DWI showed similar detection rate with DCE (P>0.05), but higher than T2WI (P<0.01). The combination of DWI and DCE detected more small malignant lesions than DWI or DCE alone (P<0.01).Conclusion DWI can detect more FLLs than T2WI, and can help DCE detect small malignant FLLs. Therefore DWI is suggested to be included in the routine protocol of liver MRI examination.

Objective To investigate the influence of knocking down Ezrin expression in combination with HSP70-induced immune killing on the apoptosis and proliferation of mouse osteosarcoma cells.Methods Human osteosarcoma cell line MG63 was cultured,the HSP70 and Ezrin-shRNA DNA fragments were cloned into the expression vector pGFP-V-RS containing CMV and pU6 promoters,and constructed the expression vector pGFP-V-RS-shRNA and pGFP-V-RS-shRNA-HSP70.The vectors were transfected into MG63 cell line,respectively.The status of transfected MG63 cells was observed by fluorescent microscope.The expressions of Ezrin and HSP70 were examined by real time RT-PCR and Western blot.Flow cytometry 、MTS test was used to detect the changes of cell apoptosis and proliferation,and changes of the expression of apoptosis and cell cycle related proteins was detected by Western blot.The specific cytotoxic T lymphocytes (CTLs) were induced by HSP70,and its killing effect on target MG63 tumor cells was analyzed by MTT assay.Results The specific vector simultaneously knocking down Ezrin and overexpressing HSP70 was constructed for the first time in China and confirmed by fluorescence microscope and gene/protein expression analysis.Compared to Ezrin knock-down alone,simultaneous HSP70 overexpression partially recovered the promoted cellular apoptosis and proliferation suppression by Ezrin knock-down,however,when compared to the normal control,the apoptosis rate of LM 8 cells was still significantly increased from 11.01％±0.22％ to 24.28％±0.50％,while the proliferation rate decreased from 395.14％±2.24％ to 310％± 2.83％.In addition,Western detected that Ezrin-shRNA could promote the expression of Bax.However,the expression of Ezrin-shRNA could reduce the Bcl-2 and Cyclin D1.Ezrin-shRNA/HSP70 also has the same effect.MTT assays revealed that the CTL cytotoxic effect on target MG63 tumor cells at all concentrations were significantly higher in CT+IL-2+HSP70 group compared with that in CT+ IL-2 group,with a cytotoxicity as high as 56.33％± 1.95％.Conclusion Simultaneous knocking down Ezrin and overexpressing HSP70 promotes the apoptosis and inhibits the proliferation of osteosarcoma cell.And the HSP70 can induce CTL which enhances the killing effect on tumor cell.And the HSP70 can induce CTL which enhance the killing effect on tumor cell.

Objective To evaluate the treatment method and time for congenital dacryocystitis.Methods The data about the treat ment massage of Congenital dacryocystitis was analyzed.Results 117 eyes of congenital dacryocystitis in 76 patients were given therapy,of which 5 eyes(5%)were cured by dacryocystitis massage,13 eyes(11%)were cured by dacryosolen lavage,99 eyes were cured by dacryorhinocystotomy,with the cure rate of 85%.Conclusion Dacryorhinocystotomy was an effective and important method to treat congenital dacryocystitis.The age from 2 months to 6 months old are available for treatment of Congenital dacryocystitis.