Progress in detection and technology applications of minimal residual disease detection in postoperative early stage non-small cell lung cancers / 国际肿瘤学杂志

Surgery is the mainstay of treatment for early lung cancers, but there is still a risk of recurrence and metastasis after surgery. With the advancement of molecular biology and detection methods, detecting the level of postoperative peripheral blood minimal residual disease (MRD) in patients can dynamically monitor recurrence and determine prognosis. Due to the wide variety of MRD detection methods, uneven detection power, lack of uniform standards and prospective study validation, clinical application is still controversial. The further development of MRD detection for early stage cell lung cancer still needs technical progress, standardized detection criteria and credible clinical data.

Adverse reactions and treatment measures of advanced solid tumors treated with antibody-drug conjugates / 国际肿瘤学杂志

Novel antibody-drug conjugates (ADCs) are a hot spot in the research and development of new drugs for advanced solid tumors. ADCs have achieved significant efficacy in the treatment of advanced breast cancer, urothelial carcinoma, gastric cancer and other solid tumors, but their adverse reactions such as ocular toxicity, pulmonary toxicity, hematological toxicity, and liver toxicity cannot be ignored, and it is crucial to effectively deal with the adverse reactions of ADCs.

Analysis on self-evaluation health management service capability of primary medical staff in Zhejiang′s county-level medical alliances / 中华医院管理杂志

Objective:To measure with Zhejiang province as an example the situation of the self-evaluation health management service capability of primary medical staff in county-level medical alliances.Methods:A self-evaluation scale for health management service capability by primary medical staff was customized, covering 5 dimensions of professional attitude, interpersonal communication ability, comprehensive knowledge integration ability, professional practice ability and professional development ability, as well as 29 items. In July-September 2019, medical alliances were selected from three counties/cities based on economic development as the survey targets, and a total of 264 primary medical staff were surveyed. Quantitative data were described in mean and standard deviation, while qualitative data were described in composition ratio, and the differences were compared by Kruskal-Willis test.Results:The self-evaluation scoring of health management service capability of the primary medical staff was (59.75±18.64) points, and the average scoring of the items was (2.06±0.64) points. The scoring of knowledge integration (1.98±0.70)and professional practical ability (2.03±0.67) were lower than the average scoring of the items; gender and occupation type of primary medical staff present statistical significances in the self-evaluation scoring of health management service capability.Conclusions:Given the health management service capabilities of primary medical staff, they still need to upgrade their knowledge integration and professional practice capabilities. County-level medical alliances should enhance their training of health management knowledge and skills, promote doctor-nurse collaboration in health management services to broaden the depth of primary health management services.

Study on the construction and countermeasure of health-centered integrated health care service system / 中华医院管理杂志

Building an integrated health care service system is key to the Healthy China strategy. Based on the integrated health care service conceptual framework, the authors took two pilots regions of health-centered medical alliances in Zhejiang province as an example, and analyzed their conception framework, organizational structure, operation elements and effects. The study found initial success of the two alliances in terms of the contents, capabilities, effects and satisfaction of primary health care service. Such alliances feature a health-centered multi-entity participation mechanism, carry out health care and prevention integration leveraging the information platform, hence conducive to the effective governance of the alliances. However, the contents of their health related services are expected to be broadened and deepened; functionalities of health-related institutions need to be clarified and refined, while their performance appraisal needs to be further improved.

Analysis on performance of primary medical service in Zhejiang′s county-level medical alliances from the perspective of supply and demand balance / 中华医院管理杂志

Objective:Based on the perspective of supply and demand balance, to analyze the implementation effects of primary-feature medical services measures in medical alliances.Methods:From July to September 2019, two regions with different levels of economic development were chosen, and from each region one leading hospital and two community health service centers/township hospitals were selected from its medical alliance. A total of 213 medical staff and 703 residents were surveyed, to learn their awareness and performance appraisal of these feature services.Frequency and proportion were calculated in a descriptive statistical analysis. The scores of the performance appraisal of both supply and demand sides were tested by independent sample t. Results:In the performance appraisal of such measures, the average scoring by medical staff was 4.39±0.07, and that by residents was 3.85±0.06; the residents were more concerned with service capabilities and contents, while medical staff were more concerned with service content and delivery mode; supply and demand sides were found with consensus in terms of improving the medical service quality of chronic diseases in primary level and service accessibility.Conclusions:The county-level medical alliances should focus on enhancing their capacity of primary medical services, and improving their primary service mode with the help of medical insurance institutions. Meanwhile, it is imperative to optimize the primary medical service policy in view of supply and demand balance.

Evaluation and analysis on the degree of patients′ trust in community TCM physicians under the TCM service capability promotion program / 中华医院管理杂志

Objective:To evaluate the degree of trust of patients in community traditional Chinese medicine(TCM)physicians, based on the TCM service capability promotion program, and to analyze the impacts by TCM prevention and health care service.Methods:1 391 patients at 22 primary health service centers in 3 cities from Zhejiang province were investigated using the Chinese version of Wake Forest Physician Trust Scale(WFPTS)in September, 2017. Quantitative and qualitative variables were described by mean±SD, and ratio respectively. Differences were compared by t test, ANOVA and Kruskal-Wallis test. Results:Chinese version of WFPTS had good reliability and validity in measuring community TCM physicians. The average scoring of patients′ trust in community TCM physicians was 38.00±6.42, while their benevolence and competence were 19.14±3.41, 18.82±3.50 respectively.For patients with different demographic characteristics, their quantity and the way to acquire and utilize TCM prevention and health care service had different degrees of trust in community TCM physicians. Patients′ gender, age, awareness and utilization of TCM prevention and health care service, etc. affect the degree of trust in community TCM physicians.Conclusions:Patients have higher degree of trust in community TCM physicians, and improving the rate of awareness and utilization of TCM prevention has positive impacts on the degree of trust in these physicians. It is proposed that health knowledge education be strengthened and skills of community TCM physicians′ capacity be enhanced through various ways.

Evaluation and analysis on the degree of patients′ trust in community TCM physicians under the TCM service capability promotion program / 中华医院管理杂志

Objective@#To evaluate the degree of trust of patients in community traditional Chinese medicine(TCM)physicians, based on the TCM service capability promotion program, and to analyze the impacts by TCM prevention and health care service.@*Methods@#1 391 patients at 22 primary health service centers in 3 cities from Zhejiang province were investigated using the Chinese version of Wake Forest Physician Trust Scale(WFPTS)in September, 2017. Quantitative and qualitative variables were described by mean±SD, and ratio respectively. Differences were compared by t test, ANOVA and Kruskal-Wallis test.@*Results@#Chinese version of WFPTS had good reliability and validity in measuring community TCM physicians. The average scoring of patients′ trust in community TCM physicians was 38.00±6.42, while their benevolence and competence were 19.14±3.41, 18.82±3.50 respectively.For patients with different demographic characteristics, their quantity and the way to acquire and utilize TCM prevention and health care service had different degrees of trust in community TCM physicians. Patients′ gender, age, awareness and utilization of TCM prevention and health care service, etc. affect the degree of trust in community TCM physicians.@*Conclusions@#Patients have higher degree of trust in community TCM physicians, and improving the rate of awareness and utilization of TCM prevention has positive impacts on the degree of trust in these physicians. It is proposed that health knowledge education be strengthened and skills of community TCM physicians′ capacity be enhanced through various ways.

Efficacy of uteroplasty aided with temporary balloon occlusion of abdominal aorta in management of pernicious placenta previa combined with placenta percreta / 中华围产医学杂志

Objective To investigate the therapeutic effect of uteroplasty aided with temporary balloon occlusion of abdominal aorta in treating pernicious placenta previa combined with placenta percreta.Methods Sixty-two third-trimester gravidas who were diagnosed as pernicious placenta previa combined with placenta percreta by prenatal ultrasound and magnetic resonance imaging (MRI) in the First Affiliated Hospital of Zhengzhou University from January 1,2013 to May 31,2016 were enrolled in this study.All of them received cesarean section and then underwent uteroplasty following temporary balloon occlusion of abdominal aorta.Efficacy of that treatment was evaluated from the perspectives of blood loss,operation time,complications and postoperative recovery.All data were analyzed by descriptive analysis.Results All of the 62 cases were diagnosed with placenta percreta during operation including 10 cases (16.1％) with perimetrium invasion,46 cases (74.2％) with invasion to the muscular layer of bladder and six cases (9.7％) with bladder invasion.The average blood loss of all cases during and within 24 hours after operation was (1 377.3±605.2) ml and (140.6±66.3) ml,respectively.The average operation time was (72.3 ±24.5) min and the average length of postoperative hospital stay was (5.8± 1.6) d.The six cases of placenta percreta with bladder invasion received bladder repair.Sixty-one cases had their uterus preserved and the other one case had a sub-total hysterectomy due to amniotic fluid embolism.One woman developed phlebothrombosis in her lower limbs after operation.No intestinal or ureteral injury,puerperal infection,uterine ischemia necrosis or death was reported.In addition to three cases lost to follow-up,the other 59 patients were followed up to May 31,2017.Results of physical examination indicated that the 59 cases had normal uterine involution after operation.Menses returned in 58 of the 59 cases without any difference from before,and did not return in one case due to breastfeeding.Conclusion Uteroplasty aided with temporary balloon occlusion of abdominal aorta is a safe and effective uterus-preserving surgery for patients with pernicious placenta previa combined with placenta percreta.

Efficacy of automated medication management system in increasing clinical anesthesia management specification / 中华麻醉学杂志

Objective To evaluate the efficacy of automated medication management system in increasing clinical anesthesia management specification.Methods Sixty registered anesthesiologists of both sexes in our hospital,residents or attending physicians,with 1-10 yr of work experience,were divided into 2 groups (n =30 each) using a random number table:traditional medication management mode group (group T) and automated medication management system group (group A).In the clinical anesthesia work,traditional artificial management mode was used in group T,the mode of automated medication management system was used in group A,and 2 licensed pharmacists worked in the center pharmacy of our hospital were introduced for each group.Time of taking medicine was recorded by licensed pharmacists,and the error rates of taking medicine and recording were determined by licensed pharmacists.Results Compared with group T,the error rates of taking medicine and recording were significantly decreased (P＜0.01),and no significant change was found in the time of taking medicine in group A (P＞0.05).Medication errors including taking wrong anesthesia drug,wrong prescription recording,wrong names of the common drugs and drug omission were not detected in group A.Conclusion Application of automated medication management system can reduce the occurrence of errors made in taking medicine and recording,specify medication management and increase the quality of clinical anesthesia management.

Construction and expression of releasable glucagon-like peptide-1 and human serum albumin fusion proteins and preliminary evaluation of their pharmacodynamics and pharmacokinetics / 军事医学

Objective To construct four types of glucagon-like peptide-1 (GLP-1) and human serum albumin (HSA) fusion proteins that can be realeased at different rate in vivo by introducing protease cleavage sites between these two moieties.The therapeutic effect and release rate are studied to achieve balanced pharmacokinetics ( PK) and pharmacody-namics ( PD) of GLP-1 and HSA fusion proteins.Methods The gene with different polypeptide joint of GLP-1 and HSA fusion proteins were synthesized by overlap extension PCR amplification, cloned into expression vector pPIC9 and transformed into Pichia pastoris GS115.Then, fusion proteins were obtained by protein purification after being induced by methanol.The preliminary PK and PD of the fusion proteins were studied after purification.Results The fusion protein Gly2-GLP-1-GGGGG-HSA showed no release while Gly2-GLP-1-VTR-HSA, Gly2-GLP-1-SARSVRA-HSA, and Gly2-GLP-1-GRSRVTRSV-HSA showed a slow, medium and fast release rate, respectively, after incubation with furin.In vitro biological activity test results dispalyed that each type of fusion protein promoted insulin secretion of MIN6 cells.In vivo PK test indicated the half-life size of fusion proteins was the largest in Gly2-GLP-1-GGGGG-HSA, followed by Gly2-GLP-1-VTR-HSA, Gly2-GLP-1-SARSVRA-HSA, and Gly2-GLP-1-GRSRVTRSV-HSA.In vivo PD test exhibited hypoglycemic activity that was the highest in Gly2-GLP-1-VTR-HSA, followed by Gly2-GLP-1-SARSVRA-HSA, Gly2-GLP-1-GRSRVTRSV-HSA, and Gly2-GLP-1-GGGGG-HSA.Conclusion GLP-1 can be released from fusion proteins with full activity after the introduction of protease cleavage sites.Releasable fusion proteins at an appropriate release rate have the most balanced PK and PD.

Clinical evaluation of reliability of autologous blood withdrawal during cesarean section / 中华麻醉学杂志

Objective To evaluate the reliability of autologous blood withdrawal during cesarean section. Methods Fifteen patients preoperatively diagnosed with pernicious placenta previa and∕or accrete by using ultrasound and magnetic resonance imaging, aged 20-35 yr, weighing 55-75 kg, at≥36 weeks of gestation, were enrolled in the study. Blood containing amniotic fluid from the surgical field was collected, and the washed blood was processed using cell?salvage machine and then filtered using a leukocyte depletion filter during cesarean section. The 20 ml blood samples collected included maternal central venous blood after delivery of fetus, unwashed blood, washed blood and filtered blood. The fetal squamous cells were counted using papanicolaou staining. The concentrations of a?fetoprotein, tissue factor, endothelin?1 and histamine were measured by enzyme linked immunosorbent assay. The fetal red blood cells were counted using the acid elution method and HE staining. Results Compared with unwashed samples, the tissue factor concentrations were significantly increased, and the fetal squamous cell count, concentrations of a?fetoprotein and endothelial?1, and fetal red blood cells were decreased in the washed samples. Compared with washed samples, the fetal squamous cell count, concentrations of a?fetoprotein and fetal red blood cells were significantly decreased in filtered samples. Compared with maternal venous blood samples, the tissue factor concentrations were significantly increased, and the fetal squamous cell count and concentrations of a?fetoprotein and endothelial?1 were decreased in filtered samples. Conclusion Autologous blood withdrawn during cesarean section can be used for reinfusion in cesarean section.

Influence of miR-21 control Smad7 expression and lung cancer A549 cell line proliferation / 安徽医科大学学报

Objective To explore miR-21 regulation of Smad7 in lung cancer A549 cell line as well as its impact on the proliferation of lung cancer A549 cell line. Methods miR-21 mimic and inhibitors in lung cancer A549 cell line were transfected by using Lipofectamine 2000 Reagent. After 48 h, Western blot and qRT-PCR were applied to assess the expression of protein and mRNA of Smad7 . MTT assay was used to determine the proliferation influence of the transfected lung cancer A549 cell line. Results Western blot and qRT-PCR showed that A549 cell trans-fected miR-21 mimic exhibited down-regulated Smad7 protein and mRNA expression, and A549 cell transfected miR-21 inhibitor exhibited up-regulated Smad7 protein and mRNA expression. The A549 cell proliferation activity decreased significantly after transfected miR-21 inhibitors. Conclusion miR-21 inhibitors can increase Smad7 pro-tein and mRNA expression, and suppress the proliferation activity of lung cancer A549 cell significantly.

Clinical analysis of seven cases of generalized pustular psoriasis of pregnancy / 中华围产医学杂志

Objective To investigate the clinical characteristics,diagnosis,therapy and maternal and perinatal prognosis of generalized pustular psoriasis of pregnancy.Methods Clinical data for seven inpatients with generalized pustular psoriasis of pregnancy were retrospectively analyzed from January 1,2005 to December 31,2012.Results Three patients had family history of psoriasis and five had previous history of psoriasis.All skin lesions were large patches of erythema,with needlepoint to miliary size pustules and scales.Two patients had oral involvement and three had nail involvement.Biopsy and bacterial culture were performed on five patients,in whom histopathological changes of pustular psoriasis were found,and bacterial culture was negative except in one patient.Among the patients,four had confirmed cause of disease; six patients were complicated with fever; four had increased leukocytes; seven had elevated neutrophils and C-reactive protein;five had increased total protein; and six had increased albumin.The disease was diagnosed according to the clinical manifestations and laboratory tests.Comprehensive treatment with glucocorticosteroids,antibiotics and local treatment were performed.Four patients had live births,and three patients underwent odinopoeia.Two babies were healthy,one had died,and another had varus foot deformity.Three patients had pustular relapse after labor.Conclusions Fetal-placental functions of patients with generalized pustular psoriasis of pregnancy should be monitored closely.Early diagnosis,treatment and termination of pregnancy can improve the maternal and perinatal prognosis.

Intraoperative different setting of respiratory parameters influence the early postoperative cognitive function after gynecological laparoscopic surgery / 临床麻醉学杂志

Objective To investigate the influence of different respiratory parameter setting during gynecological laparoscopic surgery on early postoperative cognitive function.Methods Eighty patients undergoing elective ovarian cancer or cervical cancer were grouped randomly into groups A, B,C and D.In group A patients were ventilated with respiratory parameters of VT 8 ml/kg,RR 12 times/min.While patients in groups B,C and D with identical minute volume 105 ml/kg though with respective RR of 12,1 5 and 18 times/min respectively.Patients in four groups were all graded by the MMSE at time points of preoperation(T0 ),postoperative 1 h(T1 ),6 h(T2 ),24 h(T3 ),48 h(T4 ), 72 h(T5 ).PaCO2 of arterial blood gas were tested before pneumoperitoneum(Ta)and immediately af-ter pneumoperitoneum(Tb).Results PaCO2 at Tb was higher in each group than that at Ta(P <0.05).Patients in group A showed the highest PaCO2 at Tb while PaCO2 in group C were lowest. The MMSE scores in group C were significantly higher than those in other groups at T1-T3 (P <0.05).The values at T4 in group A were lower (P <0.05)than those in other groups.Values at T1-T4 in group A were lower than that at T0 (P <0.05).In groups B and D at T1-T3 MMSE scores were lower than those at T0 and patients in group C showed lower MMSE scores at T1 and T2 (P <0.05).Conclusion Early postoperative cognitive function can be improved by regulating intraoperative respiratory parameters properly and increasing minute volume adequately in gynecological laparoscopic surgery.

Changes in expression of NRF-1 in spinal cord during remifentail-induced hyperalgesia in a rat model of incisional pain / 中华麻醉学杂志

Objective To evaluate the changes in the expression of NRF-1 in the spinal cord during remifentail-induced hyperalgesia in a rat model of incisional pain.Methods Forty-eight Sprague-Dawley rats,weighing 180-220 g,were randomly divided into 4 groups (n =12 each) using a random number table:control group (C); incisional pain group (group Ⅰ); remifentanil group (group R); incisional pain + remifentanil group (group Ⅰ + R).All the rats were anesthetized with sevoflurane.A 1-cm longitudinal incision was made through skin,fascia and muscle of the plantar aspect of the right hindpaw in I and I + R groups.In C and I groups,normal saline was subcutaneously infused for 30 min.In group I + R,remifentanil (0.04 mg/kg,0.4ml) was subcutaneously infused for 30 min starting from the onset of skin incision.Paw withdrawal threshold to mechanical stimulation (PWMT) was measured at 24 h before operation and at 2,6,12,24 and 48 h after operation.After measurement of PWMT at 48 h,the rats were sacrificed and L4,5 segments of the spinal cord were removed rapidly to detect the expression of nuclear respiratory factor 1 (NRF-1) by immunofluorescence and Western blot.Results Compared with group C,PWMT was significantly decreased at each time point after operation,and the expression of NRF-1 in the spinal cord was up-regulated in I and I + R groups (P ＜ 0.05).Compared with group I,PWMT was significantly decreased at each time point after operation,and the expression of NRF-1 in the spinal cord was up-regulated in group I + R (P ＜ 0.05).Conclusion Up-regulation of NRF-1 expression in the spinal cord may be involved in the development of remifentail-induced hyperalgesia in a rat model of incisional pain.

Establishment of in vitro metabolism of fentanyl by human liver microsomes in Chinese population / 中华麻醉学杂志

Objective To establish in vitro metabolism of fentanyl by human liver microsomes in Chinese population.Methods Thirty patients undergoing elective operation on liver were enrolled in the study.Normal liver specimens were obtained during removal of liver and gall for preparation of liver microsomes (by calcium precipitation) which were used for establishment of the liver microsomal incubation system for fentanyl.Fentanyl served as the metabolic substrate in the incubation reaction.The concentration of fentanyl in the incubation medium was detected at 0,5,10,15,20 and 30 min of incubation using HPLC-UV.Sufentanil served as the interior label element.The n-hexane-ethanol absolute was used to extract the sample.The chromatographic column used in this method was Grace C18 (4.6 mm × 250.0 mm,5 μm).The mobile phase was methyl cyanide-KH2PO4 buffer solution with the flow rate of 1.0 ml/min,detection wavelength of 205 nm and sample size of 20 μl.Linear regression analysis was performed by using the least-squares method.The specimens of the blank incubation system with the final concentration of fentanyl 0.6,2.4 and 10.0 μg/ml were obtained to determine the recovery,precision and stability.The metabolic rate of fentanyl in human hepatic microsomes was calculated.Results Fentanyl and the interior label element sufentanil were separated completely,and the retention time were 5.730 and 9.336 min,respectively.Endogenous matrix of microsomes did not interfere with the analysis.Regression equation was C =0.945 8A-0.140 4,R2 =0.999 2.C was the concentration of fentanyl,and A was the peak area ratio of fentanyl versus sufentanil.The recovery of incubation system with low,medium and high concentrations of fentanyl was 85％-115％,and relative standard deviation (RSD) was less than 10％.The RSD of intra-and inter-day precision and stability was less than 10％.The method was proved to meet the requirements of biological sample analysis.The metabolic rate of fentanyl was (1.6 + 0.8) nmol/min per milligram protein in human hepatic microsomes of 30 cases.Conclusion The in vitro metabolism of fentanyl by human liver microsomes is convenient,and the detectability is high,so it can be used for the research on the in vitro metabolism of fentanyl in Chinese population.

Effects of inhalation anesthesia with low-flow sevoflurane on renal function of neonates / 中华麻醉学杂志

Objective To evaluate the effects of inhalation anesthesia with low-flow sevoflurane on the renal function of neonates.Methods Forty ASA physical status Ⅰ or Ⅱ neonates undergoing abdominal surgery under general anesthesia,aged 6-28 days,weighing 1730-2928 g,were included in the study.After induction of anesthesia,anesthesia was maintained with sevoflurane inhalation using a semi-closed circuit system (FGF 1 L/min).The end-tidal concentration of sevoflurane was maintained at 2.5％-4.0％ according to the vital signs.Before induction of anesthesia,immediately after operation,and at 24,48 and 72 h after operation,blood samples from the peripheral vein and urine specimens were taken for determination of serum concentrations of creatinine (Cr),blood urea nitrogen (BUN),urinary retinol binding protein (RBP) and β-N-acetyl-glucosaminidase (NAG).A temperature probe was inserted to the center of soda lime canister.Results Compared with the baseline value at T0,no significant changes were found in the serum Cr and BUN concentrations at T1-4,urinary RBP concentrations were increased at T1,no significant changes were found in urinary RBP concentrations at T2-4,NAG concentrations were significantly increased at T2 and no significant changes were found in NAG concentrations at T1,3,4.The temperature of soda lime was (37 ± 3) ℃ at the end of operation.Conclusion Inhalation anesthesia with low-flow sevoflurane (FGF 1 L/min) produces no significant effect on the renal function of neonates.

Changes in expression of Toll-like receptor 4 mRNA and its down-stream cytokines mRNA in spinal cord in a rat model of incisional pain / 中华麻醉学杂志

Objective To evaluate the changes in the expression of Toll-like receptor 4 (TLR4) mRNA and its down-stream cytokines IL-1β and TNF-α mRNA in spinal cord in a rat model of incisional pain.Methods Fifty-eight male Sprague-Dawley rats,weighing 180-220 g,were used in this study.A 1-cm longitudinal incision was made through skin,fascia and muscle of the plantar aspect of the hindpaw in isoflurane-anesthetized rats.Mechanical paw withdrawal threshold to yon Frey filament stimulation (MWT) on the operated and non-operated sides was measured before operation and at 0.5,1,2,6 and 12 h and 1,2,3,5 and 7 days after operation.Six rats were chosen and sacrificed before operation and at 2 and 8 h and 1,2,3,5 and 7 days after operation.Their lumbar segments (L4-6) of the spinal cord were removed for determination of the expression of TLR4,IL-1β and TNF-α mRNA by real-time PCR.Results Compared with the baseline value before operation,MWT on the operated side was significantly decreased at 0.5 h-5 days after operation,and the expression of TLR4,IL-1β and TNFα mRNA was up-regulated at 2 and 8 h and 1,2 and 3 days after operation (P ＜ 0.05),and no significant change was found in MWT on the non-operated side (P ＞ 0.05).MWT on the operated side was lowest at 2 h after operation and then gradually increased,the expression of TLR4 mRNA peaked on 1 day after operation,and the expression of IL-1 and TNF-α mRNA peaked at 8 h after operation (P ＜ 0.05).The TLR4 mRNA expression was negatively correlated with MWT on the operative side (r =-0.484,P ＜ 0.05),and IL-1 mRNA and TNF-α mRNA expression was positively correlated with TLR4 mRNA (r =0.294 and 0.540,respectively,P ＜ 0.05).Conclusion The expression of TLR4 mRNA and its down-stream cytokines IL-1β and TNF-α(mRNA in spinal cord is up-regulated,this change is involved in the maintenace of incisional pain,but it does not play an important role.