Sorafenib is a novel oral multikinase inhibitor that inhibits Raf kinase because of its anti-proliferative property. Sorafenib also inhibits receptor tyrosine kinases of multiple proangiogenic factors, such as VEGFR-1/2/3 and PDGFR-β. The combina-tion of both its anti-proliferative and anti-angiogenic properties makes sorafenib an attractive agent in cancer treatment. To date, sorafenib is the only approved systemic treatment for patients with hepatocellular carcinoma. The most common adverse events of this inhibitor included hand-foot skin reactions, nausea, diarrhea, weight loss, and hypertension. These adverse events can severely affect patient compliance, which may negate the effect of therapy. Correct understanding and treatment of these adverse events can improve clinical outcome. This paper discusses the clinical aspect of sorafenib-induced adverse events and the molecular basis behind their toxic-ity. Recommendations for the management of the adverse effects are also provided.

Objective To study the association between sympathetic skin response(SSR) and diabetic autonomic neuropathy(DAN), and explore its use as the objective base for its early diagnosis. Methods SSR was carried out in 30 patients with DAN and 30 healthy controls. Results The SSR indices of the patient with diabetic mellitus(DM) either with or without DAN were different from those of normal objects. Conclusion The SSR detection and analysis can detect the early dysfunction of the autonomic system in diabetic mellitus and may be a useful testing for early diagnosis of diabetic neuropathy.

Objective To evalute the feasibility of a double hand allogroft to reconstuct the limbs'function. Methods A brain dead donor was chosen under the test of blood group in ABO and Rh,HLA match,PRA and the mixed leukocyte culture.The level of the transplantated hands was 5 cm proximal to the wrists The procedure of the allotransplantation was similar to that of the autologous replantation.The immunosuppressants were taken two days before the operation,in the operation and after the operation. The circulation,the vital signs and the rejection were under the supervision. Results The progress was satisfactory. No rejection was found postoperation.After 10 weeks the callus in both ends of radius and ulna was obvious.After 5 months sensation recovered.After 7 months the internal fixation(plates and screws) was removed and tenolysis was done. Now the recipient could use engrafted hands to wash face,make the bed,wear clothes,brush teeth,peel oranges,eat with a spoon,tie the shoelace slowly,pick up a telephoneor and use the conroller of Television. Conclusions With the immunosuppressive agents,the double hands allograft can survive.The growth rate of bone and nerve is faster than that of autologous replantation.

[Objective]To explore the feasibility and clinical effects of spinous proscess forming in posterior in the treatment of lower lumbar diseases. [Methods]Seventy-seven cases suffered from lower lumbar diseases were treated using spinous proscess forming as interbody fusion material.The cases included 35 of lumbar disc herniation,21 of spondylolysis,11 of degenerative spondylolisthesis and 10 of spinal canal stenosis.The clinical data and imaging results were investigated.[Results]Seventy-two patiens were followed up for 1 to 2 years while 5 were lost.During following-up,no loosened internal fixation,broken nail or stick,infravertebra prolapsed,or detachment recurrence was found.Preoperative the height of intervertebral space was 8.5?1.9 mm,10.9?1.8 mm at 2 weeks postoperatively and was 10.7?1.7 mm at last follow-up.The height of intervertebral space were significantly increased postoperatively with statistically significant difference(P

Objective To To evaluate the efficacy of Guglielmidetachable coil (GDC)F embolization in treatment of intracranial aneurysms and summarize the main points of GDC manipulation.Methods Thirty two patients were examined with digital substraction angiography (DSA) and 34 intracranial aneurysms were found, including 15 aneurysms in the anterior communication artery, 13 in the posterior communi cation artery, 2 in the middle cerebral a rtery, 1 in the anterior cerebral artery and 1 Ophthalmic artery. After wards GDC was used for embolization therapy. Results Thirty two patients with 34 aneurysms were successfully embolized with GDCs. Complete embolization achieved in 20 patients and incomplete in 12 patients; while one aneurysm ruptured during the performance, but all curedafter treatment. Vas cular spasm occurred in 2 patients, one of them had slight hemiplegia. Sixpatients with 7 aneurysms were followed up by DSA examinationl year after operation. No obvious change was observed.Conclusions Treatment of intracranial aneurysms with GDC embolization is a safe, reliable, and effective measure. Skillful techniques of the operator and correct management of complications are important factors affecting the outcome of operation. A period follow up is essential to patients with partial embolism.

Objective To evaluate the safety and efficacy of microsurgical resection of large acoustic neurinoma via the suboccipital retrosigmoid approach.Methods Forty-nine patients with large acoustic neurinoma(≥4 cm) underwent microsurgical resection through suboccipital retrosigmoid approach.The craniotomy was performed by way of an unilateral S-shaped suboccipital incision.With microsurgical techniques the outmost layer of the arachnoid membrane was preserved in order to avoid damaging to the surrounding vital structures.The tumor was resected intracapsularly from the superior pole and the internal auditory meatus was finally opened.The last pieces of tumor were removed by sharp dissection from the facial nerve bidirectionally,and were resected cautiously in a piecemeal fashion.Results Of the 49 patients,45 patients(92%) received a total resection of the tumors,and 4 patients(8%) subtotal resection.No patients died.The facial nerve was preserved anatomically in 42 patients(86%) and functionally in 36 patients(73%).The acoustic nerve was preserved anatomically in 7 patients(14%) and functionally in 3 patients(6%).One patient experienced a postoperative haematoma,and a re-operation was required.No recurrence was seen in 37 patients during a follow-up for 6 months ～ 5 years(mean,2.8 years).These patients had recovered for normal work and daily activities.Conclusions Microsurgical operation through suboccipital retrosigmoid approach is a favorable treatment for large acoustic neurinomas.The procedure can improve the rate of total resection,decrease the morbidity and mortality,and effectively protect the function of the acoustic and facial nerves.

Objective To explore the possible antiepileptic mechanism of Pingxian Powder. Methods In the experiment,Pentylenetetrazole (PTZ) was injected into abdomen of rat to make epileptic kindling model. The total number,percentage of positive area and integral optical density of N-methyl-D-aspartate receptor1 (NMDAR1) and ?-aminobutyric acid-A receptor (GABA-AR?1) of immunoreactive cells in the temporal cortex were studied by the immunohistochemical method and image analyzing system. Results The total number,percentage of positive area and integral optical density of NMDAR1 of immunoreactive cells in the temporal cortex of model group were more than normal group (P

Objective Though immunohistochemical study on the effects of Pingxian Powder on N-methyl-D-aspartate receptor1 (NMDAR1) and ?-aminobutyric acid-A receptor ?1 (GABA-AR ? 1 ) in central nervous system of pentylenetetrazol-induced epileptic rats, to explore its possible antiepileptic mechanism. Methods Sixty wistar rats were divided into control group (A), model group (B), phenobarbital group (C) and Pingxian Powder small (D), middle (E), Large (F) dosage group. Pentylenetetrazole (PTZ) was injected into abdomen of rat to reconstruct epileptic kindling model. The total number, percentage of positive area and integral optical density of NMDAR1 and GABA-AR ? 1 of immunoreactive cells in hippocampus CA 1 , CA 3 were studied by the immunohistochemical method and image analyzing system. Results The total number, percentage of positive area and integral optical density of NMDAR1 of immunoreactive cells in hippocampus formation of Group B were more than Group A (P

Objective To explore the outcomes of endoscopic minimally invasive surgery as a new technique for the treatment of glossopharyngeal neuralgia.Methods From January 2000 to May 2008,16 cases of primary glossopharyngeal neuralgia were treated by endoscopic minimally invasive surgery through suboccipital retrosigmoid approach in our hospital.We made a 6-to 8-cm vertical incision within the inner hairline to drain the cerebrospinal fluid from the cerebellopotine angle cistern(CPA) so that to form an operational path.And then,the adherent arachnoid membrane was freed and the structure of the glossopharyngeal nerve and local arteries were detected.Results After the endoscopic surgery,pharyngeal pain disappeared in all of the 16 cases.Follow-up was available for 3 months to 8 years in the patients(1-3 years in 4 cases,and 3-8 years in 2 cases).Two patients had hoarse voice after the operation.No one had dysphagia or recurrence during the follow-up.Conclusion Endoscopic surgery through suboccipital retrosigmoid approach is a minimally invasive method for primary glossopharyngeal neuralgia with good outcomes,mild surgery-related complications,and quick post-operative recovery.

Objective To summarize the experience of pterional craniotomy microsurgical resection of giant tuberculum sellae meningiomas. Methods A total of 18 patients with giant tuberculum sellae meningiomas were treated microsurgically in this hospital from February 2000 to November 2004. The patients were operated on by use of pterional craniotomy on the side of worse vision. The basal part of the tumor was firstly dissected to control the blood supply of the lesion. Through the cerebral cisterns at the sellar region and the interfaces between the tumor and the adjacent structures, the tumor was removed to the greatest possible extent with minimal invasion to the neighbouring structures. Results[WTBZ] A total resection was conducted in 16 patients (88.9%), and a subtotal resection, in 2 patients (11.1%). No surgery related death was observed. Follow-up examinations in 14 patients for 3 months ~ 4 years (mean, 2.5 years) found no recurrence of meningiomas. Conclusions[WTBZ] The pterional approach provides excellent exposure of the middle fossa and the parasellar area. Pterional approach microsurgical technique can improve the rate of total resection of giant tuberculum sellae meningiomas.