Objective To investigate the prognostic factors of sorafenib treatment in patients with advanced hepatocellular carcinoma (HCC) underwent surgical therapy or transcatheter arterial chemoembolization (TACE).Methods 62 patients with advanced HCC underwent surgical therapy or TACE were post-treated with sorafenib (400mg,bid).The overall survival (OS) and progress-free survival (PFS) were evaluated by Kaplan-Meier method.Results There were 30 patients in surgical group and 32 patients in TACE group.The median OS in surgical group and TACE group were 12.2 and 5.7 months (P =0.019) and the median PFS were 16.7 and 10.6 months (P =0.033),respectively.The liver cancer volume / liver volume ＞50 ％ and Child-Pugh classification were independent risk factors for PFS in surgical group,the Child-Pugh classification and vascular invasion were independent risk factors for OS in surgical group.Conclusion The patients' PFS and OS in surgical group by oral sorafenib are better than those of patients in TACE group.The effective ways to prolong the PFS include decreasing volume of liver cancer and the better liver function.

Objective To investigate the incidence and risk factors of surgical site infection(SSI) in patients with internal fixation surgery for limb fracture.Methods Medical data of patients with internal fixation surgery for limb fracture in a hospital from January 2013 to January 2016 were collected, 39 patients with SSI following internal fixation was as infection group, according to the 1:2 ratio, 78 patients without SSI following operation during the same period were randomly selected as the control group, risk factors of SSI were analyzed.Results Among 4 125 patients undergoing internal fixation surgery, incidence of SSI was 0.95% (n=39), the positive rate of bacterial culture in infection group was 87.2% (34/39), a total of 38 strains of pathogenic bacteria were isolated, among which 22 were gram-positive strains (57.9%), 15(39.5%)were gram-negative strains,1(2.6%) was fungi,Staphylococcus aureus was the main pathogenic bacteria (47.4%), and there were 20 isolates of multidrug-resistant organisms.Univariate analysis showed that infection group and control group was significantly different in the following aspects: combined underlying diseases, time from injury to operation≥8 hours, open fracture, multiple fracture, duration of operation≥180 minutes, intra-operative blood loss≥400 mL, allogeneic blood transfusion, duration of postoperative indwelling drainage tube≥5 days, and average length of hospital stay≥14 days (all P<0.05).Multivariate logistic regression analysis showed that the following factors were risk factors for SSI following internal fixation surgery for fracture: time from injury to operation≥8 hours, open fracture, duration of operation≥180 minutes, duration of postoperative indwelling drainage tube≥5 days, and average length of hospital stay≥14 days (all P<0.05).Conclusion Risk factors for SSI in patients with internal fixation surgery for limb fracture are multiple, reducing risk factors has a positive effect on decreasing the incidence of SSI and improving the cure rate.

Objective To analyze the outcome of the flow-through anterolateral thigh flap for reconstruction in the Gustilo type Ⅲ C traumatized extremities.Methods From June 2008 to June 2011,sixteen flow-through anterolateral thigh flaps were used for limb salvage.All in this series suffered from Gustilo type Ⅲ C open fractures in upper (4 cases) or lower extremities (12 cases).All patients had the presence of wide segmental soft tissue defects and segmental artery defects with compromised circulation.Four patients received primary operations and 12 patients received debridement combined with vacuum sealing drainage and secondary operations.Results All patients were followed up from 12 months to 40 months (average of 22 months).The mean age was 37.5 years old (from 18 to 62 years).The mean timing of free flap transfer was 6.7 days after injury (from 5 hours to 16 days).The mean artery defect was 12 cm in length (from 6 to 16 cm).All the flaps survived completely with a soft tissue texture.After operation,infection occurred in one patient,venous thrombosis occurred 1 day post-operatively in one patient,local flap necrosis occurred in two patients.No donor site morbidity was noted.In the last follow-up,according to Johner-Wruhs and Berton scores,the overall excellent/good rate for lower and upper extremities were 83.3％ and 75.0％ respectively.Conclusion Flow-through anterolateral thigh flaps provide for reconstruction of both the vessels and soft tissue simultaneously.Because of avoiding sacrificing one of the major vessels,it particularly indicates for only one major artery survival in the extremity.The clinical results show that the above reconstruction technique is useful for upper and lower extremities salvage.

Objective To evaluate the safety of Renaissance spine robot assisted system in spinal injury.Methods From March 2014 to May 2016,38 patients with spinal disease received spinal surgery assisted by spine robot system.They were 20 males and 18 females,with an average age of 42 years (range,from 12 to 69 years).There were 10 lumbar fractures,8 thoracic fractures and 20 spinal deformities.Pedicle screw implantation was conducted in 30 patients (PS group) and percutaneous vertebroplasty in 8 (PV group).One side was chosen randomly to use Mazor spine robot assisted system (assisted group) and the opposite side the conventional method (non-assisted group).The anteroposterior and lateral X-rays and CT scan of the lumbar and/or thoracic spine were performed in all patients after surgery.The precision of pedicle screws implantation in PS group was evaluated by the Abul-Kasimhierarchy grading system;location of the puncture trajectory,time used for puncture and radiation exposure time in PV group were evaluated.Results 208 pedicle screws were implanted in PS group,including 120 lumbar ones and 88 thoracic ones.For lumbar pedicle screw implantation,the excellent to good rate was 95.0％ (57/60) in the assisted group,significantly higher than that in the non-assisted group (80.0％,48/60) (P ＜ 0.05).For thoracic pedicle screw implantation,the excellent to good rate was 95.5％ (42/44) in the assisted group,significantly higher than that in the non-assisted group (77.3％,34/44) (P ＜ 0.05).There were 24 puncture trajectories in 8 patients in PV group,showing no pedicle penetration or cement leaking in any case.The mean time used for puncture was 5.5 ± 1.4 min in the assisted group,significantly shorter than that in the non-assisted group (17.8 ± 7.5 min) (P ＜ 0.05);the X-ray exposure time was 14.0 ± 4.0 s in the assisted group,significantly shorter than that in the non-assisted group (22.4 ± 6.0 s) (P ＜ 0.05).Conclusions Renaissance spine robot-assisted system deserves more clinical application,because in spinal surgery it can make pedicle screw implantation more precise and safer,and can reduce operation time and X-ray exposure time in percutaneous vertebroplasty.

Objective: To understand the real experience and feelings of self injurious cutting in adolescents with depression, to provide guidance for clinical targeted interventions. Methods: During November 2021 to May 2022, 19 adolescent patients with depression who had cut themselves as the type of non suicidal self injury were recruited from a tertiary first class psychiatric hospital in Chengdu, Sichuan Province. All the participants were interviewed in a semi structured manner, which used the interpretative phenomenological analysis to analyze the transcription data. Results: The experience and feelings of non suicidal self injury in adolescent with depression could be summarized into five themes: self injury thoughts that arise under external interference; self injurious behavior in a thousand thoughts; painful but a happy experience of self injury; cutting as the most frequently selected form of non suicidal self injury; decreases in self injurious behavior reduced when they feel love and responsibility. Conclusion Non suicidal self injury of adolescent patients with depression are affected by various factors. Clinicians should provide targeted clinical care according to the characteristics of patients, as well as the no suicide contract, alternative skills of non suicidal self injury behaviors, and a multi dimensional social support platform with the families of patients.

Objective To survey the basic situation of diagnosis and treatment in clinical nuclear medicine across Guangdong province,evaluate the risks of exposure to the radiation workers and public and explore the countermeasures to control radiation exposre.Methods A survey team was set up to survey,by filling questionnaires,the basic information on nuclear medicine practices for workers,equipment,radionuclide,frequency and dose to workers and radiation protection measures.Results A total of 71 nuclear medicine institutions was involved in the survey with 733 radiation workers in 2016 in Guangdong.The average annual effective dose to nuclear medicine workers was (0.55±0.66) mSv per year.The total pieces of nuclear medical equipment was up to 189 in 2016 including 59 SPECT/CT scanners (5 SPECT),28 PET/CT scanners and 54 thyroid scanners.Total activity of 1.15× 10s MBq in radiopharmaceuticals was used in 325 903 examinations and treatments with the number of frequency of 2.97 examinations per 1 000 population.Concluions There have been a rapid progress in practice of nuclear medicine over the past 20 years in Guangdong province with departments of nuclear medicine set up in 18 of 21 cities.Compared with 1998,the activity in radiopharmaceuticals used has increased by 414％ in 2016 and the number of frequency of examination and treatment has increased by 111％.The rapid expansion of nuclear medicine practice has also caused potential risks of radiation to the public and environment.

BackgroundGeriatric depression is a common psychiatric problem among older adults. Animal-assisted interventions （AAI） can aid in the treatment of psychiatric disorders， but their effectiveness in geriatric depression remains controversial. ObjectiveTo provide an overview of the current research on AAI in alleviating geriatric depression， in order to provide references for developing AAI programs for this population. MethodsBased on Arksey's scoping review method， a comprehensive literature search was conducted on April 16， 2023. The databases searched included China Knowledge Network， VIP， Wanfang Medical Network， China Biomedical Literature Database， Web of Science， PubMed， CINAHL， Cochrane Library and Embase. The search aimed to collect studies related to AAI and geriatric depression from the inception of each database until April 15， 2023. Two trained researchers independently screened the literature and extracted data on basic information. ResultsA total of 13 studies were included in the final review. AAI settings included nursing homes， hospitals， communities， day care centers and residences. Interventions involved touching and naming the animals， verbally interacting with the animals， playing games with the animals， communicating with the therapists and learning to care for the animals. AAI was found to improve social interaction and communication abilities， bring positive emotional experiences and enhance life satisfaction in geriatric depression. However， its effect on cognitive function improvement was inconclusive. ConclusionAAI can potentially alleviate negative mood and depressive symptoms in geriatric depression. ［Funded by National Natural Science Foundation of China （number， 82001444）］

Objective:To summarize the clinical characteristics and prognosis of acute hyperextension spinal cord injury (SCI) in children, and to provide some recommendations for the treatment and prevention of this disease.Methods:Reviewed the data of children of SCI after sustained or repeated hyperextension of the spine at Wuhan Union Hospital and Wuhan Children's Hospital from September 2010 to September 2020. According to the American Spinal Injury Association impairment scale (AIS grade), the patients were divided into complete SCI group and incomplete SCI group. The age, symptoms and evolution after injury, neurological level of injury, imaging data, laboratory examination data, prognosis and complications of the two groups were analyzed. Retrospectively summarize the characteristics of this type of injury.Results:Forty-four cases of acute hyperextension SCI in children were included. Their age ranged from 3 to 10 years old, 95% of them were under 8 years old and 95% of them were female. There was no significant difference in age at injury and time of dance training between children with complete SCI and incomplete SCI. Back and leg pain, lower limb weakness or paresthesia, and rapidly progress to complete or incomplete SCI in a short period were typical symptoms. All blood test results anddiagnostic analysis of cerebrospinal fluid were unremarkable or negative. There was no fracture or dislocation in the whole spine. Magnetic resonance imaging showed a longitudinally extended intramedullary high-intensity signal in the thoracolumbar spinal cord. Complete SCI accounted for 60% of all cases, and the prognosis was poor with spinal cord atrophy and various complications.Conclusion:Children younger than 10 years old after sustained or repeated hyperextension of the spine may suffer acute hyperextension SCI. Children with complete SCI have poor prognosis and serious complications. Therefore, prevention of this type of injury is the best strategy.

Objective To discuss the effect of main organ-preserving pancreatectomy operations on the postoperative complications and the long-term quality of life.Methods The clinical data of 320 patients undergoing pancreatic surgery from January 2013 to December 2016 in the First Affiliated Hospital of Soochow University were retrospectively analyzed and all the patients were divided into traditional pancreatectomy surgery group and organ-preserving pancreatectomy surgery group.The traditional pancreatectomy surgery group included pancreaticoduodenectomy (PD),distal pancreatectomy (DP),and laparoscopic distal pancreatectomy (LDP);and the organ-preserving pancreatectomy surgery group included pylorus-preserving pancreaticoduodenectomy (PPPD),spleen-preserving distal pancreatectomy (SPDP),enucleation pancreatectomy (EP),and middle-preserving pancreatectomy (MSP).Face to face clinic visit or telephone follow-up was scheduled every three months until May 31,2017.The operation time,intraoperative hemorrhage,intraoperative blood transfusion,postoperative complications (hemorrhage,pancreatic fistula,biliary fistula,abdominal infection,delayed gastric emptying),postoperative hospitalization stay,secondary surgery and the survival status within 30 days after surgery,the pancreatic endocrine function,exocrine function and the long-term quality of life were recorded.Results The operation time,intraoperative hemorrhage and intraoperative blood transfusion were not statistically different between PD and PPPD groups,DP and SPDP groups,LDP and LSPDP groups,DP and MSP groups,and DP and EP groups,respectively (all P values ＞0.05).Compared with MSP group,the hospitalization time in DP group was shorter [(18.61 ±12.46)d vs (26.88 ± 15.22)d],the occurrence rate of postoperative pancreatic fistula (24.07％ vs 56.25％),bleeding (3.70％ vs 25.00％),abdominal infection (1.85％ vs 18.75％),delayed gastric emptying (5.56％ vs 31.25％),secondary surgery (0 vs 25.00％),and glycemic control rate were decreased (27.78％ vs 0),and all the differences were statistically significant (all P values ＜ 0.05).After discharge,the incidence of chronic diarrhea in the PD group was higher than that in the PPPD group (17.31％ vs 2.08％).The fatigue in the DP group was higher than that in the SPDP,MSP and EP groups,and fatigue,social function,overall health score of the LDP group were lower than those in LSPDP group;emotional function in the DP group was better than that in MSP group,and all the differences were statistically significant (all P values ＜ 0.05).Conclusions The organ-preserving pancreatectomy can reduce the trauma of the operation,postoperative complications and postoperative pancreatic endocrine and exocrine dysfunction,and improve the long-term quality of life.