Objective To investigate the clinical application value of Quadrant system combined with percutaneous pedicle screw fixation for treatment of lumbar degenerative disease.Methods The clinical data of 40 patients who sufferred from lumbar degenerative disease,were randomly divided into two groups:Quadrant system combined with percutaneous pedicle screw fixation to do discectomy and intervertebral bone graft fusion as invasive group (n =20),traditional posterior lumbar interbody fusion as conventional group (n =20).The operation time,length of incision,blood loss,postoperative drainage,JOA score of preoperation and postoperation,and effect (reforming Macnab standard) between two groups were recorded and compared.Results Operations were all well done in two groups.The operation time in invasive group was longer than that in traditional group [(147.3 ± 8.9) min,(136.7 ± 10.2) min,t =3.5,P ＜ 0.05].The length of incision [(3.65 ± 0.68) cm,(1 1.11 ± 1.29) cm,t =22.88,P ＜ 0.05)],blood loss [(205.00 ± 63.04) mL,(270.50 ± 77.58) mL,t =2.93,P ＜ 0.05],postoperative drainage [(90.3 ± 10.8) mL,(180.6 ± 1 3.9) mL,t =22.96,P ＜ 0.05] and days in hospital [(16.9 ± 2.0) days,(18.9 ± 2.1)days,t =3.05,P ＜ 0.05] in invasive group were all less.than those in traditional group (P ＜ 0.05).All cases had been followed up for 6-18 months,average of 13 months.There were no significant differences in excellent and good rate (reforming Macnab standard) between two groups in the last following up (P ＞ 0.05).There were no significant differences of JOA scores in preoperation [(12.0 ± 1.7) points,(11.0 ± 1.5) points,P ＞ 0.05],postoperative half a year [(22.0 ± 2.3) points,(21.0 ± 2.5) points,P ＞ 0.05],and postoperative one year [(23.0 ± 1.9) points,(22.0 ± 2.0) points,P ＞ 0.05].Conclusion Quadrant system combined withpercutaneous pedicle screw fixation is a safe,effective and minimally invasive surgical technique in treating lumbar degenerative disease.Compared with conventional group,invasive group has advantages such as less injury,less blood loss,simple operation,and good curative effect,which should be popularized.

Objective To evaluate the prtognostic significance of preoperative serum extracellular matrix protein 1 ( ECM1 ) levels in patients with hepatocellular carcinoma (HCC).Methods Preoperative serum levels of ECM1 were detected by enzyme-linked immunosorbent assay (ELISA) in 117 HCC patients and 53 healthy volunteers.Corrrlations to the clinicopathological characteristics and patients survival were analyzed.Results ECM1 were detected in all the samples of 117 HCC patients and 53 healthy volunteers,the median serum ECM1 level in HCC patients was significantly higher than that in healthy volunteers ( 166.39 vs 108.06 pg/ml,Z =- 7.805,P ＜ 0.001 ).Median serum ECM 1 levels were significantly higher in patients with invasive phenotypes,such as larger tumor size (Z =- 3.454,P =0.001 ),multiple nodule ( Z =- 2.201,P =0.028 ),vascular invasion ( Z =- 4.685,P ＜ 0.001 ),and advanced TN M stage ( Z =-4.610,P ＜ 0.001 ).Patients with lower serum ECM1 level (≤ 180 pg/ml ) have significantly better overall and disease free survival thanthose with higher levels ( ＞ 180 pg/ml).By Cox proportional-hazard model multivariate analysis,high serum ECM1 level ( ＞ 180 pg/ml) was an independent factor for OS and DFS in HCC patients.Conclusions Serum ECM1 levels are significantly correhted to the invasive phenotypes and survival rate.Serum ECM1 level could be used as a predictive marker for HCC recurrence and prognostic factor of HCC patients after surgery.

Objective To investigate the expression of patterned matrix vasculogenic mimicry in hepatocellular carcinoma (HCC) and its prognostic significance. Methods HCC tissues from 151 patients undergoing curative resection in Anhui Provincial Hospital from January 2003 to December 2008 were studied.Postoperative follow-up and clinicopathologic data were reviewed.Immunohistochemical staining of laminin,CD34 and transmission electron microscopy were used to identify patterned matrix VM in HCC.The relations between clinicopathologic features, prognosis and patterned matrix VM were analyzed.Results Patterned matrix VM was positive in 31 out of 151 cases (20.5％ ).The expression of patterned matrix VM was positively correlated with tumor size ( x2 =4.132,P =0.042),vascular invasion ( x2 =5.825,P=0.016),high Edmondson grade (x2 =5.256,P=0.022),and late pTNM stage (x2 =6.218,P =0.013).Kaplan-Meier survival analysis revealed that cases of the VM positive group had poor overall 1,3 and 5 year survival (OS) and disease-free survival (DFS) than that of the VM negative group (67.7％,34.6％,11.5％ and 86.7％,64.7％,40.3％,respectively,x2 =14.852,P ＜ 0.001 ; and 41.9％,19.4％,6.5％ and 63.3％,40.6％,19.6％,respectively,x2 =10.065,P =0.002).Univariate and multivariate analyses revealed that multiple tumor nodules,vascular invasion and VM were independent prognostic factors for overall survival,while vascular invasion and VM were independent prognostic factors for disease-free survival. Conclusions Patterned matrix VM exists in HCC. The expression of patternedmatrix VM is associated with tumor size,Edmondson grade,pTNM stage and vascular invasion,and it might serve as an unfavorable prognostic factor for HCC patients.

Objective To assess the effects of gonadectomy on carcinogenesis and development of hepatocellular carcinoma (HCC) induced by chemical substances in rat model. Methods Fifty male and 50 female Sprague-Dawley rats (age of 5-6 weeks) were equally divided into four groups: male experimental (surgical castration) and control groups and female experimental (surgical castration)and control groups. The HCC model was induced by diethylnitrosamine (DEN) and Nnitrosomorpholine (NMOR) in SD rats. The effects of gonadectomy on occurring and development of HCC were observed. Results The incidence of HCC in female experimental group was higher than that in female control group (11/11 vs 5/14, P=0. 001), while it was lower in male experimental group than that in male control group (3/10 vs 12/12, P=0. 001). It was demonstrated that gonadectomy could increase the growth of HCC (P=0. 013) and tumor metastasis (P=0. 036) in female rats, but not in male rats. The formation of liver cirrhosis and HCC was found at 8 and 16 weeks in male experimental group, at 12 and 20 weeks in male control group, at 16 and 20 weeks in female experimental group and at 12 and 16 weeks in female control group. These findings showed that gonadectomy could improve the development of carcinogenesis in female rats and delay the carcinogenesis in male rats. Conclusion Sex hormones, especially estrogens, may be involved in development and metastasis of rats HCC.

Objective To analyze the posterolateral minimally invasive plate osteosynthesis (MIPO) in the treatment of medial open fractures of distal tibia and tibial shaft.Methods From May 2016 to September 2017,16 medial open fractures of distal tibia and tibial shaft were treated with posterolateral MIPO at Department of Orthopaedics,The First Affiliated Hospital to Anhui University of Science and Technology.They were 10 men and 6 women,from 22 to 61 years of age(average,36.5 years).According to the Gustilo-Anderson classification,type Ⅰ fracture was identified in 5 patients,type Ⅱ fracture in 6 and type Ⅲ fracture in 5.Initially,all the patients received emergency external fixation or calcaneus traction before open reduction and internal fixation was performed when their conditions of soft tissue allowed.X-ray examination of the ankle joint with anteroposterior and lateral views was performed before and after operation.At the last follow-up,the function of ankle joint was evaluated according to the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS).Results All the 16 patients were followed up for an average of 15.3 months (from 8 to 24 months).Fracture healing was achieved in all after an average time of 26.1 weeks (from 20 to 36weeks).There were no such complications as skin necrosis,wound dehiscence,deep infection,implants exposure or failure,or impingement of the flexor hallucis longus.The AOFAS ankle scores averaged 88.6 points (from 74 to 95 points),giving 9 excellent,6 good and one fair cases.Superficial infection occurred in 2 patients but healed after dressing care.Another case showed 5°varus deformity.Conclusion Application of posterolateral MIPO in the treatment of medial open fractures of distal tibia and tibial shaft can effectively protect the medial soft tissue,reduce postoperative wound complications,and safely expose,reduce and fixate the tibial fragments,leading to satisfactory outcomes.