Objective To discuss the application of Apofix interlaminar clamp for the treatment of atlantoaxial instability. Methods From April 2000 to July 2004, 30 patients with atlantoaxial instability were treated with posterior atlantoaxial fusion and Apofix fixation. There were 24 males and 6 females. The mean age of the patients was 41 years (range, 19 to 67 years). The patients included 5 with atlantoaxial dislocation, 25 with odontoid fracture (including fresh fracture for 21, old fracture and nonunion for 4; Anderson Ⅱ for 23 and Anderson Ⅲ for 2). After reducted by skull traction, atlanto-occipital space, arcus posterior atlantis and axial laminar were exposed during operation, upper and lower hooks were inserted. The iliac bone graft was inserted into the space of C1 and C2, the connecting rod of the clamp was compressed and fixed. Results The follow-up of all cases ranged from 8 months to 3 years and 10 months (with the mean of 27 months). There were 28 cases with complete reduction of fracture and dislocation, 2 cases in incomplete reduction. The operation time was 70 to 150 minutes, and the average blood loss was 65 ml. Patients could sit up 3 days (2 to 6 days) after surgery with soft collar. The mean off-bed time was 7 days (2 to 10 days) after operation in the patients without or less spinal cord injury. All cases obtained solid bony fusion 3 months postoperatively. No severe complications such as injuries of vertebral artery, nerve root and spinal cord or aggravation of spinal cord injury occurred. Conclusion Apofix interlaminar clamp has advantages of convenience in operation, provided reliable and safe stability for atlatoaxial segment. The results suggested that this technique is an efficient, reliable segmental posterior fixation.

Resection of huge hepatic tumor located at segments Ⅶ and Ⅷ with reservation of segments Ⅴ and Ⅵ is difficult,because the right hepatic vein is easy to be injured during the operation.A male patient with huge hepatic tumor in the right lobe was admitted to the Cancer Hospital of Guangxi Medical University on July 26,2012.The tumor (diameter:14 cm) was located at segments Ⅶ and Ⅷ.The tumor and the whole structure of the liver were three dimensionally reconstructed by using digital medical technology and liver surgery planning system.The right hepatic vein was closely adjacent to the tumor.During the operation,the right Glisson pedicles were occluded intermittently,the liver parenchyma was dissected with cavitron ultrasonic surgical aspirator,and the right hepatic vein was occlued with non-invasive vascular clamp.The tumor was resected completely,with successful preservation of the trunk of right hepatic vein.No blood transfusion was needed,and the blood supply to segments Ⅴ and Ⅵ was not influenced.The patient recovered rapidly and was discharged on postoperative day 14.

Objective To investigate the causes and prevention on complications of percutaneous vertebroplasty(PVP). Methods Forty three cases with 64 vertebrae were performed PVP from May 2001 to October 2003. The incidence of complication was 13 cases (30.2%). Leakage of polymethylmethacry (PMMA) without symptoms occurred in 4 cases. Leakage with pain occurred in 3 cases. No leakage but with pain occurred in 4 cases after the procedure. Fracture of adjacent vertebrae occurred in 2 cases. All cases were followed up from 3 to 29 months (in average of 13.2 months). Results There wasn′t severe complications in 7 leakage cases. The pain in 7 cases was relieved and disappeared at 2-7 days after the procedure. The symptoms of pain in 2 cases of adjacent vertebrae fracture were relieved. Conclusion If sufficient preventive measures are applied before or during the procedure of PVP,the complications may be reduced effectively.

Objective To identify potential serum biomarkers specific for hepatocellular carcinoma (HCC).Methods Eighty-one patients wilh hepatitis B-related HCC and 80 healthy controls were randomly divided into a training set (48 HCC,47 controls) and a testing set (33 HCC,33 controls).Serum proteomic profiles were measured using surface-enhanced laser desorption/ionization time-offlight mass spectroscopy (SELDI-TOF-MS).A classification tree was established by the Biomarker Pattern Software.Candidate biomarkcrs were separated by HPLC and identified by MA1DI-MS/MS and database searching.Forty-eight patients with HCC,54 cirrhotic patients and 42 healthy subjects were clinically validated using candidate biomarkers by SELDI-Immunoassay.Real-time reverse transcriptase-polymerase chain reaction was performed to observe GRO-1 and Thrombin in 55 HCC tissues and 13 normal hepatolage tissues.Results Two up-regulated protein peaks were automatically chosen as a classification tree in the training set.These biomarkers were identified as thrombin light chain and CXC chemokines ligand 1 (GRO-1).The sensitivity and specificity of this classification tree were 89.6％.The multivariate model using the two biomarkers and alpha-fetoprotein (AFP) resulted in a sensitivity of 91.7％ and specificity of 92.7％,which was significantly better than AFP alone.The mRNA expression of GRO-1 and Thrombin were found in all HCC tissues.There were significant associations between GRO-1 gene expression and some clinical and pathological findings such as metastasis and recurrence (P＜0.05).Significant differences of 5-year survival rates wee observed among subgroups according to the expression of GRO-1 (P＜0.05).There were significant associations between Thrombin gene expression and some clinical and pathological findings such as recurrence and AFP (P＜0.05).Significant differences of 5-year survival rates were observed among the subgroups according to the expression of THROMBIN (P＜0.05).A positive correlation was found between GRO-1 and Thrombin (r=0.73,P＜0.01).Conclusion Thrombin light chain and GRO-1 are potential biomarkers of HCC.The expression of GRO-1 in HCC tissues was a valuable indicator in estimating metastasis and recurrence in HCC patients.

Objective To investigate the efficacy of laparoscopic hepatectomy for the treatment of hepatocellular carcinoma (HCC).Methods The clinical data of 30 HCC patients who were admitted to the Affiliated Cancer Hospital of Guangxi Medical University from January 2011 to December 2011 were retrospectively analyzed.All patients were divided into the laparoscopic hepatectomy (LH) group (10 patients) and open hepatectomy (OH) group (20 patients) according to the operation patterns and at the ratio of 1 ∶ 2.The degree of cirrhosis,size and location of tumor of the 2 groups were analyzed using the covariance analysis.The student t test was used for analysing the difference of the 2 groups.Results In the LH group,7 patients received laparoscopic nonanatomical liver resection,3 received anatomical resection of the left lateral lobe,no patient was converted to the hand assisted laparoscopic surgery or open surgery.In the OH group,14 patients received non-anatomical liver resection,and 6 received anatomical liver resection.The volume of blood loss of the LH group was (247 ± 235) ml,which was significantly lower than (408 ± 191)ml of the OH group (t =2.199,P ＜ 0.05).The mean postoperative fasting time,postoperative abdominal drainage time and duration of hospital stay of the LH group were (1.9 ±0.6) days,(3.2 ± 1.2) days and (8.9 ± 2.3) days,which were significantly shorter than (3.0 ± 1.6) days,(4.9±1.6)daysand (11.5±2.3)days of the OH group (t=2.149,2.917,2.921,P＜0.05).The levels of alanine aminotransferase (ALT) of the LH group at day 1,3,5 were (228 ± 100)U/L,(143 ± 51)U/L,(85 ±24) U/L,and the levels of aspartate aminotransferase (AST) of the LH group at day 1,3,5 were (196 ± 67)U/L,(90 ± 35) U/L,(46 ± 10) U/L.The levels of ALT of the OH group at day 1,3,5 were (557 ± 401) U/L,(414 ±397)U/L,(217 ± 199)U/L,and the levels of AST of the OH group at day 1,3,5 were (506 ±317)U/L,(178 ± 122) U/L,(71 ± 33) U/L.The time for hepatic function recovery of the LH group was significantly shorter than that of the OH group (t =3.675,3.001,2.073 ; 4.196,2.223,2.272,P ＜ 0.05).All the 30 patients were followed up for 3-15 months.The level of alpha fetoprotein of 1 patient in the LH group was increased at postoperative month 4,and the results of computed tomography showed multiple intrahepatic lesions.The patient was cured by intervention treatment.One patient of the OH group was diagnosed as with tumor recurrence at the resection margins and adjacent hepatic segments.The patient was cured by radiofrequency ablation,with no tumor recurrence.No tumor recurrence or metastasis was observed in the other patients.Conclusion Laparoscopic hepatectomy is a feasible,safe and minimally invasive approach for patients with HCC.

[Objective]The purpose of this study was to describe mid report the result of the ulnar nerve transfer to biceps muscle to restore elbow flexion after acute and delayed upper brachial plexus injuries.[Methods]Two patients with acute brachial plexus injury (the time between the injury and the operation were six and eight months) and three patients with delayed brachial plexus injury(the time between the injury and the operation were from twevle to eighteen months) underwent nerve transfer using fascicles of the ulnar nerve to the motor branch of the biceis muscle. The average age of the patients was twenty eight and the mean follow-up periods were nine months after the surgery. Patients were evaluated with regard to reinnervation of the biceps, ulnar nerve function, elbow flexion strength, and grip strength.[Results]For the two acute patients, the first sign of biceps muscle contraction were observed within 1 week, the average time required for reinnervation of the biceps after nerve fascicle transfer was within six months. For the three delayed patients, the first sign of bicep muscle contraction was observed in about three month, and the average time required for reinnervation of the biceps was ten months.Hypoesthesia of the ulnar nerve was clinically abserved in three patients, but this symptom disappeared within month with no treatment.Compared with those delayed cases, the acute patients had faster and better recovery of their olbow flexion function.However, all patients achieved grade-3 or better elbow flexion strength according to the grading system of the Medical Research Council.[Conclusion]The author recommend this safe, simple and effective Oberlin procedure for brachial plexus injuries involving the C5、6 or C5~7 nerve roots.

Objective To evaluate the impact of different treatment strategies on patients with hepatocellular carcinoma (HCC) of less than 10 cm but with portal vein tumor thrombus (PVTT),and to investigate the prognostic factors.Methods Between 2003 and 2008,338 HCC patients with PVTT from the Affiliated Tumor Hospital,Guangxi Medical University,were retrospectively studied.These patients were divided into four groups:the conservative treatment group (n =75),the transarterial chemoembolization (TACE) group (n=86),the surgical resection group (n =90) and the surgical resection with postoperative TACE group (n=87).Survival rates were analyzed by the Kaplan-Meier method and differences among groups were compared using the log-rank analysis.The Cox' s proportional hazards model was performed to explore the risk factors of survival.Results The mean survival periods of patients in the four groups were 3.8,7,8.2,15.1 months respectively.There were significant differences in survival rate among the 4 groups.The survival rates at 1-,2-,and 3-year in the surgical resection with postoperative TACE group were 49％,37％ and 19％,which were significantly higher than the other 3 groups (P＜0.05).The 1-,2-,and 3-year survival rates in the surgical resection group were 28％,20％ and 15％ compared with 17.5％,0％ and 0％ in the TACE group.The survival rates were significantly higher after surgical resection than TACE (P＜0.05).The 1-,2-,and 3-year survival rates in the conservative treatment group were 0％.These were the lowest among the four groups (P＜0.05).Univariate analysis indicated that portal vein occlusion by tumor thrombus was a significant predictor of poor prognosis.Multivariate analysis revealed that the strategy of treatment (TACE) and the number of TACE cycles were independent survival predictors for HCC patients with PVTT.Conclusions Surgical resection is the most effective therapeutic strategy for HCC patients with PVTT and with good liver functional reserve.Postoperative TACE is necessary in preventing recurrence and prolonging survival in patients who could tolerate chemoembolization.TACE should be recommended as an effective and safe treatment for unresectable HCC patients with PVTT.The treatment provided a significantly better survival than conservative treatment.

Objective To retrospectively assess the prognostic impact of diabetes mellitus (DM) on patients with hepatocellular carcinoma (HCC) after curative resection.Methods A total of 417 HCC patients who had undergone curative hepatic resection were included into two groups.108 patients were classified into DM group and 309 patients into the non-DM group.Overall survival,disease-free survival,postoperative morbidity and mortality were compared between the two groups after reducing confounding bias by propensity score matching.Independent prognostic predictors were determined by Cox proportional hazards model.Results Propensity score matching resulted in 89 patients in each group,and variables were balanced between two groups.In the matched cohort,DM and non-DM groups showed similar morbidity and 30-and 90-day mortality after curative hepatectomy (respectively x2 =0.837,x2 =Fisher,x2 =Fisher,all P ＞ 0.05),the 1-,3-,and 5-year overall survival rates were 82.0％,59.9％,and 33.4％ in DM group and 90.7％,79.1％,and 69.3％ in non-DM group,respectively(P =0.001),however,there was no significant difference in disease-free survival between DM and non-DM groups.Cox multivariate analysis revealed that DM is an independent risk factor for overall survival in patients with HCC after curative resection,but not for disease-free survival.Conclusions DM does not increase the postoperative morbidity or mortality for patients with HCC after curative resection,however,DM may increase the risk of mortality of HCC patients in the long-term.

Objective To explore the association between ratio index of gamma glutamyl transpeptidase/platelet (GPRI) and the prognosis of patients with hepatitis B virus (HBV) related hepatocellular carcinoma (HCC) before liver resection. Methods A total of 368 patients underwent liver resection for HBV-related HCC were retrospectively analyzed in this study. Patients were divided into high GPRI group (n=184, GPRI≥0.38) and low GPRI group (n=184, GPRI<0.38). Clinicopathologic characteristics including overall survival (OS) and disease-free survival (DFS) were compared between the two groups. Independent risk factors influencing DFS and OS were determined by Cox multivariate analysis. Results Compared to low GPRI group, there were higher levels of serum total bilirubin and alanine aminotransferase, higher proportions of tumor diameter larger than 10 cm, amount of tumou more than 3, and patients with macrovascular invasion and intermediate or advanced HCC in high GPRI group (all P<0.05). Values of DFS at 1, 3, and 5 years were significantly lower in high GPRI group (50.8%, 16.9%and 5.7%) than those in low GPRI group (69.0%, 33.3%, 10.7%;P=0.001). Values of OS at 1, 3, and 5 years were also significantly lower in high GPRI group (75.0%, 51.8%and 36.0%) than those in low GPRI group (89.8%, 72.8%and 63.2%;P<0.05). Cox multivariate analysis also demonstrated that GPRI ≥0.38 was an independent risk factor for DFS and OS in patients with HBV-related HCC after liver resection. Conclusion Preoperative GPRI can predict tumor recurrence and long-term survival in patients with HBV-related HCC after liver resection.

Objective: To explore the state of mental health level of students in private college.Methods Private college students in Xi'an were tested with SCL-90,and the results were compared to those in domestic general college norm.Results: The mental health level of private college students is worse than that of general college students.Further more,there is also remarkable difference of the mental health level between new students with the junior and senior college students.Conclusion: The mental health state of private college students is not optimistic and should be taken seriously by the department responsible.For improve the mental health level of the private college students,the works and mental guides should be strengthened in private college.