Objective To investigate the expression and significance of survivin in hepatocellular carcinoma(HCC).Methods All reports published in the past 13 years on survivin and hepatocellular carcinoma (HCC) were reviewed.A Meta-analysis was conducted on these studies and it was used to determine the prognostic significance of the expression of survivin on patients with HCC.Results 18 studies were included into this Meta-analysis.There were 1 021 HCC patients and 208 normal controls.There was a significant difference between the positive rate of survivin in hepatocellular carcinoma and in normal tissues (0R =30.61; 95％ CI:16.67-56.23).The expression of survivin correlated with clinical staging,pathological differentiation,tumor metastasis,portal vein tumor thmmbus,and survival (P ＜ 0.05).There was no correlation with gender,age,AFP,HBsAg,tumor diameter,and tumor capsule (P ＞ 0.05).Conclusiom Survivin can be used as a molecular marker for the definitive prognosis of HCC.It is also a reliable marker in the choice of standardized and individualized therapy.

[Objective]To evaluate several abdominal skin flaps used for treatment of whole-finger degloving injury of multiple fingers.[Method]Since 2000, 45 patients with whole-finger degloving injury of multiple fingers except the thumb were treated with transfer of abdominal skin flaps. Among these patients,10 were treated with random abdominal tubed pattern flaps,15 with pedicle skin flaps with thoraco-umbilical perforator artery,12 with pedicle skin flaps with superficial iliaccircumflex artery,and 8 with embedding with abdominal flaps.At the second-stage operation,fingers were dissected with pedicels or with abdominal flaps before fingerweb plasty and flap plasty were carried out for many times.[Result]All the skin flaps survived. Three fingers of 3 cases had distal cutaneous necrosis after finger web plasty.Follow-up from 5 to 36 months showed the active motion of metacarpophalangeal joints averaged 60?, and interphalangeal articulations averaged 30?.Sensation recovery reached S3 in fingers with remanent palmar digital nerve, but poor in other fingers. All fingers could perform grasping. The contour of fingers was fine except for the 3 cases of necrosis.[Conclusion]Treatment of whole-finger degloving injury of multiple fingers except the thumb with suitable abdominal flaps can restore the shape and function of hand to the greatest extent and is still a practical, safe and convenient operative method.

ObjectiveTo determine the current students' social anxiety status and maternal factors in school students( grade 5-7) in Harbin,and provided scientific guidance relevant to students'social anxiety.Methods 1526 mother-child pairs collected by random cluster sampling,children completed the social anxiety scale for children (SASC),security scale,coping strategies questionnaire( consist of ambivalence and avoidance subscale),acceptance scale and psychological control scale,and mothers completed the center for epidemiologic studies depression inventory (CES-D),self-rating anxiety scale (SAS).ResultsThe total positive detection rate of social anxiety was 13.6％,there was no significantly difference between boys and girls (P ＞ 0.05) ; the positive detection rate of Grade 6 was higher than Grade 5 and Grade 7.There were positive correlation between social anxiety and mother's psychological control,mother's depression,mother's anxiety ( r =0.228,0.143,0.122) ; negative correlation with mother's acceptance( r =-0.214).Linear regression indicated that only three variables (mother's psychological control,mother's acceptance,mother's depression) were at the P ＜ 0.05 level.The regression coefficients for the three variables were 1.557,- 1.092 and 0.040,respectively.ConclusionMaternal highly psychological control,lowly acceptance and maternal anxiety depression all play a role in promoting the occurrence of students' social anxiety.

Objective To report our clinical outcomes of treating tibial defects combined with soft tissue defects using Ilizarov technique.Methods From May 2010 to February 2015,52 patients with combined bone and soft tissue defects of the tibia were treated at our department.They were 41 males and 11 females,aged from 19 to 65 years (average,37.7 years).By Gustilo classification,49 cases were type ⅢB and 3 type ⅢC.The areas of soft tissue defect ranged from 7 cm ×3 cm to 28 cm × 15 cm,and the tibial defects ranged from 5 cm to 15 cm in length (average,12.6 cm).The schemes of Ilizarov technique depended on the location and size of the tibial defects.Open wound dressing combined with bone transport was adopted in 21 cases,limb shortening followed by bone lengthening with compression at the fracture ends in 12 cases,and tissue flap transplantation combined with bone transport or lengthening in 19 cases.Results The follow-up time of the 52 patients ranged from 13 to 61 months (average,27.1 months).The distance of bone transport or lengthening ranged from 5.0 cm to 13.6 cm (average,10.8 cm);the bone transport speed averaged 0.81 mm/day.The tibiae united in all the 52 patients;the time for external fixation ranged from 13 to 21 months (average,15.3 months);the external fixation index was 2.3 months/cm.According to the Paley functional criteria,23 cases were excellent,19 good,9 fair,and one poor,yielding an excellent to good rate of 80.7％.Conclusion According to the location and size of the bone and soft tissue defects of the tibia,the 3 schemes of Ilizarov technique can be rationally chosen to obtain fine clinical outcomes.

Objective To introduce the transfer of anterolateral thigh flap with iliotibial tract in repair of massive skin and soft tissue defects of the forearm and reconstruction of extension or flexion of the forearm. Methods Eight cases of complicated raw wounds of the forearm were repaired with transfer of anterolateral thigh flap with iliotibial tract. Flexor tendons of 3 cases and extensor tendons of 5 cases were repaired with iliotibial tract. The axial vessel of the flap was used to rebuild blood supply of the hand. Results All the flaps survived completely. A follow-up ranging from 3 months to 2.5 years re- vealed that the reconstructed forearms were good in appearance and soft in texture and restored protective sensation. Affected limbs could perform extension or flexion. Total range of motion (TRM) of the hands was excellent in 6 cases and poor in 2. Conclusion Anterolateral thigh flap with iliotibial tract can not only repair soft tissue defects of the forearm, but also reconstruct the main extension or flexion of the forearm simultaneously.

Objective To summarize the successful experience of three cases of heart-lung transplantations performed in our institute.Methods From July 2003 to August 2012,three patients,with diagnosis of end-stage heart-lung diseases,received heart-lung transplantation in our institute.One case was diagnosed as congenital atrial septal defect,Eisenmanger syndrome,NYHA class Ⅳ; one was dilated cardiomyopathy with moderate/severe pulmonary arterial hypertension,NYHA class Ⅲ-Ⅳ,one was diagnosed as double outlet left ventricle (DOLV) with ventricle septal defect and stenosis of pulmonary artery and its left and right branches,NYHA class Ⅲ-Ⅳ.Donor hearts were preserved with UW solution,donor lungs were preserved with Euro-Collin solution in case one and with low potassium dextran containing prostaglandin E1 in the others.Extensive disinfection and strict scrutiny were implemented postoperatively.Immunosuppressive therapy included administration of zenapax or basiliximab preoperatively,methylprednisolone during the operation,and cyclosporine a/tacrolimus + prednisone + mycophenolate postoperatively.Surgical hemostasis is of great importance,as the total pleural effusion reaches 14 640 ml within 31 days postoperatively in case two.Strict postoperative disinfection and isolation were implemented,and management of the respiratory tract was intensified.Therapeutic bronchoscopy was performed frequently for sputum suction.In case two,bronchoscopy was used thirteen times within 40 days after transplantation.Broad-spectrum antibiotics and antifungal antibiotics were used for infection control.Results All three patients were discharged after recovery from operation.Case one died of obstructive bronchitis and lung failure caused by chronic rejection four years and ten months postoperatively.Case two died of sudden cerebrovascular accident 68 days after operation.Case three survives more than one year postoperatively so far and is still alive.Conclusion Proper preservation of the donor heart and lung,perfect surgical hemostasis,strict infection control,frequent application of bronchoscopy and appropriate immunosuppressive management are critical to the success of heart-lung transplantation.

Objective To explore the clinical effect of anteromedial thigh perforator flap for repairing soft tissue defect in lower extremity.Methods From January 2009 to December 2012,12 patients with soft tissue defect of lower extremity were treated with free anteromedial thigh perforator flap.Among them,there were 5 cases of wound in front of tibia,4 cases of dorsal foot wound,3 cases of heel wound;the wound size was 3.0 cm ×3.5 cm-7.0 cm × 9.5 cm;3 cases were repaired with free perforator flap of descending genicular artery,2 cases with free anteromedial thigh perforator flap,and 7 cases with medial vastus muscle perforator flap.Results All the transplants survived.Among them,1 case of anteromedial thigh perforator flap and 1 case of descending genicular artery perforator flap appeared vascular crisis postoperative.After anticoagulation and antispasmodic treatment aggressively,the flaps survived.One case of descending genicular artery perforator flap necrosis in edge,and then were cured by changing dressing.Twelve cases were followed up 6-12 months after operation (average 8.6 months),and the texture of flaps were good,the appearance appropriate ;7 sensation of 5 free flaps after nerve anastomosis came back to S; the donor sites in all cases were sutured directly and healed,leaving only the linear scar,and no effect on function.Conclusion The anatomy of anteromedial thigh perforator flap is constant,and the operation is convenient.The clinical result of repairing soft tissue defect of lower extremity is satisfying.

Objective To investigate the clinical effect of transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defects at foot and ankle and functional reconstruction.Methods From January,2008 to January,2013,25 pediatric patients with soft tissue defects at foot and ankle were transplantation of the free anterolateral thigh flap and iliotibial band.Of the 25 cases,there were 12 cases at heel,8 cases at dorsum of foot,3 cases at medial malleolus and 2 cases at external malleolus.All the cases were accompanied with different degree of fracture or dislocation,and with soft tissue defect such as achilles tendon,extensor tendon of dorsal,collateral ligament of ankle.The length of soft tissue defect which were reconstructed with iliotibial band were 3 cm to 16 cm.The causes of injury:19 cases were crushed by motorcycle or bicycle,4 cases were crushed machines,2 cases were injuryed in traffic accidents.The areas of free anterolateral thigh flaps were 8 cm × 5 cm to 18 cm × 12 cm.All the patients begined to early rehabilitative exercise under the protection of orthosis after 2 weeks of the operation.Results All cases were followed up from 6 to 24 months,averaged of 14 months.All the flaps survived,and only 2 cases with necrosis of small area in distal,and which were healed by dressing.The healing time were 12 to 24 days,and the average of 15.1 days; The surgery function were assessed according to Thermann's scale,and the results was 14 cases for excellent,9 cases was good,the general was 2 cases,and the excellent and good rate was 92％.Conclusion The transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defect at foot and ankle and functional reconstruction is a safe and effective strategy,and it has the advantages such as covering the wound at foot and ankle approvingly,reconstruction of power device once,the flap and iliotibial band were in the same wound,the trauma of doner site is small invasive,early recovery functional exercise,shorten the treatment cycle,and relieve the suffering of children.

Objective To investigate the clinical effect of primary internal fixation combined with flap transfer for Gustilo Ⅲ B open fracture of lower extremity with severe soft tissue defct.Methods From January,2008 to January,2013,15 patients with Gustilo Ⅲ B open fracture of lower extremity and severe soft tissue defect were treated with primary internal fixation combined with flap transfer.Among them,there were 2 cases of foot and ankle fracture,9 of lower-tibia and fibula,3 of upper-tibia and fibula and 1 of distal femur fracture.The areas of the flaps were 10 cm × 8 cm-28 cm × 16 cm.Three cases were treated by bone grafting because of bone defect.Results All patients were followed up for 6-24 months.All flaps were survived,and only small area of 2 cases with the distal necrosis were cured by changing the dressing; In 1 case,the wound was infection and healed after anti-infective and drainage treatment; 13 cases had bone union in primary stage,and the other 2 cases were achieved delayed union; the average healing time was 7.2 months,and no case of osteomyelitis was noted; the time of wound healing was 12-36 days,with an average of 18.1 days.According to lower extremity function evaluation form,the excellent and good rate was 86.6％.Conclusion It is a safe and effective strategy to treat the Gustilo Ⅲ B open fractures of lower extremity and severe soft tissue defect with primary internal fixation combined with flap transfer,which has advantages of reliable fixation,covering the wounds with satisfaction,recovering exercise early,shorten the treatment period,alleviating the suffering of patients and so on.

Objective A surface feedback-stimulation gastric-pacing device was designed to extract gastric surface information,determine the status of gastric and surface stimulation.Methods The characteristic parameters of gastric electrical formed by processing signal and extracting parameter.By that,the state of stomach could be confirmed,and stimulus signal of stomach pace-making in different frequency and intensity could be decided as needed.During the processes of the stimulation,the variations of gastric electrical parameters can be analyzed in real-time and the stimulation parameters could be modified to achieve the self-feedback mode.Results Self-feedback model in different gastric motility analog environment could be realized.Conclusion The preliminary validation of experimental results proved the effectiveness of self-feedback of gastric pacing devices and its application prospects in some areas.