Postoperative delirium is a common complication after spinal surgery, and it is a complex issue involving multiple factors. However, there is currently insufficient understanding of postoperative delirium in patients undergoing spinal surgery, and there is still a lack of clear regulation in prevention and treatment. Although the literature and research on postoperative delirium have been comprehensive, there are still few studies on postoperative delirium in patients undergoing spinal surgery. This article mainly reviews the incidence, social and economic problems, risk factors, prevention and treatment of postoperative delirium in patients undergoing spinal surgery.

Lumbosacral transitional vertebrae (LSTV) is a common phenomena of developmental anomaly, which is characterized by anatomic variation and biomechanical changes. LSTV is often accompanied with low back pain, lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis and other spinal diseases. The diagnosis of LSTV has a great significance for proper treatment process. Early imageological studies have limitations on distinguishing different types of LSTV from the aspect of morphological changes. This review focuses on recent studies of LSTV anatomy and variation, its influence in local biomechanics and spinal alignment, and its relationship with spinal diseases.

PURPOSE: The intermediate stage of hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer [BCLC] B) comprises a highly heterogeneous population, and the treatment strategy is still controversial. Because of the heterogeneity, a subclassification of intermediate-stage HCCs was put forward by Bolondi according to the ‘beyond Milan and within up-to-7' criteria and Child-Pugh score. In this study, we aim to analyze the prognosis of BCLC-B stage HCC patients who received hepatic resection according to the Bolondi's subclassification. MATERIALS AND METHODS: One thousand and one hundred three patients diagnosedwith HCC and treatedwith hepatic resectionwere enrolled in our hospital between 2006 and 2012. According to Bolondi's subclassification, the BCLC-B patients were divided into four groups. Recurrence-free survival (RFS) and overall survival (OS) were analyzed. RESULTS: According to Bolondi's subclassification, the BCLC-B patients were divided into four groups: B1 (n=41, 18.7%), B2 (n=160, 73.1%), B3 (n=11, 5.0%), and B4 (n=7, 3.2%). Significant difference was observed between B1 and other groups (B1 vs. B2, p=0.022; B1 vs. B3, p < 0.001; B1 vs. B4, p < 0.001), but no difference for B2 vs. B4 (p=0.542) and B3 vs. B4 (p=0.542). In addition, no significant differences were observed between BCLC-A and BCLC-B1 group for both RFS (p=0.087) and OS (p=0.643). In multivariate analysis, BCLC-B subclassification was not a risk factor for both OS (p=0.263) and RFS (p=0.892). CONCLUSION: In our study, HCC patients at B1 stagewere benefited from hepatic resection and had similar survival to BCLC-A stage patients. Our study provided rationality of hepatic resection for selected BCLC-B stage HCC patients instead of routine transarterial chemoembolization.
Carcinoma, Hepatocellular* ; Hepatectomy ; Humans ; Liver Neoplasms ; Multivariate Analysis ; Population Characteristics ; Prognosis ; Risk Factors

Meralgia paresthetica (MP) after posterior spine surgery is caused by mechanical compression injury of lateral femoral cutaneous nerve, which presents as numbness or paresthesia in the confined area of the anterolateral thigh. MP after posterior spine surgery is a common postoperative complication, and the incidence is 12.7%-25.5%. Because its clinical manifestations are mild and easy to be ignored, often leading to treatment delays. This article mainly reviews the incidence, risk factors, prevention and treatment of MP after posterior spine surgery.

Meralgia paresthetica (MP) after posterior spine surgery is caused by mechanical compression injury of lateral femoral cutaneous nerve, which presents as numbness or paresthesia in the confined area of the anterolateral thigh. MP after posterior spine surgery is a common postoperative complication, and the incidence is 12.7%-25.5%. Because its clinical manifestations are mild and easy to be ignored, often leading to treatment delays. This article mainly reviews the incidence, risk factors, prevention and treatment of MP after posterior spine surgery.

Though great progress on spinal sagittal alignment has been seen recently, which focuses on the lumbar spine-pelvic region and the whole spine, while there is a few research mainly concentrated on the cervical spine. In recent years, a growing number of researchers have been exploring the changes in the compensation of cervical sagittal alignment and their effect on surgery, and the preliminary results of these researches are satisfactory. The present review focuses on the measurement of sagittal plane parameters of cervical spine, changes of sagittal alignment in cervical spine disorders, and its effect on cervical surgery.

Objective To compare the prognosis prediction value of the 8th edition with the 7th edition of the American Joint Committee on Cancer Staging System in patients with resectable hepatocellular carcinoma (HCC).Methods A total of 311 HCC patients after hepatectomy were retrospectively analysed.Patients were staged according to both the 7th edition (TNM-7) and 8th edition (TNM-8) AJCC TNM staging criteria.The survival rates were estimated using Kaplan-Meier methods.Multivariate analysis was assessed by Cox proportional hazards regression analysis.The predictive ability of staging systems was evaluated by receiver operating characteristic curve (ROC) and area under curve (AUC).Results When stratified according to the TNM-7 system,the overall survival(OS) of stage T1 was higher than that of stage T2,stage T2 higher than stage T3a,however,the 5-year OS rates of stage T4 (16.7％) was higher than those of stage T3a (14.3％) and T3b(10.9％).The difference in survival was significant between stages T1 and stage T3a,T3b,T4 (all P ＜0.05),and that between stages T2 and stage T3b,T4 (all P ＜0.05).When stratified according to the TNM-8 system,the survival rates decreased as the T stage going high.OS rates vary significantly between stagesT1a and stageT3,T4 (P =0.004,0.001),between stage T1b and stage T3,T4 (both P ＜ 0.001),and between stage T2 and stage T4 (P =0.009).The difference in disease free survival (DFS) rates was significant between stages T1a,T1b,T2 and stage T3,T4 (all P ＜0.01).Finally,the area under ROC of TNM-8 is bigger than that of TNM-7.Conclusions Compared with TNM-7 staging,new TNM-8 staging can predict more accurately the prognosis of patients with resectable hepatocellular carcinoma.

Objective:To study the potential effects of intensity modulated radiation therapy (IMRT) on clinical efficacy,oral mucosa reaction and immunological foundation;and to explore the effect of immunological changes on clinical efficacy and oral mucosa reaction in patients with nasopharyngeal carcinoma.Methods:A total of 200 patients with nasopharyngeal carcinoma,who came from First Department of Nasopharyngeal Radiotherapy,the First People's Hospital of Foshan from October 2008 to November 2011,were selected.The patients were treated with nasopharyngeal radiotherapy,and divided into an observation group and a control group (n=100 in each group).The control group underwent common conventional two-dimensional radiotherapy treatment,while the observation group underwent IMRT.The 5-year survival rates and recurrence rates were recorded at follow-up.After the radiotherapy,the oral mucosa in the patients were evaluated by the classification standard of acute radioactive mucositis by American Radiotherapy Oncology Group (RTOG),and the number of T lymphocyte subsets before and after treatment was detected.Results:There were significant difference in non-regional-recurrence survival rate,disease-free survival rate,local recurrence rate between the above 2 groups (all P＜0.05),but no significant difference in the distant metastasis-free survival rate (P＞0.05).The acute oral mucosa reactions of grade 1,2,3,4 in the control group were 8.00％,20.00％,12.00％,7.00％,respectively,and those were 7.00％,22.00％,15.00％,1.00％ respectively.There was no significant difference in the acute response of oral mucosa in grade 1,2 and 3 in the 2 groups (all P＞0.05),but there was significant difference in the grade 4 (P＜0.05).There were significantly difference in CD8+,CD4+/CD8+ and CD4+ T lymphocyte subsets before and after treatment in the above 2 groups (all P＜0.01);there were also significantly difference after treatment between the observation group and the control group (all P＜0.01).Conclusion:In the process of treatment in patients with nasopharyngeal carcinoma,the use of IMRT on the basis of chemotherapy is more effective than the conventional two-dimensional radiotherapy,which can reduce the proportion of grade 4 (severe) acute oral mucosa reaction.It may be related to the protective effect of IMRT on immune function in the patients.

Objective To compare the effect of low concentration versus ultra-low concentration of ropivacaine in combination with sufentanil delivered via programmed intermittent epidural bolus (PIEB) with patient-controlled epidural analgesia (PCEA) during labour on obstetric and anesthetic outcomes.Methods Seventy-six ASA Ⅰ or Ⅱ nulliparous parturients who were at full term with a singleton fetus in vertex presentation were randomized to receive 0.1 ％ ropivacaine with 0.5 μg/mL sufentanil (Group L,38 cases) or 0.06％ ropivacaine with 0.5 μg/mL sufentanil (Group UL,38 cases).Another matched 76 cases of primiparas without labor analgesia (Group C) served as controls.For primiparas received analgesia,an epidural catheter was inserted when the cervical dilatation was up to 2-3 cm.The analgesia level was controlled below T8,and VAS score was controlled below 4.Thirty minutes after analgesia started,Group L and UL received PIEB with PCEA regimen including basal infusion of 8 mL/h of ropivacaine with sufentanil,patient-controlled bolus 6 mL and lockout interval 10 minutes.The duration of labor,delivery mode,Apgar score,VAS score and anesthetic drug consumption of each group were recorded.Results The second stage of labor were not statistically different between Group UL and C.The second stage of Group L was longer than that of Group C (P＜0.05).Furthermore,with similar performance in pain score and satisfactory level at each time point,Group UL consumed much less ropivacaine than Group L (P＜0.05).The cesarean section rate,instrumental delivery rate and the Apgar score were not significantly different among the 3 groups.Conclusions While using PIEB with PCEA,0.06％ ropivacaine was capable of providing satisfactory analgesia effects for primipara and has less effects on the obstetric outcome.Therefore,it could be recommended for labour analgesia.

OBJECTIVE: To investigate the correlation of cyclin D1 (CCND1) G870A single nucleotide polymorphism (SNP) with radiotherapy response in patients with high risk human papillomavirus (HR-HPV) related cervical cancer.
 METHODS: A total of 273 patients with cervical cancer, who were confirmed by histopathology and hybrid capture 2 (HC-2) assay and treated by radiotherapy, were enrolled for this study. The correlation of CCND1 G870A polymorphism with tumor response in patients was assessed.
 RESULTS: Compared with patients with AA genotype, the patients with GG genotype and AA genotype showed lower sensitivity to radio-therapy treatment (adjusted ORGA=2.69, 95% CI 1.28-5.67 and adjusted ORGG=3.28, 95% CI 1.47-7.29, respectively), an increase in risks of recurrence/metastasis (adjusted ORGA=2.52, 95% CI 1.12-5.63 and adjusted ORGG=3.95, 95% CI 1.68-9.26, respectively), and shorter recurrence/metastasis-free survival (PGA=0.010 and PGG=0.045).
 CONCLUSION G870A polymorphism is a frequent variation that could be used for evaluate the radio-sensitivity and prognosis for patients with HR-HPV related cervical cancer.
Cyclin D1 ; genetics ; Female ; Genotype ; Humans ; Papillomaviridae ; Polymorphism, Single Nucleotide ; Prognosis ; Uterine Cervical Neoplasms ; genetics ; radiotherapy ; virology