Research on the design of serious illness insurance scheme in Shanghai based on micro-simulation.

BACKGROUND: Urban and rural residents' basic medical insurance (URRBMI) is an institutional arrangement for rural residents and unemployed urban residents in China. The serious illness medical insurance system (SIMIS) was established to provide additional medical cover. At present, the SIMIS payment method in China is based on large expenses, and only a few areas, such as Shanghai, pay according to the treatment of serious diseases. This study aims to simulate and analyse the effect of the two payment methods on SIMIS in Shanghai. METHODS: We developed a micro-simulation model to predict the number and characteristics of SIMIS participants among urban and rural residents in Shanghai and to simulate the process of medical treatment, medical consumption, and medical insurance payments for each insured person from 2020 to 2025. We then summarised and analysed the payment compensation effect, and compared it with Shanghai's current policies. RESULTS: The payment of SIMIS according to high expenses, the total medical expenses of seriously ill patients show an increasing trend, with an average annual growth rate of 3.56%. The URRBMI fund payment covers 56%-58% of total medical expenses, and the SIMIS fund covers 5%-7% of the total medical expenses. Both cover 62%-63% of total medical expenses. Self-payment under SIMIS covers 22%-23% of the total medical expenses, total self-payment covers 14%-15% of the total medical expenses, and the medical expenses borne by individuals cover 36%-38% of the total medical expenses.The fund expenditure is 213 million yuan and average annual cost borne by individual patients ranges from 40 000 to 60 000 yuan. CONCLUSIONS: The policy of designing SIMIS according to national guidelines does not meet the development needs of Shanghai. Shanghai should take the current policy of paying compensation according to the treatment of serious illness as the policy basis, consider the security needs of patients with large medical expenses outside the scope of protection, and adjust policies appropriately to prevent poverty caused by illness.

125I Seed Promotes Apoptosis in Non-small Lung Cancer Cells via the p38 MAPK-MDM2-p53 Signaling Pathway.

Purpose: 125I seeds were effective in the treatment of non-small cell lung cancer in previous research. However, the exact signaling pathway-mediated apoptosis mechanism is still unclear. The present study analyzed the effects and potential mechanisms of 125I seed on the growth and migration of A549 cells. Methods: Lung cancer A549 cells were irradiated with 125I seed for various times. MTT, invasion assay, and flow cytometry were used to detect the proliferation, invasion, and apoptosis of treated cells, respectively. A Nimblegen genome-wide expression profile chip was used to evaluate gene expression changes in 125I seed-treated A549 cells. Validation studies were performed using phosphorylated protein chip technology, Western blot, nude mouse tumor xenograft assay, and immunohistochemical experiments. All statistical analyses were performed using unpaired Student's t tests and Kruskal-Wallis test. Results: Irradiation with 125I seed inhibited A549 cell proliferation and invasion and induced apoptosis (primarily early apoptosis). Irradiation with 125I seed also caused the downregulation of p38MAPK, degradation of mouse double-minute 2 homolog (MDM2), and higher expression of p53, which eventually resulted in non-small cell lung cancer cell apoptosis. Conclusion: 125I seed irradiation activated the p38MAPK/MDM2/p53 signaling pathway and promoted non-small cell lung cancer cell apoptosis. Future clinical studies targeting this signal may provide a new potential therapeutic approach for non-small cell lung cancer.

Analysis of the effect of serious illness medical insurance on relieving the economic burden of rural residents in China: a case study in Jinzhai County.

BACKGROUND: In 2003, China established a New Rural Cooperative Medical System (NRCMS) for rural residents to alleviate the burden of medical expenses among rural residents. However, its reimbursement for high medical costs was insufficient. Therefore, China gradually established the Serious Illness Insurance System (SIMIS) based on NRCMS. After receiving payment through NRCMS, patients in rural areas who met the requirements of SIMIS policy would receive a second payment for their high medical expenses. This study aimed to analyze the effect of the implementation of SIMIS on alleviating the economic burden of rural residents in Jinzhai County. METHODS: The study used the inpatient reimbursement data of NRCMS in Jinzhai County, Anhui Province, from 2013 to 2016. We adopted descriptive and regression discontinuity (RD) methods to analyze the payment effect of SIMIS. The RD analysis targeted patients (n = 7353) whose annual serious illness expenses were between CNY 10,000 (1414 USD) and CNY 30,000 (4242 USD), whereas the descriptive analysis was used for data of the patients compensated by SIMIS (n = 2720). RESULTS: The results of RD showed that the actual medical insurance payment proportion increased by about 2.5% (lwald = 0.025, P < 0.01), inside medical insurance self-payment proportion increased by about 2% (lwald = 0.020, P < 0.10), and outside medical insurance self-payment proportion decreased by about 1.6% (lwald = - 0.016, P < 0.05). The descriptive results showed that patients with serious illnesses mostly chose to go to a hospital outside the county. The annual average number of hospitalizations was 3.64. The reimbursement mainly came from the NRCMS. The payment amount of SIMIS was relatively small, and the out-of-pocket medical expenses were still high. CONCLUSION: The medical technology level of Jinzhai County could not meet the needs of patients with seriously illnesses, the number of beneficiaries of SIMIS was small, and the ability to relieve the burden of medical expenses of the rural residents was insufficient. The high out-of-pocket expenses increased the possibility that only people with good economic conditions could benefit from the reimbursement of SIMIS, resulting in inequity.

Characteristics of COVID-19 near China's epidemic center.

BACKGROUND: This study described and analyzed the age, gender, infection sources, and timing characteristics of the 416 confirmed cases in two cities near the center of China's COVID-19 outbreak. METHODS: This study used publicly available data to examine gender, age, source of infection, date returned from Hubei, date of disease onset, date of first medical visit, date of final diagnosis, and date of recovery of COVID-19 cases. RESULTS: Public-use data revealed similar risks of infection by age and that the numbers of new and final diagnoses of confirmed cases first increased, peaked at about 2 weeks, and then gradually decreased. The main sources of infection were firsthand or secondhand exposure in Hubei Province and contact with confirmed cases, which mostly involved contact with infected household members. The mean periods from disease onset to first medical visit, first visit to final diagnosis, and final diagnosis to recovery were 4.44, 3.18, and 13.42 days, respectively. CONCLUSIONS: The results suggest that the measures taken to control the rate of infection were effective. Prevention and control efforts should respond as quickly as possible, isolate and control activities of individuals leaving infected areas, and restrict household contact transmission.

Prevalence and risk factors for attempted suicide in the elderly: a cross-sectional study in Shanghai, China.

BACKGROUND: Previous studies have thoroughly investigated the prevalence and risk factors for completed suicide. In marked contrast is the lack of a better understanding of attempted suicide in the elderly. The aim of this study was to estimate the prevalence of attempted suicide in the elderly and examine the associated factors. METHODS: Using a multi-stage cluster sampling approach, a cross-sectional survey of 8,399 elderly house-dwelling residents was conducted in Shanghai, China. RESULTS: The two-week prevalence of attempted suicide in the elderly was 0.75%. In the bivariate analysis, having no caregivers, depressive, anxiety, sad, fear, obsessive-compulsive and anger symptom, and lower scores on the Barthel Index of Activities of Daily Living and the Lawton Instrumental Activities of Daily Living Scale were significantly associated with an increased risk of attempted suicide in the elderly. In the multivariate analysis, sad and fear symptoms were significantly and independently associated with a higher risk of attempted suicide in the elderly. CONCLUSION: The two-week prevalence of attempted suicide in the elderly is relatively high when compared with the annualized or lifetime prevalence reported in China and foreign settings. Elderly individuals with certain mental symptoms should be targeted for suicide prevention and provided with timely mental health support.

The association of multimorbidity and disability in a community-based sample of elderly aged 80 or older in Shanghai, China.

BACKGROUND: Both multimorbidity and activities of daily living (ADL) disability and instrument activities of daily living (IADL) disability are common among elderly individuals. ADL/IADL disability may reduce individuals' capacities for independent living and quality of life. This study aimed to examine the association between multimorbidity and ADL/IADL disability. METHODS: A multi-stage cluster sample of 2058 residents aged 80 or older was investigated in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases with ten common chronic conditions under consideration. Subjects who responded that they "need partial or full assistance" to any ADL/IADL items were defined as having ADL/IADL disability. We examined the association of multimorbidity with ADL/IADL disability, adjusted for socio-demographic characteristics by using logistic regression. RESULTS: Of respondents, 23.23 % had ADL disability, 37.90 % had IADL disability, and 49.17 % had multimorbidity. After adjusted socio-demographic characteristics, a graded association was showed between ADL disability and the quantity of chronic conditions: odds ratio (OR) for 1 condition, 1.53(95 % confidence interval [CI], 1.04-2.24); OR for 2 conditions, 2.06(95 % CI, 1.43-2.96); OR for 3 conditions, 3.23(95 % CI, 2.14-4.86); OR for 4 or more conditions, 5.61(95 % CI, 3.26-9.66). Similar associations were also observed between the quantity of chronic conditions and IADL disability. CONCLUSIONS: The quantity of chronic conditions had relatively strong association with both ADL and IADL disability. Initiating prevention of additional chronic conditions and interventions on clusters of diseases may decrease the potential risk of ADL/IADL disability. Additionally, more attention should been given to the older low-income women living with relatives/non-relatives with multimorbidity.

Does disability predict attempted suicide in the elderly? A community-based study of elderly residents in Shanghai, China.

OBJECTIVES: Disability, which has been proved to be associated with suicide and suicidal ideation, has received little attention in relation to suicidal attempts among the elderly. The aim of this study was to explore the influence of disability on attempted suicide within this demographic. METHOD: A multi-stage cluster sample of 8399 residents aged 60 or more was investigated from 15 communities in Shanghai, China. Disability was measured using the Lawton instrumental activities of daily living (IADL) scale. RESULTS: The prevalence of attempted suicide in the elderly was 0.75%. Specific IADL disabilities, including shopping (OR = 3.01, 95% CI = 1.56-5.81), preparing meals (OR = 4.12, 95% CI = 2.12-8.00), housekeeping (OR = 2.48, 95% CI = 1.01-6.06), doing laundry (OR = 2.82, 95% CI = 1.09-7.35), using transport (OR = 3.10, 95% CI = 1.36-6.99) and medical care (OR = 4.41, 95% CI = 2.10-9.17), were significantly and independently associated with attempted suicide in the elderly. The presence of at least one such disability was associated with an almost threefold increase in the attempted suicide rate, and the presence of five or more IADL disabilities was associated with an approximate fivefold increase in the attempted suicide rate. CONCLUSION: Specific IADL disabilities, such as preparing meals or dealing with medical care, may be significant predictive factors for risk of suicidal attempts among the elderly. Therefore, elderly people with certain disabilities should be considered for suicide prevention interventions and should be supported in IADL as much as possible.

A Cross-sectional Study on Posttraumatic Stress Disorder and General Psychiatric Morbidity Among Adult Survivors 3 Years After the Wenchuan Earthquake, China.

After the Wenchuan earthquake, a large number of studies have focused on postearthquake psychological disorders among survivors; however, most of these studies were conducted within a relatively short period. This study was conducted to examine the symptoms of posttraumatic stress disorder (PTSD) and general psychiatric morbidity among adult survivors 3 years after the Wenchuan earthquake, China. Through a multistage systematic sampling approach, a cross-sectional survey of 360 participants, 18 years or older, was conducted. The prevalence of PTSD and general psychiatric morbidity was 10.3% and 20.6%, respectively. Multivariate analysis revealed significant predictors for PTSD, including female gender and having felt guilt concerning someone's death or injury. Significant predictors for general psychiatric morbidity included unmarried status and having been in serious danger. These results suggest that mental health services should be continuously available to earthquake survivors.

Comparative quality of life study between endoscopic sphincterotomy and surgical choledochotomy.

AIM: To determine quality of life improvement in choledocholithiasis patients who underwent endoscopic sphincterotomy (EST) versus open choledochotomy (OCT). METHODS: Eligible choledocholithiasis patients (n = 216) hospitalized in the Changhai Hospital between May 2010 and January 2011 were enrolled into a prospective study using cluster sampling. Patients underwent EST (n = 135) or OCT (n = 81) depending on the patient's wishes. Patients were followed-up with a field survey and by correspondence. Patients were also given the self-administered Gastrointestinal Quality of Life Index (GIQLI) to measure patient quality of life before surgery, and at two and six weeks after the procedures. RESULTS: With respect to baseline patient characteristics, the EST and OCT groups were comparable. After the procedure, gallstones were completely eliminated in all patients. Among 216 eligible patients, 191 patients (88.4%) completed all three surveys, including 118 patients who underwent EST (118/135; 87.4%) and 73 patients who underwent OCT (73/81; 90.1%). EST was associated with a significantly shorter hospital stay than OCT (8.8 ± 6.5 vs 13.9 ± 6.7 d; P < 0.001). The GIQLI score was similar between the EST and OCT groups before cholelithotomy (103.0 ± 15.4 vs 99.7 ± 10.2), but increased significantly in the EST group at two weeks (113.4 ± 12.0 vs 107.2 ± 11.2; P < 0.001) and six weeks (120.7 ± 10.6 vs 116.9 ± 7.5; P < 0.05) after the procedures. CONCLUSION: EST, compared with OCT, is associated with better postoperative quality of life in patients treated for choledocholithiasis.

Experimental research on a novel iodine-125 seed strand connected using magnesium alloy AZ31.

BACKGROUND AND PURPOSE: Aim of this research is to study the in vivo degradation and biocompatibility in rabbits and the dose distribution of novel iodine-125 seed strands connected using magnesium alloy AZ31. METHOD: Thirty-three New Zealand rabbits were divided into three Groups (A, B, and C). All rabbits in Groups A and C were implanted with VX2 tumors. For Group A, radioactive iodine-125 seed strands were implanted into the VX2 tumors. For Group B, non-radioactive iodine-125 seed strands were implanted into thigh muscle. Rabbits in Group C were used as controls. Displacement of the seed strands was assessed using X-ray and CT. Blood and urine samples were collected from all groups to measure changes in magnesium ion concentrations. The changing effect of alloy AZ31 tube according to dose distribution of iodine-125 was evaluated using the Monte Carlo method. RESULTS: In Groups A and B, 14 days after implantation, majority of the magnesium alloy tubes were fragmented, and 28 days after implantation, the magnesium alloy tubes were completely degraded. Small differences in dose distribution were observed between bare iodine-125 seeds and iodine-125 seed strands. CONCLUSIONS: Our results suggest that these novel iodine-125 seed strands connected using magnesium alloy AZ31 are promising anti-cancer drug for brachytherapy due to the rapid degradation of connective materials and even distribution of seed doses in tumors. Some recent patents are also outlined in this article.

Traumatic experiences and mental health consequences among child survivors of the 2008 Sichuan earthquake: a community-based follow-up study.

BACKGROUND: The study was implemented to examine the relationship between traumatic experiences and longitudinal development of mental health for children and adolescents who survived the 2008 Sichuan earthquake. METHODS: Using the method of multistage systematic sampling, 596 children aged between 8 and 16 years were randomly selected from severely affected areas of the earthquake. These children were interviewed with standardized instruments of posttraumatic stress disorder (PTSD) and depression at the 15th month after the earthquake, and re-interviewed at the 36th month. RESULTS: From the initial to the follow-up assessments, there were no significant changes in both PTSD and depression scores. In addition, no significant change was found on the overall prevalence rates of the symptoms: from 12.4% to 10.7% for PTSD, from 13.9% to 13.5% for depression, and from 4.2% to 4.7% for their co-occurrence. The study also indicated that the earthquake might have a delayed impact on the psychosocial functioning of children and adolescents who were not directly affected by the disaster. CONCLUSIONS: For child and adolescent survivors of the earthquake, symptoms of PTSD and depression seemed to persist over time. The finding that children reduced their use of mental health services raised great concerns over how to fulfill the unmet psychological needs of these children. More mental health interventions should be allocated to children who had elevated risk for developing persistent course of the symptoms.

Longitudinal study on health-related quality of life among child and adolescent survivors of the 2008 Sichuan earthquake.

PURPOSE: To longitudinally characterize child survivors' quality of life after a massive earthquake in low- and middle-income settings. METHODS: Population-based surveys were conducted in the severely affected areas 15 and 36 months after the earthquake, using a multi-stage systematic sampling design. RESULTS: A total of 596 participants were included in the initial assessment, of which 430 were re-surveyed in the follow-up assessment. For both assessments, means of the PedsQL total and subscale scores fell significantly below the general healthy children (P < 0.05 for all comparisons). Reduction in PedsQL total scores was observed from the initial to the follow-up assessment (82.2 vs. 80.3, P = 0.01). In regression analysis, mental health symptoms were examined as the biggest contributors for PedsQL scores, and girls and older children were found to report lower PedsQL scores than their counterparts. CONCLUSIONS: Health-related quality of life among child and adolescent survivors decreased over time. Besides helping children with identified risk experiences, attention should also be allocated to children without specific traumatic experiences, since the earthquake may have a delayed effect on them.

Recurrent gliomas: comparison of computed tomography (CT)-guided 125I seed implantation therapy and traditional radiochemotherapy.

BACKGROUND: Primary brain tumors have always been associated with high morbidity and mortality. Glioma is the most common type of malignant brain tumors,with a high probability of recurrence after surgical excision and with poor prognosis.The purpose of this study was to compare the therapeutic efficacy of computed tomography (CT)-guided interstitial (125)I seed implantation with traditional radiochemotherapy for treatment of recurrent gliomas. RESULTS: The response rate at 1, 3, 6 and 12 months after (125)I seed implantation was 68.6, 74.3, 77.1 and 62.8% respectively, which was significantly higher than the group treated with the conventional chemoradiation protocol (p < 0.05). Patients exposed to (125)I seed implantation had a median survival of 29.0 months, whereas the median survival of those treated with traditional radiochemotherapy was 19.0 months. The difference observed between the two groups was significant. There were no severe complications or mortality associated with either treatment, except for one case of intracerebral hemorrhage around the tumor area in the (125)I seed implants group. METHODS: From November 2002 to May 2010, 73 consecutive patients with recurrent gliomas were treated with CT-guided (125)I seed implantation (35 cases) or traditional radiochemotherapy (38 cases). Patients were followed up after treatment and the therapeutic effect was evaluated by comparing the response and survival rates of the two groups. In particular, patients treated with (125)I seed implantation were monitored for adverse side effects. CONCLUSIONS: CT-guided (125)I seed implantation is safe and well-tolerated and more importantly, shows superior efficacy compared with conventional radiochemotherapy. This suggests that CT-guided (125)I seed implantation could be an alternative approach for recurrent gliomas.

Microwave ablation: results in ex vivo and in vivo porcine livers with 2450-MHz cooled-shaft antenna.

BACKGROUND: Imaging-guided thermal ablation using different energy sources continues to gain favor as a minimally invasive technique for the treatment of primary and metastatic hepatic malignant tumors. This study aimed to evaluate the performance of microwave ablation with 2450-MHz internally cooled-shaft antenna in ex vivo and in vivo porcine livers. METHODS: All studies were animal care and ethics committee approved. Microwave ablation was performed using a noncooled or cooled-shaft antenna in 23 ex vivo (92 ablations) and eight in vivo (36 ablations) porcine livers. Diameters of the coagulation zone were observed on gross specimens. The coagulation diameters achieved in different microwave ablation parameter groups were compared. Curve estimation analysis was performed to characterize the relationship between applied power and treatment duration and coagulation diameter (including short-axis and long-axis diameter). RESULTS: Coagulation zones were elliptical and an arrowed-shaped carbonization zone around the shaft was observed in all groups. But the antenna track was also coagulated in the noncooled-shaft antenna groups. In ex vivo livers, the short-axis diameter correlated with the power output in a quadratic curve fashion (R(2) = 0.95) by fixing ablation duration to 10 minutes, and correlated with the ablation duration in a logarithmic curve fashion (R(2) = 0.98) by fixing power output to 80 W. The short-axis reached a relative plateau within 25 minutes. In in vivo livers, short-axis diameter correlated with the coagulation duration in a sigmoidal curve fashion (60 W group R(2) = 0.76, 80 W group R(2) = 0.87), with a relative plateau achieved within 10 minutes for power settings of 60 W and 80 W. CONCLUSIONS: The internally cooled microwave antenna may be advantageous to minimize collateral damage. The short-axis diameter enlargement has a plateau by fixing power output.

Microwave ablation treatment of liver cancer with 2,450-MHz cooled-shaft antenna: an experimental and clinical study.

PURPOSE: To evaluate effects of microwave ablation with a 2,450-MHz internally cooled-shaft antenna in animal experiments and in a clinical study. METHODS: Microwave ablation was performed using a cooled-shaft antenna in eight in vivo (36 ablations) porcine livers. The coagulation diameters achieved in different microwave ablation parameter groups were compared. Sixty patients (44 men, 16 women; mean age 53 years) with 96, 1-8 cm (mean 3.20 +/- 0.17 cm) liver cancers were treated with the same microwave ablation technique. Complete ablation (CA), local tumor progression (LTP) rates and complications were determined. RESULTS: In vivo livers, short axis diameter correlated with the coagulation duration in a sigmoidal curve fashion (60-W group R(2) = 0.76, 80-W group R(2) = 0.87), with a relative plateau achieved within 10 min for power settings of 60 or 80 W. Within 10 min in the 60 and 80-W groups, respectively, 89 and 85.76% of maximum short axis diameter were achieved. CA rates in small (3.0 cm), intermediate (3.1-5.0 cm) and large (5.1-8.0 cm) liver cancers were 96.43% (54/56), 92.31% (24/26) and 78.57% (11/14), respectively. During a mean follow-up period of 17.17 +/- 6.52 months, LTP occurred in five (5.21%) treated cancers. There was no significant difference in the CA and LTP rate between the HCC and liver metastasis patient subgroups (P > 0.05). CONCLUSIONS: The short axis diameter enlargement has a relative plateau within 10 min by fixing power output to 60 or 80 W, using the 2,450-MHz internally cooled-shaft antenna in vivo porcine livers. Effective local tumor control was achieved during one microwave ablation session.

[Short- to mid-term evaluation of CT-guided 125I brachytherapy on recurrent or metastatic head and neck cancers].

OBJECTIVE: to evaluate the short- and medium-term clinical effects of 125I seed implantation on recurrent or metastatic head and neck cancers. METHODS: Thirty patients with recurrent or metastatic head and neck cancers after operation, radiotherapy, or chemotherapy, totaling 421 lesions 4.2 (2-9) cm in diameter, 23 males and 12 females, aged 56 (39-71), underwent implantation of 12-70 125I seeds (on average 33 per person) under the guidance of CT, ultrasonography, or endoscopy with an interval of 1 cm between any 2 seeds with the radioactive activity per seed of 29.6 MBq and matched peripheral dose of 90-160 Gy. Follow-up was conducted for 13 (4-40) months to observe the local control rate, overall survival rate, pain relief, and clinical complications. RESULTS: Follow-up 4 months later showed that 24 of the 42 lesions obtained complete remission, 11 obtained partial remission, 5 no change, and 2 progress of disease, with a clinical response rate of 83.3% (CR+PR). The overall 1-, 2-, and 3-year survival rates were 88.4%, 72.4%, and 45.2% respectively with a median survival time of 31 months. The pain relief rate was 73.4% (17/23). The long-term complications included hyperpigmentation at operative sites (n=4), insensible feeling on lateral cheek (n=3), dryness of oral cavity (n=2), and headache combined with infection (n=1). CONCLUSION: Relieving the pain, improving the life quality, CT guided radioactive 125I seed implantation is a simple, safe, and effective method in treating recurrent or metastatic head and neck cancer with minimal damage and few complications.

Short- to mid-term evaluation of CT-guided 125I brachytherapy on intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for hepatocellular carcinoma.

OBJECTIVE: To evaluate the safety and short- to mid-term efficacy of CT-guided (125)I brachytherapy on intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for hepatocellular carcinoma (HCC). RESULTS: Among the ten patients, one died of liver failure 15 months and one of renal failure 29 months after brachytherapy. All other eight patients survived till the end of the follow-up. Four of them presented good control of local tumor and no systemic recurrence; the other four survived with tumor presence, including three with recurrent tumors undergoing a second (125)I brachytherapy and one switching to a biological target drug treatment. The local control rates after 4, 6, 12 and 24 months are 90.3, 84.0, 75.6 and 72.7% respectively. Procedure-related complications were minimal. METHODS: From November 2004-May 2008, ten patients with intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for HCC underwent (125)I brachytherapy under the guidance of computed tomography. They were followed up for 4-44 months after brachytherapy and the treatment's efficacy was evaluated. CONCLUSION: CT-guided (125)I brachytherapy is a safe and effective therapy on intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for hepatocellular carcinoma. It has the advantages of minimal invasion, significant short- to mid-term local control and minimal complications.

CT guided 125iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma.

BACKGROUND: This study evaluated the clinical application of CT guided 125iodine implantation in patients with portal vein tumor thrombus in primary hepatocellular carcinoma. METHODS: The ten patients (9 males and 1 female, aged from 36 to 72 years) with portal vein tumor thrombus accompanying hepatocellular carcinoma had been treated with comprehensive therapy including surgery, transcatheter arterial chemoembolization, radiotherapy ablation, microwave ablation or percutaneous ethanol injection. The average diameter of each tumor thrombus was 21.5 mm x 30.5 mm. Seeds of 30 MBq 125I were implanted 5 mm apart within the portal vein tumor thrombus. The follow-up after 4 months included enhanced spiral CT. RESULTS: CT screening of the tumours indicated that 4 out of 10 patients showed complete response to the therapy, 5 partial response and 1 stable disease. Adverse effects included aggravated abdominal dropsy and temporarily increased transaminase, which were controlled by medical management. Severe complications such as haemorrhage, biliary fistula, hepatic abscess, pancreatic fistula and hepatic function failure were not observed. Implanted seeds migrated to lung and left hepatic lobe in 1 case. CONCLUSION: CT guided implantation of 125iodine seeds, can effectively treat portal vein tumor thrombus accompanying hepatocellular carcinoma with minimal damage and few complications.