[Low-frequency fluctuation amplitude changes in resting-state brain functional magnetic resonance imaging and its correlation with clinical hearing levels in patients with unilateral hearing impairment].

Objective: To investigate low-frequency fluctuation amplitude changes in resting-state brain fMRI and its correlation with clinical hearing levels in patients with clinical hearing level in patients with unilateral hearing impairment. Methods: Forty-five patients with unilateral hearing impairment[12 males and 33 females, aged 36-67 (46.0±9.7) years], and 31 controls with normal hearing[9 males and 22 females, aged 36-67 (46.0±10.1) years], were retrospectively included. All subjects underwent blood oxygen level-dependent (BOLD) resting-state functional magnetic resonance imaging and high-resolution T1-weighted imaging. The patients were divided into the left-sided hearing impaired group(24 cases), and the right-sided hearing impaired group(21 cases). After data being preprocessed, differences in low frequency amplitude (ALFF) metrics between the evaluated patients and controls were calculated and analyzed, and the statistics were corrected for Gaussian random field (GFR). Results: Overall comparative analysis of patients with hearing impairment showed that one-way ANOVA among the three groups showed abnormal ALFF values only in the right anterior cuneiform lobe (GRF adjusted P=0.002). The ALFF value of the hearing impaired group was higher than that of the control group in one cluster (peak coordinates: X=9, Y=-72, Z=48, T=5.82), involving the left occipital gyrus, right anterior cuneiform lobe, left superior cuneiform lobe, left superior parietal gyrus, and left angular gyrus (GRF adjusted P=0.031). The ALFF value of the hearing impaired group was lower than that of the control group in three clusters (peak coordinates: X=57, Y=-48, Z=-24; T=-4.99; X=45, Y=-66, Z=0, T=-4.06; X=42, Y=-12, Z=36, T=-4.03), involving the right inferior temporal gyrus, the right middle temporal gyrus, and the right precentral gyrus (GRF adjusted P=0.009). Compared with the control group, the ALFF value of the left hearing impairment group was significantly higher than that of the control group in one cluster (peak coordinates: X=-12, Y=-75, Z=45, T=5.78), involving the left anterior cuneiform lobe, right anterior cuneiform lobe, left middle occipital gyrus, left superior parietal gyrus, left superior occipital gyrus, left cuneiform lobe, and right cuneiform lobe (P=0.023 after GRF correction). Compared with the control group, the right hearing impairment group had a significantly higher ALFF value in one cluster (peak coordinates: X=9, Y=-46, Z=22, T=6.06), involving the left middle occipital gyrus, right anterior cuneiform lobe, left cuneiform lobe, right cuneiform lobe, left superior occipital gyrus, and right superior occipital gyrus (GRF adjusted P=0.022); The brain area with reduced ALFF values is located in the right inferior temporal gyrus (GRF adjusted P=0.029). Spearman's two-tailed correlation analysis between ALFF values and pure tone average in the abnormal brain regions showed that ALFF values in the abnormal brain regions correlated to some extent with the pure tone average (PTA) only in the left-sided hearing impaired group(PTA=2 000 Hz, r=0.318,P=0.033;PTA=4 000 Hz,r=0.386,P=0.009). Conclusion: The abnormal neural activity within the brain are different in patients with left-sided and right-sided hearing impairment, and the severity of hearing impairment is related to the difference in functional integration of brain regions.

[Clinical efficacy of single/double 125I-seed strands combined with biliary stents in the treatment of malignant obstructive jaundice].

Objective: To compare the clinical efficacy of single/double 125I-seed strands combined with biliary stents in the treatment of malignant obstructive jaundice. Methods: Totally 67 cases of patients with malignant obstructive jaundice who received single/double125I-seed strands combined with biliary stents implantation from September 2018 to December 2021 were analyzed retrospectively. Among them, 36 patients received single 125I-seed strands combined with biliary stents (single strand group) and 31 patients received double 125I-seed strands combined with biliary stents(double strands group). The technical success rate, clinical success rate, complications, biochemical and tumor indexes at 8 weeks after operation [total bilirubin (TB), direct bilirubin (DB), alanine transaminase (ALT), aspartate transaminase (AST), carbohydrate antigen 19-9 (CA19-9)], stent patency time (SP), median progression-free survival time (mPFS) and median survival time (mOS) were analyzed. Results: There was no significant difference (P>0.05) in technical success rate (100% vs 100%), clinical success rate (97.2% vs 96.8%) and major complications (5.6% vs 6.5%) between single strand group and double strands group. There were significant differences in TB, DB, ALT, AST and CA19-9 indicators between the two groups before and 8 weeks after operation (all P<0.05), but there was no significant difference in the difference value of preoperative and postoperative 8-week indicators between the two groups (all P>0.05).The SP and mPFS of double-stranded stents were longer than those of single-stranded stents.[8.6 months (95%CI:6.9-10.4) vs 6.2 months (95%CI:5.8-6.6), 3.2 months (95%CI:3.0-3.4) vs 3.0 months (95%CI:2.9-3.1), all P<0.05]. The mOS of single and double strands groups was 11.2 months (95%CI:8.3-14.1) and 13.4 months (95%CI:9.9-16.9) respectively, with no statistical difference (P=0.137). Conclusion: Compared with single 125I-seed strands, double 125I-seed strands can prolong biliary SP and mPFS, but the long-term survival index still needs further observation.

[Clinical efficacy of transjugular intrahepatic portosystemic shunt for gastrointestinal hemorrhage in patients with idiopathic noncirrhotic portal hypertension].

Objective: To explore the medium-long term efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for gastrointestinal hemorrhage in patients with idiopathic non-cirrhotic portal hypertension (INCPH). Methods: From March 2013 to July 2018, clinical data of 13 INCPH patients, including 5 males, 8 females,with gastrointestinal hemorrhage were retrospectively analyzed, who were diagnosed at the First Affiliated Hospital of Zhengzhou University, Anyang Fifth People' s Hospital and Yuncheng Central Hospital. All patients received TIPS treatment. The general information, postoperative survival rate, the incidence of rebleeding, shunt dysfunction rate, and incidence of hepatic encephalopathy were analyzed. Results: All 13 patients with INCPH completed TIPS successfully with an average age of 45±8 (33 to 59) years. The hepatic venous pressure gradient (HVPG) decreased from 20.0-26.0 (22.6±1.9) mmHg before procedure to 8.0-14.0 (9.4±3.2) mmHg after. The median follow-up time was 44±7 (31 to 53) months. One patient died of liver failure 27 months after TIPS. Hepatic encephalopathy occurred cumulatively in 1 case (1/13), 1 case (1/13) and 1 case (1/13) in 12, 24 and 36 months after TIPS. Stent restenosis occurred cumulatively in 2 cases (2/13), 3 cases (3/13) and 3 cases (3/13) in 12, 24 and 36 months after TIPS. Portal vein thrombosis occurred cumulatively in 2 cases (2/13), and no primary liver cancer developed. Conclusions: TIPS is safe and effective in the treatment of INCPH with gastrointestinal bleeding with favorable medium-long term outcome.

[The application of artificial intelligence on the classification of benign and malignant breast tumors based on dynamic enhanced MR images].

This retrospective analysis was conducted on clinical obtained DCE-MR images of 198 patients, age from 21 to 79 years(45.5±13.7). The CBAM-ResNet model was developed to perform the classification automatically at the image-level based on deep learning method using the pathological examination as the reference standard,then the classification result of each individual patient was obtained by ensemble learning. The proposed method can have an accuracy of 82.69% for correctly distinguishing between benign and malignant breast tumors at the slice-level based on CBAM-ResNet model and with a sensitivity of 85.67%.. After the voting mechanism is applied, the classification accuracy can reach up to 88.24% at the patient-level with a sensitivity of 87.50%. Our experimental results demonstrated the proposed approach have a high classification accuracy.

[Transjugular intrahepatic portosystemic shunt for the treatment cavernous transformation of the portal vein with vareceal bleeding].

Objective: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS) for the treatment of patients with cavernous transformation of portal vein (CTPV) with vareceal bleeding. Methods: From September 2016 to June 2018, a total of 21 patients suffered CTPV complicated with vareceal bleeding were admitted to First Affiliated Hospital of Zhengzhou University. TIPS were performed combined with percutaneous transhepatic portal vein assist. There were 13 males and 8 females, with an average age of 27-67 (48±11) years. Blood routine examination, liver function test, blood ammonia and ultrasound Doppler were conducted 1,3,6 months after operation, and every 6 months during follow-up. Abdominal enhanced CT and digital substraction angiography were followed every year. Results: TIPS were successfully performed in 19 cases (90.5%), esophageal and gastric varices were embolized in 17 cases; 2 cases failed to selective catheterized, then endoscopic therapy was performed.All bleeding stopped after operation. The pressure of portal vein decreased from 25.0-44.0 (33.7±5.4) mmHg (1 mmHg=0.133 kPa) to 17.0-30.0 (24.5±3.1) mmHg, portosystemic pressure gradient decreased from 16.0-32.0 (23.5±4.6) mmHg to 9.0-15.0 (11.4±1.9) mmHg after TIPS (all P<0.05). During 3-24 months follow-up, 2 patients suffered from hepatic encephalopathy, 3 patients had recurrent upper gastrointestinal bleeding, including 1 duodenal ulcer and 2 esophageal varices. In-stent restenosis were found in 6 patients,in which 3 patients underwent shunt revision operation. At the end of the follow-up, the cumulative patency was 16/19. Conclusion: For patients with CTPV and vareceal bleeding, TIPS could reduce portal hypertension while embolizing varicose veins.It is a safe and effective treatment.

[Establishment of percutaneous nephrolithotomy pathway guided by C-arm CT].

Objective: To investigate the feasibility and advantages of establishing percutaneous nephrolithotomy pathway guided by C-arm CT. Methods: The data of 258 patients who were established a percutaneous nephrolithotomy pathway under the guidance of C-arm CT in the Department of Interventional Medicine of the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2019 were retrospectively analyzed, including168 males and 90 females, and aged 19-88 (60±11) years. There were 84 cases of single stone, 174 cases of multiple stone, and 18 cases of cast stone. The stone size was 9-42 (22±6) mm. Among them, dual access was established in 18 cases, and nephrolithotomy access was established in 276 cases. The three-dimensional guiding function of C-arm CT was used to puncture the target calyces and establish the percutaneous nephrolithotomy pathway. Results: The pathway was successfully established in 258 cases at the first time, with a success rate of 93.5%; successfully established in 15 cases at the second time, with a success rate of 98.9%; and unable to establish in 3 cases, with a failure rate of 1.1%. The operation time was (7.9-32.5) min, with an average of (16±5) min. The lithotripsy time was (25-115) min, with an average of (43±8) min. The intraoperative blood lose was (45-420) ml, with an average of (75±11) ml. There were 23 cases with postoperative calculus residual (8.3%). Postoperative complications included fever in 86 cases (33.3%), which improved after symptomatic treatment. Postoperative hematuria was observed in 128 patients (49.6%) with varying degrees of gross hematuria, among which 2 patients (0.72%) were treated with arterial embolization due to excessive bleeding and ineffective conservative treatment, while the hematuria disappeared after symptomatic treatment in the rest of the patients. Conclusion: The method of establishing percutaneous nephrolithotomy pathway under the guidance of C-arm CT was simple to operate. Especially for patients without hydronephrosis, this method had a high success rate and low complications, which was worthy of clinical promotion and reference.

[Clinical application and efficacy of TIPS combined with AngioJet mechanical thrombectomy for liver cirrhosis with extensive portal vein thrombosis].

Objective: To assess the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with AngioJet mechanical thrombectomy for liver cirrhosis with extensive portal vein thrombosis. Methods: From March 2018 to April 2019, a total of 11 patients with liver cirrhosis and extensive portal vein thrombosis were treated by TIPS combined with AngioJet mechanical thrombectomy, including 6 males and 5 females, with the age of 37-71 (46±9) years old, 3 cases of Child-Pugh grade A, 8 cases of grade B and 0 cases of grade C. The intraoperative immediate thrombus clearance rate, perioperative complication rate, postoperative thrombus recurrence rate, rebleeding rate, the incidence of hepatic encephalopathy and the rate of stent patency of all cases were collected and analyzed. Results: All the patients were treated successfully. The immediate complete thrombus clearance (grade Ⅲ) rate of portal vein trunk was 9/11, and grade Ⅱ was 2/11, The average dose of urokinase was 30-60 (40±5) ten thousand U, slight puncture point bleeding occurred in 3 cases, and recurrence of PVT in portal vein trunk occurred in 1 case with Ⅱ grade clearance rate after operation, rebleeding occurred in 1 case, hepatic encephalopathy occurred in 2 cases, the primary patency rate of stents was 9 cases. Conclusion: TIPS combined with AngioJet mechanical thrombectomy can treat the liver cirrhosis with extensive portal vein thrombosis effectively and safely, and postoperative portal vein patency rate and intrahepatic shunt patency rate are high.

[Preliminary study on the application of abdominal aortic balloon occlusion in the treatment of cesarean scar pregnancy].

Objective: To explore the clinical value by analyzing the application of abdominal aortic balloon occlusion in the uterine curettage treatment for patients with cesarean scar pregnancy (CSP). Methods: Totally 42 CSP patients in the first Affiliated Hospital of Zhengzhou University were analyzed retrospectively, 21 cases in the observation group, placing the balloon catheter to the abdominal aorta under the renal artery under the digital substraction angiography(DSA), conducting curettage under hysteroscopy or uterine laparoscopy immediately, and making intermittent blockage in abdominal aorta blood flow during the surgery;21 patients in the control group, conducting uterine artery embolization (UAE) before operation, conducting curettage under hysteroscopy or uterine laparoscopy after 1-3 days. The fluoroscopy time under DSA, body surface radiation dose, intraoperative blood loss, operation time, incidence of postoperative adverse reactions, hospitalization time and follow-up menstruation were comparatively analyzed. Results: All patients operated and retained the uterus successfully. In the control group, all 21 patients had different degrees of fever, pain and other symptoms after UAE. In the observation group and control group, the fluoroscopy time and body surface radiation dose under DSA respectively were (7.4±1.4) s, (5.4±1.1) mGy and (1 142.8±315.5) s, (1 442.0±300.0) mGy (both P<0.01);the average amount of intraoperative blood loss were (22±15), (19±14) ml (P>0.05), the time of uterine curettage were (37±20), (42±19) minutes (P>0.05);hospitalization time were (5.0±0.9), (7.7±1.3) days (P<0.01). The follow-up period was more than 3 months, no adverse reactions were observed in the observation group; 4 cases of menstrual reduction and 1 case of intrauterine adhesions were found in the control group. Conclusion: Abdominal aortic balloon occlusion and UAE could effectively reduce intraoperative bleeding in uterine curettage for patients with CSP; abdominal aortic balloon occlusion has significant reduction of the X-ray dose, shorter hospitalization time, and fewer adverse events comparing to UAE.

[Application of real-time image fusion technique in transjugular intrahepatic portosystemic shunt].

Objective: To assess the feasibility and value of real-time image fusion technique guiding the procedure of transjugular intrahepatic portosystemic shunt(TIPS). Methods: From July 2017 to May 2018,a total of 48 consecutive patients complicated by portal venous hypertension due to cirrhosis who underwent TIPS were prospectively allocated into two groups that 27 cases underwent normal TIPS and 21 cases underwent image fusion guided TIPS. There were 25 males and 23 females with a mean age of 29-74(51±10) years. The differences of portal vein(PV) between image fusion angiographyand digital subtraction angiography(DSA), and the times of puncture PV, X-ray exposure dose and exposure time and contrast agent amount of all cases were collected and analyzed. Results: The longitudinal and traverse difference of PV between image fusion angiography and DSA were 1.7-2.5(2.1±0.2) mm and 0.9-1.8(1.4±0.3) mm, respectively.The times of puncture PV, X-ray exposure time and dose, and contrast agent amount between normal TIPS group and image fusion guided TIPS group were 1-7(3.8±0.6) times vs 1-3(2.0±0.6) times, 41-63(53±8)min vs 27-42(35±5) min, 513-787(644±96) mGy vs 357-524(423±59) mGy,102-196(151±23) ml vs 87-145(105±14) ml(all P<0.05), respectively. Conclusions: There are minor differences between image fusion angiography of PV and DSA. Real-time image fusion guided TIPS is feasible and valuable to reduce intraprocedural X-ray exposure time and dose and contrast agent amount of TIPS.

An Individualised Strategy and Long-Term Outcomes of Endovascular Treatment of Budd-Chiari Syndrome Complicated by Inferior Vena Cava Thrombosis.

OBJECTIVES: The aim was to evaluate individualised treatment and long-term outcomes of endovascular treatment of Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis. METHODS: Between April 2005 and December 2015, 108 consecutive patients with BCS complicated by IVC thrombosis underwent endovascular treatment. According to the type, size, extent, and degree of organisation of the thrombus, agitation thrombolysis (n = 7), agitation thrombolysis combined with retrieval stent filter (n = 5), pre-dilation (n = 32), retrieval stent filter (n = 56), or direct large balloon dilation (n = 8) was performed. Peri- and post-operative follow-up data were recorded. RESULTS: The endovascular treatment was technically successful in 107 of the 108 patients (99.1%). The incidence of thrombosis related complications was 7.4% (8/108). Major and minor complications occurred in four patients. The mean follow-up duration was 61.7 ± 39.3 months (range 3-140 months). The cumulative 1, 2, 5, and 10 year primary patency rates were 91%, 88%, 79%, and 79%, respectively, and the cumulative 1, 2, 5, and 10 year secondary patency rates were 100%, 100%, 97%, and 97%, respectively. The cumulative 1, 5, and 10 year survival rates were 95%, 86%, and 81%, respectively. Serum albumin and total bilirubin values were independent predictors of survival. CONCLUSIONS: For patients with BCS complicated by IVC thrombosis, an individualised endovascular treatment strategy based on the type, size, extent, and degree of organisation of the thrombus is associated with long-term patency of the IVC and favourable survival and complication rates.

Thoracic stomach-right main bronchus fistula treated with dual Y-shaped covered airway stents.

AIM: To determine the efficacy of dual Y-shaped covered airway stents to treat thoracic stomach-right main bronchus fistulae. MATERIAL AND METHODS: Fifteen patients who developed thoracic stomach-right main bronchus fistula after oesophageal cancer resection and postoperative irradiation were retrospectively analysed. All fistulae were close to the right upper lobe bronchus. Two Y-shaped covered airway stents were designed for each patient. Under radiographic guidance, one stent was placed from the right main bronchus into the bifurcation of upper lobe and intermediate bronchus, the other was placed from the trachea into both main bronchi. RESULTS: All fistulae were closed immediately after stenting. All patients could eat a semi-solid diet. The symptom of coughing while lying down resolved in all patients, and no complications, such as airway bleeding or pneumothorax, occurred. The average survival time was 26.65 months (range 2-40 months, 11 patients were still alive at the study end). Two patients died of tumour recurrence. Another two patients died of pulmonary infections. In one of these patients, there was a long delay between symptom onset and stenting. In the other patient, a small rupture occurred in the silicone membrane covering the stent, which allowed the leakage of gastric contents into the lung. CONCLUSION: Dual Y-shaped covered airway stent placement is feasible and safe to treat thoracic stomach-right main bronchus fistulae. Improvements to the material covering the stents is required.

Abnormal placentation: the role of MRI in diagnosis and therapeutic planning.

AIM: To evaluate the role of magnetic resonance imaging (MRI) for diagnosis and therapeutic planning in patients with abnormal placentation (AP). MATERIALS AND METHODS: Overall, 168 consecutive patients with suspected placenta previa and AP were referred for MRI before caesarean section (CS). The ability of MRI to properly detect and assess abnormal placentation was correlated with findings at CS, which were considered the reference standard diagnostic tool. For each patient, MRI was used to determine whether the AP was suitable for complete/incomplete delivery, hysterectomy, or conservative treatment. Treatment planning with MRI was prospectively compared with the actual treatment that had been carried out in each patient decided at CS. RESULTS: Placenta previa was detected at MRI in 63 patients and AP in 105 patients; 16 patients had false-positive MRI findings, and three had false-negative findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI compared to findings at CS were 88.9% (149 of 168), 96.7% (89 of 92), 78.9% (60 of 76), 84.8% (89 of 105), and 95.2% (60 of 63), respectively. Treatment planning could be correctly made on the basis of MRI with accuracy, sensitivity, specificity, PPV, and NPV of 97%, 100%, 92.6%, 95.2%, and 100%, respectively. CONCLUSIONS: MRI offers high diagnostic accuracy in the detection of AP, and it may be helpful in the detailed planning of treatment.

Serum Proteomics Analysis in Rats of Immunosuppression Induced by Chronic Stress.

The immune system can be damaged by chronic stress. However, for this process, the involved molecular alterations and their regulatory roles played in immunosuppression still remain unclear. This study was aimed to identify the differences in serum protein expressions that are closely associated with the effect of chronic stress on immune function. Serum protein levels of rats in control group and chronic stress group were measured by iTRAQ analysis. Subsequently, among the 121 differentially expressed proteins screened between the two groups, 46 proteins were upregulated (>1.5-fold, P < 0.05), while 75 proteins were downregulated (<0.67-fold, P < 0.05). Bioinformatics analysis revealed that most of the differentially expressed proteins were in relation with the metabolic, cellular, response stimulus and immune system processes. The significantly differential expression of ceruloplasmin, haptoglobin, catalase and peroxiredoxin-1 were picked out for reconfirmation by ELISA analysis. The results were consistent with those obtained by iTRAQ. What is more, the roles of above-mentioned four proteins, apolipoprotein B-100 and heat-shock protein 90 in immunosuppression induced by chronic stress were discussed. Taken together, these findings may provide a new insight into better understanding the molecular mechanisms of immunosuppression induced by chronic stress.

C-arm CT-guided renal arterial embolisation followed by radiofrequency ablation for treatment of patients with unresectable renal cell carcinoma.

AIM: To explore the value of using flat detector (FD) equipped angiographic C-arm CT (CACT) systems in treating unresectable renal cell carcinoma (RCC) by selective renal arterial embolisation (RAE) followed by radiofrequency ablation (RFA) (RAE-RFA). MATERIALS AND METHODS: A total of 28 patients who were not candidates for surgery were enrolled. The average size of tumours was 6.7±2.2 cm (range 4.1-9.6 cm). Twenty-eight tumours were treated with CACT-guided RFA, 5-7 days after CACT-guided RAE. RESULTS: CACT-guided RAE-RFA was technically successful in all patients. Tumour enhancement disappeared after a single RAE-RFA session in 20 patients, after two RAE-RFA sessions in four patients and after three RAE-RFA sessions in the other four patients. One patient died of lung metastasis and haematuria 13 months after RAE-RFA, and another patient died of pulmonary heart disease 23 months after repeat RAE-RFA. In the 26 living patients, tumours remained controlled during a mean follow-up period of 27 months and showed significant reduction in tumour size (6.7±2.2 cm to 3.9±1.7 cm, p<0.01). There were no significant changes in creatinine levels or urea nitrogen concentrations before and after the last RAE-RFA (p>0.05). There were no serious complications during and after the procedure. CONCLUSION: CACT-guided RAE followed by RFA appears to be a safe and effective technique for treating patients with inoperable RCC.

Caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation for the management of placenta accreta.

AIM: To determine the efficacy and safety of caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation (UAE) for the treatment of patients with placenta accreta. MATERIALS AND METHODS: This retrospective study involved 42 patients with placenta accreta. All patients underwent caesarean section combined with temporary aortic balloon occlusion followed by UAE through the right femoral approach. RESULTS: All patients were confirmed to have placenta praevia and accreta, including five patients with placenta percreta, at the time of delivery. The technical success rate of the combined treatment was 97.6% (41/42). Forty-one patients underwent successful caesarean section with conservation of the uterus. Hysterectomy was required in one (3.1%) patient. The amount of blood loss and blood transfusion, and the operation time were was 586 ± 355 ml, 422 ± 83 ml and 65.5 ± 10.6 minutes, respectively. The mean postoperative hospital stay, occlusion time and fetal radiation dose were 5.5 ± 2.6 days, 22.4 ± 7.2 minutes and 4.2 ± 2.9 mGy, respectively. There were no significant changes before and 7 days after the endovascular procedure in creatinine levels (56.8 ± 13.8 µmol/l versus 63.4 ± 16.7 µmol/l, p = 0.09) or urea nitrogen (6.3 ± 2.5 µmol/l versus 7.4 ± 3.8 µmol/l, p = 0.17). There were no access-site complications after the endovascular procedure and no complications related to the intervention during follow-up. CONCLUSION: Temporary aortic balloon occlusion followed by UAE can effectively control postpartum haemorrhage during placental dissection, and reduce transfusion requirements, hysterectomy rate, and operation time in patients with placenta accreta.

Determination of the potential of induced pluripotent stem cells to differentiate into mouse nucleus pulposus cells in vitro.

We determined the potential for induced pluripotent stem (iPS) cells to differentiate into nucleus pulposus (NP)-like cells in mice. iPS cells were generated from tail-tip fibroblasts. We used a pellet culture model with the aim of determining the applicability of iPS cell-based therapy to intervertebral disc degeneration (IVD). The cell pellet was cultured in an NP cell basal medium comprising Dulbecco's modified Eagle's medium supplemented with transforming growth factor beta 1, dexamethasone, ascorbate-2-phosphate, and 1% ITS-Premix. The pellet was evaluated by quantitative reverse transcription polymerase chain reaction, immunohistochemical staining, and biochemical composition. The differentiation of iPS cells into NP cells was demonstrated by the protein and mRNA expression levels of proteoglycan, collagen II, aggrecan, and CD24. Furthermore, increased hydroxyproline content and dimethylmethylene blue staining demonstrated that the collagen II and glycosaminoglycan content in the NP cells increased with time. We have shown that cultured mouse iPS cells can be induced to differentiate into NP cells. Such proof-of-concept opens up the possibility of producing patient-specific NP cells in a relatively simple and straightforward manner with high efficiency. We are confident that such cells could be immediately useful for the study of IVD disease.

Percutaneous transhepatic cholangiobiopsy to determine the pathological cause of anastomotic stenosis after cholangiojejunostomy for malignant obstructive jaundice.

AIM: To investigate the feasibility and advantages of cholangiobiopsy during percutaneous transhepatic cholangiography in the histopathological diagnosis of anastomotic stenosis after cholangiojejunostomy for malignant obstructive jaundice. MATERIALS AND METHODS: Using biopsy forceps, specimens were collected from the site of stenosis in patients with recurrent jaundice (n = 24) who had previously undergone cholangiojejunostomy for malignant obstructive jaundice. RESULTS: Stenosis occurred in all patients at the biliary-enteric anastomosis based on percutaneous transhepatic cholangiography, and was the location of the biopsy. Satisfactory specimens were obtained from 22 out of 24 patients. The sensitivity was 91.7% (22/24). Tumour tissue was obtained in 18 cases, confirming disease recurrence. Histopathological changes in four patients were diagnosed as fibroplasia and/or inflammation. These were considered cicatricial stenoses based on histopathological, imaging, and laboratory findings. The remaining two histopathology-negative patients were proven to have recurrent tumour based on imaging, laboratory, and follow-up data. No complications occurred during biopsy, including gastrointestinal haemorrhage or perforation. Either cholangial drainage and/or an inner stent was used following biopsy, which resulted in a noticeable decrease in jaundice postoperatively (p < 0.05). CONCLUSION: Percutaneous transhepatic cholangiobiopsy using biopsy forceps for the diagnosis of anastomotic stenosis after cholangiojejunostomy for malignant biliary obstructive jaundice is easy to perform and safe, with a high level of sensitivity. Interventional therapies, such as percutaneous transhepatic cholangial drainage and stent placement, can be performed concurrently, markedly improving the symptoms of patients with obstructive jaundice.

Budd-Chiari syndrome with fresh inferior vena cava thrombosis: agitation thrombolysis and balloon dilation.

BACKGROUND: To evaluate retrospectively our initial clinical experience of agitation thrombolysis and balloon dilation in the treatment of Budd-Chiari syndrome (BCS) in patients with fresh inferior vena cava (IVC) thrombosis. PATIENTS AND METHODS: Between August 2004 and March 2009, a total of 12 BCS patients with fresh IVC thrombosis were treated with agitation thrombolysis and balloon dilation. Color Doppler ultrasound results, as well as mortality, morbidity, and the clinical outcomes were evaluated immediately after the treatment and at one week and 1, 3, 6, 12 months after the procedure and then annually thereafter. RESULTS: Agitation thrombolysis and balloon dilation were technically successful in all patients, without immediate procedural complications. The inferior vena cavagrams after the procedure demonstrated complete resolution of the IVC thrombi without pulmonary embolism and full patency of the obstructed IVC. Thirty-day mortality was nil. Clinical success was observed in all patients respectively one month after the procedure. As of February 2010, the mean (± SD) follow-up period for the color Doppler ultrasound procedure was 21.7 ± 8.9 months (range, 12 - 32 months). All patients showed complete patency of the treated IVC without thrombosis, restenosis, or reobstruction, and all patients are alive with resolution of the symptoms at the time of this report. CONCLUSIONS: Our preliminary results suggest that agitation thrombolysis and balloon dilation may be a feasible approach for patients with BCS and fresh IVC thrombosis. However, larger studies are warranted to confirm these results.