[The characteristics of digital subtraction angiography and the analysis of the therapeutic effect of interventional therapy on hemorrhage after partial nephrectomy].

Objective: To investigate the digital subtraction angiography (DSA) manifestations of hemorrhage after partial nephrectomy (PN) for renal tumors, and the safety and efficacy of interventional therapy. Methods: The clinical data, DSA images and interventional treatment of 15 patients undergoing emergency interventional therapy due to hemorrhage after PN in the Department of Interventional Therapy of Beijing University Cancer Hospital from January 2015 to January 2019 were retrospectively analyzed. The DSA manifestations, safety and prognosis of interventional therapy were summarized. Results: Among the 15 patients, 10 had abdominal hemorrhage, 2 had abdominal hemorrhage with hematuria, and 3 had hematuria, all of which occurred 6 hours to 7 days after the operation. The DSA manifestations included contrast medium overflow, local artery wall unevenness, local artery branch expansion, pseudoaneurysm formation and renal arteriovenous fistula. There were 14 survivors, followed up for 6-12 months, and further no bleeding occurred. The success rate of interventional therapy was 100% (14/14), and the success rate of hemostasis was 100% (14/14). One patient died of asphyxia due to intraoperative nausea and vomiting. The creatinine levels were (76.0±11.0), (80.0±9.0), (76.0±9.0) µmol/L before operation, 1 week after operation and 1 month after operation respectively. There was no significant difference in creatinine levels among the three groups (F=3.171, P=0.058). The levels of urea nitrogen before operation, 1 week after operation and 1 month after operation were (6.80±1.04), (7.13±0.89), (6.81±0.79) µmol/L respectively. There was significant difference among the three groups (F=4.322, P=0.024). The level of urea nitrogen at 1 month after operation was significantly lower than that at 1 week after operation (P=0.016), but there was no difference compared with that before operation (P=1.000). Conclusion: Contrast medium overflow, pseudoaneurysm formation and renal arteriovenous fistula were the main manifestations of DSA hemorrhage after PN. Interventional therapy was safe and effective and might be a priority in cases of hemorrhage after PN.

[The occurrence and clinical significance of contrast agent spillover on immediate enhanced CT reexamination after radiofrequency ablation of liver cancer].

Objective: To investigate the relationship between radiofrequency ablation immediately after enhanced CT scanning and the occurrence of contrast agent spillover and postoperative severe bleeding, and analyze the risk factors for hepatocellular carcinoma (HCC). Methods: A retrospective analysis of 199 patients with hepatocellular carcinoma who underwent radiofrequency ablation of liver cancer in our hospital from January 2016 to January 2017 was reviewed. A total of 232 cases were treated with ablation. The agent spillovers were divided into two groups, one for the contrast agent spill group and the other for the non-contrast agent spill group. Its basic clinical data, laboratory data related to the risk of bleeding, and imaging data were analyzed to explore their clinical treatment effects and the risk factors for their occurrence. According to different data, t-test, χ2 test or logistic regression test was used for statistical analysis. Results: In 199 patients, a total of 232 cases were treated with ablation, including 138 males and 61 females. The average age was (57.56 ± 12.09) years and the average diameter of lesions was (3.42 ± 2.30) cm. A total of 30 cases (12.93%) of contrast agent spillover occurred immediately after the ablation of CT scanning needle. There were no severe bleeding and no special clinical intervention after the operation. The other 202 cases were non- contrast agent spill group, but 2 cases had severe bleeding and had corresponding clinical interventions. Univariate analysis showed that there were statistically significant differences in thoracentesis (P = 0.019), complications of cirrhosis (P < 0.001), and histological types of liver cancer (P = 0.013), and other clinical data [age, lesion size]. There were no significant differences in Child-Pugh classification, preoperative hemoglobin (HGB), platelet count, prothrombin time, APTT, international standardized ratio, number of puncture needles, and puncture length. There was also no significant difference in postoperative HGB (P = 0.160), preoperative-postoperative HGB change (P = 0.999), and length of hospital stay (P = 0.730) between the two groups. Logistic regression analysis showed that with cirrhosis (OR = 5.59, P < 0.001), transthoracic puncture (OR = 2.67, P = 0.021) may be a risk factor for contrast agent spillover after CT-enhanced CT scan in patients with hepatocellular carcinoma. Conclusion: Contrast agent spillover is not uncommon in the evaluation of curative effect of CT immediately after ablation (12.93%). It is not predictive for the occurrence of postoperative severe bleeding and does not require excessive clinical intervention. Liver cirrhosis and transthoracic cavity puncture may be the risk factors for its occurrence. The risk of severe postoperative bleeding should not be ignored for patients who have no contrast agent spills after surgery.

[The regulation of CD44 expression by new tumor suppressor gene Arid2 and the influence of Arid2 on the invasion and metastasis in hepatocellular carcinoma cells].

OBJECTIVE: To investigate the effect of a new tumor-suppressor gene Arid2 on the expression level of CD44 and the mechanism that Arid2 regulates the invasion and metastasis in human hepatocellular carcinoma cells HepG2 and Huh7. METHODS: Recombinant pGL3-CD44 reporter plasmids were transfected into hepatoma cell lines HepG2 and Huh7 cells infected with adenovirus Arid2(Ad-Arid2). Dual luciferase assays were used to determine the relative luciferase activities of reporter plasmids. Western blot technique was used to detect the influence of Arid2 on the expression of transmembrane glycoprotein CD44. Cell migration assays of tumor cells were employed to observe the impact of overexpression of Arid2 on the invasion and metastasis abilities of tumor cells. The sizes of transplanted tumors were recorded to observe the growth of subcutaneous transplanted tumors in nude mice. Statistical significance was analyzed by one-way ANOVA for multiple comparisons, and independent-samples t-test was utilized to compare two groups. RESULTS: Luciferase assay showed cells were transfected with different length of CD44 reporter plasmids, and their relative luciferase activities were improved to different degrees, compared with pGL3-Basic control. Meanwhile, the mean luciferase activities of pGL3-CD44 -791~+224bp reporter plasmids were significantly repressed by the overexpression of Arid2 which inhibition rates were up to 73.83%±0.92%(P< 0.05, HepG2) or 48.99%±1.37% (P <0.05, Huh7), compared with Ad-GFP control. Western blot results showed that CD44 protein expression was obviously decreased by overexpression of Arid2. Cell migration assays confirmed that the invasion and metastasis abilities were inhibited by increasing Arid2 expression in Human HepG2 or Huh7 cells, which inhibition rates were 66.95%±0.59%(P< 0.05)in HepG2 cells and 73.86%±0.49%(P< 0.05) in Huh7 cells respectively. The animal experiment results indicated that Arid2 could obviously delay or restrict the subcutaneous transplanted tumors growth in nude mice, which was declined by 98.57%±0.34%(P< 0.05). CONCLUSION: CD44 promoter activities and protein expressions were significantly down-regulated by Arid2 in vitro. The growth and metastasis of tumors were obviously restrained in the hepatocellular carcinoma cells and nude models. In brief, these researches indicate CD44 may play important roles in the process where the invasion and metastasis of hepatocellular carcinoma cells are under the control of Arid2.The studies introduce and evaluate the relationships between Arid2 and CD44, and further provide a new research direction with the occurrence and development of hepatocellular carcinoma.

Smooth muscle tumors of the gastrointestinal tract. Expression of ras P21 oncogene product and the association with clinicopathology.

Quantitative analysis of ras oncogene product P21 was performed on paraffin blocks from 55 smooth muscle tumors of the gastrointestinal tract by immunofluorescence and flow cytometry. No positive evidence for P21 was found in 5 cases of normal smooth muscle tissues. Eight of 14 leiomyomas were P21 positive (57%) but all of them were lower expressed with fluorescence index (FI) < 1.25, whereas a total of 29 leiomyosarcomas and 12 potential malignant smooth muscle tumors were found to be P21 positive (100%), and the majority were overexpressed with FI > 1.25 (P < 0.005). ras P21 was overexpressed significantly in the tumors with mitotic counts of more than 1/10 high power field (P < 0.005). It was also overexpressed significantly as soon as the mild cytologic atypia of the tumor was found (P < 0.005). Five-year survival rate was significantly higher in the patients with lower-expression of ras P21 than those with overexpression (P < 0.005). It was suggested that the expression of ras oncogene product P21 could be used as an objective parameter in distinguishing malignants from benigns and predicting the prognosis of the patients with smooth muscle tumors of the gastrointestinal tract.