Application of arterial infusion ports in hepatic arterial infusion chemotherapy and embolization for advanced hepatocellular carcinoma.

OBJECTIVES: To investigate the safety and feasibility of subcutaneous implantable infusion ports in repeated hepatic arterial infusion chemotherapy (HAIC) for advanced hepatocellular carcinoma (HCC) in China. METHODS: A total of 237 patients who were clinically diagnosed with advanced HCC (CNLC III a/III b) in our hospitals from December 2020 to October 2022 were retrospectively analyzed. The approaches of HAIC were divided into 2 groups: arterial infusion port implantation (group A) and one-time femoral artery catheterization (group B) based on the physicians' suggestion and the patients' intention. The comfort level (evaluated with the General Comfort Questionnaire), complications and average inpatient expenditure were compared between the 2 groups. RESULTS: 116 patients were finally enrolled in the study (group A: 69; group B: 47) and completed HAIC (FOLFOX-4 regimen) according to the dosing schedules (mean: 6±1 cycles). The comfort level of group A was greater than that of group B (p<0.05). The average inpatient expenditure of group A was lower than that of group B (5.4±2.4 vs 10.4±1.9 thousand yuan RMB/cycle, p<0.05). No patients developed port incision infection, hematoma or catheter-related thrombosis in group A, whereas four patients had groin hematomas, one had femoral artery dissection and four had deep vein thrombosis in group B. CONCLUSION: Hepatic arterial infusion chemotherapy via arterial infusion ports for advanced HCC decreased complications and medical expenditures and improved patient comfort levels compared with indwelling catheters.

Preliminary application of three-dimensional venography and fusion navigation technique in May-Thurner syndrome.

OBJECTIVE: The purpose of this study was to report a technique for intraprocedural guidance of endovascular iliac vein stenting procedures using three-dimensional (3D) venography images as an overlay on live biplanar fluoroscopy. METHODS: Using 3D venography and a fusion navigation technique, percutaneous transluminal angioplasty and stent placement were performed to evaluate the feasibility of using 3D venography images and the fusion navigation technique to treat MTS compared with traditional digital subtraction angiography. The general epidemiologic data (ie, age, gender), clinical manifestations (ie, major symptoms, affected extremity, CEAP [clinical, etiology, anatomy, pathophysiology] classification, comorbidity, stenosis rate), intraoperative findings (ie, stent type, stent count, stent to inferior vena cava distance, procedure time, radiation dose, contrast agent dosage), and postoperative recovery were obtained and analyzed. RESULTS: A total of 30 consecutive patients with symptomatic MTS from our institution were enrolled in the present study. Of the 30 patients, 12 (group A) were treated using 3D venography images and fusion navigation and 18 (group B) were treated with two-dimensional venography images during endovascular management. Significant differences were observed between the two groups with respect to the procedure time (64.42 ± 4.35 minutes vs 76.61 ± 3.47 minutes; P = .04), radiation dose (2152 ± 124.7 mGy vs 2561 ± 105.6 mGy; P = .02), and contrast agent dosage (71.42 ± 4.87 mL vs 86.17 ± 4.14 mL; P = .03). CONCLUSIONS: 3D venography and its fusion navigation technique can improve prediction of the coverage area of the stent. Its use can also shorten the procedure time and reduce the contrast agent dose and radiation exposure, making it a valuable tool for both the diagnosis and the treatment of symptomatic MTS.

Exploration of risk factors for hemoglobinuria and acute kidney injury following iliofemoral venous mechanical thrombectomy.

Objective: To evaluate the risk factors for hemoglobinuria and acute kidney injury (AKI) after percutaneous mechanical thrombectomy (MT) with or without catheter-directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (IFDVT). Methods: Patients with IFDVT who had MT with the AngioJet catheter (group A), MT plus CDT (group B), or CDT alone (group C) from January 2016 to March 2020 were retrospectively evaluated. Hemoglobinuria was monitored throughout the treatment course, and postoperative AKI was assessed by comparing the preoperative (baseline) and postoperative serum creatinine (sCr) levels from the electronic medical records of all patients. AKI was defined as an elevation in the sCr level exceeding 26.5 â€‹µmol/L within 72 â€‹h after the operation according to the Kidney Disease Improving Global Outcomes criteria. Results: A total of 493 consecutive patients with IFDVT were reviewed, of which 382 (mean age, 56 â€‹± â€‹11 years; 41% of them were females; 97 in group A, 128 in group B, and 157 in group C) were finally analyzed. Macroscopic hemoglobinuria was evident in 44.89% of the patients of the MT groups (101/225, 39 in group A, and 62 in group B), with no significant difference between the groups (P â€‹= â€‹0.219), but not in the patients in group C. None of the patients developed AKI (mean sCr difference -2.76 â€‹± â€‹13.80 â€‹µmol/L, range â€‹= â€‹-80.20 to 20.60 â€‹µmol/L) within 72 â€‹h after surgery. Conclusions: Rheolytic MT is an independent risk factor for hemoglobinuria. A proper aspiration strategy, hydration, and alkalization following thrombectomy are particularly favorable for preventing AKI.

Irradiation stent insertion for distal biliary obstruction secondary to primary common biliary cancer.

PURPOSE: To assess the effectiveness and safety of irradiation stent insertion for patients with distal biliary obstruction (DBO) secondary to primary common biliary cancer. MATERIAL AND METHODS: Eighty-two consecutive patients with DBO secondary to primary common biliary cancer were treated via either normal (n = 45) or irradiation stenting (n = 37) between January 2013 and December 2019. The instant and long-term outcomes were compared. RESULTS: Technical success rates of normal and irradiation stenting were both 100%. Clinical success rates of normal and irradiation stenting were 91.1 and 100%, respectively (p = .179). Stent reobstruction was observed in 13 and 7 patients in the normal and irradiation stenting groups, respectively (p = .295). The median stent patency was 162 and 225 days in the normal and irradiation stenting groups, respectively (p < .001). The median survival was 178 and 250 days in the normal and irradiation stenting groups, respectively (p < .001). Cholangitis was, respectively, observed in 8 and 12 patients in normal and irradiation stenting groups (p = .124). CONCLUSION: Irradiation stenting is effective and safe for patients with DBO secondary to primary common biliary cancer and can prolong stent patency and survival.

Endoscopic metal stenting for malignant hilar biliary obstruction: an update meta-analysis of unilateral versus bilateral stenting.

INTRODUCTION: Malignant hilar biliary obstruction (MHBO) can arise in patients with malignant hilar hepatobiliary tumors or lymph nodules. Most MHBO patients are not suitable for surgical resection due to the advanced tumor stage. The only palliative treatment available is provided by endoscopic or percutaneous stenting. AIM: To compare the efficacy of endoscopic unilateral versus bilateral metal stent insertion for treating MHBO. MATERIAL AND METHODS: A search of the PubMed, Embase, and Cochrane Library databases identified all relevant studies published until June 2020. The meta-analysis was undertaken using RevMan v5.3. RESULTS: We identified 154 studies initially, eight of which were used in our meta-analysis. The eight studies included 818 MHBO patients treated using either endoscopic unilateral (n = 396) or bilateral (n = 422) metal stenting. No significant differences were observed between the two groups in clinical success rate (OR = 2.64; p = 0.18), complication rate (OR = 0.63; p = 0.46), or OS (HR = 1.03; p = 0.53). The bilateral group had a lower stent dysfunction rate without significance (OR = 1.43; p = 0.09). Significantly longer stent patency was observed in the bilateral group (HR = 1.28; p = 0.01). Technical success rate was significantly higher in the unilateral group (OR = 0.26; p = 0.04). Funnel plot analysis indicated an absence of publication bias related to the selected study endpoints. CONCLUSIONS: Our meta-analysis indicated that endoscopic unilateral stenting had a greater technical success rate for MHBO patients than bilateral stenting. However, the bilateral stenting could achieve longer stent patency.

Ethanol extract of Acanthopanax senticosus (Rupr. & Maxim.) Harms induces liver cancer cell apoptosis through inhibiting NF-κB.

BACKGROUND: Acanthopanax senticosus (Rupr. & Maxim.) Harms, a traditional Chinese medicine, has been used to treat various diseases, including ischemic, heart diseases, hepatocellular carcinoma (HCC), hypertension and neurasthenia. The purpose of this study was to investigate the anticancer activity of A. senticosus (ASE). MATERIALS: MTT assay, clonogenicity, reverse transcription-polymerase chain reaction (RT-PCR), flow cytometry and Western blot were employed to evaluate the viability and invasion of liver cancer cells. In addition, luciferase assay was used to delineate the inhibitory activity of ethanol extract against NF-κB. RESULTS: Our results showed that the ethanol extract of ASE could decrease the viability of cancer cells. In addition, the ethanol extract could decrease the protein levels of Matrix metalloproteinase-2 (MMP-2), MMP-9, t-protein kinase B (Akt) and p-Akt, but increase those of E-cadherin. Nuclear factor kappa beta (NF-κB)-Luciferase assay showed the ethanol extract could effectively inhibit the activity of NF-κB. Furthermore, fourteen compounds including seven active compounds were isolated and activities against NF-κB were investigated. CONCLUSIONS: This study confirmed that the ASE could be as an alternative or complementary therapy to treat liver cancer.

Retraction: Ethanol extract of Acanthopanax senticosus (Rupr. & Maxim.) Harms induces liver cancer cell apoptosis through inhibiting NF-κB.

[This retracts the article DOI: 10.21037/tcr.2020.01.02.].

Overwork Death of Chinese Physicians under High-Intensity Pressure, 2007-2018.

BACKGROUND: To summarize the cases of physicians overwork death between Jan 2007 and Dec 2018, the tragedy merits the attention of the authorities and policy-makers to increase their efforts to reduce death among physicians in China. METHODS: Data were extracted from medical databases, local mass media, official documents and medical Bulletin Board System (BBS), in which only included articles, reports and news listed in the retrieval strategy, and unpublished data were excluded. RESULTS: Overall, 110 cases (7 females and 103 males) were enrolled in this study. Most incidents have occurred since 2012, especially in 2017. Of these, 86 (78.18%) physicians worked in public tertiary hospitals, four times more than the number of cases taking place in secondary hospitals. Additionally, overwork death was the most common in surgery-related departments that account for up to 65 (59.1%). Notably, these events, taking place in first-tier cities and the southeastern coastal areas of China, included 27 chief physicians, 31 associate of chief physicians, 21 attending physicians, 10 resident physicians and 4 standardized training physicians. CONCLUSION: Overwork death among Chinese physicians is not only a contemporary health problem but also a critical social issue. The laws and regulations should be perfected to prevent the events. Meanwhile, the public should be aware of the need for more understanding and trust in physicians in China.

Ventricular fibrillation in congenitally corrected transposition of great arteries treated with pacing: a case report.

BACKGROUND: Congenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease which may present with sudden death from malignant arrhythmias including complete heart block and ventricular tachyarrhythmias as late complications. Only few cases about ventricular tachyarrhythmias, usually in those with markedly depressed systemic ventricular function, have been reported. CASE SUMMARY: A 26-year-old woman with a known history of CCTGA presented to the emergency department with palpitations and breathlessness for 3-4 weeks and worsening symptoms for 8 h. She had a history of ventricular septal defect repair 14 years ago. Her initial presentation electrocardiogram demonstrated high degree atrioventricular block with a ventricular rate of 44 b.p.m. She had two episodes of complete syncope during this hospitalization, both required external defibrillation due to documented bradycardia-dependent ventricular fibrillations. Her two-dimensional echocardiography study confirmed the diagnosis of CCTGA with preserved systolic ventricular function. She underwent urgent temporal pacing wire placement with a paced ventricular rate at 90 b.p.m. Having thoroughly reviewed the arrhythmia events and discussed with the patient about the option of defibrillator vs. pacemaker therapy a decision was made upon her request for dual-chamber pacemaker implantation. She was discharged home uneventfully 3 days after hospital presentation and has been physically active at 3-, 6-, and 9-month follow-ups. DISCUSSION: Our case illustrates the individualized clinical decision making in choosing device therapy for a rare congenital heart disease presented with malignant arrhythmia. Careful history taking, open communication, and closely planned long-term follow-up will be essential in caring for such patients.

MicroRNA-187 inhibits tumor growth and metastasis via targeting of IGF-1R in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the primary and most frequently occurring type of malignant liver cancer, accounting for 70-85% of total liver cancer cases worldwide. It has previously been demonstrated that the aberrant expression of microRNAs (miR) contributes to carcinogenesis and progression of various human malignancies, including HCC. However, mechanisms underlying the differential expression and specific roles of miR­187 in HCC remain to be elucidated, particularly regarding how the modulation of malignant phenotypes in HCC cells occurs. The present study demonstrated that miR­187 was significantly downregulated in HCC tissues and cell lines. Restoration of miR­187 expression inhibited cell proliferation, migration and invasion in HCC. Furthermore, insulin­like growth factor 1 receptor (IGF­1R) was demonstrated to act as a direct target gene of miR­187 in HCC. IGF­1R knockdown mimicked the effects of miR­187 overexpression in HCC, resulting in a significant inhibition of cell proliferation, migration and invasion. The results of the present study demonstrated that miR­187 acted as a tumor suppressor in HCC progression via direct targeting of IGF­1R. miR­187 may therefore exhibit the potential to act as a novel and therapeutic target for HCC treatment in the future.

Precision cardio-oncology: understanding the cardiotoxicity of cancer therapy.

Current oncologic treatments have brought a strong reduction in mortality in cancer patients. However, the cancer therapy-related cardiovascular complications, in particular chemo-therapy and radiation therapy-induced cardiotoxicities are a major cause of morbidity and mortality in people living with or surviving cancer. The simple fact is that all antineoplastic agents and radiation therapy target tumor cells but also result in collateral damage to other tissues including the cardiovascular system. The commonly used anthracycline chemotherapy agents can induce cardiomyopathy and congestive heart failure. Targeted therapies with human epidermal growth factor antibodies, tyrosine kinase inhibitors or vascular endothelial growth factor antibodies, and the antimetabolites also have shown to induce cardiomyopathy and myocardial ischemia. Cardiac arrhythmias and hypertension have been well described with the use of tyrosine kinase inhibitors and antimicrotubule agents. Pericarditis can happen with the use of cyclophosphamide or cytarabine. Mediastinal radiation can cause constrictive pericarditis, myocardial fibrosis, valvular lesions, and coronary artery disease. Despite significant progresses in the understanding of the molecular and pathophysiologic mechanisms behind the cardiovascular toxicity of cancer therapy, there is still lack of evidence-based approach for the monitoring and management of patients. This review will focus mainly on the recent advances in the molecular mechanisms of cardiotoxicity related to common cancer therapies while introducing the concept of cardio-oncology service. Applying the general principles of multi-disciplinary approaches toward the diagnosis, prevention, monitoring, and treatment of cancer therapy-induced cardiomyopathy and heart failure will also be discussed.

Osteoprotegerin is associated with depletion of circulating endothelial progenitor cells and elevation in pulmonary arterial pressure in patients with systolic heart failure.

OBJECTIVE: Osteoprotegerin (OPG) may predict progression of chronic congestive heart failure (CHF) with increased mortality and play an important role in the development of pulmonary arterial hypertension (PAH). Mounting evidence suggests that PAH developed during CHF is not solely caused by a "passive" increase from the left ventricular enddiastolic pressure, but rather a "reactive" response from contributing lung endothelial dysfunction and vascular remodelling, a pathological process that can be significantly influenced by endothelial progenitor cells (EPCs).This study aims to examine whether circulating EPCs from patients with CHF are affected and if OPG could be implicated during disease progression. METHODS: In this study EPCs were isolated, cultured, and quantified from patients of CHF with (n = 20) or without PAH (n=40) as measured by right heart catheterization. Serum levels of OPG and N-terminal pro-brain natriuretic peptide (NT-pro BNP) were analysed and correlated with EPCs. RESULTS: A significant decrease in circulating EPCs (39.3 ?9.1 vs 67.1 ?10.5 EPCs/x200 field; P <0.05) was found in CHF patients who developed PAH compared to those without PAH. Both OPG (551.90 +/- 49.83 vs. 312.29 +/- 31.12 pg/ml; P<0.05) and NT-pro BNP (2,946.50 +/- 1,434.50 vs. 1,328.20 +/- 811.90; P < 0.05) were also significantly elevated in CHF patients with PA H. Circulating level of OPG correlated inversely with EPCs (r = -0.45, P = 0.037) but positively with mPAP (r =0.53, P=0.011). CONCLUSIONS: Our study demonstrates that OPG elevation and EPC depletion are associated with CHF patients who have developed PAH. The inverse relationship of circulating OPG with EPCs suggests a possible mechanism for OPG in the development of pulmonary vascular dysfunction, thus worsening prognosis for CHF patients.