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Objective To explore the value of dynamic nomogram constructed by multi spiral computed tomography(MSCT)features combined with inflammatory indicators in predicting the status of microvascular invasion(MVI)of hepatocellular carcinoma(HCC)before surgery.Methods The clinical and imaging data of 137 patients with postoperative pathologically confirmed HCC were analyzed retrospectively.According to the status of the MVI,they were divided into positive group(44 cases)and negative group(93 cases).Multivariate logistic regression analysis was used to screen independent risk factors for predicting the MVI status of HCC patients,and a joint prediction model was constructed,which was displayed in the form of a dynamic nomogram.The receiver operating characteristic(ROC)curve,calibration curve and Hosmer-Lemeshow test were used to evaluate the diagnostic efficiency,calibration and goodness of fit of the model,Akaike information criterion(AIC)and Bayesian information criterion(BIC)were used for comparison between the models,and a 5-fold cross-validation and decision curve analysis(DCA)were also used to evaluate the stability and clinical applicability of the model.Results Multivariate logistic regression analysis showed that necrosis and delayed-phase enhancement(DEd),and alkaline phosphatase to lymphocyte ratio(ALR)were independent risk factors for predicting MVI status in HCC patients.The area under the curve(AUC)of the dynamic nomogram was 0.721,with the sensitivity of 0.705 and the specificity of 0.656.The AIC and BIC values were 152.372 and 158.212,respectively.The calibration curve and the Hosmer-Lemeshow test showed that the model had a high degree of calibration and goodness of fit(χ2=2.372,P=0.967),the average AUC of the 5-fold cross-validation was 0.787,and the DCA showed that the nomogram model had a good clinical applicability.Conclusion The dynamic nomogram model constructed by MSCT features combined with inflammatory indicators is feasible to predict the MVI status of HCC patients before surgery,and the dynamic nomogram can directly generate the prediction results of different individuals.
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Objective To observe the value of drug-eluting bead TACE(D-TACE)combined with apatinib and camrelizumab for treating massive hepatocellular carcinoma(HCC).Methods Data of 35 patients with massive HCC who underwent D-TACE sequential apatinib and camrelizumab were retrospectively analyzed.The overall survival(OS)and progression free survival(PFS)were recorded,and the objective response rate(ORR),disease control rate(DCR)and treatment-related adverse event(TRAE)were evaluated.Results Combination treatment were all successfully performed in all 35 cases.At the last follow-up,the median PFS was 8.09 months,and the median OS was 20.00 months.One,3,6,and 12 months after treatments,ORR was 65.71%(23/35),71.43%(25/35),65.71%(23/35)and 60.71%(17/28),respectively,DCR was 94.29%(33/35),88.57%(31/35),80.00%(28/35)and 67.86%(19/28),respectively.TRAE of combination treatment mainly ranged from grade 1 to 2,and all relieved after symptomatic treatments.Conclusion D-TACE combined with apatinib and camrelizumab was effective and safe for treating massive HCC,with controllable adverse reactions.
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Objective:To observe and analyze the effect of peripore cavity size on visual function of macular area before and after surgery for idiopathic macular hole (IMH).Methods:A retrospective clinical study. From July 2020 to February 2021, a total of 25 patients with 25 eyes with monocular IMH (operation group) diagnosed by ophthalmology examination in Department of ophthalmology, Fourth Hospital of Hebei Medical University were included in the study. The control group was contralateral healthy eyes. All subjects were examined by best corrected visual acuity (BCVA), microfield of vision, frequency domain optical coherence tomography (SD-OCT), and OCT angiography (OCTA). The diameter of macular hole was measured by SD-OCT. The cystic morphology of deep capillary plexus (DCP) was detected by en face OCT, and the cystic area was measured by Image J software. MP-3 microperimeter was used to measure central macular retinal light sensitivity (MS) and mean macular retinal light sensitivity (MMS). Central macular retinal light sensitivity (CMS), MMS and cystic cavity MS were measured in the operation group. MMS was measured in the control group. The microperimetry images were superimposed on the DCP layer of OCTA to identify and calculate the average MS within the lumen and compare it with the control group. Standard three incisions were performed in all affected eyes by vitrectomy of the flat part of the ciliary body + stripping of the inner boundary membrane + intraocular sterile air filling. Three months after the operation, the same equipment and methods were used to perform relevant examinations. Paired sample t test was used to compare MS between operation group and control group. Pearson correlation analysis was used to analyze the correlation between capsular area, macular hole diameter before and after operation and MS before and after operation. The correlation between BCVA and capsular area before and after surgery was analyzed by Spearman correlation analysis. Results:In the surgical group, the retinal MS was (4.24±3.07) dB. The MMS of control group was (19.08±6.11) dB. The MS in the surgical group was significantly lower than that in the control group, and the difference was statistically significant ( t=10.832, P<0.01). Before operation, the area of cyst was (1.04±0.55) mm 2, and the diameter of macular hole was (564.80±166.59) μm. CMS and MMS were (2.27±2.29) dB and (9.08±3.65) dB, respectively. The diameter of macular hole ( r=0.50, P=0.010) and BCVA before operation ( r=0.57, P<0.001) were positively correlated with peripore cavity area. Before operation, CMS and MMS were negatively correlated with peripore cavity area ( r=-0.53, -0.47; P=0.010, 0.020). At 3 months after surgery, the capsular area was negatively correlated with CMS and MMS ( r=-0.65,-0.76; P=0.020, 0.030). There was no correlation with BCVA ( r=0.23, P=0.470). Conclusions:Retinal MS is decreased in the peri-capsular area of IMH pore. There is a positive correlation between capsule area, BCVA and macular hole diameter before operation. The capsular area is negatively correlated with CMS and MMS before operation.
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Methods:From Jan 2019 to Nov 2021, 20 patients underwent 3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique and branched stents for the EVAR at the three hospitals. The clinical data patients were collected and analyzed.Results:All the 20 cases underwent 3D printed template assisted pre-fenestration of stent graft according to the data of pre-operative the computed tomographic angiography (CTA). EVAR was successfully performed in all patients(included 2 cases with one fenestration,5 cases with 2 fenestration,10 cases with 3 fenestration and 3 cases with 4 fenestration). Fifty-four reinforced fenestrations (20 in right renal artery, 18 in left renal artery, 13 in superior mesenteric artery and 3 in celiac artery) were performed. During the follow-up period (mean 14.6 months), 1 case died, and the one-stage patency rate of splanchnic artery branch stent was 98.1%. Four patients had endoleak, 1 patient died of intracranial hemorrhage during postoperative period. None of patients had postoperative paraplegia or organ ischemia.Conclusions:3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique is feasible for EVAR in the treatment of complex abdominal aortic aneurysms and dissections. The technique is capable to reinforce the blood supply of visceral arteries with satisfied short-term effectiveness.Ojective:To evaluate 3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique and branched stents for the endovascular aortic aneurysm repair (EVAR).
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ObjectiveTo investigate the efficacy and safety of 125I intraluminal irradiation combined with lenvatinib in the treatment of progressive extrahepatic cholangiocarcinoma. MethodsA retrospective analysis was performed for 25 patients with progressive extrahepatic cholangiocarcinoma who attended Department of Interventional Radiology， The First Affiliated Hospital of Zhengzhou University， from January 2018 to November 2021， and according to the treatment modality， they were divided into combination group with 13 patients （125I intraluminal irradiation combined with lenvatinib） and control group （125I intraluminal irradiation alone）. The two groups were compared in terms of technical success rates， changes in liver function， stent patency， survival time， and incidence rates of adverse events. The independent－samples t test was used for comparison of normally distributed continuous data between two groups， and the Wilcoxon rank－sum test was used for comparison of continuous data with skewed distribution between two groups； the Fisher’s exact test was used for comparison of categorical data between groups. The Kaplan－Meier method and the log－rank test were used to evaluate survival time and stent patency. ResultsAll patients had successful implantation of biliary stents and 125I particles， with a technical success rate of 100%. After 1 month of treatment， both groups had significant improvements in the serum levels of total bilirubin， direct bilirubin， alanine aminotransferase， and aspartate aminotransferase （all P<0.05）. There were significant differences between the control group and the combination group in the duration of stent patency （7.0 months vs 9.5 months， P=0.022） and median survival time （11.5 months vs 15.6 months， P=0.008）. There were no intolerable adverse events in the combination group during treatment. ConclusionCompared with 125I intraluminal irradiation alone， 125I intraluminal irradiation combined with lenvatinib has better efficacy and is a safe and effective treatment regimen for progressive extrahepatic cholangiocarcinoma.
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Objective To investigate the effects of N-acetyl-D-glucosamine(GlcNAc)on acute pancreatitis in rats.Methods Twenty male SD rats were randomly divided into a control group,AP group,low GlcNAc + AP group and high GlcNAc + AP group,with five rats in each group.Acute pancreatitis was induced in AP group,low GlcNAc + AP group and high GlcNAc + AP group by two intraperitoneal injections of 2.5 g/kg L-arginine with a 1 hour interval.Among them,low GlcNAc + AP group and high GlcNAc + AP group were administered 50 and 200 mg/kg GlcNAc,respectively,by intraperitoneal injection at 24 hours before the first intraperitoneal injection of L-arginine.Group control and AP were intraperitoneally injected with the same volume of normal saline.After 24 h,the rats were sacrificed,and serum and pancreatic tissues were collected.Pancreatic tissue morphology was observed by HE staining,and serum levels of amylase(AMY),lipase(LPS),interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),superoxide dismutase(SOD)and malondialdehyde(MDA)were measured by enzyme-linked immunosorbent assay.Protein expression of nuclear factor E2-related factor 2(NRF2),heme oxygenase-1(HO-1),and peroxisome proliferator-activated receptor-γ(PPAR-γ)in pancreatic tissue was detected by Western Blot.Cluster of differentiation(CD)86,CD206 and macrophage markers(F4/80)were detected by immunofluorescence.Expression of CD86 and CD206 in pancreatic tissue was detected by immunohistochemistry.Results(1)Compared with control group,AMY,LPS,IL-1β,IL-6,TNF-α,and MDA levels and pancreatic CD86 expression in AP group were significantly increased(P<0.05),while SOD activity,protein expression levels of NRF2,HO-1,and PPAR-γ,and pancreatic CD206 expression were significantly decreased(P<0.05).(2)Compared with AP group,serum IL-1β,IL-6,TNF-α,MDA,and LPS and the pancreatic CD86 expression in low GlcNAc + AP group were significantly decreased(P<0.05).The PPAR-γ protein level in the pancreas was significantly increased(P<0.05).(3)Compared with AP group,serum AMY,LPS,IL-1β,IL-6,TNF-α,and MDA and pancreatic CD86 expression in high GlcNAc + AP group were significantly decreased(P<0.05),while serum SOD,and NRF2,HO-1,PPAR-γ,and pancreatic CD206 expression were significantly increased(P<0.05).(4)Compared with low GlcNAc + AP group,serum LPS,IL-1β and IL-6 in high GlcNAc + AP group were significantly decreased(P<0.05).Pancreatic expression of HO-1,PPAR-γ,and pancreatic CD206 were significantly increased(P<0.05).Conclusion GlcNAc treatment attenuates acute pancreatitis injury in AP rats,possibly by activating the NRF2/HO-1 signaling pathway to inhibit oxidative stress and promoting M2 macrophage polarization to attenuate pancreatic injury in AP rats.
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Objective:To evaluate the efficacy and safety of a novel domestic pulmonary thromoboectomy system Tendvia TM in the treatment for high-risk patients complicated with acute pulmonary embolization (APE). Methods:The study was designed as a prospective single-center clinical trial. Twenty-four high-risk patients with APE were recruited and underwent percutaneous mechanical thromoectomy (PMT) with the Tendvia TM pulmonary thromoboectomy system. The primary efficacy endpoint was the reduction of RV/LV ratio at the post-operative 48 h. The secondary efficacy endpoints included technical success rate, mean pulmonary arterial pressure (mPAP), arterial PaO 2 and the instant post-operative thrombus clearance rate. The evaluation of the safety included the intraoperative complications and related complications during the follow-up period associated with the PMT operation and the major adverse event (MAE) rate within the post-operative 48 h. The pre-and post-operative data were compared with paired sample t-test or Wilcoxon rank sum test to evaluate the efficacy and safety of Tendvia TM pulmonary thromoboectomy system. Results:The technical success rate of PMT with Tendvia TM pulmonary thromoboectomy system was 100% (24/24). The 48 h pre-operative RV/LV ratio was 1.19±0.25 and the post-operative RV/LV ratio was 0.82±0.16. The mean RV/LV ratio of the patients was decreased by 0.37±0.25 at post-operative 48 h with significant statistical difference ( t=7.03, P<0.001). The 48 h pre-operative mPAP was (31.09±6.09) mmHg and the post-operative mPAP was (25.91±4.36) mmHg. The mPAP of the patients was reduced by 5.18 mmHg at post-operative 48 h with significant statistical difference ( t=6.73, P<0.001). The pre-operative PaO 2 was (74.66±11.28) mmHg and the post-operative PaO 2 was (88.01±10.57) mmHg. The pressure of oxygen in artery was increased by 13.36 mmHg. The differences were statistically significant( t=-4.08, P<0.001). The rate of thrombus removal was 68.17%±22.66%. 87.5% (21 cases) of patients achieved a thrombus removal greater than grade Ⅱ. One patient underwent catheter directed thrombolysis (CDT) after PMT based on the evaluation of operator. The patient′s thrombus removal achieved grade Ⅲ after 48 h and the CDT was ceased. Hemoptysis occurred intra-operatively in one case underwent PMT and the symptom of the patient was alleviated with conservative medication. The MAE incidence within the post-operative 48 h was 4.17% (1/24). No device-related mortality or all-cause mortality occurred in the trial. Conclusions:The Tendvia TM pulmonary thromoboectomy system is a safe and effective device to remove the pulmonary arterial thrombus for the treatment of patients with APE. The Tendvia TM pulmonary thromoboectomy system can be a new choice in the treatment for the patients with APE.
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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.
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Objective:To investigate the effects of supplemental parenteral nutrition on postoperative nutritional status, immune function and inflammatory response in patients with esophageal cancer after operation.Methods:A prospective study was performed on 72 patients with esophageal cancer who visited the Department of Thoracic and Cardiovascular Surgery of the Affiliated Hospital of Putian University from June 2018 to June 2020. According to the random table of new drug data statistics and processing software, they were randomly divided into experimental group (supplementary parenteral nutrition group) and the control group (complete enteral nutrition group), with 36 cases in each group. The experimental group was given enteral nutrition (EN) from the first day after operation, and EN and parenteral nutrition (PN) was given on the 4th to 8th day after operation. In the control group, EN was started on the first day after operation. The changes of nutritional status, immune function and inflammatory indexes in the perioperative period were compared between the two groups. Mann-Whitney U test was used for measurement data that did not meet the normality standard, and t test was used to compare measurement data that met the normality standard between groups. Nutrition indicators, inflammatory indicators and immune indicators used repeated measures analysis of variance. For enumeration data, Mann-Whitney U test was used for hierarchical classification data, and χ 2 test was used for unordered multi-classification data. Results:On the 1st day after operation, the prealbumin concentration ((95.34±37.93) mg/L and (81.60±37.68) mg/L) in the experimental group and the control group was significantly higher than that before the operation ((144.86±46.79) mg/L and (130.39±50.91) mg/L), and the differences were statistically significant (all P<0.001), and there was no significant difference between the two groups (all P>0.05). Immunoglobulin (Ig) A ((0.48±0.39) g/L and (0.41±0.30) g/L), IgG ((4.21±3.44) g/L and (4.08±2.98) g/L), IgM( (0.32±0.26) g/L and (0.30±0.27) g/L) in the experimental group and the control group were compared with preoperative ((0.55±0.45) g/L and (0.47±0.39) g/L, (5.16±3.36) g/L and (5.48±3.30) g/L, (0.38±0.32) g/L and (0.35±0.30) g/L), and the difference was not statistically significant (all P>0.05), and there was no significant difference between the two groups (all P>0.05). In the experimental group and the control group, CD3 ((31.75±11.81) % and (28.03±9.30)%) were lower than those before operation ((40.86±12.50)% and (42.31±8.09)%), CD4 ((14.19±5.39)% and (16.06±9.08)%) were lower than those before operation ((21.69±8.54)% and (24.11±12.09)%), CD4/CD8 ((0.24±0.09) and (0.29±0.18)) were lower than those before operation ((0.42±0.16) and (0.50±0.28)), and CD8 ((59.03±8.14)% and (56.39±7.42)%) were lower than those before operation ((51.25±6.64)% and (49.14±6.53)%), the differences were statistically significant (all P<0.05). There was no significant difference in C3, C4 and C reactive protein (CRP) compared with preoperatively (all P>0.05), and there was no significant difference between the two groups (all P>0.05). On the 7th day after operation, the prealbumin concentration ((186.70±40.88) mg/L) in the experimental group was higher than that before operation and on the 1st day after operation, and the difference was statistically significant (all P<0.05), which was higher than that in the control group ((131.62±53.37) mg/L), the difference was statistically significant (all P<0.05); the prealbumin concentration in the control group ((131.62±53.37) mg/L) was higher than that on the 1st day after operation, and the difference was statistically significant (all P<0.05). IgA ((0.88±0.42) g/L), IgG ((10.70±4.39) g/L) in the experimental group was higher than that before operation, and the difference was statistically significant (all P<0.05), and it was higher than that on the 1st day after operation, and the difference was statistically significant (all P<0.05), lower than those in the control group ((0.59±0.44) g/L and (4.08±2.98) g/L), the difference was statistically significant (all P<0.05). In the test group, CD3 ((45.92±14.31)%), CD4 ((27.06±10.53)%), CD4/CD8 (0.66±0.33) increased and and CD8 (43.64±11.34%) decreased compared with the first day after operation, with statistically significant differences (all P<0.05). The elevated levels of CD4 and CD4/CD8 were statistically significant compared with the control group (all P<0.05). The CRP ((8.90±7.56) mg/L) in the experimental group on the 7th postoperative day was lower than that before operation and on the 1st postoperative day, and the difference was statistically significant (all P<0.05), which was lower than the control group ((16.24±13.53) mg/L), the difference was statistically significant (all P<0.05). The incidence of postoperative pulmonary infection (22.22% (8/36)), the incidence of anastomotic leakage (5.56% (2/36)), and the postoperative hospital stay ((14.17±4.79) d) in the experimental group were lower than those in the control group (44.44% (16/36), 25.00% (9/36), (18.47±6.34) d), the total hospitalization expenses in the experimental group ((71 261.94±11 503.50) yuan) were higher than those in the control group ((65 226.81±10 106.43) yuan), the difference was statistically significant (the statistical values were χ 2=4.00, χ 2=5.26, t=3.74, t=2.37; P values were 0.046, 0.022, <0.001 and 0.021, respectively). Conclusion:Supplemental parenteral nutrition for perioperative esophageal cancer patients can effectively maintain nutritional status, improve immune function, and reduce the inflammatory stress response.
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Objective:To investigate the clinical value of transjugular liver biopsy (TJLB) in patients with unexplained liver disease complicated with massive ascites or coagulopathy.Methods:A retrospective analysis was performed from patients underwent TJLB in the First Affiliated Hospital of Zhengzhou University, Zhoukou Central Hospital, Shangqiu First People's Hospital and Jincheng People's Hospital from March 2015 to January 2022 due to unexplained liver disease complicated with massive ascites or coagulopathy. A total of 37 patients were included, including 21 males and 16 females, aged (53.5±11.9) years. According to different puncture points, the patients were divided into two groups: transhepatic right vein TJBL and transhepatic middle vein TJBL. The obtained liver tissue sampling effect, puncture times, complications were analyzed.Results:The success rate of TJLB was 97.3%(36/37). Thirty-six patients were able to obtain more than three segments of liver tissue and obtain histological diagnosis, and the pathological diagnosis rate was 100.0%(36/36). The number of puncture times, the amount of hepatic tissue and the number of portal areas in the right hepatic vein group (21 cases) were (3.7±0.9), (3.7±0.7) and (6.5±0.9) respectively, and those in the middle hepatic vein group (15 cases) were (3.7±0.7), (3.7±0.7) and (6.3±0.8) respectively. There were no significant differences between the two groups (all P>0.05). Conclusion:TJLB is safe and feasible for patients with unexplained liver disease complicated with massive peritoneal effusion and coagulopathy. Good liver tissue specimens can be obtained by TJLB from both right hepatic vein and middle hepatic vein.
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Objective:To observe the short-term efficacy and safety of bronchial arterial chemoembolization (BACE) combined with anlotinib for treatment of advanced non-small cell lung cancer (NSCLC).Methods:The clinical data of 14 patients with advanced NSCLC in the First Affiliated Hospital of Zhengzhou University from June 2018 to March 2019 were retrospectively analyzed. The short-term efficacy and adverse reactions of BACE combined with anlotinib hydrochloride were evaluated.Results:All patients successfully received BACE treatment twice. The median follow-up time was 19 months (8-26 months). The objective response rate (ORR) of patients at 1, 3 and 6 months after the first treatment was 100.0% (14/14), 71.4% (10/14) and 57.1% (8/14), and the disease control rate (DCR) was 100.0% (14/14), 92.8% (13/14) and 78.6% (11/14), respectively. The median progression-free survival (PFS) time was 9.5 months (95% CI 9.0-17.3 months), and the 6-month and 12-month PFS rates were 78.6% and 28.6%, respectively. The median overall survival (OS) time was 19.0 months (95% CI 18.4-23.1 months), and the 6-month and 12-month OS rates were 100.0% and 85.7%, respectively. Anlotinib hydrochloride-related adverse reactions included hand-foot syndrome [42.9% (6/14)], fatigue [35.7% (5/14)], hypertension [35.7% (5/14)], oral mucositis [28.6% (4/14)], hemoptysis [28.6% (4/14)], elevated aminotransferases [21.4% (3/14)] and diarrhea [14.3% (2/14)]. There were no grade ≥3 adverse reactions. Conclusion:BACE combined with anlotinib is safe and effective for treatment of advanced NSCLC, and the short-term clinical efficacy is satisfactory.
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Objective:To evaluate the curative effect, safety and feasibility of percutaneous transhepatic cholangio drainage(PTCD) combined with balloon dilatation in treating benign biliary-enteric anastomosis stricture(BBES).Methods:The clinical data of 33 patients with benign biliary-enteric anastomosis stricture, who were admitted to the First Affiliated Hospital of Zhengzhou University during the period from January 2013 to May 2019, were retrospectively analyzed. There were 23 cases of benign etiology and 10 cases of malignant etiology, benign strictures of which 15 cases were located in the hepatic hilum and of which 18 cases outside of it. All patients were considered as benign stenosis by at least two imaging examinations of magnetic resonance imaging of pancreatic or enhanced MRI or enhanced CT, laboratory examinations of tumor markers and other clinical data before operation. 10 cases of malignant etiology were confirmed by intraoperative biopsy and pathology. All patients were treated with balloon dilatation at an interval of 1 to 4 weeks after PTCD. The changes of clinical symptoms, bilirubin and liver function before and after operation were compared and analyzed, and the postoperative complications and anastomotic patency rate were followed up.Results:PTCD combined with balloon dilatation was performed successfully in all patients, and the success rate was 100%. After operation, the benign biliary-enteric anastomosis stricture was significantly improved in all patients, and the clinical symptoms were improved obviously. The liver function and bilirubin decreased significantly in all patients after operation, and there was significant statistical significance ( P<0.05). There is no serious complications such as biliary bleeding and biliary fistula were found after operation. At 3 months, 6 months, 12 months, 24 months and 36 months after operation, the anastomotic patency rates of all patients were 90.9%(30/33), 72.7%(24/33), 63.6%(21/33), 63.6%(21/33), 60.6%(20/33), respectively. During the whole follow-up period, anastomotic restenosis happened in 13 patients, of which 9 cases with restenosis, the benign stenosis site of the anastomosis was the hepatic hilum and of which 4 cases located on the outside of the hepatic hilum. After treatment, the incidence of benign restenosis of the anastomosis at the hepatic hilum (60.0%, 9/15) was higher than that at outside of the hepatic hilum (22.2%, 4/18) and it's statistically significant ( P<0.05). Among the 13 patients with recurrence of BBES, 4 cases underwent choledochojejunostomy for malignant causes and 9 cases with benign causes. The recurrence rates after the first balloon dilatation were 40.0% (4/10) and 39.1% (9/23), respectively, and the average recurrence time was 5.8 months and 6.8 months respectively, the difference was not statistically significant( P>0.05). Conclusion:For the treatment of benign biliary-enteric anastomosis stricture, percutaneous transhepatic cholangio drainage combined with balloon dilatation with reliable curative effect, with high safety and less trauma, with less operative complications, and with repeatability, so it is worth applying in clinic.
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Objective:To investigate the morphological feature and clinical significance of MRI around tumor after drug-eluting bead transcatheter arterial chemoembolization (DEB-TACE) of primary hepatocellular carcinoma.Methods:We reviewed and analyzed the data of hepatocellular carcinoma patients admitted from January 2017 to December 2018 in the Department of Radiological Intervention of the First Affiliated Hospital of Zhengzhou University. A total of 42 patients were enrolled, including 35 males and 7 females, aged (57.0±11.9) years. For the first time after operation, MRI enhancement showed peri-tumor margin enhancement as the starting point of follow-up. Follow-up and measure enhanced edge thickness, delayed enhancement, progression or remission data.Results:A total of 49 tumors and 84 peritumoral enhancement margins were included in 42 patients, with 30 sharp type , 40 rough type and 14 nodular type. The thickness of sharp type is less than that of rough type and nsodular type, and the differences were statistically significant (all P<0.05). The sharp type is the majority of the tumors with maximum diameter <5 cm, rough type and nodule type are the majority of tumors with maximum diameter ≥5 cm. Most of the sharp type are continuously enhanced, while the rough type and nodular type are not. Most sharp type relief (93.3%, 28/30), while rough type (80.0%, 32/40) and nodular type ( n=12) are mostly of deterioration, the differences are statistically significant (all P<0.05). Conclusion:Compared with the rough type and nodular type, the sharp type usually occurs in smaller tumors and more prone to local mitigation in the enhanced morphology around MRI after DEB-TACE in primary hepatocellular carcinoma.
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Objective Toanalyzetheclinicalefficiencyofendovascularinterventionaltherapyinthetreatmentofsolitarykidney withrenalaneurysm.Methods FromJune2014toDecember2017,7casesofsolitarykidneypatientscombinedwithrenalaneurysm werecollected,including4casesofrenalaneurysmlocatedinthemainrenalartery,1caseinrenalsegmentalarteryand2casesinthe renalparenchyma.4casesofmainrenalarteryaneurysmsweretreatedwithstentimplantation;1caseofrenalsegmentalarteryaneurysm was treatedwithstent-assistedcoilembolization;2casesofrenalparenchymaaneurysm wererespectivelytreatedwithpolyvinylalcohol (PVA)embolizationandPVA withcoilembolization.After1month,3months,6monthsandevery6months,therenaldopplerexamination,blood routine,urineroutine,renalfunctionandotherbiochemicalexaminationswerereviewed,andrenalarterialCTAorrenalangiographywereperformed whennecessary.Results Thesuccessrateofoperationwas100%in7solitarykidneypatientswithrenalaneurysm,andtheaneurysmswere graduallyreducedafteroperationwithoutseriousadversereactionsandcomplications.Norecanalizationorrecurrenceofrenalaneurysmwasfound duringthefollow-up,andtherenalfunctionwasbetterthanbefore.Conclusion Endovascularinterventionaltherapyinthetreatment ofsolitarykidneywithrenalaneurysmisminimallyinvasiveandlessrisky.Anditismoretargetedandflexibleforthetreatmentof solitarykidneywithdifferenttypesofrenalaneurysm.
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ObjectiveTo investigate the expression and significance of the ABAT gene in hepatocellular carcinoma (HCC) using related databases. MethodsThe Oncomine database and GEPIA were used to analyze the expression of ABAT in HCC tissue. GEPIA was used to investigate the correlation of ABAT mRNA with the survival time and pathological stage of HCC patients. The MethHC database was used to analyze the methylation level of ABAT promoter region. The String database was used to analyze the network of proteins interacting with ABAT protein. The Human Protein Atlas was used to analyze the expression of ABAT protein in HCC tissue and the influence of the protein expression of ABAT on prognosis. ResultsThe mRNA expression of ABAT in HCC tissue was significantly lower than that in normal liver tissue; patients with lower mRNA expression tended to have a poorer prognosis (log-rank, P=0.002 1) and a higher degree of malignancy (P=0.002 34). The protein expression of ABAT in HCC tissue was significantly lower than that in normal liver tissue, and patients with lower protein expression tended to have a poorer prognosis (log-rank, P=2.14×10-3). The methylation level of ABAT promoter region in HCC tissue was significantly higher than that in normal liver tissue (P＜0.005). The proteins interacting with ABAT included ALDH1A3, ALDH9A1, ALDH3A2, GAD1, and GAD2, which might be involved in cell functions such as cell apoptosis, redox, and neurotransmitter secretion. ConclusionData mining of tumor gene databases shows that there are low levels of mRNA and protein expression of ABAT in HCC tissue, which is associated with patient’s survival time. At present, database mining can provide a reference for the diagnosis and prognosis evaluation of HCC and a theoretical basis for tumor research in the future.
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ObjectiveTo investigate the expression and significance of the ABAT gene in hepatocellular carcinoma (HCC) using related databases. MethodsThe Oncomine database and GEPIA were used to analyze the expression of ABAT in HCC tissue. GEPIA was used to investigate the correlation of ABAT mRNA with the survival time and pathological stage of HCC patients. The MethHC database was used to analyze the methylation level of ABAT promoter region. The String database was used to analyze the network of proteins interacting with ABAT protein. The Human Protein Atlas was used to analyze the expression of ABAT protein in HCC tissue and the influence of the protein expression of ABAT on prognosis. ResultsThe mRNA expression of ABAT in HCC tissue was significantly lower than that in normal liver tissue; patients with lower mRNA expression tended to have a poorer prognosis (log-rank, P=0.002 1) and a higher degree of malignancy (P=0.002 34). The protein expression of ABAT in HCC tissue was significantly lower than that in normal liver tissue, and patients with lower protein expression tended to have a poorer prognosis (log-rank, P=2.14×10-3). The methylation level of ABAT promoter region in HCC tissue was significantly higher than that in normal liver tissue (P＜0.005). The proteins interacting with ABAT included ALDH1A3, ALDH9A1, ALDH3A2, GAD1, and GAD2, which might be involved in cell functions such as cell apoptosis, redox, and neurotransmitter secretion. ConclusionData mining of tumor gene databases shows that there are low levels of mRNA and protein expression of ABAT in HCC tissue, which is associated with patient’s survival time. At present, database mining can provide a reference for the diagnosis and prognosis evaluation of HCC and a theoretical basis for tumor research in the future.
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Objective The aim of this study was to evaluate the number of Treg cells in preeclamp-sia (PE) patients, to explore the expression levels of microRNA-210 (microRNA-210) and forkhead box p3 (Foxp3) genes in preeclampsia, and to reveal the regulatory mechanism of microRNA-210 and Foxp3 in preeclampsia. Methods Serum levels of cytokines [ interleukin ( IL)-6, IL-10, IL-17, and transforming growth factor-beta 1 (TGF-β1)] were detected with enzyme-linked immunosorbent assay (ELISA). 29 pa-tients with late-onset preeclampsia (≥36 weeks of gestation) , 27 pregnant women with normal uncomplicat-ed pregnancies (≥36 weeks of gestation) and 20 healthy non-pregnant women were enrolled in the study. Reverse-transcription polymerase chain reaction ( qRT-PCR) was performed to detect mRNA expression for maternal placenta retinoic acid-related orphan receptor C (RORc), Foxp3, and miR-210. Foxp3 protein expression was evaluated by Western blot. Results ⑴The serum levels of IL-6, IL-17 and TGF-beta 1 in preeclampsia patients were significantly higher than those in normal pregnant women, and the level of Treg cytokine IL-10 was lower than that in normal pregnant women ( P <0. 05 ) . ⑵ The percentage of CD4 +CD25 +CD127 - /CD4 +T cells in peripheral blood of preeclampsia patients was significantly lower than that of normal pregnancy group and healthy non-pregnant women ( P <0. 001 ) . ⑶ The mRNA expression of Foxp3 in placenta of preeclampsia patients was significantly lower than that of normal pregnant women, RORc in preeclampsia patients was significantly higher than that of normal pregnant women, and the expres-sion of microRNA210 in preeclampsia patients was enhanced ( P<0. 01 ) . ⑷ Consistent with mRNA ex-pression results, lower protein expression levels of Foxp3 was observed in patients with PE compared with normal pregnant subjects. Conclusions Treg cells decreased in preeclampsia patients and Treg/Th17 im-balance existed in preeclampsia patients, which regulate maternal immune tolerance to fetuses. The expres-sion of Foxp3 in placenta of preeclampsia patients was significantly decreased, which was correlated with the expression of microRNA-210.
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Objective To study pharmacokinetics and tissue distribution of CalliSpheres Beads (CB) loaded Arsenic trioxide (ATO) on rabbit VX2 liver tumor by transcatheter arterial chemoembolization (TACE). Method Sixty four rabbits with VX2 liver tumors were randomly divided into 4 groups: control group, CB group, CBATO group and cTACE group. Blood samples were taken at specific time points after TACE.The blood concentration of ATO,liver and kidney functions were examined respectively. In each group, every 4 rabbits were sacrificed on 1 days,3 days,7 days and 14 days after operation. The tumor,liver,kidney, lung,heart and muscle were taken to detect the drug concentration. Bilateral t?test was used to compare the drug concentration in blood and tissue between CBATO group and cTACE group. Results Statistically,The levels of ALT and AST in group CBATO and cTACE on 1st,3rd and 7th days after TACE were significantly higher than those in CB group(ALT: F=25.872, 17.69, 7.016, AST: F=46.365, 32.385, 12.548, P<0.05) respectively. The ALT and AST levels in CBATO group were statistically lower than those in cTACE group (ALT: t=0.369, 0.432, 0.169, 0.353, AST: t=0.488, 0.593, P>0.05). There were no statistically significant differences in the levels of BUN and Scr between the four experimental groups at each observation time point. Statistically, 10 minutes and 20 minutes after TACE, the blood drug concentration inCBATO was significantly lower than that in cTACE (t=7.675, 6.461, P<0.001). while 12 hours after operation,blood drug concentration in CBATO group was higher than that in cTACE group. In tumor tissue,the concentration of ATO in CBATO was higher than that in cTACE,and there was no statistical differences on the 1st day after TACE(t=2.155, P=0.068), but there was a statistical differences between 3rd, 7th and 14th days (t=11.462, 7.624, 2.649, P<0.05). Conclusion CBATO could prolong the time of drug metabolism,increase the drug concentration in tumor tissue,and didn′t aggravate the damage of liver and kidney function.
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Objective To evaluate the clinic effect of transcatheter arterial chemoembolization (TACE) by using arsenic trioxide (ATO) drug-bearing CalliSpheres beads (CB) in treating BCLC stage B hepatocellular carcinoma (HCC) . Methods The clinical data of 13 patients with advanced HCC, who received TACE by using CB loaded with ATO (CBATO) during the period from January 2017 to September 2017, were retrospectively analyzed. The clinical data, imaging materials, laboratory examinations, interventional complications, prognosis, etc., were summarized and evaluated. Results The patients were followed up for9-15 months, with a median period of 11 months. The survival rate was 100％. One, 3, 6 and 9 months after treatment, the disease remission (CR+PR) rates were 76.9％, 76.9％, 69.2％ and 61.5％ respectively, and the disease control rates were 92.3％, 92.3％, 92.3％ and 84.6％ respectively. In all 13 patients, no severe complications such as hepatic failure, renal insufficiency, bone marrow suppression, liver abscess, bile leakage complicated by infection and gastrointestinal bleeding occurred. Conclusion For the treatment of BCLC stage B HCC, TACE by using CBATO is safe and effective with reliable short-term effect.
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Objective To evaluate the clinical efficacy of combination of transjugular intrahepatic portosystemic shunt (TIPS) and catheter-directed thrombolysis (CDT) in the treatment of acute portal vein thrombosis (PVT) accompanied by Budd-Chiari syndrome (BCS) with extensive occlusion of the hepatic veins.Methods From March 2013 to December 2015,nine patients of acute PVT accompanied by BCS with extensive occlusion of the hepatic veins were collected,and the patients were treated by the combination of TIPS and CDT.The clinical symptoms,liver function and portal vein hemodynamics of patients were observed.After operation,portal vein and shunt patency was followed up by Doppler ultrasound.The patients were followed up seven days,one,three,six months,and every six months after the operation.Paired sample t test was performed for statistically analysis.Results The study enrolled nine patients,six male and three female,with an average age of (41.6 ± 10.9) years old.Operation was successfully performed in eight patients,and of whom three were completed under the assist of perctaneous transhepatic approach.After operation,the blood flow of portal vein was unobstructed and clinical symptoms of portal vein hypertension were obviously improved.There was no significant difference in portal vein diameter between pre-operation ((13.6 ± 2.1) cm) and seven days ((12.5±1.7) cm),one month ((12.1±2.9) cm),three months ((12.9±3.2) cm),six months ((11.6± 1.8) cm) after operation (all P＞0.05).And the portal vein velocity after operation were (79.3± 14.6),(84.4±17.3),(87.3±21.4) and (80.1±12.6) cm/s,respectively,which were higher than that before operation ((9.8 ± 3.1) cm/s),and the differences were statistically significant (t=28.169,34.713,36.519,30.314,all P＜0.01).The maximum cross sectional area ratios of the thrombus to the lumen after operation were (17.1±6.9)％,(19.1±6.2)％,(16.2±±5.5)％ and (16.7±5.1)％,respectively,which were lower than that before operation ((78.2 ±14.5)％),and the differences were statistically significant (t=26.182,23.931,29.371,27.471,all P＜0.01).At the seventh day after operation,the pressure of portal vein decreased from (42.2±8.9) cmH2O (1 cmH2O=0.098 kPa) to (19.6±4.2) cmH2O (t=17.410,P＜0.01).At seven days,one month,three months and six months after operation,albumin levels ((30.7±3.9),(30.9±4.2),(29.9±3.1) and (33.1±4.7) g/L) were all higher than that before operation ((26.5 ± 4.8) g/L),and the differences were statistically significant (t =4.785,4.874,2.874,5.402,all P＜0.05).The levels of transaminase after operation (32.9±21.6),(39.5±22.4),(24.8± 19.8),(37.1±26.9) U/L) were all lower than that before operation ((99.6±31.7) U/L),and the differences were statistically significant (t=27.624,24.913,33.671 and 25.019,all P＜0.01).During eight to 17 months follow-up,TIPS stent shunt stenosis was found in one case at three months after operation and the blood flow recovered after treatment of balloon dilation.The shunt and blood flow of portal vein of the other seven cases were clear.None of the eight patients had the symptoms of hepatic encephalopathy and pulmonary embolism.Operation was not successfully performed in one case,and 29 days later the patient died of hepatic and renal failure.Conclusion The combination of TIPS and CDT is safe and effective in the treatment of acute PVT accompanied by BCS with extensive occlusion of the hepatic veins,which maintain the blood flow of portal vein clear during short-and medium-term follow-up.