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ObjectiveTo investigate the clinical effect and safety of transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA) in the treatment of advanced primary liver cancer. MethodsA total of 186 patients with advanced primary liver cancer who were treated in The Fifth Medical Center of Chinese PLA General Hospital from April 2015 to June 2019 were enrolled and divided into study group and control group using a random number table, with 93 patients in each group. Both groups of patients underwent TACE, and the patients in the study group were treated with ultrasound-guided percutaneous MWA. The two groups were compared in terms of clinical outcome and complications. Quantitative real-time PCR was used to measure the serum level of microRNA-202 (miR-202), ELISA was used to measure the serum levels of fragile histidine triad (FHIT) and P16 protein, and the changes in the above three indices at 3 months after treatment were compared. The two-independent-samples t test was used for comparison of continuous data between two groups, and the paired t-test was used for comparison within one group before and after treatment; The chi-square testwas used for comparison of categorical data between groups. ResultsThe study group had a significantly higher objective response rate than the control group (47.32% vs 27.96%, χ2=7.422, P=0.006), and there was no significant difference in disease control rate between the two groups(P＞0.05). Both groups had significant increases in the serum levels of miR-202, FHIT, and P16 protein at 3 months after treatment (all P＜0.05), and compared with the control group, the study group had significantly higher serum levels of miR-202 (0.84±0.14 vs 0.58±017, t=11.385, P＜0.001), FHIT (1126.35±73.05 pg/ml vs 762.87±56.71 pg/ml, t=37.904, P＜0.001), and P16 protein (52.86±651 pg/ml vs 39.06±5.37 pg/ml, t=15.770, P＜0.001). ConclusionUltrasound-guided MWA in addition to TACE can improve the short-term response of patients with advanced primary liver cancer and increase the serum levels of miR-202, FHIT, and P16 protein, with relatively high safety.
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PURPOSE: Cancer patients are at increased risk of treatment- or disease-related admission to the intensive care unit. Over the past decades, both critical care and cancer care have improved substantially. Due to increased cancer-specific survival, we hypothesized that the number of cancer patients admitted to the intensive care unit (ICU) and survival have increased. MATERIALS AND METHODS: MIMIC-III was used to study trends and outcomes of cancer patients admitted to the ICU between 2002 and 2011. Multiple logistic regression analysis was performed to adjust for confounders of mortality. RESULTS: Among 41,468 patients analyzed, 1,083 were hemato-oncologic, 4,330 were oncologic and 66 patients had both a hematological and solid malignancy. Admission numbers more than doubled and the proportion of cancer patients in the ICU increased steadily from 2002 to 2011. In both the univariate and multivariate analyses, solid cancers and hematologic cancers were strongly associated with 28-day mortality. This association was even stronger for 1-year mortality, with odds ratios of 4.02 (95% confidence interval [CI], 3.69 to 4.38) and 2.25 (95% CI, 1.93 to 2.62), respectively. Over the 10-year study period, both 28-day and 1-year mortality decreased, with hematologic patients showing the strongest annual adjusted decrease in the odds of death. There was considerable heterogeneity among solid cancer types. CONCLUSION: Between 2002 and 2011, the number of cancer patients admitted to the ICU more than doubled, while clinical severity scores remained overall unchanged, suggesting improved treatment. Although cancer patients had higher mortality rates, both 28-day and 1-year mortality of hematologic patients decreased faster than that of non-cancer patients, while mortality rates of cancer patients strongly depended on cancer type.
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Humans , Critical Care , Hematology , Hospitals, Teaching , Intensive Care Units , Logistic Models , Mortality , Multivariate Analysis , Odds Ratio , Population CharacteristicsABSTRACT
Objective@#To investigate the CT and MR imaging features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage.@*Methods@#A total of 36 patients diagnosed with hepatic ischemia/necrosis by both medical imaging and clinical diagnosis shortly after hepatosplenic surgery and upper gastrointestinal hemorrhage were collected, including 9 patients with liver cancer resection, 5 patients with liver cancer ablation (microwave ablation/radiofrequency ablation, argon-helium knife, alcohol injection), 11 patients with spleen resection, and 11 patients with upper gastrointestinal bleeding. Conventional liver CT and / or MR plain and dynamic enhancement scan were performed to comprehensively analyze the morphology and density/signal performance of the lesions.@*Results@#(1) Number of lesions: All cases had multiple lesions. (2) Distribution of lesions: scattered in the liver lobes, clustered or regional distribution, mainly in the periphery of the liver. (3) Size of lesions: the boundary of the nodular lesion was clear, and the single maximum diameter was 1.0-1.5 cm. It can be fused into a wedge-shaped patch or a segmental/sub-segmental large patch with a slight mass effect. (4) CT density or MR signal characteristics: CT plain scan showed slightly low density; MR plain scan showed slightly low signal on T1WI, high signal on T2WI, slightly high signal on DWI and no lipid/fat on dual phase imaging; 24 out of 36 cases (66.7%) showed no enhancement, while some lesions showed thin ring enhancement on the edge; emboli were found in the main and/or branches of portal vein (21/36 cases, 58.3%). (5) In the short-term review (minimum 5 days), the lesions became smaller or disappeared, and the local liver volume became smaller or the surface was depressed.@*Conclusions@#Hepatic ischemia/necrosis occurs after hepatosplenic surgery and upper gastrointestinal hemorrhage. The imaging manifestations are multiple nodular or flaky hypovascular foci, and the short-term review shows a markedly improvement. It needs to be differentiated from infection and metastasis of malignant tumors after operation.
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Objective To investigate the CT and MR imaging features of hepatic ischemia/necrosis after hepatosplenic surgery and upper gastrointestinal hemorrhage.Methods A total of 36 patients diag-nosed with hepatic ischemia/necrosis by both medical imaging and clinical diagnosis shortly after hepato-splenic surgery and upper gastrointestinal hemorrhage were collected,including 9 patients with liver cancer resection,5 patients with liver cancer ablation(microwave ablation/radiofrequency ablation,argon-helium knife,alcohol injection),1 1 patients with spleen resection,and 11 patients with upper gastrointestinal bleeding.Conventional liver CT and/or MR plain and dynamic enhancement scan were performed to com-prehensively analyze the morphology and density/signal performance of the lesions.Results(1)Number of lesions:AU cases had multiple lesions.(2)Distribution of lesions:scattered in the liver lobes,clustered or regional distribution,mainly in the periphery of the liver.(3)Size of lesions:the boundary of the nodu-lar lesion was clear.and the single maximum diameter Was 1.0-1.5 ca.It can be fused into a wedge-shaped patch or a segmental/sub-segmental large patch with a slight mass effect.(4)CT density or MR sig-nal characteristics:CT plain scan showed slightly low density;MR plain scan showed slightly low signal on T1 WI,high signal on T2WI,slightly high signal on DWI and no lipid/fat on dual phase imaging;24 out of 36 cases(66.7％)showed no enhancement,while some lesions showed thin ring enhancement on the edge;emboli were found in the main and/or branches of portal vein(21/36 cases,58.3％).(5)In the short-term review(minimum 5 days),the lesions became smaller or disappeared,and the local liver volume be-came smaller or the surface was depressed.Conclusions Hepatic ischemia/necrosis OCCURS after hepato-splenic surgery and upper gastrointestinal hemorrhage.The imaging manifestations are multiple nodular or flaky hypovascular foci,and the short-term review shows a markedly improvement.It needs to be differentia-ted from infection and metastasis of malignant tumors after operation.
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Objective To investigate the value of DWI in the evaluation of the therapeutic effect of cyber knife in the treatment of hepatocellular carcinoma.Methods Ninety patients who were clinically diagnosed with hepatocellular carcinoma (95 lesions) in the 5th Medical Center of General Hospital of PLA from February 2011 to December 2013 were retrospectively analyzed. All 90 patients underwent pre‐treatment dynamic contrast‐enhanced MRI scans of liver. Fourty six of them underwent liver MRI scan 3 months after treatment with cyber knife, and 49 patients underwent liver MRI scans 6 months after treatment. According to the evaluation criteria of solid tumor effect, complete necrosis tumor lesions and postoperative residual active lesions were determined. The ADC values of residual active tissue lesion, necrosis lesion in tumor and normal liver were measured. Paired sample t test was used to compare the difference of ADC values of tumor necrosis lesions and normal liver tissues between 3 and 6 months after treatment and before treatment, and ROC was used to evaluate the efficacy of ADC values in predicting complete tissue necrosis after treatment. Results In the 95 lesions, 91 lesions were completely necrotic, and active tissues were found in 4 lesions after treatment. There were statistically significant differences in the ADC values of the lesions at 3 and 6 months after treatment and before treatment (P<0.05),and the ADC values of the tissues after treatment were higher than those before treatment. There was no statistically significant difference in ADC values between 3 and 6 months after treatment and before treatment in normal liver tissue (P>0.05). The area under the ROC of using ADC value to predict the complete necrosis after treatment with cyber knife was 0.767, and the ADC value was 1.23×10‐3 mm2/s as the diagnostic cutoff value. The sensitivity and specificity of the diagnosis were 76.5% and 70.6%, respectively. Conclusion ADC values can distinguish the necrotic component from the active component of hepatocellular carcinoma after treatment, and can be used to evaluate the therapeutic effect of cyber knife in hepatocellular carcinoma.
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Objective To discuss the diagnostic value of intravoxel incoherent motion(IVIM)DWI in the inflammation activity of chronic hepatitis B. Methods One hundred and seventy-five patients with chronic hepatitis B were prospectively collected as inflammation group, and 15 healthy volunteers with no history of hepatitis and normal liver function as control group.All subjects were performed MR plan scans for liver and IVIM tests.The liver apparent diffusion coefficient(ADC),the diffusion coefficient of the true water molecule (D), microcirculation perfusion coefficient (D*) and perfusion fraction (f) were measured. After MRI examination, the inflammation group received liver biopsy within two days, and obtained the pathological hepatitis activity grades.According to the degree of inflammation activity(G),the inflammation group was divided into G1,G2 and G3+G4 groups.The independent sample t test was used for the parameter values between the inflammation group and the control group.A single factor variance analysis was used to compare the parameters among different levels of inflammation group. Spearman correlation analysis was used to evaluate the correlation between inflammation activity grades and IVIM parameters.ROC curve was used to evaluate each parameter in the diagnosis of hepatitis activity pathology classification efficiency.Results The values of ADC, D, D*, f between control group and inflammation group were statistically significant(P<0.05).The results of pathological puncture showed that there were 61 cases of G1,62 cases of G2 level and 52 cases of G3+G4.The ADC,D*and f values in the G1,G2,G3+G4 groups decreased with the increase of the level of inflammation activity, and the difference was statistically significant (P<0.05). There was no statistically significant difference between D values (P>0.05). ADC, D* and f values were correlated negatively with low,moderate and low levels of inflammation activity(r=-0.377,-0.434,-0.226, P<0.05).There was no correlation between D value and inflammation activity(r=-0.076,P>0.05).Areas of ADC,D*and ADC combined with D*values under ROC curves to diagnose≥G2 grade inflammation activity were 0.732, 0.748, 0.837 respectively. Areas of f values under ROC curve to diagnose ≥G3+G4 grade inflammation activity was 0.600.Conclusion ADC and D*values help to identify≥G2 grade inflammation activity,and ADC combined with D*value has the highest diagnostic performance,and has certain reference value for clinical treatment.
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Purpose To investigate the application value of diffusion weighted imaging (DWI) in differential diagnosis of common liver lipid-containing tumors.Materials and Methods Sixty patients with pathologically confirmed liver lipid-containing tumors from January 2011 to August 2015 were retrospectively analyzed,including 25 cases ofhepatocellular carcinoma (HCC),20 cases of hepatic adenoma (HA) and 15 cases of hepatic angiomyolipoma (HAML).Apparent diffusion coefficient (ADC) value and ratio of ADCtumor/ADCliver (rADC) of tumors were respectively measured.Routine MRI findings were analyzed.Results The MRI findings of these three common liver lipid-containing tumors were with their own characteristics.For HCC,HA and HAML,the average ADC value was (1.225±0.221)×10-3 mm2/s,(1.318±0.212)×10-3 mm2/s and (1.317±0.297)×103 mm2/s,respectively,(b=800 s/mm2);the average rADC value was 1.004± 0.151,0.984 ± 0.146 and 1.027±0.223,respectively.There was no significant difference in ADC and rADC among these three tumors (P＞0.05).Conclusion ADC and rADC had no differential diagnosis value in common liver lipid-containing tumors.Routine MRI signals and enhanced imaging features are the main diagnostic basis.
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Vitamin D is essential for maintaining calcium and phosphate homeostasis, and vitamin D analogues have been prescribed to treat osteoporosis and hyperparathyroidism. Emerging evidence suggests that cardiovascular and chronic kidney diseases are closely associated with vitamin D deficiency resulting from either decreased sunshine exposure or inadequate intake. Vitamin D is through stimulating vitamin D receptor to form a transcriptional complex with cofactors to modulate approximately 3% gene transcription. For example, renin, matrix metalloprotease, and tumor necrosis factor-α are regulated by vitamin D. Both experimental and clinical studies support the health benefits of vitamin D in the cardiovascular system, and such benefits include protecting cardiac function, lowering blood pressure, improving endothelial function, inhibiting oxidative stress, and reducing the activity of renin-angiotensin system. This article will briefly review the cardiovascular benefits of vitamin D and its bioactive analogues and discuss the novel cellular and molecular mechanisms accounting for cardiovascular protection.
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Humans , Blood Pressure , Calcium , Physiology , Cardiovascular Diseases , Cardiovascular Physiological Phenomena , Endothelium, Vascular , Physiology , Oxidative Stress , Receptors, Calcitriol , Physiology , Renin-Angiotensin System , Vitamin D , Physiology , Vitamin D DeficiencyABSTRACT
AIM To elucidate the effect of rhynchophylline(Rhy) on carotid sinus baroreceptor activity (CBA). METHODS By recording sinus nerve afferent discharge activity with isolated carotid sinus perfusion, parameters of CBA, such as peak slope (PS), peak integral value (PIV), threshold pressure (TP) and saturation pressure (SP) were examined. ①Rhy 10, 50, and 100 μmol·L-1, dissolved in K-H solution, was perfused into isolated carotid sinus, then the effects of Rhy on parameters of CBA were observed while intrasinus pressure was altered in a stepwise manner. ②NG-nitro-L-arginine methyl ester (L-NAME) 10 mmol·L-1, tetraethylammonium (TEA) 1 mmol·L-1 and Bay K8644 500 nmol·L-1 were perfused into isolated carotid sinus, and effects of them on the response of carotid baroreceptor to Rhy were observed. RESULTS ① By perfusing the isolated carotid sinus with Rhy 10 μmol·L-1, PS decreased from (19.2±0.3)% to (18.2±0.1)%·kPa-1and the PIV decreased from (219.3±3.3)% to (199.1±3.8)%, while TP and SP increased from (8.2±0.3) to (9.1±0.1)kPa and (21.5±0.1) to (22.1±0.1)kPa, respectively. By perfusing with Rhy 50 and 100 μmol·L-1, the changes in PS, TP and SP were in concentration-dependent manner, and this indicated inhibitory effect of Rhy on CBA. ②Pretreatment with L-NAME 100 μmol·L-1 did not affect inhibitory action of Rhy 50 μmol·L-1 on CBA. ③Pretreatment with TEA 1 mmol·L-1 had no effect on inhibitory effect of Rhy 50 μmol·L-1 on CBA. ④Pretreatment with Bay K8644 500 nmol·L-1 could mostly attenuate effect of Rhy 50 μmol·L-1 on CBA. CONCLUSION Rhy inhibits CBA via blocking calcium influx in baroreceptor nerve ending.
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Objective To investigate the diagnosis and the curative effects of interventional therapy by spiral CT in rupture of hepatocellular carcinoma(HCC). Methods 46 patients were checked by spiral CT and abdominal puncture of non-condensable blood. All the patients were treated by the transcatheter arterial embolization (TAE) with iodinated oil and/or gelatin sponge. Results Characteristic findings were detected in 31 patients,of which 7 patients were chiefly detected by spiral CT. The bleeding of ruptured HCCs was controlled effectively in all the cases treated by TAE without serious complications. Conclusion Spiral CT is susceptive to the diagnosis of the ruptured HCC. TAE can be the chiefly treatment in ruptured HCC with fewer serious complications.
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AIM To study if cholecystokinin octapeptide (CCK-8) alter cardiovascular functions by its direct inhibitory effect on carotid sinus baroreceptor (CSB) activity. METHODS The functional curve of carotid baroreceptor (FCCB) was constructed and the functional parameters of carotid baroreceptor were measured by recording sinus nerve afferent discharge in anesthetized male rats with perfused isolated carotid sinus. RESULTS ① CCK-8 0.1, 0.5 and 1.0 μmol·L-1 shifted FCCB to the right and downward, with a marked decrease in peak slope and peak integral value of carotid sinus nerve discharge in a concentration-dependent manner, indicating the inhibitory effect of CCK-8 on CSB activity. ② Pretreatment with proglumide (100 μmol·L-1), a nonselective CCK receptor antagonist, or Bay K8644 (0.5 μmol·L-1), an agonist of calcium channel, partially attenuated the inhibitory effect of CCK-8 (0.5 μmol·L-1) on CSB activity. Pretreatment with L-NAME (100 μmol·L-1), an inhibitor of NO synthase, did not affect the inhibitory action of CCK-8. CONCLUSION CCK-8 inhibits CSB activity, which may be mediated by activating CCK receptors in the carotid sinus area and thereby resulting in an inhibition of stretch-sensitive channels and decrease in Ca2+ influx.