The important role of whole-process computed tomography guidance for percutaneous gastrostomy in esophageal cancer patients who are unsuitable for or have had unsuccessful attempts with endoscopic and fluoroscopic gastrostomy.

PURPOSE: To explore the value of clinical application with the whole process computed tomography (CT) guided percutaneous gastrostomy in esophageal tumor patients. MATERIALS AND METHODS: A consecutive series of 32 esophageal tumor patients in whom endoscopic gastrostomy or fluoroscopy guided gastrostomy were considered too dangerous or impossible due to the esophagus complete obstruction, complicate esophageal mediastinal fistula, esophageal trachea fistula or severe heart disease. All of the 32 patients were included in this study from 2 medical center and underwent the gastrostomy under whole process CT guided. RESULTS: All of the gastrostomy procedure was finished successfully under whole process CT guided and the technical success rate was 100%. The average time for each operation was 27 min. No serious complications occurred and the minor complications occurred in 3 patients, including local infection, severe hyperplasia of granulation tissue and tube dislodgment. There were no procedure related deaths. CONCLUSION: The technical success rate of whole process CT guided percutaneous gastrostomy is high and the complication is low. This technique can be used feasible and effectively in some special patients.

Arterial chemotherapy for hepatocellular carcinoma in China: consensus recommendations.

Hepatocellular carcinoma (HCC) is one of the most common malignancies and the third leading cause of cancer-related deaths globally. Hepatic arterial infusion chemotherapy (HAIC) treatment is widely accepted as one of the alternative therapeutic modalities for HCC owing to its local control effect and low systemic toxicity. Nevertheless, although accumulating high-quality evidence has displayed the superior survival advantages of HAIC of oxaliplatin, fluorouracil, and leucovorin (HAIC-FOLFOX) compared with standard first-line treatment in different scenarios, the lack of standardization for HAIC procedure and remained controversy limited the proper and safe performance of HAIC treatment in HCC. Therefore, an expert consensus conference was held on March 2023 in Guangzhou, China to review current practices regarding HAIC treatment in patients with HCC and develop widely accepted statements and recommendations. In this article, the latest evidence of HAIC was systematically summarized and the final 22 expert recommendations were proposed, which incorporate the assessment of candidates for HAIC treatment, procedural technique details, therapeutic outcomes, the HAIC-related complications and corresponding treatments, and therapeutic scheme management.

CT-guided percutaneous microwave ablation of liver metastases from nasopharyngeal carcinoma.

PURPOSE: To access efficacy of percutaneous microwave ablation (MWA) of liver metastases from nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: From March 2007 to June 2012, 18 consecutive patients with NPC and liver metastases (15 men and three women; average age, 45.7 y; age range, 31-61 y) received computed tomography (CT)-guided percutaneous MWA treatment. A total of 27 ablations were performed involving 24 liver metastatic lesions in 18 patients with NPC. Average patient follow-up after ablation was 22.4 months (range, 2-52 mo). The average number of liver metastases per patient was 1.3 (range, 1-4 lesions), with lesion diameters ranging from 1.9 cm to 4.2 cm. Evaluation was then performed to assess percentage of complete necrosis, local tumor progression, and safety. RESULTS: Technical success was achieved in all 27 MWA procedures performed. During follow-up, new metastatic lesions developed in four of 18 patients. Of these, two were liver metastases, and were successfully treated with repeat WMA. Only two major complications were observed: pneumothorax in a patient with an ablation pathway involving the thorax and postprocedural pain in two other patients. A median overall survival time of 41.4 months was observed (range, 2-50 mo); three of 18 patients died during follow-up. CONCLUSIONS: CT-guided MWA is safe and offers an effective treatment alternative for local tumor control in selected patients with liver metastases from NPC.

Transarterial Chemoembolization Combined With Apatinib Plus PD-1 Inhibitors for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Multicenter Retrospective Study.

INTRODUCTION: The aim of this study was to compare transarterial chemoembolization (TACE) combined with apatinib and PD-1 inhibitors (TACE-AP) with TACE combined with apatinib alone (TACE-A) in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) and to explore the prognostic factors affecting the survival of patients. METHODS: This retrospective study analyzed data of patients with HCC with PVTT who were treated with TACE-AP or TACE-A between December 2018 and June 2021. The primary end points of the study were progression-free survival (PFS) and overall survival (OS), and the secondary end points were objective response rate (ORR) and adverse events (AEs). Propensity score matching (PSM) and stabilized inverse probability weighting (sIPTW) analyses were used to reduce patient selection bias, and Cox regression analysis was used to analyze prognostic factors affecting patient survival. RESULTS: Sixty-nine and 40 patients were included in the TACE-A and TACE-AP groups, respectively. After PSM and IPTW analyses, the median PFS and median OS in the TACE-AP group were significantly higher than those in the TACE-A group (PFS: after PSM, 6.9 vs 4.0 months, P < 0.001, after IPTW, 6.5 vs 5.1 months, P < 0.001; OS: after PSM, 14.6 vs 8.5 months P < 0.001, after IPTW, 16.1 vs 10.5 months, P < 0.001). After PSM and IPTW analyses, the tumor ORR in the TACE-AP group was significantly higher than that in the TACE-A group (PSM, 53.6% vs 17.9%, P = 0.005; IPTW, 52.5% vs 28.6%, P = 0.013). All treatment-related AEs were observed to be tolerated. Multivariate Cox regression analysis showed that the main prognostic factors affecting the survival of patients were tumor number, PVTT type, alpha-fetoprotein, and treatment mode. DISCUSSION: In the treatment of patients with HCC with PVTT, TACE-AP significantly improved PFS, OS, and ORR, and the AEs were safe and controllable.

[Net power and energy of cooled antenna microwave ablation:ex vivo versus in vivo results in porcine liver].

OBJECTIVE: To explore the net power and net energy of a cooled antenna radiator in ex vivo and in vivo porcine livers. METHODS: All animal experiments complied with the guidelines of our animal use committee. Microwave ablation (MWA) was performed in ex vivo and in vivo porcine livers with a cooled-shaft antenna in different microwave ablation parameter groups (50, 80 and 110 W for 10 min). The energy losses from the microwave antenna or cables were calculated. And the net power, net energy and the relationship between net power and power readout were determined. RESULTS: When the power displayed by the machine indicated 50 W, 80 W and 110 W, the net power during MWA was 31.3 ± 0.6, 47.3 ± 0.8 and 62.1 ± 0.9 W ex vivo and 31.8 ± 0.8, 47.4 ± 0.3 and 61.7 ± 1.5 W in vivo. For the same power readout, the ex vivo or in vivo effective power was the same (P = 0.841, P = 0.133, P = 0.551). For both ex vivo and in vivo experiments, the ratio of microwave antenna energy loss to microwave antenna input energy was relatively constant (P = 0.613, 0.326). For the same treatment time and net power, the difference was significant between ex vivo and in vivo ablation volumes (P = 0.001, 0.006, 0.001). CONCLUSION: Using net power as a reference during MWA is more accurate compared to the traditional power readout. And net energy offers a more realistic reflection of MWA energy in tissues.

Transarterial chemoembolization combined with apatinib with or without PD-1 inhibitors in BCLC stage C hepatocellular carcinoma: A multicenter retrospective study.

Objective: We evaluated the efficacy and safety of transarterial chemoembolization (TACE) combined with apatinib plus PD-1 inhibitors (TACE-AP) compared with TACE combined with apatinib (TACE-A) in patients with advanced hepatocellular carcinoma (HCC) and to explore the prognostic factors affecting patient survival. Methods: Data from patients with unresectable HCC who received TACE-AP or TACE-A from December 2018 to June 2021 were collected retrospectively. The main outcome of the study was overall survival (OS) and prognostic factors affecting survival, while the secondary outcomes were progression-free survival (PFS), the objective response rate (ORR), and treatment-related adverse events (TRAEs). Propensity score matching (PSM) analysis was used to reduce patient selection bias, and the random survival forest (RF) model was employed to explore prognostic factors affecting patient survival. Results: We enrolled 216 patients, including 148 and 68 patients in the TACE-A and TACE-AP groups, respectively. A total of 59 pairs of patients were matched using PSM analysis. Before and after PSM, the OS, PFS, and ORR in the TACE-AP group were significantly higher than in the TACE-A group (before, OS: 22.5 months vs. 12.8 months, P < 0.001; PFS: 6.7 months vs. 4.3 months, P < 0.001; ORR: 63.2% vs. 34.5%, P < 0.001; after, OS: 22.5 months vs. 12.0 months, P < 0.001; PFS: 6.7 months vs. 4.3 months, P < 0.001; ORR: 62.7% vs. 30.5%, P = 0.003). Multivariate Cox regression and RF models before and after PSM analysis revealed that the main prognostic factors affecting survival were tumor number, portal vein tumor thrombus (PVTT) invasion, alpha-fetoprotein (AFP) levels, total bilirubin (TBIL) level, and treatment. There was no significant difference in TRAEs between the two groups (P > 0.05). Conclusion: Compared with TACE-A, TACE-AP significantly improved OS, PFS, and ORR in patients with advanced HCC. The number of tumors, PVTT invasion, AFP levels, TBIL level, and treatment were significant prognostic factors associated with patient survival. All observed TRAEs were mild and controllable.

Plasma arginase-1 as a predictive marker for early transarterial chemoembolization refractoriness in unresectable hepatocellular carcinoma.

Objective: To explore the relationship between plasma arginase-1 (ARG1) and early transarterial chemoembolization (TACE) refractoriness in patients with hepatocellular carcinoma (HCC) and develop nomograms for predicting early TACE refractoriness. Methods: A total of 200 patients with HCC, treated with TACE, were included in the study, including 120 in the training set and 80 in the validation set. Pre-treatment enzyme-linked immunosorbent assay was used to detected the plasma ARG1 levels of the patient, and independent predictors of early TACE refractoriness were determined using a multivariate logistic regression model, based on which a predictive model was developed using a nomogram. Results: Risk of early TACE refractoriness was negatively correlated with plasma ARG1 levels, and multivariate logistic analysis showed tumour size (OR = 1.138, 95% CI = 1.006-1.288, P = 0.041), multiple tumors (OR=4.374, 95% CI = 1.189-16.089, P = 0.026), platelet count (OR = 0.990, 95% CI = 0.980-0.999, P = 0.036), and plasma ARG1 levels (OR = 0.209, 95% CI = 0.079-0.551, P = 0.002) to be independent prognostic factors for early TACE refractoriness.The AUC value for the nomogram of the training cohort was 0.786 (95% CI = 0.702-0.870), and the validation set AUC value was 0.833 (95% CI = 0.791-0.875).The decision curve analysis suggested that the nomogram had good clinical utility. Conclusion: High plasma ARG1 expression was associated with a lower incidence of early TACE refractoriness. The nomogram constructed based on four independent prognostic factors could facilitate an individualised prediction of the incidence of early TACE refractoriness.

Local ablation of pulmonary malignancies abutting pleura: Evaluation of midterm local efficacy and safety.

Objective: To retrospectively evaluate the efficacy and safety of local ablation treatment for adjacent pleural lung tumors. Materials and methods: Sixty-two patients who underwent pulmonary nodule ablation at the Affiliated Cancer Hospital of Zhengzhou University were enrolled between January 2016 and December 2020. All patients were followed up with enhanced computed tomography or magnetic resonance imaging within 48 h after treatment and 2, 4, 6, 9, and 12 months after treatment. All patients were followed for at least 12 months. Results: A total of 84 targeted tumors (62 patients) underwent 94 ablations. In the 12-month follow-up images, 69 of the 84 targeted tumors were completely ablated, 15 had incomplete ablation, and the 12-month incomplete ablation rate was 17.8% (15/84). Of the 15 incompletely ablated tumors, six had partial responses, five had stable disease, and four had progressive disease. The most common adverse event was pneumothorax, with an incidence of 54.8% (34/62). The second most common complication was pleural effusion, with an incidence rate of 41.9% (26/62). The incidence of needle-tract bleeding was 21% (13/62) and all patients were cured using hemostatic drugs. Serious complications were bronchopleural fistula in four patients (6.5%, 4/62) and needle tract metastasis in one patient. Four cases of bronchopleural fistula were found in the early stages and were cured after symptomatic treatment. Conclusion: Local ablation is effective for the treatment of adjacent pleural lung tumors, and its operation is safe and controllable.

Prospective study of TACE combined with sorafenib vs TACE combined with 125I seed implantation in the treatment of hepatocellular carcinoma with portal vein tumor thrombus and arterioportal fistulas.

Purpose: To compare the efficacy of TACE combined with sorafenib and TACE combined with 125I seed implantation in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) combined with arterioportal fistulas (APFs), and discuss the efficacy and safety of TACE combined with 125I seed implantation. Patients and methods: Between January 2017 and December 2018, the clinical data of patients with HCC complicated with PVTT and APFs who were admitted to the Affiliated Cancer Hospital of Zhengzhou University, First Affiliated Hospital of Zhengzhou University, and Henan Provincial People's Hospital were prospectively collected. The patients were divided into the TACE+sorafenib (TACE-S) group based on their treatment willingness. There were 26 and 32 patients in the TACE-S and TACE-125I groups, respectively. Both groups of patients underwent APFs occlusion during TACE therapy. The embolization effect of APFs was observed and recorded in the two groups, the efficacy of intrahepatic lesions and PVTT was evaluated, and the effects of different treatment methods on the efficacy were analysed. Results: All patients completed the 3 months follow-up. The improvement rates of APFs in TACE-S and TACE-125I groups were 30.77% (8/26) and 68.75% (22/32), respectively, and difference was statistically significant (χ2 = 8.287, P=0.004). The median survival time of TACE-S and TACE-125I groups was 8.00 months and 12.8 months, respectively (χ2 = 7.106, P=0.008). Multivariate analysis showed that the PVTT subtype (IIa/IIb) and treatment method (TACE-S or TACE-125I) were independent factors affecting the recanalization of APFs in patients (P<0.05). Conclusion: For patients with HCC with PVTT and APFs, TACE combined with 125I seed implantation can effectively treat portal vein tumor thrombus, thereby reducing the recanalization of APFs and prolonging the survival time of patients.

[Comparison between biliary cirrhosis and normal porcine liver treated with microwave ablation using a cooled-tip electrode].

OBJECTIVE: To elucidate the difference in both in vivo and ex vivo microwave ablation in a biliary cirrhotic porcine liver model using a cooled-tip antenna. METHODS: Two months after biliary ductal ligation, liver biopsy was performed to confirm the establishment of biliary cirrhosis in 4 Tibetan miniature pigs. Microwave ablation with cooled-tip antenna was conducted under laparotomy using 70 W for five minutes in the experimental group (4 pigs). The control group (2 pigs) also received microwave ablation using the same settings but no surgery. Both in-vivo and ex-vivo ablations were performed in the two groups. Morphological and pathological characteristics of the ablation areas were compared. Paired comparison among the groups were conducted using t-test. RESULTS: In the cirrhotic liver group, after ablation at 70 W for five minutes, the short and long axes and volume of in vivo ablation areas were (1.90 ± 0.10) cm, (2.95 ± 0.12) cm, and (6.0 ± 0.8) cm(3) compared to (2.08 ± 0.08) cm, (3.08 ± 0.75) cm, and (7.0 ± 0.5) cm(3) of ex vivo ablation. In the normal liver group the dates were (2.04 ± 0.05) cm, (3.14 ± 0.11) cm and (6.8 ± 0.5) cm(3); (2.30 ± 0.18) cm, (3.60 ± 0.08) cm and (10.0 ± 1.7) cm(3), respectively. In vivo ablation area was smaller than ex vivo ablation area in terms of short and long axes and volume (P = 0.028 0.026, 0.008, respectively). With the same ablation settings, both in vivo and ex vivo ablation areas in normal pig liver were larger than their counterparts in cirrhotic liver in terms of the short and long axes and volume (P = 0.019, P = 0.000; P = 0.024, P = 0.036, respectively), but the differences in the short axes of in vivo and ex vivo ablation areas failed to reach significance. CONCLUSION: Both in vivo and ex vivo ablation areas in biliary cirrhotic pig liver were smaller than their counterparts in normal pig liver suggesting that, the ablation time or power should be relatively prolonged to enlarge the ablation zone within cirrhotic liver in order to prevent incomplete ablation with viable residual tumor.

[Comparison of safety and efficacy for transcatheter arterial chemoembolization alone and plus radiofrequency ablation in the treatment of single branch portal vein tumor thrombus of hepatocellular carcinoma and their prognosis factors].

OBJECTIVE: To compare the transcatheter arterial chemoembolization (TACE) alone or plus radiofrequency ablation (RFA) in the treatment of single branch portal vein tumor thrombus(PVTT)in patients with hepatocellular carcinoma (HCC) so as to evaluate the safety, control rate, prognostic factors and overall survival. METHODS: From January 2004 to December 2007, 50 HCC patients (< 5 cm in diameter and 3 parenchymal lesions) with concurrent PVTT were enrolled and treated by TACE alone or TACE plus RFA randomly (TACE, n = 25; TACE-RFA, n = 25). In TACE group, the intra-hepatic lesions received TACE sequentially with RFA; in TACE-RFA group, PVTT and intra-hepatic lesions were treated with TACE sequentially with RFA separately. Strict follow-up was conducted by computed tomography and alpha-fetoprotein (AFP) assay. The survival time was analyzed by the Kaplan-Meier method and Cox regression analysis was performed to evaluate the prognostic factors. RESULTS: Of all 50 HCC patients with single branch PVTT with TACE or RFA, 47 patients (TACE, n = 24; TACE-RFA, n = 23) received all the scheduled procedures and completed the follow-up. Two patients (8.3%) in TACE group had liver dysfunction versus none in TACE-RFA group, 2 patients (8.7%) developed bile duct injury in TACE-RFA group related with the RFA procedure. The OR (overall response) for PVTT was 54.2% (complete response (CR) 8.3%, partial response (PR) 45.8%) in TACE group while 87.0% (CR 60.9%, PR 26.1%) in TACE-RFA group during the follow-up. From the definite diagnosis of HCC, the median survival was 8 months. And the 1-, 2- & 3-year survival rates were 33.3%, 12.5%, 8.3% in TACE group. And 26 months, 65.2%, 47.8%, 30.4% in TACE-RFA group respectively. The difference between two groups was significant. From the definite diagnosis of PVTT, the respective data were 7 months, 12.5% and 4.2%, 0 in TACE group versus 22 months, 52.2%, 34.8%, and 8.7% in TACE-RFA group with a significant P value. In multivariate analysis, only therapy (TACE or TACE-RFA) showed a protective value (hazard rate 0.430 vs 0.345, P < 0.05). Survival was not correlated with age, intra-hepatic tumor status, liver functions and AFP level for all patients. CONCLUSION: RFA is both safe and efficacious to prolong survival in the treatment of single branch PVTT plus TACE in selected HCC patients. It may provide rationales for further studies of evaluating the outcome of RFA plus other therapies in the treatment of HCC with single branch PVTT.

Frequent amplification of HDAC genes and efficacy of HDAC inhibitor chidamide and PD-1 blockade combination in soft tissue sarcoma.

BACKGROUND: The advent of immune checkpoint therapy has been a tremendous advance in cancer treatment. However, the responses are still insufficient in patients with soft tissue sarcoma (STS). We aimed to identify rational combinations to increase the response to immune checkpoint therapy and improve survival. METHODS: Whole-exome sequencing (WES) was performed in 11 patients with liposarcoma. Somatic copy number alterations (SCNAs) were analyzed at the gene level to identify obvious amplification patterns in drug-target genes. The expression and prognostic value of class I histone deacetylases (HDACs) was evaluated in 49 patients with sarcoma in our center and confirmed in 263 sarcoma samples from The Tumor Cancer Genome Atlas (TCGA) database. Q-PCR, flow cytometry and RNA-seq were performed to determine the correlations between class I HDACs, chidamide and PD-L1 in vitro and in vivo. The efficacy of combining chidamide with PD-1 blockade was explored in an immunocompetent murine model and a small cohort of patients with advanced sarcoma. Western blot, ChIP assay and dual luciferase assessment were applied in the mechanistic study. RESULTS: The HDAC gene family was frequently amplified in STS. SCNAs in the HDAC gene family were extensively amplified in 8 of 11 (73%) patients with liposarcoma, based on a drug-target gene set, and we verified amplification in 76.65% (197/257) of cases by analyzing TCGA sarcoma cohort. Class I HDAC expression is associated with a poor prognosis for patients with STS, and its inhibition is responsible for promoting apoptosis and upregulating of programmed cell death ligand 1 (PD-L1). The HDAC class I inhibitor chidamide significantly increases PD-L1 expression, increased the infiltration of CD8+ T cells and reduced the number of MDSCs in the tumor microenvironment. The combination of chidamide with an anti-PD-1 antibody significantly promotes tumor regression and improves survival in a murine model. Moreover, chidamide combined with the anti-PD-1 antibody toripalimab is effective in patients with advanced and metastatic sarcoma, and the side effects are tolerable. Mechanistically, chidamide increases histone acetylation at the PD-L1 gene through the activation of the transcriptional factor STAT1. CONCLUSIONS: The combination of chidamide and anti-programmed cell death 1 (PD-1) therapy represents a potentially important strategy for STS.

[Percutaneous retroperitoneal splenorenal stent shunt:an experimental study in swine model with portal hypertension].

OBJECTIVE: To evaluate the effect of depressing the press and the technical possibility of creating a percutaneous retroperitoneal splenorenal shunts (PRESS) by means of treating with swine with portal hypertension. METHODS: There were five normal microswine, all of which underwent portal vein embolization with polyvinyl alcohol (PVA) particles to create the model of portal hypertension. After the successful creation of the model with portal hypertension, PRESS were placed to depress the portal venous press, placing covered-stents to connect the left renal vein and the splenic vein. The variance of relative venous press was observed. Splenic venogram was taked after the PRESS to observe the condition of blood flow in the vein and stents. RESULTS: Acute portal hypertension were created successfully in the five animals, then PRESS were placed. One animal died during the operation (died of overdose of anesthesia), stent placement were successfully completed in the other four animals. The splenic venogram revealed good flow from the splenic vein to the left renal vein through the shunt track. After the PRESS, the portal venous and the splenic press press descended, and the left renal press elevated. CONCLUSION: Creation of a PRESS for swine with portal hypertension is technically possible, and further experimental studies of its safety are warranted.

The theoretical direct-band-gap optical gain of Germanium nanowires.

We calculate the electronic structures of Germanium nanowires by taking the effective-mass theory. The electron and hole states at the Γ-valley are studied via the eight-band k.p theory. For the [111] L-valley, we expand the envelope wave function using Bessel functions to calculate the energies of the electron states for the first time. The results show that the energy dispersion curves of electron states at the L-valley are almost parabolic irrespective of the diameters of Germanium nanowires. Based on the electronic structures, the density of states of Germanium nanowires are also obtained, and we find that the conduction band density of states mostly come from the electron states at the L-valley because of the eight equivalent degenerate L points in Germanium. Furthermore, the optical gain spectra of Germanium nanowires are investigated. The calculations show that there are no optical gain along z direction even though the injected carrier density is 4 × 1019 cm-3 when the doping concentration is zero, and a remarkable optical gain can be obtained when the injected carrier density is close to 1 × 1020 cm-3, since a large amount of electrons will prefer to occupy the low-energy L-valley. In this case, the negative optical gain will be encountered considering free-carrier absorption loss as the increase of the diameter. We also investigate the optical gain along z direction as functions of the doping concentration and injected carrier density for the doped Germanium nanowires. When taking into account free-carrier absorption loss, the calculated results show that a positive net peak gain is most likely to occur in the heavily doped nanowires with smaller diameters. Our theoretical studies are valuable in providing a guidance for the applications of Germanium nanowires in the field of microelectronics and optoelectronics.

[CT guided radio frequency ablation as a treatment of pelvis tumor].

OBJECTIVE: To explore the clinical value of CT guided radio frequency ablation in the treatment of pelvis tumor. METHODS: 11 males and 8 females ranging from 25 to 49 years old (average 37) were enrolled in this study, all the 19 patients were suffering from pelvis tumor including giant cell tumor of bone (2/19), Ewing's sarcoma (2/19), malignant fibrous histiocytoma (3/19) and metastatic diseases (12/19). The average diameter of the lesions were 6.2 cm. The predominant clinical symptom of the patients was pain in the local region. All the patients were treated by CT guided radio frequency ablation. Single pole or multiple poles radio frequency ablation device was used according to the characteristics of the tumor tissue. Time of therapy was 5-15 min. Superposition was performed if necessary. RESULTS: All the patients received PET-CT scan or enhanced CT scan 1 month after the treatment, CR, PR was seen in 10 and 7 cases respectively. Total pain relief was seen in 10 patients, partial pain relief was seen in 8 patients, and gently pain relief was seen in 1 patient. CONCLUSION: CT guided CT guided radio frequency ablation is an effective methods in the treatment of pelvis tumor.

[Experimental radiofrequency ablation in porcine liver ex vivo with "wet" unipolar electrode].

OBJECTIVE: To observe the effects of radiofrequency ablation in porcine liver ex vivo with "wet" RITA UniBlate unipolar electrode, evaluate the morphologic characteristic of the ablated zones and explore the impact upon the ablation lesions of time, temperature and set power of "wet" monopolar electrodes. METHODS: The maximal effective ablation electrode length of this "wet" unipolar electrode is 2.5 cm. According to ablation time, temperature and power respectively, the experiment was divided into three major groups of A, B, C (11 sub-groups). The investigators observed the morphological characteristics of ablation lesions, measured the longitudinal and transverse distance of ablation beyond the electrode tip and calculated the volume of ablation lesion. Statistical analysis was performed with one-way ANOVA upon the above-mentioned four parameters. And the pathological examinations were made with HE staining. RESULTS: (1) All of ablated zones were ellipsoid. The cross-section of ablation lesions appeared to have 3 zones from the inside out: central zone, coagulated zone, hemorrhage and edema zone. (2) When ablating time and temperature increased to 15 min and 103 degrees C respectively, the ablated zones peaked: longitudinal diameter, transverse diameter, ablation distance beyond electrode tip and volume of each ablated zone was (3.49 +/- 0.09) cm, (2.40 +/- 0.13) cm, (0.79 +/- 0.09) cm and (10.6 +/- 1.3) cm(3) respectively. With power as a variable, different sizes between ablated zones showed no statistical significance. (3) The morphology of ablated zones became irregular when the electrodes were located around larger blood vessels. CONCLUSION: The ablating time and temperature are the major factors of affecting the size of radiofrequency ablation lesion with RITA "wet" unipolar electrode.

[Experimental study of the effect of radiofrequency ablation with series of WHK-3 conformable electrode in ex vivo ox liver].

OBJECTIVE: To evaluate the conformablity and quantization controllability of multi-cluster conformable radiofrequency ablation electrode by ex vivo animal experiment. METHODS: The subject using in this experiment were fresh ex vivo ox liver. The electrode we used were the series of WHK-3 (including WHK-3 I and II), which were design and made by Welfare Electronic Technological Company (Beijing). Each electrode had 6 sub-electrode on opposite side (A and B). Both A and B side could separately in different length and radian so to form asymmetric shape. The difference between WHK-3 I and II were the shaft of I are electric conductive while it of WHK-3 II were inconductive by coating with insulant material. Our subject were divide into 3 group. In group 1 we do radiofrequency ablation in ex vivo ox liver with both sub-electrode (WHK-3 I and II) fully spread out symmetrically, then the diameter of 3D cross section in zone of melt necrosis between type I and II were compared. In group 2 we do radiofrequency ablation in ex vivo ox liver with WHK-3 I while the two side of sub-electrode were spread out asymmetrically in different shapes. Then the diameter of cross section which were parallel to the electrode shaft in zone of melt necrosis in different sub-electrode shape were compared. In group 3 we do the test same way as in group 2 on WHK-3 II electrode. RESULTS: In group 1, there had no significant different between the diameter of melt necrosis zone in ex vivo ox liver with WHK-3 I and II (average around 6 x 6 x 3 cm(3)) while sub-electrodes were fully spread out symmetrically. In group 2, while sub-electrode in A side were fully spread and sub-electrode in B side were half spread, WHK-3 I electrode could form an asymmetric melt necrosis zone. The diameter on A side were 3.24 + or - 0.32 cm and it on B side were 1.87 + or - 0.24 cm. While only A side sub-electrode were spread out, the diameter on A side were nearly the same and it on B side were decreased to 1.55 + or - 0.16 cm. In group 3, while sub-electrode in A side were fully spread and sub-electrode in B side were half spread, WHK-3 II electrode could form an asymmetric melt necrosis zone too. The diameter on A side were 3.27 + or - 0.35 cm and it on B side were 1.65 + or - 0.23 cm. While only A side sub-electrode were spread out, the diameter on A side were nearly the same and it on B side were decreased even to 0.90 + or - 0.18 cm. CONCLUSIONS: The series of WHK-3 could form an asymmetric melt necrosis zone in ex vivo tissue, which were more suitable to clinical usage. And both of them had quantization controllability, especially in WHK-3 II.

[Clinical value of percutaneous ethanol ablation in complicated renal carcinoma].

OBJECTIVE: To probe clinical value of percutaneous ethanol ablation (PEA) in complicated renal carcinoma. METHODS: 10 cases complicated renal carcinoma patients with 16 lesions ranged from 1.7-8.4 cm totally, renal cancer in 7 cases, renal hamartoma in 3 cases,underwent CT guided percutaneous ethanol ablation (PEA) by local anesthesia Plain and contrast CT scan was adopted to evaluate clinical effect and make follow-up. RESULTS: Each patient accepted 2 times PEA in average with follow-up time ranged from 2 to 26 months averaged in 18 months. No recurrence was seen in 1 case isolated renal patient unfortunately with renal cancer through 1 year and 9 months follow-up after 2 times PEA. The other isolated renal cancer patient died of acute renal failure after 4 times PEA. Lesions were fully ablated in 2 cases renal cancer patients with low back pain and blood urine and symptoms disappeared after PEA accordingly. Other 3 cases renal cancer patients went through 1 year and 6 months, 2 years and 2 months, and 1 year follow-up respectively. 1 case died of distant metastasis and 2 cases kept stabilization evaluated by CT scan. Hemorrhage within lesions disappeared in 2 cases renal hamartoma after just one time PEA, which kept stabilization through 1 year, 1 year and 10 months follow-up respectively. 1 case hamartoma patient gave up treatment after 2 times PEA. No complications including urinary fistula, hemorrhage, intestinal perforation and needle track implantation were seen in all patients. CONCLUSION: CT guided PEA is a microinvasive, positive curative effect and facultative method in treating complicated renal carcinomas. But for isolated renal patient with renal cancer,PEA should be performed cautiously.

[Clinical effect of transcatheter arterial chemoembolization combined with high intensity focused ultrasound ablation in treatment of large hepatocellular carcinoma].

OBJECTIVE: To investigate the clinical effect of transcatheter arterial chemoembolization (TACE) combined with high intensity focused ultrasound (HIFU) ablation in treatment of large hepatocellular carcinoma (HCC). METHODS: Sixty-eight patients with unresectable HCC were randomized into 2 age, tumor size, TNM stages, and liver function grade-matched groups: TACE group (n=30) undergoing TACE and TACE+HIFU group (n=38) undergoing 2-3 weeks after TACE. A total of 88 tumors (9.3+/-3.2) (5.0-14.5) cm in diameter were detected, and the largest tumor in a specific patients with multiple lesions was selected for observation. Follow-up was conducted for (13+/-7) (3-24) months to observe the necrosis of tumor, size of tumor, local recurrence, and survival of patient. RESULTS: The clinical symptom remission rate was 90.6% (29/32) in the TACE+HIFU group and 70.8% (28/38) in the TACE group. The tumor necrosis and minification rates of the TACE+HIFU and TACE groups were 73.7% and 68.4% respectively, both significantly higher than those of TACE group (26.7% and 33.3% respectively, both P<0.01). The tumor local recurrence rate of the TACE+HIFU group was 21.1%, not significantly different from that of the TACE group (33.3%, P>0.05). The median survival duration of the TACE+HIFU group was 18 months, significantly longer than that of the TACE group (10 months, P<0.05). CONCLUSION: Compared with the TACE therapy alone, the combination therapy improves the tumor necrosis rate and prolongs the patients' survival duration.