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Nephrostomy catheter misplacement into the inferior vena cava after percutaneous nephrolithotomy is an extremely rare complication, and subsequent catheter-related thrombosis has been more rarely reported. Here, we report a rare case of nephrostomy catheter misplacement after percutaneous nephrolithotomy. During the procedure, due to bleeding upon establishing the puncture channel, a renal fistula catheter with a balloon was inserted to facilitate hemostasis. However, the catheter inadvertently migrated into the inferior vena cava, with the inflated balloon obstructing venous return, resulting in thrombosis formation within the inferior vena cava. The patient was urgently transferred to our hospital for intervention. Upon administering anticoagulation and antimicrobial therapy, we first placed a filter in the patient's inferior vena cava to prevent thrombus embolism to the pulmonary arteries during catheter removal. Under fluoroscopy, the catheter was withdrawn into the renal vein, followed by catheter-directed thrombolysis and thrombus aspiration. Eventually, the renal fistula catheter was gradually removed in stages without any bleeding and pulmonary embolism occurring throughout the treatment process. Through a review of relevant literatures, we analyzed the reasons for catheter misplacement and summarized the associated treatment experience.
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The rapid advancement of artificial intelligence (AI) and robotics has led to significant progress in various medical fields including interventional radiology (IR). This review focuses on the research progress and applications of AI and robotics in IR, including deep learning (DL), machine learning (ML), and convolutional neural networks (CNNs) across specialties such as oncology, neurology, and cardiology, aiming to explore potential directions in future interventional treatments. To ensure the breadth and depth of this review, we implemented a systematic literature search strategy, selecting research published within the last five years. We conducted searches in databases such as PubMed and Google Scholar to find relevant literature. Special emphasis was placed on selecting large-scale studies to ensure the comprehensiveness and reliability of the results. This review summarizes the latest research directions and developments, ultimately analyzing their corresponding potential and limitations. It furnishes essential information and insights for researchers, clinicians, and policymakers, potentially propelling advancements and innovations within the domains of AI and IR. Finally, our findings indicate that although AI and robotics technologies are not yet widely applied in clinical settings, they are evolving across multiple aspects and are expected to significantly improve the processes and efficacy of interventional treatments.
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Objective@#To explore the intervention effect of 12 week spinal health exercise on adolescents high and low shoulders, in order to provide empirical evidence for exploring simple and feasible measures to intervene.@*Methods@#In February 2023, 60 high and low shoulder students from a vocational high school in a certain county of Luzhou City were randomly selected as the research subjects by convenient sampling method. Paired sampling was used to randomly divide participants into an intervention group and a control group with 30 students each group. The intervention group received spinal health gymnastics intervention during 12 weeks of morning exercises and large break exercises for twice a day, with two groups each time; the control group maintained their previous morning exercises and large break exercises. A follow up study was conducted on the height difference between the left and right shoulder peaks of the intervention group and the control group students before intervention, after 12 weeks intervention, at 4 weeks post intervention. The t-test was used to analyze the changes in shoulder peak height difference between the intervention group and the control group.@*Results@#Before intervention, there was no statistically significant difference in the height of the left and right shoulder peaks between the intervention group [(2.50±1.19)cm] and the control group [(2.49±1.20)cm] adolescents ( t=0.05, P > 0.05). After 12 weeks of intervention, the difference in shoulder height between the left and right sides of adolescents in the intervention group decreased, compared to that before intervention [(1.43±1.15, 2.50±1.19)cm], while the control group increased compared to that before intervention [(2.58±1.19, 2.49±1.20) cm], and the differences were both statistically significant ( t= -78.17 , 20.15, P <0.05). At 4 weeks post intervention, there was no statistically significant difference in the height of the left and right shoulder peaks between the intervention group [(1.44±1.15)cm] and the control group [(2.59±1.18)cm] compared to 12 weeks after the intervention ( t=1.80, 1.05, P >0.05). The intervention group [(2.49±1.26, 2.52±1.16) (1.43±1.21, 1.44±1.13) (1.44±1.21, 1.45±1.14)cm] and the control group [(2.45±1.24, 2.52±1.20) (2.55±1.24, 2.61±1.18) (2.55±1.22, 2.62±1.18)cm] showed no statistically significant difference in the height of the left and right shoulder peaks between males and females before intervention, after 12 weeks of intervention, and after stopping intervention for 4 weeks ( t =-0.08, -0.03, -0.02; -0.15, -0.12, -0.15, P >0.05).@*Conclusions@#Spinal health gymnastics has a good effect on correcting high and low shoulders in adolescents. Spinal health gymnastics should be promoted on campus to promote adolescent posture health.
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OBJECT: To obtain Pulmonary Inflammation Index scores from imaging chest CT and combine it with clinical correlates of viral pneumonia to predict the risk and severity of viral pneumonia using a computer learning model. METHODS: All patients with suspected viral pneumonia on CT examination admitted to The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from December 2022 to March 2023 were retrospectively selected. The respiratory viruses were monitored by RT-PCR and categorized into patients with viral pneumonia and those with non-viral pneumonia. The extent of lung inflammation was quantified according to the Pulmonary Inflammation Index score (PII). Information on patient demographics, comorbidities, laboratory tests, pathogenetic testing, and radiological data were collected. Five machine learning models containing Random Forest(RF), Radial Basis Function Neural Network (RBFNN), Support Vector Machine (SVM), K Nearest Neighbour Algorithm (KNN), and Kernel Ridge Regression (KRR) were used to predict the risk of onset and severity of viral pneumonia based on the clinically relevant factors or PII. RESULTS: Among the five models, the SVM model performed best in ACC (76.75 %), SN (73.99 %), and F1 (72.42 %) and achieved a better area under the receiver operating characteristic curve (ROC) (0.8409) when predicting the risk of developing viral pneumonia. RF had the best overall classification accuracy in predicting the severity of viral pneumonia, especially in predicting pneumonia with a PII classification of grade I, the RF model achieved an accuracy of 98.89%. CONCLUSION: Machine learning models are valuable in assessing the risk of viral pneumonia. Meanwhile, machine learning models confirm the importance in predicting the severity of viral pneumonia through PII. The establishment of machine learning models for predicting the risk and severity of viral pneumonia promotes the further development of machine learning in the medical field.
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Neumonía Viral , Humanos , Estudios Retrospectivos , Algoritmos , Análisis por Conglomerados , Aprendizaje AutomáticoRESUMEN
BACKGROUND: Acute pancreatitis (AP) is one of the most common digestive emergencies, and vascular complication is one of the primary reasons for death, with splanchnic venous thrombosis being the most common. Although extra-splanchnic venous thrombosis is rare, it carries the risk of life-threatening secondary pulmonary embolism. CASE PRESENTATION: We have, herein, reported a case of AP complicated by rare brachiocephalic vein thrombosis and superior vena cava thrombosis. A 40 years old woman was diagnosed with severe AP for abdominal pain 21 days ago. The patient received symptomatic treatment, including acid suppression, enzyme suppression, lipid-lowering, fluid infusion, anti-infection, and continuous renal replacement therapy. The patient was discharged after symptomatic relief. Recently, the patient was admitted again for middle-upper abdominal pain and discomfort. On admission, her blood platelet, DDimer, fibrin degradation products (FDP), and triglyceride levels have been found to be increased; abdominal enhanced CT showed pancreatic necrosis and an accumulation of peripancreatic necrosis and fluid, while chest enhanced CT suggested thrombosis in the right brachiocephalic vein and superior vena cava. The patient, however, improved and was discharged after anticoagulation combined with insulin and trypsin inhibitors. CONCLUSION: In diagnosing and treating AP, dynamic monitoring of D-dimer levels is necessary for the timely detection of the development of thrombotic complications.
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Pancreatitis , Síndrome de la Vena Cava Superior , Trombosis de la Vena , Femenino , Humanos , Adulto , Vena Cava Superior , Venas Braquiocefálicas/diagnóstico por imagen , Síndrome de la Vena Cava Superior/complicaciones , Pancreatitis/complicaciones , Pancreatitis/diagnóstico por imagen , Enfermedad Aguda , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Dolor Abdominal/complicacionesRESUMEN
BACKGROUND: The Armed Forces Institute of Pathology (AFIP) had higher accuracy and reliability in prognostic assessment and treatment strategies for patients with gastric stromal tumors (GSTs). The AFIP classification is frequently used in clinical applications. But the risk classification is only available for patients who are previously untreated and received complete resection. We aimed to investigate the feasibility of multi-slice MSCT features of GSTs in predicting AFIP risk classification preoperatively. METHODS: The clinical data and MSCT features of 424 patients with solitary GSTs were retrospectively reviewed. According to pathological AFIP risk criteria, 424 GSTs were divided into a low-risk group (n = 282), a moderate-risk group (n = 72), and a high-risk group (n = 70). The clinical data and MSCT features of GSTs were compared among the three groups. Those variables (p < 0.05) in the univariate analysis were included in the multivariate analysis. The nomogram was created using the rms package. RESULTS: We found significant differences in the tumor location, morphology, necrosis, ulceration, growth pattern, feeding artery, vascular-like enhancement, fat-positive signs around GSTs, CT value in the venous phase, CT value increment in the venous phase, longest diameter, and maximum short diameter (all p < 0.05). Two nomogram models were successfully constructed to predict the risk of GSTs. Low- vs. high-risk group: the independent risk factors of high-risk GSTs included the location, ulceration, and longest diameter. The area under the receiver operating characteristic curve (AUC) of the prediction model was 0.911 (95% CI: 0.872-0.951), and the sensitivity and specificity were 80.0% and 89.0%, respectively. Moderate- vs. high-risk group: the morphology, necrosis, and feeding artery were independent risk factors of a high risk of GSTs, with an AUC value of 0.826 (95% CI: 0.759-0.893), and the sensitivity and specificity were 85.7% and 70.8%, respectively. CONCLUSIONS: The MSCT features of GSTs and the nomogram model have great practical value in predicting pathological AFIP risk classification between high-risk and non-high-risk groups before surgery.
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To evaluate the treatment efficacy of uterine artery embolization (UAE) using 8Spheres conformal microspheres for symptomatic uterine leiomyoma. In this prospective observational study, 15 patients were enrolled and underwent UAE by 2 experienced interventionalists from September 1, 2018, to September 1, 2019. All patients underwent menstrual bleeding scores, the symptom severity domain of the Uterine Fibroid Symptom and Quality of Life questionnaire scores (with lower scores indicating mild symptoms), pelvic contrast-enhanced magnetic resonance imaging, ovarian reserve tests (estradiol, prolactin, testosterone, follicle-stimulating, luteinizing, and progesterone), and other appropriate preoperative examinations within 1 week before UAE. During follow-up, menstrual bleeding scores and the symptom severity domain of the Uterine Fibroid Symptom and Quality of Life questionnaire scores were recorded at 1, 3, 6, and 12 months after UAE to assess the efficacy of symptomatic uterine leiomyoma. Pelvic contrast-enhanced magnetic resonance imaging was performed 6 months after the interventional therapy. Biomarkers of ovarian reserve function were reviewed at 6 and 12 months after treatment. All 15 patients successfully underwent UAE, without severe adverse effects. Six patients experienced abdominal pain, nausea, or vomiting, all of which improved significantly after symptomatic treatment. The menstrual bleeding scores declined from baseline (350.2 ± 61.9 mL) to (131.8 ± 42.7 mL), (140.3 ± 42.4 mL), (68.0 ± 22.8 mL), and (64.43 ± 17.0 mL) at 1, 3, 6, and 12 months, respectively. The symptom severity domain scores at 1, 3, 6, and 12 months postoperatively were significantly lower and statistically significant compared to the preoperative scores. The uterus and dominant leiomyoma volumes decreased from baseline (340.0 ± 35.8 cm3), (100.6 ± 24.3 cm3) to (266.6 ± 30.9 cm3), (56.1 ± 17.3 cm3) at 6 months after UAE, respectively. Moreover, the ratio of leiomyoma volumes and uterus decreased from (27.4 ± 4.5%) to (18.7 ± 3.9%). At the same time, there was no significant effect on changes in the biomarkers of ovarian reserve levels. Only the changes in testosterone levels before and after UAE were statistically significant (P < .05). 8Spheres conformal microspheres are ideal embolic agents for UAE therapy. This study showed that 8Spheres conformal microsphere embolization for symptomatic uterine leiomyoma could effectively relieve heavy menstrual bleeding, improve the symptom severity of patients, reduce the volume of leiomyoma, and have no significant effect on ovarian reserve function.
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Leiomioma , Embolización de la Arteria Uterina , Femenino , Humanos , Microesferas , Estudios Prospectivos , Calidad de Vida , Leiomioma/diagnóstico por imagen , Leiomioma/terapiaRESUMEN
Hepatocellular carcinoma (HCC) has the sixth-highest new incidence and fourth-highest mortality worldwide. Transarterial chemoembolization (TACE) is one of the primary treatment strategies for unresectable HCC. However, the therapeutic effect is still unsatisfactory due to the insufficient distribution of antineoplastic drugs in tumor tissues and the worsened post-embolization tumor microenvironment (TME, e.g., hypoxia and reduced pH). Recently, using nanomaterials as a drug delivery platform for TACE therapy of HCC has been a research hotspot. With the development of nanotechnology, multifunctional nanoplatforms have been developed to embolize the tumor vasculature, creating conditions for improving the distribution and bioavailability of drugs in tumor tissues. Currently, the researchers are focusing on functionalizing nanomaterials to achieve high drug loading efficacy, thorough vascular embolization, tumor targeting, controlled sustained release of drugs, and real-time imaging in the TACE process to facilitate precise embolization and enable therapeutic procedures follow-up imaging of tumor lesions. Herein, we summarized the recent advances and applications of functionalized nanomaterials based on TACE against HCC, believing that developing these functionalized nanoplatforms may be a promising approach for improving the TACE therapeutic effect of HCC.
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Carcinoma Hepatocelular , Quimioembolización Terapéutica , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Disponibilidad Biológica , Sistemas de Liberación de Medicamentos , Microambiente TumoralRESUMEN
RATIONALE: Traumatic carotid-cavernous sinus fistula (TCCF) is a pathological shunt between the carotid arteries and cavernous sinus due to trauma. Imaging-guided (e.g., ultrasonic image and fluoroscopic roadmap image) direct puncture of the superior ophthalmic vein (SOV) for embolization of TCCF has been previously described in other studies. PATIENT CONCERNS AND DIAGNOSIS: We report a case of TCCF in a 58-years-old male patient who was admitted to our hospital with a sustained head injury after falling from a high platform, resulting in rapidly progressive swelling, pain, diminishing vision for more than 6 months, and blindness in his left eye for 1 month. INTERVENTIONS AND OUTCOMES: The patient underwent digital subtraction angiography and endovascular embolization. After the failure of super-selection of the left cavernous sinus, an alternative approach to obliterating the TCCF by puncturing the SOV is directly guided by Dyna-CT. After embolization, the patient's clinical symptoms gradually disappeared and discharged from the hospital 5 days later. No recurrence or complications occurred during follow-up for 1 year. CONCLUSION: This case illustrates that direct puncture of the SOV guided by Dyna-CT as an alternative approach to embolization of TCCF is safe, effective, and feasible.
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Fístula del Seno Cavernoso de la Carótida , Seno Cavernoso , Embolización Terapéutica , Masculino , Humanos , Persona de Mediana Edad , Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Fístula del Seno Cavernoso de la Carótida/etiología , Fístula del Seno Cavernoso de la Carótida/terapia , Seno Cavernoso/diagnóstico por imagen , Embolización Terapéutica/métodos , Punciones/métodos , Tomografía Computarizada por Rayos X/efectos adversosRESUMEN
OBJECTIVE: To compare the accuracy of multi-slice spiral computerized tomography (MSCT) with colonoscopy for diagnosing synchronous colorectal carcinoma (SCC). METHODS: We retrospectively analyzed all consecutive patients admitted to our institution with colorectal carcinoma between 19 September 2014 and 31 January 2020. Data on SCC patients who had undergone MSCT and colonoscopy were analyzed. Information on tumor location, tumor size, missed diagnosis by MSCT or colonoscopy, T stage, pathological type, and reasons for missed diagnosis was recorded and used to assess the diagnostic accuracies of MSCT and colonoscopy. RESULTS: Twenty-three cases met the inclusion criteria. MSCT plus colonoscopy had a significantly higher diagnostic accuracy (93.5%) than colonoscopy alone. There were significant differences in missed diagnosis rates of proximal cancer (34.8%) and distal cancer (4.3%) by colonoscopy. For MSCT, the missed diagnosis rate for tumors with a median long diameter of 1.25 cm (interquartile range 0.80, 1.50) was significantly lower than that for larger tumors (long diameter 4.00 cm; 3.00, 6.00). CONCLUSIONS: MSCT is a valuable diagnostic tool for SCC that can effectively minimize the missed diagnosis rate of primary tumors when combined with colonoscopy.
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Neoplasias Colorrectales , Tomografía Computarizada Espiral , Colonoscopía , Neoplasias Colorrectales/diagnóstico por imagen , Humanos , Estudios RetrospectivosRESUMEN
BACKGROUND: Gastric metastases (GMs) are rare and often accompanied with synchronous metastases of other organs. Synchronous isolated GMs from ascending colon carcinoma are uncommon and rarely studied. GMs may be confused with primary gastric tumors. METHODS: A 45-year-old man presented to our hospital with abdominal distensionand anal pendant expansion. The abdominal physical examination was negative. The positive fecal occult blood test and the negative tumor marker were obtained. Colonoscopy and gastroduodenoscopy revealed a polypoidal lesion in the ascending colon and a polypoid mass in the gastric body, respectively. CT showed the thickened wall of ascending colon and polypoid mass in the gastric body with homogenous enhancement. Additionally, synchronous gastric metastases from the ascending colon carcinoma were confirmed by pathology after laparoscopic right hemicolectomy and partial gastrectomy. After 13 individual doses of fluorouracil (2.8 g/time), calcium leucovorin (0.8 g/time), and oxaliplatin (85 mg/time), the patient was discharged without any discomfort, without any additional metastases detected during the following 18 months.1. RESULTS: A rare case of synchronous isolated gastric metastasis from ascending colon carcinoma was confirmed by computed tomography (CT) and pathological diagnosis. CONCLUSION: GM may appear as a polypoid lesion. Surgery combined with chemotherapy may improve the prognosis in patients with synchronous isolated GM.
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Carcinoma , Neoplasias del Colon , Masculino , Humanos , Persona de Mediana Edad , Colon Ascendente/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Colon/cirugía , Estómago/patología , Carcinoma/patologíaRESUMEN
Purpose: The goal of this study was to assess the clinical efficacy and safety of the arsenic trioxide (ATO)/lipiodol emulsion in the transcatheter arterial chemoembolization (TACE) combined with apatinib in the treatment of advanced hepatocellular carcinoma (HCC). Methods: From December 2015 to February 2017, a total of 87 patients were consecutively enrolled and underwent ATO-TACE (aTACE) combined with apatinib in the treatment of advanced HCC. The treatment response and adverse events were assessed at the first month and third month after aTACE therapy. Progression-free survival (PFS), overall survival (OS), and treatment-related adverse events were also analyzed. Results: 87 patients (57 men; 30 women) were enrolled in the present study. Compared to that at the pre-aTACE examination, the levels of AST and ALT were elevated at the first week after procedure (65.84 U/L ± 22.93 U/L vs. 54.15 U/L ± 19.60 U/L, p=0.032; 63.44 U/L ± 22.50 U/L vs. 51.60 U/L ± 13.89 U/L, p=0.027, respectively). Most of the adverse events were grade 1 or 2 according to National Cancer Institute Common Terminology Criteria for Adverse Event (CTCAE). Of the exception, 4 persons (2%) did have grade 3 hand-foot skin reactions, 1 (1%) had grade 3 diarrhea, 1 (1%) had grade 3 hypertension, and 3 (3%) had grade 3 proteinuria and forced to reduce the dose of apatinib by half. The survival analysis of the combination with aTACE and apatinib therapy found that the median PFS was 10.2 months (95% CI: 8.543-11.857), and the median OS was 23.300 months (95% CI: 20.833-25.767). Additionally, both univariate and multivariate Cox regression revealed that the tumor burden (≤50%) and the patients without portal vein tumor thrombus (PVTT) significantly impacted the patient's PFS and OS and were related to better survival. Conclusion: aTACE combined with apatinib is a safe and promising treatment approach for patients with advanced HCC. Additionally, tumor burden (≤50%) and the patients without PVTT are associated with better PFS and OS.
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Carcinoma Hepatocelular , Quimioembolización Terapéutica , Neoplasias Hepáticas , Trióxido de Arsénico , Carcinoma Hepatocelular/tratamiento farmacológico , Quimioembolización Terapéutica/efectos adversos , Emulsiones , Aceite Etiodizado , Femenino , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Masculino , Piridinas , Resultado del TratamientoRESUMEN
BACKGROUND: Given their widespread availability and relatively low cost, percutaneous thermal ablation is commonly performed under the guidance of computed tomography (CT) or ultrasound (US). However, such imaging modalities may be restricted due to insufficient image contrast and limited tumor visibility, which results in imperfect intraoperative treatment or an increased risk of damage to critical anatomical structures. Currently, magnetic resonance (MR) guidance has been proven to be a possible solution to overcome the above shortcomings, as it provides more reliable visualization of the target tumor and allows for multiplanar capabilities, making it the modality of choice. Unfortunately, MR-guided ablation is limited to specialized centers, and the cost is relatively high. Is ablation therapy under MR guidance better than that under CT guidance? This study retrospectively compared the efficacy of CT-guided and MR-guided microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC ≤ 5.0 cm). METHODS: In this retrospective study, 47 patients and 54 patients received MWA under the guidance of CT and MR, respectively. The inclusion criteria were a single HCC ≤ 5.0 cm or a maximum of three. The local tumor progression (LTP), overall survival (OS), prognostic factors for local progression, and safety of this technique were assessed. RESULTS: All procedures were technically successful. The complication rates of the two groups were remarkably different with respect to incidences of liver abscess and pleural effusion (P < 0.05). The mean LTP was 44.264 months in the CT-guided group versus 47.745 months in the MR-guided group of HCC (P = 0.629, log-rank test). The mean OS was 56.772 months in the patients who underwent the CT-guided procedure versus 58.123 months in those who underwent the MR-guided procedure (P = 0.630, log-rank test). Multivariate Cox regression analysis further illustrated that tumor diameter (< 3 cm) and the number of lesions (single) were important factors affecting LTP and OS. CONCLUSIONS: Both CT-guided and MR-guided MWA are comparable therapies for the treatment of HCC (< 5 cm), and there was no difference in survival between the two groups. However, MR-guided MWA could reduce the incidence of complications.
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Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/radioterapia , Ablación por Catéter/métodos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/radioterapia , Espectroscopía de Resonancia Magnética/métodos , Ablación por Radiofrecuencia/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Carcinoma Hepatocelular/patología , Femenino , Humanos , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the feasibility and safety of using cone-beam CT (CBCT) to measure changes in parenchymal blood volume (PBV) of patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and to guide microwave ablation (MWA) for residual tumors. METHODS: A retrospective study was performed on 42 patients with HCC who completed TACE and received CBCT-guided perfusion imaging. The residual active lesions after TACE were supplemented with MWA to complete the treatment process according to the residual PBV. The outcomes were analyzed, including PBV changes, interventional-related complications, local tumor progression (LTP) and overall survival (OS). RESULTS: Technical success was achieved in all lesions. Correlation analysis revealed that greater volume of residual PBV after MWA is negatively correlated with LTP. (p = .000); and the decrease of PBV was positively correlated with LTP (p = .000). All adverse events and complications were CTCAE Grade 1/2. After combination treatment, the 1-, 3-, and 5-year LTP-free survival were 97.6%, 69.0% and 15.1%, respectively, with a median LTP of 49.0 months (95% CI:43.129,54.871). Multivariate Cox regression revealed that the residual PBV > 13 ml/1000 was an independent factor predicting a shorter OS and LTP (Both p< .05). For LTP, multivariate Cox regression showed that a tumor in a single lesion were independently predicted to have a longer LTP in patients with HCC (p = .033). CONCLUSION: CBCT is feasible and safe to use to measure changes in the PBV before and after TACE treatment, while it can also guide MWA for the treatment of residual tumors in one session.
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Carcinoma Hepatocelular , Quimioembolización Terapéutica , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/terapia , Tomografía Computarizada de Haz Cónico , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Perfusión , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
ABSTRACT: To evaluate the outcomes of the transjugular intrahepatic portosystemic shunt (TIPS) combined with AngioJet thrombectomy in patients with noncirrhotic acute portal vein (PV) thrombosis.Retrospective analysis from January 2014 to March 2017, 23 patients underwent TIPS combined with AngioJet thrombectomy for acute PV thrombosis in noncirrhosis. The rates of technical success, the patency of the PV, liver function changes, and complications were evaluated.Twenty-three patients underwent combined treatment, with a technical success rate of 100%. Twenty-four hours after treatment, PV thrombosis grade was improved significantly (Pâ=â.001). Before and after treatment, Albumin (gm/dl), aspartate transaminase (IU/l), alanine transaminase (IU/l), and platelets (109/L) were all significantly improved (Pâ<â.05). Minor complications include hematoma, hematuria, and hepatic encephalopathy. After 1 week of treatment, computed tomography scan revealed 8.7% (2/23) cases of hepatic envelope hematoma (thickness less than 2âcm). Hemoglobinuria occurred in 18/23 (78.3%) patients after treatment and returned to normal within 1 to 2âdays. Two patients 2/23 (8.7%) had transient grade I encephalopathy after TIPS. The 1-year overall survival rate was 100% (23/23). No major complications during treatment in all patientsAngioJet thrombectomy via TIPS has a favorable short-term effect in clearing thrombus and alleviating symptoms in diffuse acute PVT. The long-term efficacy of this treatment needs to be further studied.
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Vena Porta , Derivación Portosistémica Intrahepática Transyugular/métodos , Trombectomía/métodos , Trombosis de la Vena/cirugía , Enfermedad Aguda , Angiografía por Tomografía Computarizada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vena Porta/diagnóstico por imagen , Estudios Retrospectivos , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico por imagenRESUMEN
Advanced glycation end products (AGEs) have been widely regarded as an important inducing factor in the pathogenesis of diabetic arteriosclerosis, and the proliferation and migration of vascular smooth muscle cells (VSMCs) are also involved in this process. However, it is not clear whether AGEs promote atherosclerosis by inducing the proliferation and migration of VSMCs. To figure out this question, this study investigated the effects of AGEs on the proliferation and migration of human aorta vascular smooth muscle cells (HASMCs) and the underlying mechanisms. This study evaluated the effects of different concentrations of AGEs on cell proliferation and migration. CCK8, transwell, and western blotting assays demonstrated that AGEs significantly increased cell proliferation and migration in a concentration-dependent manner and that the optimal proproliferative and promigratory concentrations of AGEs were 10 mg/L and 20 mg/L, respectively. AGE-induced cell proliferation, migration, and expression of filament actin (F-actin) were markedly attenuated by a PI3K inhibitor (LY2940002). Additionally, the phosphorylation of AKT was reduced when the receptor of advanced glycation end product (RAGE) gene was silenced by lentivirus transfection, which led to a concomitant reduction of the expression of proliferation and migration-related proteins. These data indicate that AGEs may activate the PI3K/AKT pathway through RAGE and thus facilitate the proliferation and migration of HASMCs.
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Aorta/citología , Productos Finales de Glicación Avanzada/farmacología , Miocitos del Músculo Liso/citología , Fosfatidilinositol 3-Quinasas/metabolismo , Proteínas Proto-Oncogénicas c-akt/metabolismo , Movimiento Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Humanos , Miocitos del Músculo Liso/efectos de los fármacos , Fosforilación/efectos de los fármacos , Transducción de Señal/efectos de los fármacosRESUMEN
INTRODUCTION: Transient hepatic attenuation differences (THAD) are areas of high parenchymal enhancement observed during the hepatic arterial phase on computed tomography (CT). THAD in the left lobe of the liver can lead to surgical complications. METHODS: A retrospective study was conducted on patients who underwent multislice computed tomography (MSCT) examination of the upper abdomen to understand the morphology, distribution, and causes of THAD and their correlation with hepatic artery variation. RESULTS: Among 179 cases, 65 and 114 belonged to diseased and normal groups, respectively. THAD as observed in MSCT demonstrated various shapes: lobe/segment (127 cases; 70.9%), irregular sheet (31; 17.3%), strip shape (9; 5.02%), arc/semicircle (7; 3.9%), and segment + flaky (5; 2.79%). THAD were found to be caused by liver tumor (32.3%), hepatic inflammatory lesions (6.15%), biliary tract diseases (13.8%), perihepatic disease compression (9.23%), portal vein obstructive disease (1.53%), and lesion in left hepatic lobe with hepatic artery variation (29.2%). THAD exhibited variation in distribution in the left lobe of the liver. Among 114 cases, THAD in 18 (15.7%) cases were observed in the S2 segment, six (5.26%) in the S3 segment, and 90 (78.9%) in multiple segments of the liver, that is, 50 cases in S2 and S3 segments and 40 cases in S2, S3, and S4 segments. The hepatic artery of 179 cases was of various types based on Hiatt classification: 57 cases of Hiatt I (31%), 65 cases of Hiatt II (37%), 11 cases of Hiatt III (6%), 17 cases of Hiatt IV (10%), 7 cases of Hiatt V (4%), 12 cases of large left hepatic artery (7%), 6 cases of right hepatic artery originating from the celiac trunk (3%), and 4 cases (2%) of superior mesenteric artery originating from the celiac trunk. CONCLUSION: THAD can occur as a result of specific pathological causes and hence should be considered as a diagnostic sign in liver pathologies.
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Arteria Hepática/citología , Arteria Hepática/diagnóstico por imagen , Hepatopatías/diagnóstico por imagen , Hepatopatías/diagnóstico , Hepatopatías/fisiopatología , Tomografía Computarizada Multidetector/métodos , Adulto , Anciano , Anciano de 80 o más Años , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the feasibility and safety of portal vein stenting (PVS) combined with 125I particle chain implantation and sequential arsenic trioxide (As2O3) for the treatment of hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) by transcatheter arterial chemoembolization (TACE). METHODS: From January 2015 to January 2018, the clinical data of 30 patients with HCC complicated by PVTT were retrospectively analysed (26 men and 4 women). The laboratory examinations, incidence of adverse events, cumulative survival rate, and stent patency were analysed for all enrolled patients. RESULTS: The success rate of interventional treatment in all patients was 100%. The results of the laboratory tests before and 1 week after surgery showed that the mean concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) decreased from 50.9 U/L ± 25.8 to 41.8 U/L ± 21.6 (P < 0.001) and 57.6 U/L ± 19.9 to 44.2 U/L ± 26.1 (P < 0.001) and 57.6 U/L ± 19.9 to 44.2 U/L ± 26.1 (. CONCLUSION: PVS combined with 125I particle chain implantation followed by TACE with As2O3 is safe and feasible for patients with PVTT. The long-term efficacy of this treatment needs to be further studied.
Asunto(s)
Trióxido de Arsénico/uso terapéutico , Carcinoma Hepatocelular/terapia , Radioisótopos de Yodo/uso terapéutico , Neoplasias Hepáticas/terapia , Vena Porta/cirugía , Stents , Trombosis de la Vena/complicaciones , Trombosis de la Vena/terapia , Adulto , Anciano , Trióxido de Arsénico/efectos adversos , Carcinoma Hepatocelular/complicaciones , Femenino , Humanos , Radioisótopos de Yodo/efectos adversos , Estimación de Kaplan-Meier , Neoplasias Hepáticas/complicaciones , Masculino , Persona de Mediana Edad , Vena Porta/patología , Complicaciones Posoperatorias/etiología , Stents/efectos adversos , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
PURPOSE: To evaluate the method and effectiveness of transcatheter arterial chemoembolization (TACE) combined with simultaneous DynaCT-guided Microwave ablation (MWA) for the treatment of small hepatocellular carcinoma (SHCC). MATERIALS AND METHODS: From June 2015 to May 2017, a total of 28 consecutive patients with SHCC received single treatment of TACE and 23 subjects received a combination treatment of TACE with simultaneous DynaCT-guided MWA. Following 1 month of treatment, the tumor response was assessed using the mRECIST criteria and the outcomes were analyzed including intervention-associated complications, changes in liver function, imaging response, and progression-free survival (PFS). RESULTS: The technical success rate was 100%. The rates of CR (65%) in the combined TACE and MWA group were higher than those of the TACE group (46%). The rate of common adverse events, such as liver abscess, spontaneous bacterial peritonitis and liver dysfunction, in the combined TACE and MWA group (56%) was comparable to the corresponding rate of the TACE group (P > 0.411). The median and mean PFS of the TACE group were significantly lower than those of the combined TACE and MWA group (19.00 months vs. 29.00 months, 21.076 months vs. 24.693 months, p = 0.019, log-rank test). CONCLUSION: Stereotactic DynaCT-guided MWA is a safe and effective method for the treatment of SHCC, which usually provides an effective tumor puncture path, notably for lesions that cannot be detected following TACE. Overall, the data suggested that this treatment method could improve the clinical outcome of patients with SHCC.