ABSTRACT
BACKGROUND: Malignant obstructive jaundice is mainly caused by cholangiocarcinoma. Only a few patients are indicated for surgical resection, and the 3-year survival rate is < 50%. For patients who are not eligible for surgery, biliary stent placement can relieve biliary obstruction and improve liver function and quality of life. However, restenosis after biliary stents has a poor prognosis and is a clinical challenge. Biliary stent combined with iodine-125 (125I) seed implantation can prolong stent patency and improve survival. AIM: To evaluate the safety and efficacy of biliary stent combined with 125I seed strand implantation in malignant obstructive jaundice. METHODS: We enrolled 67 patients between January 2016 and June 2018 with malignant obstructive jaundice and randomized them into a biliary stent combined with 125I seed strand treatment (combined) group (n = 32) and biliary stent (control) group (n = 35). All patients underwent enhanced computed tomography and magnetic resonance imaging and were tested for biochemical and cancer markers. Twelve patients underwent pathological examination before surgery. All patients were followed up by telephone or clinical visit. Postoperative liver function improvement, postoperative complications, stent patency time, and survival time were compared between the two groups. Prognostic risk factors were evaluated. RESULTS: Technical success was achieved in all patients in both groups. Postoperative liver function improved significantly in all patients (total bilirubin, direct bilirubin, alanine aminotransferase, and aspartate aminotransferase decreased significantly in all patients, the P values were less than 0.05). There was no significant difference in preoperative or postoperative indexes between the two groups for changes in total bilirubin (P = 0.147), direct bilirubin (P = 0.448), alanine aminotransferase (P = 0.120), and aspartate aminotransferase (P = 0.387) between the two groups. The median stent patency time of the combined group was 9.0 ± 1.4 mo [95% confidence interval (CI): 6.3-11.8 mo], which was significantly longer than the that of the control group (6.0 ± 0.3 mo, 95%CI: 5.5-6.5 mo, P = 0.000). The median survival time of the combined group was 11.0 ± 1.4 mo (95%CI: 8.2-13.7 mo), which was significantly longer than that of the control group (7.0 ± 0.3 mo, 95%CI: 6.4-7.6 mo, P = 0.000). Location of obstruction and number of stents were independent risk factors affecting prognosis. CONCLUSION: Biliary stent combined with 125I seed strand implantation is safe and effective in malignant obstructive jaundice and improves stent patency time and median survival time.
ABSTRACT
Analysis on the revolution and regional characteristics of air quality by hourly monitored readings from 1 to 15 November 2014 released by Environmental Monitoring Station of China and research of the impacts of weather situation and meteorological elements released by China Meteorological Administration towards air quality of Beijing and its surrounding cities during the Asia-Pacific Economic Cooperation (APEC) indicated that: (1) The air quality was good because of the implementation of mitigation measures, while the Air Quality Index (AQI) increased along with the termination of mitigation measures. Thus it can be seen that mitigation measures made a great contribution to the improvement of air quality of Beijing and its surrounding cities. (2) Affected by thermal inversion layer, AQI of Beijing and its surrounding cities increased quickly during the initial of the implemental of reducing measures which proved that pollutants would accumulate in the context of unfavourable weather, hence the influence of weather situation towards air quality could not be ignored. (3) Although affected by thermal inversion layer, the concentration of pollutants of Beijing was not accumulated to a high degree at the end period of reducing measures, while Tianjin, Tangshan, Baoding and Xingtai suffered from moderate and severe pollution at the same time which further illustrated that the implementation of mitigation measures have made a great contribution to the improvement of air quality in Beijing during APEC.
