Preoperative computed tomography-guided localization for pulmonary nodules: comparison between hook-wire and anchored needle localization.

Introduction: Both hook-wire (HW) and anchored needle (AN) techniques can be used for preoperative computed tomography (CT)-guided localization for pulmonary nodules (PNs). But the outcomes associated with these two materials remain unclear. Aim: To assess the relative safety and efficacy of preoperative CT-guided HW and AN localization for PNs. Material and methods: This was a retrospective analysis of data collected from two institutions. Consecutive patients with PNs between January 2020 and December 2021 who underwent preoperative CT-guided HW or AN localization followed by video-assisted thoracoscopic surgery (VATS) procedures were included in these analyses, which compared the safety and clinical efficiency of these two localization strategies. Results: In total, 98 patients (105 PNs) and 93 patients (107 PNs) underwent CT-guided HW and AN localization procedures, respectively. The HW and AN groups exhibited similar rates of successful PN localization (95.2% vs. 99.1%, p = 0.117), but the dislodgement rate in the HW group was significantly higher than that for the AN group (4.8% vs. 0.0%, p = 0.029). The mean pain score of patients in the HW group was significantly higher than that for the AN group (p = 0.001). HW and AN localization strategies were associated with comparable pneumothorax (21.4% vs. 16.1%, p = 0.349) and pulmonary hemorrhage (29.6% vs. 23.7%, p = 0.354) rates. All patients other than 1 individual in the HW group successfully underwent VATS-guided limited resection. Conclusions: These data suggest that AN represents a safe, well-tolerated, feasible preoperative localization strategy for PNs that may offer value as a replacement for HW localization.

Technical Risk Stratification Nomogram Model for 90-Day Mortality Prediction in Patients With Acute Basilar Artery Occlusion Undergoing Endovascular Thrombectomy: A Multicenter Cohort Study.

BACKGROUND: This study aimed to establish and validate a nomogram model for predicting 90-day mortality in patients with acute basilar artery occlusion receiving endovascular thrombectomy. METHODS AND RESULTS: A total of 242 patients with basilar artery occlusion undergoing endovascular thrombectomy were enrolled in our study, in which 172 patients from 3 stroke centers were assigned to the training cohort, and 70 patients from another center were assigned to the validation cohort. Univariate and multivariate logistic regression analyses were adopted to screen prognostic predictors, and those with significance were subjected to establish a nomogram model in the training cohort. The discriminative accuracy, calibration, and clinical usefulness of the nomogram model was verified in the internal and external cohorts. Six variables, including age, baseline National Institutes of Health Stroke Scale score, Posterior Circulation-Alberta Stroke Program Early CT (Computed Tomography) score, Basilar Artery on Computed Tomography Angiography score, recanalization failure, and symptomatic intracranial hemorrhage, were identified as independent predictors of 90-day mortality of patients with basilar artery occlusion and were subjected to develop a nomogram model. The nomogram model exhibited good discrimination, calibration, and clinical usefulness in both the internal and the external cohorts. Additionally, patients were divided into low-, moderate-, and high-risk groups based on the risk-stratified nomogram model. CONCLUSIONS: Our study proposed a novel nomogram model that could effectively predict 90-day mortality of patients with basilar artery occlusion after endovascular thrombectomy and stratify patients with high, moderate, or low risk, which has a potential to facilitate prognostic judgment and clinical management of stroke.

Transarterial Chemoembolization Plus Tyrosinkinase Inhibitors and PD-1 Inhibitors for Spontaneously Ruptured Hepatocellular Carcinoma.

PURPOSE: To compare the efficacy and safety of transcatheter arterial chemoembolization (TACE) in combination with tyrosinkinase inhibitors (TKI) and PD-1 inhibitors, versus TACE monotherapy for the treatment of ruptured hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This study included 104 patients with ruptured HCC receiving either combination therapy or TACE monotherapy at two centers between June 2015 and June 2022. Propensity score matching (PSM) analysis was used at a 1:2 ratio to reduce bias between the two groups. The primary outcome measures were overall survival (OS) and progression-free survival (PFS), and the secondary outcome measures were the occurrence of adverse events (AEs, Common Terminology Criteria for AEs, version 5.0.) and the peritoneal metastasis rate. RESULTS: A total of 69 patients were enrolled after PSM, including 23 patients in the combination group and 46 patients in the monotherapy group. The combination group exhibited a significantly longer median OS (553 days, 95% confidence interval [CI] 222.6-883.9) compared to the monotherapy group (105 days, 95% CI 81.2-128.7; P < 0.001). Similarly, the combination group showed a better median PFS (356 days, 95% CI 299.5-412.4) compared to the monotherapy group (97 days, 95% CI 75.9-118.1; P < 0.001). Moreover, there was no significant difference in the peritoneal metastasis rate (combination group: 8.6% vs. monotherapy group: 26.1%, P = 0.119). Grade 3 AEs occurred at a rate of 21.7% and 13% in combination and monotherapy groups, respectively. No Grade 4/5 AEs were observed in either group. CONCLUSIONS: Our study demonstrated that the combination of TACE with TKI and PD-1 inhibitors significantly enhances OS and PFS compared to TACE monotherapy in ruptured HCC patients. Furthermore, this combined approach exhibited an acceptable safety profile.

Trans-radial versus trans-femoral approach for cerebral angiography: a meta-analysis of randomized controlled trials.

Introduction: Both the trans-radial approach (TRA) and the trans-femoral approach (TFA) have been employed for cerebral angiography, but the relative advantages of these two techniques remain uncertain. Aim: To compare the relative safety and efficacy of the TRA and TFA when conducting cerebral angiography. Material and methods: Relevant studies published up to August 2022 were identified in the PubMed, Embase, and Wanfang databases. The rate of successful cerebral angiography was the primary study endpoint, while secondary endpoints included successful puncture rates, operative duration, puncture time, fluoroscopic duration, complication rates, and duration of postoperative recovery. Results: This meta-analysis incorporated 6 randomized controlled trials (RCTs) enrolling 542 and 539 patients who underwent TRA and TFA cerebral angiography, respectively. Comparable pooled successful puncture rates (p = 0.05), successful cerebral angiography rates (p = 1.00), and operative duration (p = 0.10) were observed when comparing these two groups of patients. Relative to the TFA, the TRA was associated with a significantly reduced puncture time (p < 0.00001), a decreased fluoroscopic duration (p < 0.00001), lower rates of complications (p < 0.00001), and more rapid postoperative recovery (p < 0.00001). Significant heterogeneity was found when analyzing the puncture duration (I2 = 98%), operative duration (I2 = 97%), and fluoroscopic duration (I2 = 82%). Conclusions: These results suggest that TRA and TFA cerebral angiography strategies can yield similar rates of successful cerebral angiography outcomes. However, complication rates are lower and postoperative recovery is more rapid for patients who undergo TRA cerebral angiography as compared to TFA cerebral angiography.

Efficacy and safety of camrelizumab plus transarterial chemoembolization in intermediate to advanced hepatocellular carcinoma patients: A prospective, multi-center, real-world study.

Objective: Camrelizumab is a newly developed program-death receptor one inhibitor; the real-world evidence about its application in hepatocellular carcinoma (HCC) treatment is lacking. Therefore, this prospective, multi-center, real-world study evaluated the efficacy and safety of camrelizumab plus transarterial chemoembolization (TACE) in treating intermediate-to-advanced HCC patients. Methods: This study consecutively enrolled 101 intermediate to advanced HCC patients. All patients received camrelizumab-based treatment within 30 days of the perioperative period of the TACE operation. The primary outcome was progression-free survival (PFS), and the secondary effects were overall survival (OS), objective response rate (ORR), disease control rate (DCR), and AEs. Results: Specifically, the median PFS was 9.7 (95% confidence interval: 7.4-12.0) months, with a 1-year PFS rate of 30.6%. Meanwhile, the median OS was not reached (NR) yet, with a 1-year OS rate of 61.9%. Besides, the CR, PR, SD, and PD rates were 12.8%, 44.9%, 29.5%, and 12.8%, respectively. The ORR and DCR were 57.7% and 87.2%, respectively. More cycles of camrelizumab were independently correlated with prolonged PFS (hazard ratio (HR): 0.415, P = 0.002), whereas longer intervals between camrelizumab administration and TACE were independently associated with unfavorable PFS (HR: 1.873, P = 0.032). The incidence of total AEs was 90.1%; most AEs were grade 1 (20.8%), grade 2 (28.7%) and grade 3 (37.6%), while only 3 (3.0%) patients had grade 4 AEs. Conclusion: The camrelizumab plus TACE regimen is effective and safe, indicating its potential to serve as a promising treatment choice for intermediate to advanced HCC patients.

Serum Exosomal mir-340-5p Promotes Angiogenesis in Brain Microvascular Endothelial Cells During Oxygen-Glucose Deprivation.

Ischemic stroke (IS) is a cerebrovascular disease with high morbidity, recurrence, and mortality. The purpose of the present study was to investigate the role and mechanism of human serum exosomes on angiogenesis after IS. The middle cerebral artery occlusion (MCAO) in vivo model and oxygen-glucose deprivation (OGD) in vitro model were established. Human serum exosomes from healthy samples (NC-exo) and IS samples (IS-exo) were injected into MCAO mice. Neurobehavioral tests were performed to assess the extent of neurological deficits. The infarct volume was assessed by 2,3,5-triphenyl tetrazolium chloride (TTC) staining, and the levels of inflammatory cytokines were analyzed by enzyme-linked immunosorbent assay (ELISA). In addition, human serum exosomes were cocultured with brain microvascular endothelial cells (BMECs). Cell Counting Kit-8 (CCK-8), Transwell, and tubule formation assays were performed to investigate the proliferation, migration, invasion, length, and branching of BMECs. The miRNA expression profiles of NC-exo and IS-exo were analyzed by high-throughput sequencing and compared. Bioinformatics and luciferase reporter assays were performed to evaluate the relationship between miR-340-5p and CD147. Serum NC-exo and IS-exo had protective effects on IS injury and promoted BMEC angiogenesis. Interestingly, the protective effect of IS-exo was weaker than that of NC-exo. In addition, miR-340-5p was downregulated in IS-exo, and miR-340-5p accelerated angiogenesis of BMECs after OGD. Mechanistically, CD147 was confirmed as a direct target of miR-340-5p. Finally, miR-340-5p promoted angiogenesis by directly targeting CD147. Serum exosome-derived miR-340-5p promote angiogenesis in OGD-induced BMECs by targeting CD147.

The combination of radiofrequency ablation and vertebroplasty shows advantages over single vertebroplasty in treating vertebral neoplastic lesions.

OBJECTIVE: To investigate the safety and efficacy of the combination of radiofrequency ablation (RFA) and vertebroplasty versus single vertebroplasty in treating spinal metastases. MATERIALS AND METHODS: The data of 35 patients with vertebral neoplastic lesions who received RFA combined with vertebroplasty (group A, 15 patients with 17 lesions) or single vertebroplasty (group B, 20 patients with 24 lesions) from March 2016 to June 2019 were retrospectively compared. The data of patients' Visual Analogue Scale (VAS) scores prior to the treatments, 1 week, 1 month, 3 months, and 6 months after the treatments, injected cement volume, ratios of cement leakage were compared between the two groups. RESULTS: All procedures were successfully done without severe complications. The VAS scores in group A were decreased more rapidly 1 week after the treatments and remained more stable at 6 months than that in group B (P < 0.05). The cement injected in group A (5.95 ± 1.45 mL, range 4-9.5 mL) was significantly more than that in group B (4.09 ± 0.55 mL, range 3.1-5.5 mL) (P < 0.05). The ratio of vascular cement leakage in group A was significantly lower than that in group B (P < 0.05), while no statistical difference was found in the non-vascular cement leakage (P > 0.05). CONCLUSIONS: Our study shows that the combination of RFA and vertebroplasty has a better analgesic effect with more injected cement and lower rates of venous cement leakage than single vertebroplasty.

A CT-based radiomics nomogram for classification of intraparenchymal hyperdense areas in patients with acute ischemic stroke following mechanical thrombectomy treatment.

Objectives: To develop and validate a radiomic-based model for differentiating hemorrhage from iodinated contrast extravasation of intraparenchymal hyperdense areas (HDA) following mechanical thrombectomy treatment in acute ischemic stroke. Methods: A total of 100 and four patients with intraparenchymal HDA on initial post-operative CT were included in this study. The patients who met criteria were divided into a primary and a validation cohort. A training cohort was constructed using Synthetic Minority Oversampling Technique on the primary cohort to achieve group balance. Thereafter, a radiomics score was calculated and the radiomic model was constructed. Clinical factors were assessed to build clinical model. Combined with the Rad-score and independent clinical factors, a combined model was constructed. Different models were assessed using the area under the receiver operator characteristic curves. The combined model was visualized as nomogram, and assessed with calibration and clinical usefulness. Results: Cardiogenic diseases, intraoperative tirofiban administration and preoperative national institute of health stroke scale were selected as independent predictors to construct the clinical model with area under curve (AUC) of 0.756 and 0.693 in the training and validation cohort, respectively. Our data demonstrated that the radiomic model showed good discrimination in the training (AUC, 0.955) and validation cohort (AUC, 0.869). The combined nomogram model showed optimal discrimination in the training (AUC, 0.972) and validation cohort (AUC, 0.926). Decision curve analysis demonstrated the combined model had a higher overall net benefit in differentiating hemorrhage from iodinated contrast extravasation in terms of clinical usefulness. Conclusions: The nomogram shows favorable efficacy for differentiating hemorrhage from iodinated contrast extravasation, which might provide an individualized tool for precision therapy.

Incomplete radiofrequency ablation induced chemoresistance by up-regulating heat shock protein 70 in hepatocellular carcinoma.

Radiofrequency ablation (RFA) is a common minimally invasive treatment for hepatocellular carcinoma (HCC). Incomplete RFA (iRFA) due to the sub-lethal heat shock challenge of some cell populations leads to the generation of transformed survivor cells with enhanced chemoresistance. However, the underlying mechanism of iRFA on HCCs chemoresistance remains unknown. In the present study, we investigated the effect of iRFA on HCCs sensitivity to cisplatin. Cells treated with the sub-lethal heat shock challenge were used to mimic iRFA treatment in vitro. An orthotopic implantation HCC model was established and also performed iRFA treatment. Flow cytometry, transwell assay, and cell counting kit-8 assay were used to determine the effect of iRFA treatment on cisplatin-induced HCC cell apoptosis, invasion, and cell viability. ELISA and Western blot were used to detect the effect of iRFA treatment on cisplatin-induced HCC cell pyroptosis. We found that iRFA treatment increased the HCC cell proliferation and invasion ability, and inhibited cisplatin-induced pyroptosis. Further experiments showed that iRFA treatment induced upregulation of HSP70, which inhibited the cisplatin-induced NLRP3 inflammasome activation, leading to inhibition of pyroptosis. HSP70 knockdown or NLRP3 overexpression could reverse the effect of iRFA treatment in vitro. In vivo, HSP70 knockdown reversed the chemosensitivity of HCC to cisplatin, which was decreased by iRFA. In conclusion, we demonstrated that iRFA induced drug resistance by HSP70-mediated inhibition of cell pyroptosis in HCC.

Endovascular treatment combined with vertebral artery endarterectomy for patients with acute tandem vertebrobasilar artery occlusion.

PURPOSE: To evaluate the safety and efficacy of endovascular treatment combined with vertebral artery endarterectomy in patients with acute tandem vertebrobasilar artery occlusion. METHODS: From April 2017 to March 2019, three patients with acute basilar artery occlusion combined with ostial vertebral occlusion in our institution were enrolled in the study. They underwent endovascular treatment combined with vertebral artery endarterectomy. The clinical, technical and functional outcomes of the patients were retrospectively analysed. RESULTS: All three patients in the study underwent complete recanalization. The modified Thrombolysis in Cerebral Infarction (mTICI) grade was 2b/3 in all patients. The modified Rankin Scale (mRS) score was 0-2 for the three patients at 3 months. Follow-up CT scans revealed no cerebral haemorrhage, and no patients died during follow-up. All patients achieved good clinical outcomes after the combined treatment. CONCLUSION: Endovascular treatment combined with vertebral artery endarterectomy is a feasible method to treat patients with acute basilar artery occlusion combined with ostial vertebral occlusion, especially when the guidewire cannot pass through the ostium of the dominant vertebral artery occlusion.

Neutrophil-Lymphocyte Ratio Predicts Functional and Safety Outcomes after Endovascular Treatment for Acute Ischemic Stroke.

BACKGROUND AND OBJECTIVE: Endovascular treatment (EVT) is proven to be safe and effective for treating acute large vessel occlusion stroke (LVOS). The neutrophil-lymphocyte ratio (NLR) reflects systemic inflammation, which plays an important role in the process of treating ischemic stroke. This study aims to explore the relationship between NLR and the clinical outcomes of LVOS patients undergoing EVT. METHODS: Patients were selected from the EVT for acUte Anterior circuLation (ACTUAL) ischemic stroke registry. The laboratory data (neutrophil count, lymphocyte count) before EVT were collected. Poor functional outcome was defined as modified Rankin Scale (mRS) of 3-6 at 3 months. Multivariable logistic regression analyses were performed to explore the relationship of NLR with functional outcome, symptomatic intracranial hemorrhage (sICH), and mortality. RESULTS: We eventually included 616 patients (median of age, 66 years; 40.3% female). There were 350 (56.7%) patients achieving mRS of 3-6 at 3 months, 98 (15.9%) patients with sICH, and the mortality at 3 months was 24.8% (153/616). Baseline NLR was independently associated with poor functional outcome (OR 1.58; 95% CI 1.02-2.45; p = 0.039) and sICH (OR 1.84; 95% CI 1.09-3.11; p = 0.023) but showed a trend for predicting 3-month mortality (OR 1.57; 95% CI 0.94-2.65; p = 0.088). CONCLUSIONS: NLR independently predicts 3-month functional outcome and sICH but the existence of a trend association with mortality after EVT for acute anterior circulation LVOS patients.

Primary angioplasty and stenting may be superior to thrombectomy for acute atherosclerotic large-artery occlusion.

Objective The objective of this article is to compare the effectiveness of primary angioplasty and/or stenting with stent retriever thrombectomy in acute anterior large-vessel occlusion due to atherosclerotic disease. Methods Patients were retrospectively reviewed from the endovascular treatment for acute anterior circulation ischemic stroke registry. Patients with large-vessel occlusions due to atherosclerosis were selected. We evaluated modified Rankin Scale (mRS) score at 90 days, modified thrombolysis in cerebral infarction (mTICI) score immediately post-procedure, and symptomatic and asymptomatic intracranial hemorrhage within 72 hours. Results Of 302 patients with acute anterior circulation occlusion due to atherosclerotic disease, 269 were treated with stent retriever thrombectomy as first-line therapy and 33 with angioplasty and/or stenting. Patients who received primary angioplasty treatment showed favorable independent outcome at 90 days (69.7% (23/33) vs 47.6% (128/269), p = 0.02) and lower rate of asymptomatic intracranial hemorrhage (9.1% (3/23) vs 30.5% (82/269), p = 0.01). Recanalization immediately post procedure did not differ (78.8%% (26/33) vs 86.2% (232/269), p = 0.29). Primary angioplasty therapy (OR, 0.27; 95% confidence interval (CI): 0.08-0.90; p = 0.03) and small baseline infarct (OR 0.36: 0.16-0.82; p = 0.02) were protective factors against poor functional outcome, while old age (OR 1.04:1.01-1.07; p = 0.006), severe neurological deficits (OR 3.76: 2.00-7.07; p < 0.001), and high glucose (OR 1.11: 1.01-1.23; p = 0.03) were associated with poor prognosis. Conclusions Patients with acute anterior circulation large-vessel occlusion due to atherosclerosis may benefit from urgent angioplasty and/or stenting as first-line therapy. Randomized controlled trials are warranted.

Clinical Effectiveness and Safety Outcomes of Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke in China.

BACKGROUNDS AND PURPOSE: This study was aimed at investigating the outcomes and predictors for the poor functional outcome after endovascular treatment (EVT) in a large, mostly Asian population. METHODS: Between January 2014 and June 2016, acute stroke patients with anterior circulation occlusion and EVT were retrospectively enrolled from 21 stroke centers in China. The main outcomes were modified Rankin Scale (0-2 as functional independence, 3-6 as poor) at 90 days, symptomatic intracranial hemorrhage (sICH) at 72 h, and death at 90 days. Logistic regression was used to identify predictors for poor functional outcome at 90 days. RESULTS: Of the 698 patients, 304 (43.6%) patients had functional independence at 90 days. The sICH rate was 15.5% (108/698) and mortality rate at 90 days was 25.4% (177/698). Age (OR 1.04, 95% CI 1.02-1.07), National Institutes of Health Stroke Scale score at admission (11-20 vs. ≤10, OR 2.38, 95% CI 1.23-4.59; ≥21 vs. ≤10, OR 3.66, 95% CI 1.72-7.80), baseline glucose level (OR 1.09, 95% CI 1.01-1.18), onset to groin puncture >6 h (OR 1.88, 95% CI 1.06-3.31), sICH (OR 15.49, 95% CI 5.16-46.43), and pneumonia (OR 3.15, 95% CI 1.86-5.32) were independent predictors of poor functional outcomes, while good recanalization (OR 0.26, 95% CI 0.13-0.54), preoperative Alberta Stroke Program Early CT Score 8-10 (OR 0.48, 95% CI 0.28-0.83), and good collateral flow (OR 0.50, 95% CI 0.32-0.79) were protective factors. CONCLUSIONS: This study provides evidence in real world to support the performance of EVT in acute anterior circulation stroke patients in Chinese population. Patients with small infarct core, successful recanalization, good collateral status, and short treatment delay without sICH or pneumonia may benefit from EVT.

Predictors for Symptomatic Intracranial Hemorrhage After Endovascular Treatment of Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: Symptomatic intracranial hemorrhage (SICH) pose a major safety concern for endovascular treatment of acute ischemic stroke. This study aimed to evaluate the risk and related factors of SICH after endovascular treatment in a real-world practice. METHODS: Patients with stroke treated with stent-like retrievers for recanalizing a blocked artery in anterior circulation were enrolled from 21 stroke centers in China. Intracranial hemorrhage was classified as symptomatic and asymptomatic ones according to Heidelberg Bleeding Classification. Logistic regression was used to identify predictors for SICH. RESULTS: Of the 632 enrolled patients, 101 (16.0%) were diagnosed with SICH within 72 hours after endovascular treatment. Ninety-day mortality was higher in patients with SICH than in patients without SICH (65.3% versus 18.8%; P<0.001). On multivariate analysis, baseline neutrophil ratio >0.83 (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.24-3.46), pretreatment Alberta Stroke Program Early Computed Tomography Score of <6 (OR, 2.27; 95% CI, 1.24-4.14), stroke of cardioembolism type (OR, 1.91; 95% CI, 1.13-3.25), poor collateral circulation (OR, 1.97; 95% CI, 1.16-3.36), delay from symptoms onset to groin puncture >270 minutes (OR, 1.70; 95% CI, 1.03-2.80), >3 passes with retriever (OR, 2.55; 95% CI, 1.40-4.65) were associated with SICH after endovascular treatment. CONCLUSIONS: Incidence of SICH after thrombectomy is higher in Asian patients with acute ischemic stroke. Cardioembolic stroke, poor collateral circulation, delayed endovascular treatment, multiple passes with stent retriever device, lower pretreatment Alberta Stroke Program Early Computed Tomography Score, higher baseline neutrophil ratio may increase the risk of SICH.

Transarterial Chemoembolization Monotherapy in Combination with Radiofrequency Ablation or Percutaneous Ethanol Injection for Hepatocellular Carcinoma.

PURPOSE: To evaluate whether combined transarterial chemoembolization (TACE) with radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI) for hepatocellular carcinoma (HCC) have superior efficacy to transarterial chemoembolization (TACE) alone a retrospective review was conducted. METHODS: During January 2009 to March 2013, 108 patients with hepatocellular carcinoma underwent TACE or combined therapies (TACE+RFA or TACE+PEI). The long-term survival rates were evaluated in those patients by various statistical analyses. RESULTS: The cumulative survival rates in the combined TACE+RFA/PEI group were significantly superior to those in the TACE alone group. When the comparison among the groups was restricted to patients with two or three tumors fulfilling the Milan criteria, significantly greater prolongation of survival was observed in the combined TACE+ RFA/PEI group than in the RFA/PEI alone group. CONCLUSIONS: In terms of the effect on the survival period, combined TACE+ RFA/PEI therapy was more effective than TACE monotherapy, and also more effective than PEI or RFA monotherapy in cases with multiple tumors.

Sequential Transarterial Embolization Followed by Percutaneous Vertebroplasty Is Safe and Effective in Pain Management in Vertebral Metastases.

BACKGROUND: Vertebral metastases are the most frequent vertebral tumor. Transarterial embolization (TAE) devascularizes the tumor, resulting in tumor necrosis. Percutaneous vertebroplasty (PVP), a minimally invasive procedure, can effectively relieve tumor-related pain and improve spine stability. Unfortunately, the PVP technique is of limited use in controlling the progression of vertebral tumor, especially for paravertebral metastases. TAE combined with PVP may achieve a better control on vertebral metastases with paravertebral extension, but little information regarding the combination is available. OBJECTIVES: The present study is intended to assess the safety and effectiveness of the combination of TAE and PVP in patients suffering from vertebral metastases with paravertebral extension. STUDY DESIGN: Sequential TAE followed by PVP was used in 25 patients with symptomatic vertebral metastases. The safety and effectiveness of the sequential therapy were evaluated. SETTING: Three hospitals' clinical research centers. METHODS: This retrospective study was conducted with 25 consecutive patients (11 women and 14 men; mean age 59.3 years, range 38 - 80 years) with vertebral and paravertebral metastases from March 2009 to March 2014. The patients were treated with TAE, and 5 - 7 days later with the PVP procedure. The clinical outcomes were assessed by the control of pain using visual analog scale (VAS) scores, and computed tomography (CT) imaging. X2 or Fisher exact testing was performed for univariate analysis of variables. The VAS scores between groups were compared using ONE-WAY ANOVA, with a P-value of less than 0.05 considered statistically significant. RESULTS: All the TAE and PVP procedures were successfully done. Mean VAS scores decreased after TAE (from 8.64 ± 0.58 to 5.32 ± 1.46, P < 0.05) and further decreased after PVP (from 5.32 ± 1.46 to 2.36 ± 0.54, P < 0.05), and the decrease in VAS lasted until the third month (3.08 ± 1.52, P > 0.05) follow-up. However, VAS scores at the sixth month were statistically higher than those at the third month (4.8 ± 1.24 versus 3.08 ± 1.52, P < 0.05), VAS scores at the twelfth month were statistically higher than those at the sixth month (6.29 ± 1.07 versus 4.8 ± 1.24, P < 0.05). We found paravertebral cement leakage in 6 cases. No clinical or symptomatic complications were observed. In the follow-up, no patient showed further vertebral compression or spinal canal compromise. LIMITATIONS: This is a retrospective clinical study of a small number of patients. CONCLUSION: The sequential TAE followed by PVP is safe and effective in treating vertebral metastases with paravertebral extension. KEY WORDS: Spine, metastases, pain, embolization, vertebroplasty, interventional radiology, PVP, TAE.

Efficacy of Transarterial Chemoembolization Combined with Radiofrequency Ablation in Treatment of Hepatocellular Carcinoma.

PURPOSE: To evaluate efficacy of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treatment of patients with hepatocellular carcinoma. MATERIALS AND METHODS: During January 2009 to March 2012, 80 patients with hepatocellular carcinoma underwent TACE, with or without RFA. Alfa- fetoprotein (AFP) was checked before and after procedure. CT scans were obtained one month after TACE or RFA for all patients to evaluate tumor changes. Complete response+partial response+stable disease (CR+PR+SD)/n were used to assess the disease control rate (DCR). Survival at 3, 6 and 12 months was compared in both groups. RESULTS: AFP levels in TACE + RFA group dropped rapidly, becoming obviously lower than that of the TACE group. In the TACE + RFA group DCR was 93.8%, while only 76.8% in the TACE group. The treatment effect between the two groups was statistically significant (P<0.05) by Ridit analysis. 1 year survival rate in the TACE + RFA group was 92.5%, significantly higher than that of the TACE group at 77.5% (P<0.05). CONCLUSIONS: TACE and RFA as combined therapy method for patients with middle and terminal stage HCC gives full play to synergy between the two and improves the therapeutic effect.

Radiofrequency Ablation for Liver Metastases after Transarterial Chemoembolization: A Systemic Analysis.

BACKGROUND: This systemic analysis was conducted to evaluate tumor recurrence rate and one-year survival rate for patients with liver metastases received radiofrequency ablation after transarterial chemoembolization and introduce a new method of radiofrequency ablation by puncture navigation technology for single liver metastases after transarterial chemoembolization. MATERIALS AND METHODS: Clinical studies evaluating tumor recurrence rate and one-year survival rate. Appling the innova trackvision software to process one liver metastases received transarterial chemoembolization and using radiofrequency ablation by puncture navigation technology to treat the liver metastases. RESULTS: 3 clinical studies which including 235 patients with liver metastases after transaeterial chemoembolization were considered eligible for inclusion. Systemic analysis suggested that tumor recurrence rate was 23% (54/235), one-year survival rate was 76% (178/235). The new procedure was performed successfully and the patient received a good prognosis. CONCLUSIONS: This systemic analysis suggests that radiofrequency ablation is a good method for liver metastases after transarterial chemoembolization and could receive a relatively good prognosis.

Comparison of infection between internal-external and external percutaneous transhepatic biliary drainage in treating patients with malignant obstructive jaundice.

PURPOSE: Percutaneous transhepatic biliary drainage (PTBD) is a form of palliative care for patients with malignant obstructive jaundice. We here compared the infection incidence between internal-external and external drainage for patients with malignant obstructive jaundice. METHODS: Patients with malignant obstructive jaundice without infection before surgery receiving internal-external or external drainage from January 2008 to July 2014 were recruited. According to percutaneous transhepatic cholangiography (PTC), if the guide wire could pass through the occlusion and enter the duodenum, we recommended internal-external drainage, and external drainage biliary drainage was set up if the occlusion was not crossed. All patients with infection after procedure received a cultivation of blood and a bile bacteriological test. RESULTS: Among 110 patients with malignant obstructive jaundice, 22 (52.4%) were diagnosed with infection after the procedure in the internal-external drainage group, whereas 19 (27.9%) patients were so affected in the external drainage group, the difference being significant (p<0.05). In 8 patients (36.3%) in the internal-external group infection was controlled, as compared to 12 (63.1%) in the external group (p<0.05). The mortality rate for patients with infection not controlled in internal-external group in one month was 42.8%, while this rate in external group was 28.6% (p<0.05). CONCLUSION: External drainage is a good choice, which could significantly reduce the chance of biliary infection caused by bacteria, and decrease the mortality rate at one month and improve the long-term prognosis.

Radiofrequency Ablation in Treating Colorectal Cancer Patients with Liver Metastases.

PURPOSE: To evaluate efficacy of radiofrequency ablation (RFA) in treating colorectal cancer patients with liver metastases. METHODS: During January 2010 to April 2012, 56 colorectal cancer patients with liver metastases underwent RFA. CT scans were obtained one month after RFA for all patients to evaluate tumor response. (CR+PR+SD)/n was used to count the disease control rates (DCR). Survival data of 1, 2 and 3 years were obtained from follow up. RESULTS: Patients were followed for 10 to 40 months after RFA (mean time, 25±10 months). Median survival time was 27 months. The 1, 2, 3 year survival rate were 80.4%, 71.4%, 41%, 1 % respectively. 3-year survival time for patients with CR or PR after RFA was 68.8% and 4.3% respectively, the difference was statistically significant. The number of CR, PR, SD and PD in our study was 13, 23, 11 and 9 respectively. CONCLUSIONS: RFA could be an effective method for treating colorectal cancer patients with liver metastases, and prolong survival time, especially for metastatic lesions less than or equal to 3 cm. But this result should be confirmed by randomized controlled studies.