Percutaneous Transhepatic Papillary Balloon Dilation versus Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones: A Multicenter Prospective Study.

Background Endoscopic retrograde cholangiopancreatography (ERCP) is recommended by major guidelines for the removal of common bile duct (CBD) stones but is technically challenging in patients with low cardiopulmonary reserve and anatomic abnormalities of the upper gastrointestinal (GI) tract. Purpose To compare percutaneous transhepatic papillary balloon dilation (PTPBD) with ERCP for CBD stone removal. Materials and Methods Participants with one to three CBD stones (largest stone ≤30 mm) and without intrahepatic bile duct or gallbladder stones were eligible for this prospective cohort study. PTPBD was recommended in participants with low cardiopulmonary reserve or definitive anatomic abnormalities of the upper GI tract. Otherwise, both procedures were offered without preference. Follow-up, including abdominal CT, was conducted at 1-week and 1-, 3- and 6-month follow-up, and every 6 months thereafter. US and MR cholangiopancreatography were conducted if recurrence could not be confirmed with CT. Technical success rate was the primary outcome. Results A total of 531 participants were analyzed: there were 360 undergoing PTPBD (median age, 76 years; interquartile range [IQR], 64-82 years; 163 men) and 171 undergoing ERCP (median age, 66 years; IQR, 57-74 years; 94 men). The technical success rate was 99% (355 of 360) in the PTPBD group and 98% (167 of 171) in the ERCP group (relative risk, 1.02; P = .12). The incidence of overall complications was 4% (13 of 360) for PTPBD and 8% (13 of 171) for ERCP (relative risk, 0.27; 95% CI: 0.12, 0.61; P < .001). The PTPBD group showed a longer fluoroscopy time and a higher radiation exposure, with adjusted differences of 28.7 minutes (95% CI: 22.2, 35.2) and 384.3 mGy (95% CI: 296.5, 472), respectively. A propensity score-matching analysis (n = 123 per group) indicated that PTPBD had a slightly higher technical success rate and significantly fewer complications. Conclusion When compared with endoscopic retrograde cholangiopancreatography, percutaneous transhepatic papillary balloon dilation has a similar technical success rate and fewer perioperative complications but a higher radiation exposure. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by van Sonnenberg and Mueller in this issue.

N-Doped Graphene/Melamine Formaldehyde Composite Carbon Foam as a Binder-Free Electrode for Supercapacitors.

A N-doped graphene/melamine formaldehyde composite carbon foam (G/C) with a porous structure was prepared by a physical foaming method and high-temperature carbonization. Samples of the G/C with various graphene content (i.e., 0%, 1% and 2%) were synthesized and characterized by X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS) and field-emission scanning electron microscopy (FESEM). The XPS and TEM analyses show that the as-prepared G2%/C foam has the highest nitrogen content of 14.7%, with an apparent porous structure. The electrochemical performances of the G/C samples were investigated by charge-discharge cycles. The G2%/C exhibits a high capacitance of 619.3 Fg-1 at a current density of 0.5 Ag-1. The N-doped graphene/melamine formaldehyde composite carbon foam is a promising electric double-layer capacitor material for binder-free electrodes with excellent properties for supercapacitors.

Combined effect of 125I and gemcitabine on PANC-1 cells: Cellular apoptosis and cell cycle arrest.

BACKGROUND: 125I seed implantation has recently become an effective, safe, and feasible treatment for advanced pancreatic cancer in China. Gemcitabine (GEM), superior to fluorouracil, has been widely proved as effective chemotherapy for many solid tumors and become the standard treatment for locally advanced and metastatic pancreatic cancer. The study aimed to evaluate the combined effect of 125I and GEM on pancreatic carcinoma cells (PANC-1) cells and explore the underlying molecular basis. SUBJECTS AND METHODS: PANC-1 cells were treated with 125I continuously at a low dose of radiation, combined with or without sensitizing concentration of GEM. The clonogenic capacity, cellular proliferation, cell cycle distribution, apoptosis, and molecular pathways of the cells following these treatments were analyzed in vitro. RESULTS: The cell growth could be significantly inhibited after the treatment with GEM or 125I alone, while the inhibition effects would be greater with combination therapy than either monotherapy (72 h, C vs. GEM, t = 16.59, P < 0.01; C vs. 125I, t = 9.808, P < 0.05; C vs. 125I + GEM, t = 17.87, P < 0.01; 125I vs. 125I+GEM, t = 8.191, P < 0.05). GEM increased radiation-induced apoptosis (4 Gy, 125I vs. 125I+GEM, t = 10.43, P < 0.01) and induced the arrest of G1. Caspase-3 expression and the Bax/Bcl2 ratio were lower in cells receiving combination treatment than that of in cells treated with 125I or GEM alone. CONCLUSION: The combined treatment of 125I and GEM-induced stronger anti-proliferation effect than single-treatment, due to the cell cycle arrest and more cellular apoptosis in PANC-1 cells. The increased Bax/Bcl-2 ratio may lead to enhanced apoptosis.

Transarterial Chemoembolization of Giant Liver Haemangioma: A Multi-center Study with 836 Cases.

The purpose of the study is to evaluate the effectiveness and safety of transarterial chemoembolization (TACE) with pingyangmycin-lipiodol emulsion for the treatment of symptomatic giant hepatic haemangioma. Four hospitals (The Second Hospital of Shandong University, Qilu Hospital of Shandong University, Shandong Provincial Hospital and Jinan Municipal Hospital) participated in this study during 2002-2012. A total of 836 patients with symptomatic giant haemangioma were treated with pingyangmycin-lipiodol emulsion via selective TACE. The patients were followed-up for 12 months-10 years. The effectiveness of the treatment was evaluated by symptom assessments and upper abdominal magnetic resonance imaging or computed tomography. TACE was successfully performed for a total of 1120 lesions in 836 patients. Success rate of the procedure was 100 %. The mean diameter of the haemangiomas was significantly reduced after the interventional therapy (mean diameter 9.6 ± 0.8 vs. 3.6 ± 0.5 cm; P < 0.05). Symptom relief was achieved in all the patients during the follow-up period. No mortality was identified. TACE with pingyangmycin-lipiodol emulsion is a safe, feasible, and effective treatment for the giant symptomatic hepatic haemangioma.

[Clinical study of percutaneous transhepatic balloon dilation:a novel procedure for common bile duct stone].

OBJECTIVE: To investigate the safety and efficacy of percutaneous transhepatic balloon dilation for the removal of common bile duct stone. METHODS: Sixty-eight cases with common bile duct stone treated with percutaneous transhepatic balloon dilation in our department from July 2008 to April 2011 were analyzed retrospectively.Record CA19-9, total bilirubin, indirect bilirubin and albumin before the procedure, 1 week and 1 month later. Check if immediate complications occurs, including hemorrhage, perforation, pancreatitis and cholangitis. During the following up for 2 years, stone recurrence, reflux cholangitis and other long-term complications were observed. Analyze the changes of indicators between preoperative and postoperative and the correlation. RESULTS: All of the 68 patients were treated successfully.53 patients underwent one procedure, and 15 patients received twice or more times of procedures. CA19-9, TBIL and IBIL decreased significantly 1 week later and 1 month later compared with those before the procedure, while ALB was opposite.Incidences of biliary tract infection, hemorrhage, and pancreatitis were 4.4% (3/68), 2.9% (2/68) and 1.5% (1/68) respectively.No severe complications occurred, including perforation of gastrointestinal or biliary tract.Incidences of recurrent stone and reflux cholangitis were 14.7% (10/68) and 5.9% (4/68) in two years after the procedure. CONCLUSION: Percutaneous transhepatic balloon dilation is a safe and effective procedure for patients with common bile duct stone. For the cases which could not be handled with endoscopic procedures, it provides a new therapeutic approach.