Transradial versus Transfemoral Access for Patients with Liver Cancer Undergoing Hepatic Arterial Infusion Chemotherapy: Patient Experience and Procedural Complications.

PURPOSE: To determine whether transradial access (TRA) is a more favorable and safe method for hepatic arterial infusion chemotherapy (HAIC) than transfemoral access (TFA). MATERIALS AND METHODS: Retrospective and prospective cohorts of patients with liver cancer were included. Sixty-seven patients in the retrospective cohort were divided into 2 groups: (a) TRA-HAIC (n = 24) and (b) TFA-HAIC (n = 43). Another 33 patients were prospectively enrolled to receive both TRA and TFA for HAIC in a crossover design. Prolonged arterial access was required for up to 48 hours. The primary endpoint was quality of life (QOL) using the visual analog scale. The secondary endpoints mainly included procedural success, adverse events, and operation time. RESULTS: Patient QOL measures revealed significantly lower scores of indices in the TRA-HAIC group than in the TFA-HAIC group in the retrospective cohort (all P < .001). The significant improvement of the QOL indices by TRA-HAIC, such as overall discomfort (P = .019) and pain at the access site (P = .018), was validated in the prospective cohort. The satisfaction scores were significantly higher in the TRA-HAIC group than in the TFA-HAIC group, and patients preferred TRA-HAIC (P < .001). Radial artery occlusion (RAO) as an access-related adverse event occurred more frequently in both the retrospective and prospective cohorts (38% and 33%, P < .001 and P = .001, respectively). Notably, the multivariate analysis of RAO-associated factors showed that enoxaparin use was significantly correlated with a reduced risk of postprocedural RAO (P = .036). CONCLUSIONS: TRA was superior to TFA in patient experience. However, because of the high incidence of access-related adverse events, especially for RAO with a total incidence of 35%, strategies should be optimized for patients to benefit from TRA in future procedures.

microRNA-375 inhibits the malignant behaviors of hepatic carcinoma cells by targeting NCAPG2.

Hepatocellular carcinoma (HCC) is a major cause of cancer-related deaths worldwide. Emerging evidence has revealed the vital functions of microRNAs (miRNAs) in cancer malignant progressions. miR-375 has been verified to serve as an antioncogene in tumorigenesis and a potential therapeutic target in various types of cancer. In this study, we aimed to determine the role of miR-375 in the regulation of chemoresistance and metastasis of HCC. Differentially expressed miR-375 and NCAPG2 were externally validated using expression data from The Cancer Genome Atlas (TCGA) database. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to detect the expression levels of miR-375 in HCC tissues and cell lines. miR-375 mimics and NCAPG2-overexpression were transfected into HepG2 and Huh7 cells to establish miR-375 overexpression models. Cell Counting Kit-8, Transwell, and flow cytometry experiments were conducted to monitor cell proliferation, migration, and apoptosis. The targeting relationship between miR-375 and non-SMC condensin II complex subunit G 2 (NCAPG2) was determined by qRT-PCR, western blot, and luciferase reporter gene assay. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were conducted using Gene Set Enrichment Analysis (GSEA). The pathway enrichment analysis was used to predict the potential pathways for further study. miR-375 was significantly downregulated in HCC tissues and cells compared to adjacent tissue and normal hepatocyte cell line respectively while NCAPG2 was upregulated. The targeting relationship was verified by luciferase reporting assay, and miR-375 could target the 3'UTR of NCAPG2 mRNA and effectively suppress NCAPG2 protein expression. Replenishing of miR-375 significantly repressed HCC cell proliferation and migration, and induced cell apoptosis. Overexpression of NCAPG2 recovered those biological abilities in miR-375 overexpressed cells. Collective data suggested that miR-375 served as a tumor suppressor via regulating NCAPG2. Replenishing of miR-375 or knockout of NCAPG2 could be therapeutically exploited for HCC.

[Clinical Effect of Unilateral Biportal Endoscopic Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion on Single-segment Lumbar Stenosis with Instability].

Objective To compare the early clinical effects of unilateral biportal endoscopic lumbar interbody fusion (ULIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF)on single-segment lumbar stenosis with instability. Methods The patients who had single-segment lumbar spinal stenosis with instability and were treated in our hospital from August 2020 to May 2021 were selected.According to the operation methods,they were classified into ULIF group and MIS-TLIF group.The operation duration,hospital stay after operation,perioperative blood loss (drainage volume 48 h after operation,total blood loss),creatine kinase,inflammatory cytokines (C-reactive protein,interleukin-6),D-dimer,and the incidence of lower-extremity venous thrombosis were compared between the two groups.The visual analogue scale and Oswestry disability index were used to evaluate the functional recovery of the two groups in 1 week,1 month,and 3 months after operation. Results The ULIF group had longer operation duration (P<0.001) and shorter hospital stay after operation (P=0.022)than the MIS-TLIF group.The drainage volume 48 h after operation and total blood loss in ULIF group were lower than those in MIS-TLIF group (all P<0.001).The levels of creatine kinase (all P<0.001),C-reactive protein (P<0.001,P=0.002),and interleukin-6 (P=0.003,P<0.001) in ULIF group were lower than those in MIS-TLIF group on the 1st and 3rd day after operation.However,the D-dimer in ULIF group was insignificantly different from that in MIS-TLIF group on the 1st and 3rd day after operation (P=0.117,P=0.683).Lower-extremity venous thrombosis occurred in neither group.The score of visual analogue scale showed no significant difference between the two groups 1 week,1 month,and 3 months after operation (P=0.447,P=0.578,P=0.538),so did the Oswestry disability index (P=0.832,P=0.797,P=0.619). Conclusion ULIF shows similar clinical effect on single-segment lumbar stenosis with instability to MIS-TLIF,which features less bleeding,mild inflammation,mild muscle injury,but long operation duration.

Is Emergency Transcatheter Hepatic Arterial Embolization Suitable for Spontaneously Ruptured Hepatocellular Carcinoma in Child-Pugh C Cirrhosis?

PURPOSE: To evaluate the utility of emergent transcatheter arterial embolization for spontaneously ruptured hepatocellular carcinoma (HCC) in patients with Child-Pugh class C (CPC) liver cirrhosis presenting hemorrhagic shock. MATERIALS AND METHODS: A study of all 94 patients was retrospectively conducted from January 2006 to January 2016. Sixty patients underwent conservative treatment (control group) and 34 underwent embolization. RESULTS: Embolization provided better stabilization of hemodynamic status than conservative treatment (91.2% vs 61.7%), with greater overall survival (OS) rates at 30, 60, and 120 days (73.5%, 52.9%, and 29.4% vs 33.3%, 13.3%, and 0%, respectively). Mean follow-up duration was 51.07 days (range, 3-237 d). Median survival time was longer for the embolization group than the control group, specifically for patients with a shock index (SI) of ≥ 0.6 to < 1 (106.0 d ± 39.4 vs 34.0 d ± 4.7) or ≥ 1 (18.0 d ± 7.5 vs 11.0 d ± 3.2), those with CPC scores 10 or 11 (88.0 d ± 29.4 vs 28.0 d ± 4.5), and those with segmental (165.0 d ± 20.6 vs 34.0 d ± 9.7) or lobar (54.0 d ± 7.9 vs 26.0 d ± 3.4) portal vein tumor thrombus (PVTT). SI ≥ 1, Child-Pugh score of 12/13, tumor size ≥ 10 cm, and PVTT were independent factors in poor prognosis for OS. CONCLUSIONS: Emergent transcatheter arterial embolization is an effective intervention for ruptured HCC in patients with CPC liver function in hemorrhagic shock, particularly those with a SI ≥ 1, Child-Pugh scores of 10/11, and first- or lower-order PVTT.

[Establishment of a quantitative real-time PCR for rapid detection of Panax quinquefolius].

In this study, the specific primers and probes of Panax quinquefolius were designed for a quantitative real-time PCR, and the rapid identification method of P. quinquefolius was established by optimizing conditions. The method was used to validate 43 samples of the traditional Chinese medicine,and the results showed that 22 samples of P. quinquefolius were identified accurately. The limit of detection of the method can be reach to 1×10⁻4 ng. The method is accurate, fast, sensitive and specifically.

Effect of Calcium-sensing Receptor on the Apoptosis of Rat Spinal Cord Neurons in Anoxia/Reoxygenation Injury and Its Significance.

Objective To investigate the effect and significance of calcium-sensing receptor (CaSR) on the apoptosis of rat spinal cord neurons in anoxia/reoxygenation(A/R) injury. Methods The spinal cells were in ischemia and hypoxia environment for 1 h and in normal environment for 24 h to establish a model of A/R. After spinal A/R model was established,the spinal cells were divided into four groups randomly:the control group,A/R group,A/R+GdCl3 group,and A/R+NPS-2390 group. The expression of CaSR in each group was detected by immunofluorescence and Western blotting. The concentration of intracellular calcium was measured by laser confocal scanning microscopy. The expressions of Caspase-3,Bax,and Bcl-2 were detected by using Western blotting. The apoptotic rate of spinal cells was detected by Tunel assay. Results Compared to the control group, there was a significant increase in the level of CaSR (t=5.462, P=0.006), the concentration of intracellular calcium (t=8.573, P=0.001), the apoptotic rate (t=4.899, P=0.008), Caspase-3 (t=5.118, P=0.007), and Bax (t=10.930,P=0.001) in A/R group. Compared to the A/R group, there was a significant increase in the level of CaSR (t=4.975, P=0.008),the concentration of intracellular calcium (t=4.899, P=0.008), the apoptotic rate (t=7.746, P=0.002), Caspase-3 (t=4.776, P=0.009), and Bax (t=5.281, P=0.006) in A/R+GdCl3 group. Compared to the A/R group, there was a significant decrease in the level of CaSR (t=3.674,P=0.021), the concentration of intracellular calcium (t=3.846, P=0.018), the apoptotic rate (t=4.281,P=0.013), Caspase-3 (t=3.521, P=0.024), and Bax(t=3.473, P=0.026) in A/R+NPS-2390 group. However, compared to the control group, there was a significant decrease in the level of Bcl-2 (t=6.242,P=0.003) in A/R group. Compared to the A/R group, there was a significant decrease in the level of Bcl-2(t=3.028, P=0.004) in A/R+GdCl3 group. Compared to the A/R group, there was a significant increase in the level of Bcl-2 (t=2.840, P=0.047) in A/R+NPS-2390 group.Conclusion During the process of A/R injury in rat spinal cord neurons,the expression of calcium sensing receptor increases,along with increase in intracellular calcium and spinal neuron apoptosis.

[Effect of Basic Fibroblast Growth Factor and Transforming Growth Factor-Β1 Combined with Bone Marrow Mesenchymal Stem Cells on the Repair of Degenerated Intervertebral Discs in Rat Models].

OBJECTIVE: To evaluate the effects of the combination of basic fibroblast growth factor (bFGF), transforming growth factor-Β1 (TGF-Β1), bone marrow mesenchymal stem cells (BMSCs), and temperature-responsive chitosan hydrogel (TCH) gel on the repair of degenerative intervertebral disc in rat models. METHODS: Rat models of intervertebral disc degeneration were established by acupuncture. The degenerative effects were observed under magnetic resonance imaging (MRI). The BMSCs was cultured in vitro and then transfected by adenovirus with enhanced green fluorescent protein to make it carry the gene of enhanced green fluorescent protein,which functioned as fluorescence labeling. The SD rat models of intervertebral disc degeneration were divided into four groups: group A, treated with the combination of bFGF, TGF-Β1,BMSCs,and TCH gel; group B, treated with the combination of BMSCs and TCH gel;group C, treated with the combination of bFGF,TGF-Β1, and TCH gel;and group D, treated with PBS buffer solution. After the corresponding reagents were injected into the degenerative intervertebral discs of each group, the rats were cultivated for another four weeks and then the repair effects of the intervertebral discs were observed under MRI. Furthermore,the intervertebral discs of each group were taken out and observed by HE and Masson staining. The nucleus pulposus was aspirated and the expressions of aggrecan,collagen 2,Sox-9,and collagen I of nucleus pulposus of each group were tested by reverse transcription polymerase chain reaction and Western blot. RESULTS: The transplanted BMSCs survived in the intervertebral disc and differentiated into nucleus pulposus-like cells. MRI showed that:the signal intensity of the nucleus pulposus of group A was much higher than that of the rest groups, the signal intensity of group B was higher than that of group C, and the signal intensity of group D was the lowest,in which the dura mater spinalis was in compression and the spinal cord changed in beaded shape. The differences of the Pfirrmann grading among the four groups had statistical significance (P<0.05). The results of the HE and Masson stains showed:the intervertebral disc of group A was well-structured,the quantity of nucleus pulposus cells was larger than that of the other three groups,and the boundary between the nucleus pulposus and the annulus fibrosus was clearly defined;the quantity of the nucleus pulposus cells of group B was larger than that of group C, and the broken annulus fibrosus was not observed in group B, while the broken annulus fibrosus could be observed in group C; and, the nucleus pulposus cells of group D were replaced by fibrous tissue. The results of the reverse transcription polymerase chain reaction and Western blot tests showed that,in terms of the expressions of aggrecan,collagen 2 and Sox-9,group A was the highest, followed by group B,group C,and group D (P<0.05); in terms of the expression of collagen 1,there was no obvious difference among these four groups (P>0.05). CONCLUSIONS: The transplanted BMSCs can survive in the degenerative intervertebral disc and differentiate into nucleus pulposus-like cells. The combination of bFGF, TGF-Β1, BMSCs,and TCH gel has obvious repair effect on the degenerative intervertebral discs. The effect of the combination of BMSCs and TCH gel on transplantation therapy of the degenerative intervertebral discs is better than that of the combination of bFGF, TGF-Β1 and TCH gel but worse than that of the combination of bFGF, TGF-Β1, BMSCs, and TCH gel.

[Role of bone marrow mesenchymal stem cells in restoring the functions of degenerative nucleus pulposus cells].

OBJECTIVE: To explore the effects of bone mesenchymal stem cells (BMSCs) in restoring the functions of degenerative nucleus pulposus cells (dNPCs). METHODS: The animal models of degenerative nucleus pulposus were established by means of acupuncture and aspiration. The BMSCs as well as the normal and degeneratived nucleus pulposus cells of SD rats were isolated and cultured. The BMSCs/alginate gel complex and dNPCs/alginate gel complex were used for indirect co-culture in vitro, which was set as experiment group. The NPCs and dNPCs cultured alone as positive and negative controls. The cell growth conditions were observed by light microscopy, and suitable cells were selected to combine alginate gel stents and cultured in transwell plate. Seven days later, nucleus pulposus cells of each group were recycled, and the mRNA expressions of Collagen2, SOX 9, and Aggrecan were detected by RT-PCR, and the Collagen1, 2, and Aggrecan were detected by Western blotting and immunofluorescence. RESULTS: After non-contact co-culture for 7 days, the mRNA levels of Collagen2, SOX 9, and Aggrecan increased apparently in BMSCs+dNPCs group, while it was significantly lower in dNPCs sample (all P<0.05). The content of Collagen2 and Aggrecan detected by Western blotting in BMSCs+dNPCs group got close to NPCs sample, but it was significantly higher than dNPCs samples (all P<0.05), while the content of Collagen1in BMSCs+dNPCs group got close to NPCs samples, but it was significantly lower than dNPCs sample (P<0.05). Immunofluorescence results showed that cytoplasm was dyed red and the color near the caryon became dark in BMSCs+dNPCs group and dNPCs group;however, the colored scope of cytoplasm and the dark colored scope surrounding the caryon in BMSCs+dNPCs group was obviously larger than dNPCs group. CONCLUSION: Under a 3D non-contact co-culture system, BMSCs can promote the expression of epimatrix of the dNPCs, which shows that BMSCs can restore the functions of dNPCs of intervertebral disc to certain extent.

Comparison of biportal endoscopic technique and uniportal endoscopic technique in Unilateral Laminectomy for Bilateral Decomprssion (ULBD) for lumbar spinal stenosis.

OBJECTIVE: Unilateral laminotomy for bilateral decompression (ULBD) has been adopted widely to treat lumbar spinal stenosis (LSS). The objective of the study is to investigate clinical and radiological outcomes of the biportal endoscopic ULBD (BE-ULBD) and uniportal endoscopic ULBD (UE-ULBD). METHODS: We collected retrospectively 65 patients' data who met the inclusion criteria (July 2019-June 2021). 33 patients underwent BE-ULBD surgery, and 32 patients underwent the UE-ULBD surgery, and were followed up for at least 1 year. The following preoperative and postoperative outcomes were compared between groups: the visual analog scale (VAS) for pain, the Oswestry disability index (ODI) for nerve function, and modified Macnab criteria for satisfaction, the cross-sectional area of the dural sac (DSCSA), the mean angle of facetectomy. RESULTS: Age, BMI, gender, levels of involvement and duration of symptoms were not significantly different at baseline in this study. Clinical data showed that postoperative ODI, VAS scores and Modified Macnab Criteria were not statistically different between the two groups. The BE-ULBD group had a shorter operation time than the UE-ULBD group (P < 0.001). Patients in the BE-ULBD group had a larger postoperative expansion of DSCSA expansion postoperatively (85.58 ± 3.16 mm2 VS 71.43 ± 3.35 mm2, P < 0.001) and a larger contralateral facetectomy angle (63.95 ± 3.34° vs 57.80 ± 3.43°, P < 0.001) compared with patients in the UE-ULBD group. There were no statistical differences in the incidence of postoperative complications between the two groups. CONCLUSION: Both the BE-ULBD and the UE-ULBD yielded clinical improvement in terms of pain and stenosis symptoms. The BE-ULBD technique has the advantages of the shorter operation time, larger DSCSA expansion and larger contralateral facetectomy angle.

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.

[The analysis of the efficacy and safety of combined transarterial chemoembolization with sorafenib in patients with large hepatocellular carcinoma].

OBJECTIVE: To evaluate the efficacy and safety of combined transarterial chemoembolization with sorafenib in patients with large hepatocellular carcinoma. METHODS: 79 patients with large HCC(larger than 10 cm in diameter)were enrolled from July 2008 to June 2012 for this retrospective study. 24 patients undertaken TACE combined with sorafenib as T + S group. 35 patients undertaken TACE alone as T group, and other 20 patients treated with sorafenib alone as S group. RESULTS: The median survival time was 15 months in T + S group, 10 months in T group, and 5 months in S group, respectively (P = 0.000). The median time of tumor progress was 6 months, 3 months and 2.5 months, respectively (P = 0.000). The most common adverse events related to sorafenib in group T + S group and S group alone were hand foot skin reaction, diarrhea and alopecia. The incidence rate of adverse events related to sorafenib was no significant difference between two groups. There was no 4 or more grade adverse event occurred in each group. The most common complications related to interventional treatment in group T + S group and T group alone were mild jaundice, ascites, inguinal region hematoma. The incidence rate of complications related to interventional treatment was no significant difference between two groups. CONCLUSION: The combination of TACE and sorafenib in patients with large HCC is well tolerated and safe, which is available to delay tumor progression and prolong survival.

Progression of Gastrointestinal Injury During Antiplatelet Therapy After Percutaneous Coronary Intervention: A Secondary Analysis of the OPT-PEACE Randomized Clinical Trial.

Importance: Gastrointestinal injury progression induced by antiplatelet therapy in patients after percutaneous coronary intervention (PCI) has not been well studied. Objective: To assess the association of aspirin, clopidogrel, and their combination with gastrointestinal injury progression among patients without high bleeding risk after PCI. Design, Setting, and Participants: This secondary analysis assessed data from the Optimal Antiplatelet Therapy for Prevention of Gastrointestinal Injury Evaluated by ANKON Magnetically Controlled Capsule Endoscopy (OPT-PEACE) double-masked, placebo-controlled, multicenter randomized clinical trial. The OPT-PEACE trial was conducted at 28 centers in China, and recruitment took place from July 13, 2017, to July 13, 2019. The trial included patients with stable coronary artery disease or acute coronary syndromes without ST-segment elevation after PCI. Statistical analysis was conducted from September 13, 2022, to January 23, 2023. Interventions: Patients underwent magnetically controlled capsule endoscopy (MCE) at baseline and after 6 months of dual antiplatelet therapy (DAPT) with aspirin (100 mg/d) plus clopidogrel (75 mg/d). Those with no evidence of gastrointestinal ulcers or bleeding (ie, the intention-to-treat [ITT] cohort) were randomized (1:1:1) to aspirin (100 mg/d) plus matching placebo (aspirin alone), clopidogrel (75 mg/d) plus matching placebo (clopidogrel alone), or DAPT for an additional 6 months. A third MCE was performed 12 months after PCI. Main Outcomes and Measures: The primary outcome was the rate of gastric injury progression as assessed with the results of the 3 MCEs (at baseline, 6 months, and 12 months) in the modified intention-to-treat (mITT) population. The key secondary outcome was the rate of small-intestinal injury progression. Gastric or small-intestinal injury progression was defined as a quantitative increase in erosions or ulcers between the second and third MCEs (at 6 and 12 months, respectively). Results: This study included the 394 patients in the mITT cohort. Their mean (SD) age was 56.9 (8.7) years, and most were men (296 [75.1%]). A total of 132 patients were randomized to aspirin alone, 132 to clopidogrel alone, and 130 to DAPT. Gastric injury progression occurred in 49 aspirin users (37.1%), 64 clopidogrel users (48.5%), and 69 DAPT users (53.1%) (P = .02), reflecting a lower rate of gastric injury progression among aspirin users vs DAPT users (risk ratio [RR], 0.70 [95% CI, 0.49-0.99]; P = .009). No significant difference was observed between clopidogrel alone and DAPT (48.5% vs 53.1%; P = .46) or between aspirin alone and clopidogrel alone (37.1% vs 48.5%; P = .06). A total of 51 aspirin users (38.6%), 65 clopidogrel users (49.2%), and 71 DAPT users (54.6%) (P = .03) developed progressive small-intestinal injury, reflecting a lower rate of small-intestinal injury among aspirin users vs DAPT users (RR, 0.71 [95% CI, 0.50-0.99]; P = .01). No difference was observed between patients treated with clopidogrel vs DAPT (49.2% vs 54.6%; P = .38) or with aspirin vs clopidogrel (38.6% vs 49.2%; P = .08). Conclusions and Relevance: In this secondary analysis of a randomized clinical trial, ongoing use of aspirin, clopidogrel, or their combination between 6 and 12 months after PCI was associated with progressive gastric and small-intestinal injury in a substantial proportion of patients, more so with DAPT than with monotherapy. Clopidogrel was at least as likely as aspirin to induce gastrointestinal injury progression. Future research is warranted to determine what impact the findings from MCEs would have on decision-making of antiplatelet therapy. Trial Registration: ClinicalTrials.gov Identifier: NCT03198741.

[A clinical study on multi-disciplinary team and surgery for resectable colorectal cancer with liver metastases].

OBJECTIVES: To analyze the survival outcomes of the surgery for colorectal cancer with liver metastases (CRCLM), and study the mode of multi-disciplinary team (MDT) for CRCLM. METHODS: The retrospective analysis was conducted for 38 patients with CRCLM received MDT management and surgical treatment from January 2009 to August 2011. The peri-operative and survival outcomes of MDT and surgery were evaluated. RESULTS: All the cases met the present criteria of resetability for CRCLM, but only 4 cases (10.5%) met the previous one. Coloproctectomy and hepatectomy were performed in all cases, with 39 colorectal neoplasms and 155 liver lesions removed. One case died of postoperative septic shock. Colorectal and hepatic specific complications were absent in the others patients except one case of biliary leak which was treated with conservative management. Neoadjuvant chemotherapy was arranged in 13 cases. Adjuvant chemotherapy was administered for every patient. After a mean follow-up of (22 ± 10) months according to the finding time of liver metastases, recurrence and metastases were observed in 16 cases and 6 cases died of late-stage cachexia. The 1-, 2- and 3-overall survival rate were 94.4%, 85.3% and 75.8% respectively, and the 1-, 2- and 3-disease-free survival rate were 70.1%, 54.2% and 54.2% respectively. CONCLUSIONS: MDT mode for resectable CRCLM is recommendable. Surgical resection of CRCLM is feasible and safe, which seems to achieve favourable short-middle oncologic outcomes. And long-term survival is expected.

[Development and clinical application of an adjustable digital cannulated nail guide based on Mimics software].

OBJECTIVE: To evaluate effectiveness of self-designed adjustable cannulated screw guide, and to provide an effective auxiliary tool for inverted triangular arrangement of compression cannulated screws in clinical treatment for transcervical femoral neck fractures. METHODS: The sketch of instrument was drawn with Solidworks software, and physical product was obtained after production. The data were obtained by Mimics software. Combined with the guide, it was first used on 22 cadaveric bones, 22 dry cadaveric bones, including 12 males and 10 females. Then the distribution of guide pins was evaluated by X-ray film. The anatomical size and screw distance of femoral head and neck were measured in different ways, and statistically compared. From January 2018 to June 2020, 45 hospitalized patients with femoral neck fracture were selected and divided into new guide group (22 patients) and free hand nail group (23 patients) according to whether the instrument was used or not. The clinical data and operation conditions between two groups were recorded and compared. RESULTS: The anatomical data of X-ray, three-dimensional and physical measurement were basically the same, whlie had no difference (P>0.05). There was no significant difference between physical measurement and three-dimensional measurement (P>0.05). The distance between screws and needle entry point was designed as an isosceles triangle(r=0.992 8, P<0.000 1), but due to the existence of femoral anteversion and torsion angle, it was an approximate isosceles triangle in the femoral neck (r=0.824 1, P<0.000 1). The patients between two groups were followed up for an average of 2 years. There was no significant difference in the number of fluoroscopy and puncture between new guide group and free hand nail group(P>0.05). The screw parallelism was better and operation time was shorter which had statistically difference(P<0.05). However, there was no significant difference in final Harris score and incidence of complications between two groups(P>0.05). CONCLUSION: Self-made femoral neck cannulated screw guide combined with preoperative planning of Mimics software is conducive to placement of inverted triangular arrangement of cannulated screws, but it still needs to be improved and followed up in the later large-scale use.

Natural Orifice Translumenal Endoscopic Surgery (NOTES): patients' perceptions and attitudes.

BACKGROUND: Natural orifice translumenal endoscopic surgery (NOTES) has generated a surge of enthusiasm among researchers by virtue of its challenge to the dogma and potential benefits. However, no data is available in the medical literature about NOTES' acceptance by patients in Asia. The aim of the study is to survey patients' perceptions and attitudes towards NOTES. METHODS: It is a questionnaire-based multi-center study on inpatient subjects with various gastrointestinal disorders from 14 hospitals in 12 cities of China. Procedural details with the benefits and risks of NOTES, laparoscopic surgery, and conventional surgery were explained to all registered candidates. They were required to choose and cite reasons for adopting one of the above three surgical techniques as the preferred mode of treatment. The reasons for selection of the surgical treatment were: safety, efficacy, cost, postoperative pain, abdominal wounds, and scarring. RESULTS: There were 1,797 cases, including 976 (54.3%) males and 821 females (45.7%). Based on their comprehension of the procedure, 802 (44.6%) patients opted for NOTES, 757 (42.1%) for laparoscopic surgery, and 238 (13.2%) for conventional surgery. NOTES was mainly selected by the young and educated persons, especially females and by those with past exposure to laparoscopy or conventional surgery. The choice of treatment was significantly correlated with age (P=0.0021), education (P=0.0209), past medical history (laparoscopy, P=0.0134; open surgery, P<0.0001), and department of admission (P=0.0173). The preference for NOTES was based on safety (37.3%), cost (17.6%), elimination of postoperative scars (16.1%), abdominal wounds (16.0%), and efficacy (13.1%). CONCLUSIONS: The vast majority of patients prefer mini-invasive surgery to conventional surgery. The potential recipients of NOTES are educated and younger age groups. However, a few consider NOTES as a safe and effective intervention at present.

[Protein expression and significance of survivin and NF-κB in hepatocellular carcinoma].

OBJECTIVE: To detect the protein expressions of survivin and NF (nuclear factor)-κB and investigate their roles in the pathogenesis of hepatocellular carcinoma. METHODS: A total of 206 cases were diagnosed as hepatocellular carcinoma, and immunohistochemical technique was used to detect the protein expressions of survivin and NF-κB in hepatocellular carcinoma samples and normal liver tissue specimens. Statistical analysis was performed to analyze the relationship of protein expressions of survivin and NF-κB and clinico-pathological parameters and prognosis. RESULTS: The expression of survivin was predominant in cytoplasm while that of NF-κB was in nucleolus. The positive rate of survivin protein was 78.2% in hepatocellular carcinoma and that of NF-κB was 81.1%. The positive rate of survivin and NF-κB was higher in hepatocellular carcinoma than that in benign hepatic tissue (11.7% and 15.5%). Significant differences existed in the expressions of survivin and NF-κB between hepatocellular carcinoma and normal hepatic tissue (P < 0.01). The expression of survivin was related to amicula invasion, portal vein tumor thrombus, lymph node metastasis and clinical stage in hepatocellular carcinoma (P < 0.01). The expression of NF-κB was also related to portal vein tumor thrombus, lymph node metastasis and clinical stage in hepatocellular carcinoma (P < 0.05). There was an obviously positive correlation between the expressions of survivin and NF-κB in hepatocellular carcinoma (r = 0.52, P < 0.01). Survival rate of patients for 1, 3 year of positive expression of survivin and NF-κB in hepatocellular carcinoma was 70.3% and 30.4%, respectively. And it was obviously lower than that of those of negative expression (88.5% and 61.5%). There was significant difference in the expressions of survivin and NF-κB between positive and negative subjects in 1, 3 year (P < 0.05). CONCLUSION: Protein expressions of survivin and NF-κB are higher in hepatocellular carcinoma. And they play mutually promoting roles in the development of hepatocellular carcinoma. Thus, an important prognostic indicator may be adopted.

[Transcriptional targeting gene therapy of double suicide gene driven by hTERT promoter in hepatic carcinoma].

OBJECTIVE: To examine the selective killing effects of pEGFP-C1-mediated double suicide gene system driven by the hTERT promoter (hTERT-CDglyTK) on hepatic carcinoma cells. METHODS: The hTERT promoter and gene fragments SV40, yCD and TKgly were amplified by PCR (polymerase chain reaction) and then inserted into pEGFP-C1. And the constructs of pEGFP-hTERT-CD, pEGFP-hTERT-TK and pEGFP-hTERT-CDglyTK were transfected to SMMC 7721 or HL7702 respectively. The transfection effects were observed and the cellular expressions of suicide genes detected by RT-PCR (reverse transcription-polymerase chain reaction), QPCR (quantitative polymerase chain reaction) and Western blot. The transfected cells were treated with 5-fluorocytosine and ganciclovir at different concentrations and the cell-killing and bystander effects evaluated by the method of MTT (3-(4,5)-dimethyl thiadiazole (-z-y1)-3,5-di-phenytetrazoliumromide). The activity of cell telomerase was detected by the method of TRAP-argentation and the apoptotic rates analyzed by flow cytometry. All results of double and single gene systems were analyzed. RESULTS: The fragments of enzyme digestion corresponded to the expectations. RT-PCR, QPCR and Western blot demonstrated the expressions of CD, TK and CDglyTK. pEGFP-hTERT-CD, pEGFP-hTERT-TK and pEGFP-hTERT-CDglyTK showed the similar transfection efficiencies in SMMC7721 (74.5%, 76.3%, 76.9%). More sensitive to the prodrugs (P = 0.020, P = 0.015), higher apoptotic rates (P = 0.023, P = 0.017) and bystander effects (P = 0.012, P = 0.001)and lower telomerase activities (P = 0.045, P = 0.038) were observed in double gene system versus those in single gene system. However, the transfection and growth of HL7702 cell could not be infected by this double suicide gene. CONCLUSION: The plasmid of CDglyTK fusion gene system driven by hTERT promoter has been successfully constructed. It has demonstrated highly specific killing effects on hepatic carcinoma cells.

[Transcatheter arterial chemoembolization plus percutaneous thermal ablation in large hepatocellular carcinoma: clinical observation of efficacy and predictors of prognostic factors].

OBJECTIVE: To explore the technical success rate, efficacy, overall survival, recurrence-free survival and prognostic factors of transcatheter arterial chemoembolization (TACE) plus thermal ablations of radiofrequency ablation (RFA) and microwave ablation (MWA) in the patients with large hepatocellular carcinoma (HCC). METHODS: Forty-five cases with Child-pugh class A, B cirrhosis and large HCC with a maximum tumor between 5.0 cm to 10.0 cm underwent TACE and thermal ablation. Twenty-five patients received TACE plus RFA while the other 20 patients underwent TACE plus MWA. Their efficacy, long-term survival and prognostic factors were statistically analyzed. RESULTS: TACE plus thermal ablation were performed in 84 tumors with a successful rate of 100% (86/86) and a complete ablation rate of 94.0% (79/84). The major complication rate was 6.7% (3/45). Local and distant recurrence rates were 66.7% (30/45) and 71.1% (32/45) respectively. The 1 and 2-year recurrence-free survival rates were 26.7% (12/45) and 13.3% (6/45). And the 1, 2 and 3-year survival rates were 80.0% (36/45), 33.3% (15/45) and 6.7% (3/45) respectively. Univariate and Cox regression analyses indicated that tumor size > 7.0 cm, multi-nodularity, incomplete necrosis and pretherapy α-fetoprotein (AFP) ≥ 200 µg/L were 4 unfavorable prognostic factors for the long-term survival. CONCLUSION: The combined procedures of TACE and percutaneous thermal ablation are both safe and effective for the unresectable large HCC (> 5.0 cm). It represents an alleviate treatment for those patients with tumor size > 7.0 cm. Tumor size, tumor number, completeness of necrosis and AFP level are all significant prognostic factors.

Delayed pericardial tamponade following central venous recanalization.

A patient with central venous occlusion at the junction of the superior vena cava and right atrium underwent endovascular revascularization. The leakage of contrast agents was detected during sharp recanalization that was then managed with covered stent deployment. The initial symptom of facial swelling disappeared and the vital signs were stable after treatment. Regrettably, the patient suffered from the clinical features of cardiac tamponade on the third day post-treatment, which was confirmed by computed tomography. Finally, a pericardial effusion was drained, leading to dramatic improvement in the cardiovascular status of the patient.

Prognostic value of splenic volume in hepatocellular carcinoma patients receiving transarterial chemoembolization.

BACKGROUND: Liver function is a key determinant for the survival of hepatocellular carcinoma (HCC) patients receiving transarterial chemoembolization (TACE). However, establishing robust prognostic indicators for liver insufficiencies and patient survival remains an unmet demand. This retrospective study evaluated the prognostic value of splenic volume (SV) in HCC patients undergoing TACE. METHODS: A total of 67 HCC patients who underwent at least two consecutive TACE procedures were retrospectively included in this study. Comprehensive clinical information and follow-up data were collected, and the SV was measured based on dynamic contrast enhanced images. Risk factors of SV enlargement were assessed. The prognostic value of SV on survival was analyzed and compared with Child-Pugh (CP) classification and albumin-bilirubin (ALBI) grade. RESULTS: The baseline SV was 299.74±143.63 cm3, and showed a moderate and statistically significant correlation with CP classification (R=0.31, P<0.05). The SV increased remarkably after the first and second TACE procedures (330.16±155.38 cm3, P<0.01, and 355.63±164.26 cm3, P<0.01, respectively). In survival analysis, the optimal cut-off value of SV was determined as 373 cm3 using X-tile software, and the patients were divided into the small SV group and the large SV groups accordingly. Based on the pre-TACE SV, the median overall survival (mOS) for patients in the small SV group and the large SV group was 458 days and 249 days, respectively (P<0.05). After the first and second TACE, the mOS in the small SV group and the large SV group were 454 vs. 266 days (P<0.05) and 526 vs. 266 days (P<0.05), respectively. No prognostic value of CP classification and ALBI grade was identified for these patients. Furthermore, there were no significant differences between the small and large SV groups in age, tumor stage, and ALBI grade, except for CP classification (P<0.05). CONCLUSIONS: SV was correlated with CP classification and was a robust predictor for HCC patients undergoing TACE treatment.