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Objective:To evaluate the efficacy and prognostic factors of 125I seeds implantation for primary hepatocellular carcinoma. Methods:From December 2011 to January 2021, 102 primary hepatocellular carcinoma patients (86 males, 16 females; median age 61 years) who underwent 125I seeds implantation from 5 hospitals in China were enrolled in this retrospective study. Local progression-free survival (LPFS), overall survival (OS) and the prognostic factors were analyzed. Kaplan-Meier method was used to draw the distribution curve of survival time, and LPFS rate and OS rate were calculated. Log-rank test and Cox regression were used to analyze the influencing factors of survival. Results:The median follow-up time was 38 months until April 2021. The local control rate was 96.1%(98/102). The 1-, 3- and 5-year LPFS rate were 61.3%, 25.5% and 12.7%, and the 1-, 3- and 5-year OS rate were 73.9%, 39.1% and 22.6%, respectively. There were 75 patients with progressive disease, including 42 patients with intrahepatic recurrence and metastasis after seed implantation, and 55 patients died. Multivariate analyses showed that short-term efficacy complete response (CR) (hazard ratio ( HR)=0.34, 95% CI: 0.20-0.58) was protective factor related to LPFS; short-term efficacy CR ( HR=0.25, 95% CI: 0.13-0.47) was the protective factors related to OS; Barcelona clinic liver cancer (BCLC) C stage ( HR=2.33, 95% CI: 1.27-4.27), intrahepatic progression and extrahepatic metastasis ( HR=3.18, 95% CI: 1.28-7.86; HR=3.23, 95% CI: 1.27-8.21) were independent risk factors related to OS. No sever adverse effects were observed. Conclusions:125I seeds implantation is safe and effective for the treatment of primary hepatocellular carcinoma. BCLC stage, short-term efficacy and post-implantation progression are independent factors related to survival time.
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Objective:To investigate the effect of radioactive 125I seed on angiogenesis of subcutaneously transplanted hepatocellular carcinoma in nude mice and underlying mechanism. Methods:The subcutaneous transplanted tumor model of human hepatocellular carcinoma Huh7 cells was established in nude mice. Twelve nude mice were randomly divided into observation group and control group with 6 mice in each group. The 125I seed with activity of 2.96×10 7Bq was implanted into the transplanted tumor of observation group and another with 0 Bq as control group, respectively. The volume of the transplanted tumor was measured every 4 d and the growth curve of the tumor was recorded. The microvessel density (MVD) of the transplanted tumor was evaluated by immunohistochemical detection of CD31. VEGF-A and HIF-1α protein and mRNA were detected by immunohistochemistry and RT-PCR, respectively. Results:The growth rate of tumor in the observation group was slower than that in the control group, and the difference of tumor volume between two groups at 12 d after 125I seed implantation was significantly different( t=3.167, P<0.05). At 28 d after transplantation, the tumor volumes of control and observation group approached to (963.61 ± 89.56) mm 3and (602.10±75.98) mm 3, respectively. The MVD of the observation group was significantly lower than that of the control group ( t=6.361, P<0.05). The relative expression of VEGF-A and HIF-1α mRNA in the observation group was significantly lower than that in the control group ( t=10.480, 6.414, P<0.05). Protein expression levels of VEGF-A and HIF-1α in the observation group were lower than those in the control group ( t=10.890, 12.250, P<0.05). Conclusions:Radioactive 125I seed can inhibit the growth of HCC xenografts by reducing tumor microvessels, which may be related to the decrease of VEGF-A and HIF-1α expression.
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Objective:To compare the differences in dosimetric parameters of target areas between 125I seed implantation with degradable catheters and by hand under the assistance of a real-time intraoperative treatment planning system (TPS). Methods:Forty-two simulated lesions were divided into a degradable catheter group and a free-hand group, with twenty-one lesions in each group. 125I seeds were implanted according to the TPS.The pre-plan and post-implant dosimetric parameters were collected, including the minimum dose ( Dmin), maximum dose ( Dmax), mean dose ( Dmean), conformal index (CI), external index (EI), homogeneity index (HI), minimum prescription dose delivered to 90% of the target volume ( D90), and the mean percentage of volume receiving 90% of the prescription doses ( V90). The Bland-Altman method was employed to analyze the consistency of pre-plan and post-implant dosimetric parameters and the Wilcoxon rank-sum test was used for the comparison of the two groups. Results:According to the Bland-Altman analysis, the dosimetric parameters of the two groups were all in agreement before and after seed implantation except for the Dmin and V90 of the free-hand group.Furthermore, the degradable catheter group had smaller error ranges of Dmax ( Z=-3.824, P<0.005), CI ( Z=-1.962, P<0.005), HI ( Z=-2.352, P<0.005), D90 ( Z=-2.453, P<0.005), and V90 ( Z=-3.159, P<0.005). Conclusions:The dosimetric parameters of 125I seed implantation with degradable catheters under the assistance of real-time TPS have good pre-plan and post-implant consistency and smaller error ranges.
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Objective:Through the establishment and application of the biosafety autopsy pathology platform in Huoshenshan Hospital, the feasibility and application effect of the biosafety autopsy pathology platform were analyzed.Methods:The feasibility and application effect of the biosafety autopsy pathology platform were analyzed by layout design, instruments and equipment preparation, testing methods examination, and effect evaluation.Results:A total number of 26 cases of systematic autopsy and 8 cases of minimally invasive autopsy (puncture) were performed on the biosafety autopsy pathology platform, and no one was infected. Some pathology original findings were identified, including COVID-19 and pathological characteristics of identification, SARS respiratory failure mechanism and treatment significance, systemic distribution and spreading mechanism of the new coronavirus, the " storm" of inflammation pathological basis, some tumor markers rise in pulmonary pathological cell source and the overcast with fibrosis characteristics, such findings play important roles in the clinical diagnosis and treatment of COVID-19.Conclusions:The study of autopsy pathology is of great significance for the prevention and control of emerging infectious disease, which calls for early intervention. To promote the standard construction of biosafety autopsy platform is the key to the pathological study of emerging infectious diseases. Pathological research and clinical diagnosis and treatment should be combined to inform each other.
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Objective To investigate the safety and efficacy of irreversible electroporation (IRE) hepatic ablation with high-frequency bipolar pulse in swine.Methods The experimental study was conducted.A total of 18 swines of either gender,aged (6.8+0.8)months with a range of 5.5-8.0 months,were collected from Animal Laboratory Center of Army Medical University.were randomly divided into 15 in experimental group and 3 in control group.The swines in experimental group underwent IRE hepatic ablation with high-frequency bipolar pulse,and 3 swines were chose randomly and underwent enhanced CT examination immediately after ablation,and at 3,7,14,and 28 days after ablation.The liver tissues were taken for histopathological examination.The swines in the control group underwent IRE hepatic ablation with high-frequency monopolar burst,and was performed enhanced CT examination at 3 days after ablation.Liver tissues were taken for histopathological examination.Observation indicators:(1) comparison of muscle contraction of siwnes between two groups;(2) imaging performance on enhanced CT after IRE ablation in the experimental group;(3) hepatic histopathological findings after IRE ablation in the experimental group;(4) comparison of apoptotic index in the ablation zone between two groups.The measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was performed by the independent sample t test.Results (1) Comparison of muscle contraction between two groups:swines in both groups underwent ablation successfully.The degree of muscle contraction was (9.8±0.4)m/s2 and (48.6±0.5) m/s2 in the experimental group and in the control group,respectively,showing statistically significant difference between the two groups (t =-163.50,P＜0.05).(2) Imaging performance on enhanced CT after IRE ablation in the experimental group:the enhanced CT examination of swines immediately after IRE ablation showed a low-density shadow and clear boundary in the ablation zone.There was no obvious abnormality in the ablation zone and its adjacent large vessels.No serious complications occurred after the ablation.The boundary between the ablation zone and the normal liver tissue of the experimental group gradually became blurred over time,and the ablation zone was gradually replaced by normal liver tissue.The ablation zone at the 28 days after ablation was significantly reduced or even disappeared on imaging of enhanced CT examination.The maximum diameter of the ablation zone was (1.81±0.17) cm immediately after ablation,(1.75±0.19) cm at the 3 days after ablation,(1.32±0.22)cm at the 7 days after ablation,(0.65±0.14)cm at the 14 days after ablation,(0.28±0.10)cm at the 28 days after ablation,respectively.(3) Hepatic histopathological findings after IRE ablation in the experimental group:the HE staining of ablated tissue immediately after ablation showed that the cells in the ablation zone were swollen,arranged disorderly,and bleeding was observed around some of the needles.The bile ducts and blood vessels were intact in the ablation zone,and a large number of deeply stained nuclei were seen at 3 days after ablation,some of the nucleus and apoptotic bodies were partially dissolved or cleaved.A large number of inflammatory cell were infiltrated around the ablation zone.Intact vascular and biliary endothelial cells were observed by yon Willebrand factor staining,a larger number of apoptotic cells with deeply stained nuclei in the ablation zone were observed by terminal-deoxynucleoitidyl transferase mediated nick end labeling staining,and partial deposited dark brown calcium salt was seen by Von Kossa staining.More newborn hepatocytes were observed growing from the periphery of the ablation zone to the center at the 7,14,28 days after ablation.Smooth muscle cell proliferation was observed at 14 and 28 days after ablation.The ablation zone was replaced by new cells on 28 days after ablation.(4) Comparison of apoptotic index in the ablation zone between two groups:the apoptotic index of the ablation zone was significantly higher in the experimental group than in the control group on the 3 days after operation (76.67％±0.04％ vs.64.03％±0.05％,t=4.79,P＜0.05).Conclusion IRE hepatic ablation of swine using high-frequency bipolar pulse is safe and reliable,and it has more apoptotic cells than IRE ablation with high-frequency monopolar burst.
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Objective@#To investigate the safety and efficacy of irreversible electroporation (IRE) hepatic ablation with high-frequency bipolar pulse in swine.@*Methods@#The experimental study was conducted. A total of 18 swines of either gender, aged (6.8+ 0.8)months with a range of 5.5-8.0 months, were collected from Animal Laboratory Center of Army Medical University. were randomly divided into 15 in experimental group and 3 in control group. The swines in experimental group underwent IRE hepatic ablation with high-frequency bipolar pulse, and 3 swines were chose randomly and underwent enhanced CT examination immediately after ablation, and at 3, 7, 14, and 28 days after ablation. The liver tissues were taken for histopathological examination. The swines in the control group underwent IRE hepatic ablation with high-frequency monopolar burst, and was performed enhanced CT examination at 3 days after ablation. Liver tissues were taken for histopathological examination. Observation indicators: (1) comparison of muscle contraction of siwnes between two groups; (2) imaging performance on enhanced CT after IRE ablation in the experimental group; (3) hepatic histopathological findings after IRE ablation in the experimental group; (4) comparison of apoptotic index in the ablation zone between two groups. The measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was performed by the independent sample t test.@*Results@#(1) Comparison of muscle contraction between two groups: swines in both groups underwent ablation successfully. The degree of muscle contraction was (9.8±0.4)m/s2 and (48.6±0.5)m/s2 in the experimental group and in the control group, respectively, showing statistically significant difference between the two groups (t=-163.50, P<0.05). (2) Imaging performance on enhanced CT after IRE ablation in the experimental group: the enhanced CT examination of swines immediately after IRE ablation showed a low-density shadow and clear boundary in the ablation zone. There was no obvious abnormality in the ablation zone and its adjacent large vessels. No serious complications occurred after the ablation. The boundary between the ablation zone and the normal liver tissue of the experimental group gradually became blurred over time, and the ablation zone was gradually replaced by normal liver tissue. The ablation zone at the 28 days after ablation was significantly reduced or even disappeared on imaging of enhanced CT examination.The maximum diameter of the ablation zone was (1.81±0.17)cm immediately after ablation, (1.75±0.19)cm at the 3 days after ablation, (1.32±0.22)cm at the 7 days after ablation, (0.65±0.14)cm at the 14 days after ablation, (0.28±0.10)cm at the 28 days after ablation, respectively. (3) Hepatic histopathological findings after IRE ablation in the experimental group: the HE staining of ablated tissue immediately after ablation showed that the cells in the ablation zone were swollen, arranged disorderly, and bleeding was observed around some of the needles.The bile ducts and blood vessels were intact in the ablation zone, and a large number of deeply stained nuclei were seen at 3 days after ablation, some of the nucleus and apoptotic bodies were partially dissolved or cleaved. A large number of inflammatory cell were infiltrated around the ablation zone. Intact vascular and biliary endothelial cells were observed by von Willebrand factor staining, a larger number of apoptotic cells with deeply stained nuclei in the ablation zone were observed by terminal-deoxynucleoitidyl transferase mediated nick end labeling staining, and partial deposited dark brown calcium salt was seen by Von Kossa staining. More newborn hepatocytes were observed growing from the periphery of the ablation zone to the center at the 7, 14, 28 days after ablation. Smooth muscle cell proliferation was observed at 14 and 28 days after ablation. The ablation zone was replaced by new cells on 28 days after ablation. (4) Comparison of apoptotic index in the ablation zone between two groups: the apoptotic index of the ablation zone was significantly higher in the experimental group than in the control group on the 3 days after operation (76.67%±0.04% vs. 64.03%±0.05%, t=4.79, P<0.05).@*Conclusion@#IRE hepatic ablation of swine using high-frequency bipolar pulse is safe and reliable, and it has more apoptotic cells than IRE ablation with high-frequency monopolar burst.
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Objective To compare the accuracy of 125I seeds longitudinal distance between groups by degradable catheters and hand.Methods The study was divided into two groups (implantation by degradable catheters and that by hand).There were 12 simulated lesions in each group.Seed needle and 125I seeds were implanted by three physicians according to the set longitudinal distance (0.5 and 1.0 cm).Postoperative CT was conducted and the longitudinal distance between seeds was measured,and then the data was analyzed between the actual distance and the designed distance in each group.Results The degree of deviation from the set distance were (0.184 ±0.047) and (0.127 ±0.051) cm in the group by hand,and (0.007 ± 0.006) and (-0.003 ± 0.006) cm in degradable catheters group.The degree of deviation of the seeds in the catheter group was significantly lower than the group by hand (t =3.804,2.499,P ＜0.05).Conclusions The accuracy of the longitudinal distance of the group by catheter is much better than that by hand.
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BACKGROUND@#The preferred therapy for patients with pulmonary nodules which highly suspected as lung cancer by low-dose spiral computed tomography (CT) is surgery, but the best screening method of whole body is not clear yet. The aim of this study is to investigate the differences in the progression-free survival (PFS) of patients with Ia stage non-small cell lung cancer after screening of positron emission computed tomography (PET)-CT and conventional imaging (B-ultrasound/CT/MRI/ECT, BCME).@*METHODS@#A total of 300 cases of Ia stage non-small cell lung cancer were collected, of which 170 cases were performed PET-CT and 130 cases were performed BCME before operation. The basic characteristics of the two groups were analyzed by propensity score matching (PSM), and 114 cases of each group were included in the study. The survival analysis was carried out by the Kaplan-Meier survival curve and the Cox regression analysis.@*RESULTS@#There was no significant difference between each group analyzed by PSM. The PFS of PET-CT and BCME were (44.9±27.2) months and (44.1±33.1) months (χ2=1.284, P=0.257). Both of the method ssucceed in screening. It is not the PFS influence factors. The false positive of PET-CT and BCME were 10 cases and 8 cases (χ2=0.241, P=0.623).@*CONCLUSIONS@#Both PET-CT and BCME can be used as a screening method for Ia stage non-small cell lung cancer according to individualized choice of patients.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma de Pulmón de Células no Pequeñas , Diagnóstico por Imagen , Patología , Cirugía General , Supervivencia sin Enfermedad , Detección Precoz del Cáncer , Métodos , Fluorodesoxiglucosa F18 , Neoplasias Pulmonares , Diagnóstico por Imagen , Patología , Cirugía General , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones , Periodo PreoperatorioRESUMEN
Objective To investigate the diagnostic value of CT-guided percutaneous biopsy of peritoneum for unknown ascites.Methods The clinical data of 106 cases of unknown peritoneum in our hospital were collected retrospectively over the past five years (May 23,2011 to August 2,2016).The sensitivity and specificity of the percutaneous biopsy of peritoneum in diagnosis of the patients with unknown etiological ascites were evaluated.Complications were collected to evaluate the safety.Results The 106 patients with unknown ascites were performed with CT-guided percutaneous biopsy of peritoneum.The diagnoses of 91 patients were confirmed pathologically,accounted for 85.85％ of the total.Among the 91 patients,there were 60 cases (56.60％) of malignant and 31 cases (29.25％) of benign.The other 15 patients had no clinical diagnosis,which accounted for 14.15％ of the total.The diagnostic sensitivity and specificity was 88.35％ and 100％ respectively,which were significantly superior to cytological examination,biochemical markers and other routine analysis.No severe complications were observed in all patients.Conclusion CT-guided percutaneous biopsy of peritoneum for unknown ascites plays an important instructive role in diagnosis with high accuracy,and it is a safe and effective method.
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Objective To investigate the risk factors of pneumorrhagia and pneumothorax occurring after CT-guided cutting needle biopsy for pulmonary solid nodules.Methods The clinical data and imaging materials of 320 patients with pulmonary solid nodule (≤3 cm),who received 16 G semi-automatic cutting needle biopsy,were retrospectively analyzed.Both univariate and multivariate logistic regression analysis methods were used to evaluate the risk factors of pneumorrhagia and pneumothorax.Results The incidence of needle track hemorrhage was 33.1％ and the incidence of pneumothorax was 18.1％,the diagnostic accuracy for benign and malignant nodules was 99.6％.Needle track length was an independent risk factor for pneumorrhagia;every increase of 3 cm in needle track length,the risk of pneumorrhagia would increase 3.881 times,besides,the risk of pneumorrhagia had a parallel relationship with the time used for puncturing (P=0.061) as well as with the number of pleural puncturing (P=0.062).The age,lesion's location and needle-pleural angle were independent risk factors for pneumothorax.Each increase of 10 years in age,the risk of pneumothorax would increase 2.102 times.The pneumothorax risk of pulmonary lesion located at upper lung lobe was strikingly lower than that of pulmonary lesion located at lower lung lobe.Each increase of 20 degrees in needle-pleural angle,the risk of pneumothorax would increase 2.413 times.Emphysema was excluded from the equation because it had only a minute difference (P=0.086).Based on the pneumorrhagia and pneumothorax probability values,ROC curves of pneumorrhagia and pneumothorax were drawn,and AUC values of pneumorrhagia and pneumothorax were 0.753 and 0.725 respectively.Conclusion The occurrences of pneumorrhagia and pneumothorax after CT-guided cutting needle biopsy for pulmonary solid nodules are affected by many factors.Careful preoperative evaluation and skilled intraoperative manipulation can effectively reduce the incidence of pneumorrhagia and pneumothorax.
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Objective To introduce several commonly used puncture techniques for retroperitoneal lymph node metastases in order to provide technical guidance in performing 125I seed implantation therapy. Methods The puncture methods used at authors’ interventional department in performing 125I seed implantation therapy for retroperitoneal lymph node metastases were summarized. Results The commonly used puncture methods included parallel needle puncturing technique , trans-viscera puncturing technique , broadening path puncturing technique and coaxial needle puncturing technique. Conclusion An effective combination use of various puncturing techniques to uniformly implant the radioactive 125I seeds into the lesion can improve the therapeutic result and reduce the occurrence of complications.
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<p><b>BACKGROUND AND OBJECTIVE</b>125I seed implantation treatment of pulmonary metastases, often because of complicated structure of the chest, was considered as restricted areas. The aim of this study is to evaluate the effectiveness of CT guided radioactive 125I seed implantation in treating lung metastatic tumors.</p><p><b>METHODS</b>Totally 115 metastatic masses were found in 30 patients with CT guiding. 125I seeds were implanted into lung metastatic masses. The approach of implantation was determined according to the location of the lesions (hilar masses, peripheral masses and masses covered by skeletal thorax). The therapeutic effects were evaluated by CT.</p><p><b>RESULTS</b>Uniform distribution were achieved by single puncture in 84.3% of patients. The rest patients (15.7%) were received replanting. The follow-up period was 6-24 months (mean 14.6). Among 115 lesions in 30 cases, complete response (CR) was achieved in 80 nodes, partial response (PR) in 20 nodes, No change (NC) in 8 nodes and progressive disease (PD) in 7 nodes. The total response rate was 86.9%. The one-year local control rate were 93.9% (108/115). No severe perioperative complications occurred.</p><p><b>CONCLUSION</b>CT guided radioactive seed 125I implantation is a safe and effective procedure in treating multiple lung metastatic tumor with minimal invasion.</p>
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radioisótopos de Yodo , Usos Terapéuticos , Neoplasias Pulmonares , Diagnóstico por Imagen , Radioterapia , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Objective To investigate nursing methods of CT -guided 125I seeds implantation brachytherapy for malignant tumor. Methods Nursing methods in 236 cases of 125I seed implantation therapy were summarized. Results Perfect preoperative examination,and psychological intervention could significantly improve patients mental state. Observation distribution of particles and postoperative observation could promote patients postoperative recovery. Conclusion Preopertive and postopertive nursing and radiation protection is an important factor for 125I implantation brachytherapy
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Objective To obtain the CT image 3 D reconstruction of head and neck region of the first Chinese visible human. Methods The CT data of head and neck region of the first Chinese visible human were processed with Siemens 3 D Virtuoso VA(R2.6) software in SGI Graphics Computer Workstation. The 3 D reconstruction of head and neck surface and skeletal structure were carried out and studied. Results The face and neck were well reconstructed. The nose, lips, ears and chin could be clearly shown. The skeletal structures in the head and neck region were fairly reconstructed and displayed very well and even the fine structures in skull base such as foraman ovale and foramen spinosum could be seen. Many anatomic structures such as pituitary gland, brain stem, cervical marrow, sphenoid sinus, nasopharynx could be displayed in detail on the 3 D reconstruction section. Conclusion This study has realized the CT image 3 D reconstruction and visualization of head and neck region of the first Chinese visible human and provided morphologic data for further studies of 3 D structures, comparative studies of anatomy and imaging of the head and neck.
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Objective To assess the clinical diagnostic value of CT guided transthoracic core needle biopsy (TNB) in patients with pulmonary peripheral lesions. Methods The pathological findings, follow up results, mass size, complications due to paracentesis, and other examination results in 223 patients with pulmonary peripheral lesions undergoing TNB were analyzed retrospectively. Results The positive predictive value of malignant lesions was 100%. False negative was found in 3 cases. There was no false positive of malignant lesions in all the cases. The sensitivity and specificity were 93.6% and 100%, respectively. The negative predictive value of benign lesions was 94.8%. There was no significant difference in the satisfaction rate of multiple biopsy between the large and small nodules. The satisfaction rate of a single biopsy of the large nodule was significantly better than that of the small nodule ( P
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Eighteen patients with hemangioma of alimentary tract were treated in our hospital from 1980 to 1994 There were 11 males and 7 females,with average age of 48?18 years (ranged from 19 to 76 years) Of them,14 patients were treated with operation,2 with hemangioma of rectum were treated with ligation with snare.All of the 16 patients were cured. The etiology,pathology,diagnosis and management are discussed in this paper The experiences of finding small hemangiomas of jejunum and ileum during operation are also introduced in the paper