RESUMO
Objective:To explore the effect of magnetic resonance imaging (MRI) examination in evaluating the severity of liver fibrosis in schistosomiasis.Methods:A prospective study was carried out to select 50 patients with chronic schistosomiasis admitted to the First People's Hospital of Huzhou City from December 2016 to December 2019 as the observation group, and 35 healthy physical examination subjects during the same period as the control group. All subjects underwent 1.5T MRI scan and diffusion-weighted imaging, and the diffusion sensitivity coefficient (b value) was set to 600 s/mm 2. Using liver biopsy as the gold standard, the degree of liver fibrosis stage was determined. The correlation between apparent diffusion coefficient (ADC), exponential apparent diffusion coefficient (eADC) of diffusion-weighted imaging and liver fibrosis stage was analyzed. And receiver operating characteristic curve (ROC curve) was drawn to evaluate the diagnostic value of ADC and eADC in liver fibrosis of schistosomiasis. Results:Among the 50 patients with chronic schistosomiasis, the MRI scan showed that 39 patients presented with liver lobe proportion imbalance, widened liver fissure, atrophy of right lobe of liver, obvious enlargement of the left outer lobe and caudate lobe of liver; hyperfibrosis and hyperplasia around portal vein leaded to thickening of portal vein wall and appearance of fiber cuff sign; both T1WI and T2WI showed low signals but were not sensitive to late calcification; and there was no obvious change of liver lobe contour and proportion imbalance in other 11 patients. Among them, 7 cases were complicated with liver cancer, and 44 cases were complicated with cholecystolithiasis and cholecystitis. The MRI diffusion-weighted imaging showed that there were statistically significant differences in ADC [(1.17 ± 0.08) × 10 -3, (1.38 ± 0.13) × 10 -3 mm 2/s] and eADC value [(0.51 ± 0.07) × 10 -3, (0.40 ± 0.06) × 10 -3 mm 2/s] between the observation group and the control group ( t = 8.497, 7.762, P < 0.05); and the differences in ADC and eADC values of patients in different liver fibrosis stages in the observation group were statistically significant ( F = 21.526, 23.814, P < 0.05). Correlation analysis results showed that chronic schistosomiasis liver fibrosis was negatively correlated with ADC value ( r = - 0.236, P < 0.05), and positively correlated with eADC value ( r = 0.484, P < 0.05). The ADC value for diagnosing of schistosomiasis liver fibrosis with area under ROC curve (AUC) was 0.826, the 95% confidence interval ( CI) was 0.785 - 0.953, the diagnostic specificity was 89.25%, and the sensitivity was 79.58%; eADC value for diagnosing schistosomiasis liver fibrosis with AUC was 0.681, the 95% CI was 0.582 - 0.879, the diagnostic specificity was 81.14%, and the sensitivity was 73.81%. The ADC and eADC values diagnosed liver fibrosis in S2 - S4 stages were significantly higher in AUC than those in S0 and S1 stages ( P < 0.05), but there was no significant difference between S1 and S0 stages ( P > 0.05). Conclusions:In MRI examination of patients with chronic schistosomiasis liver fibrosis, ADC values decreases significantly, and eADC values increases significantly; and there is a correlation between chronic schistosomiasis liver fibrosis and ADC and eADC values. The ADC and eADC values have certain diagnostic value for schistosomiasis liver fibrosis.
RESUMO
Objective:To compare the therapeutic efficacies of mechanical thrombectomy (MT) and intravenous thrombolysis (IT) in patients with acute vertebrobasilar occlusive cerebral infarction.Methods:A prospective inclusion of 111 patients with acute vertebrobasilar artery occlusion admitted to our hospital from February 2014 to December 2019 was performed; these patients were divided into MT group ( n=66) and IT group ( n=45) according to the wishes of their families. MT was performed directly in patients from the MT group; IT was performed firstly in those from the IT group, and MT (also known as bridging treatment) was then used for those who showed no efficacy in IT when condition permission and having family member's willing. Vascular recanalization rate, incidence of symptomatic intracranial hemorrhage, National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Scale (mRS) scores and mortality rate were assessed in the two groups after treatment. Results:During the course of the study, 7 patients (4 in the MT group and 3 in the IT group) dropped out, and finally 104 (62 in the MT group and 42 in the IT group) were included in the statistical analysis. Fifty-four patients in MT group had succeeded recanalization, and the recanalization rate (87.1%) was statistically higher than that in IT group (61.9%, P<0.05). There were 8 patients (12.9%) with symptomatic intracranial hemorrhage in MT group and 6 patients (14.3%) in IT group, without significant difference ( P>0.05). The treatment effective rate (difference value of NIHSS scores before and after treatment≥4 or NIHSS score after treatment=0) in patients from MT group (67.7%) was significantly higher than that in IT group (38.1%), the good prognosis rate (58.1%) was statistically higher than that in IT group (28.6%), and the mortality rate (3.2%) was statistically lower than that in IT group (14.3%, P<0.05). Among the 16 patients who did not receive IT, 14 patients changed to accept bridging treatment (2 family members refused re-thrombectomy); the vascular recanalization rate (78.6%), intracranial hemorrhage rate (14.3%), treatment effective rate (50.0%), good prognosis rate (57.1%), and mortality rate (7.1%) showed no significant differences as compared with those in the MT group ( P>0.05). Conclusion:For patients with acute vertebrobasilar occlusive cerebral infarction, MT can improve the vascular recanalization rate and clinical prognosis; even after the failure of IT, re-thrombectomy (bridging treatment) is still safe and effective.
RESUMO
Objective To explore the effect of prophylactic hepatic artery infusion chemotherapy (HAIC) on survival after curative resection in patients with primary pancreatic cancer. Methods A total of 106 patients with pancreatic cancer after pancreatectomy received 2 cycles of HAIC plus 4 cycles of systemic chemotherapy (HAIC) or 6 cycles of sys-temic chemotherapy alone (Control). Both the HAIC and systemic chemotherapy regimen consisted of 5-fluorouracil 1000 mg/m2 on day 1 and Gemcitabine 800 mg/m2 on day 1 and 8. The treatment was started on an average of 3 weeks after surgery and repeated every 4 weeks. The disease-free survival , overall survival and liver metastases-free survival were compared. Results Significant differences were found in 3-year overall survival (HAIC, 23.08 %; Control, 14.81%;P=0.0473) and liver metastases-free survival (HAIC, 80.77%;Control, 55.56%;P=0.0014). There was no significant difference in adverse effects between two groups. Conclusion HAIC effectively and safely prevented liver metastases and improved the prognosis of patients with pancreatic cancer after pancreatectomy.
RESUMO
Objective To evaluate the effects of preoperative regional intra-arterial infusion chemotherapy for patients with advanced gastric cancer (AGC). Methods A total of 82 patients with clinical stage Ⅲ,Ⅳ gastric cancer received two cycles of neoadjuvant regional intra-arterial infusion chemotherapy (arterial infusion group, n=42) or neoadjuvant systemic chemotherapy (systemic chemotherapy group, n=40). The operation was administrated in 10 to 15 days before chemotherapy. All patients received 6 course of systemic chemotherapy after surgery. Chemotherapy toxicity and sur-vival rate were retrospectively analyzed. Results No significant difference was found in chemotherapy toxicity between two groups. The median survival period was 25.3 months in arterial infusion group and 19.1 months in systemic chemotherapy group. 3-year survival rate was 36.4% in arterial infusion group and 21.0% in systemic chemotherapy group respectively, there were significant differences (P<0.05). Conclusion Preoperative regional intra-arterial infusion chemotherapy is well tolerated in advanced gastric cancer patients and could improve short-term survival.
RESUMO
Objective To investigate the influence of preoperative arterial chemoembolization on the expression of Survivin,and study the clinical significance in bladder cancer.Methods The tissue before and after chemoembolization of 50 patients with bladder cancer were selected,the Survivin expression was examined by immunohistochemical method.The Survivin expression was compared between before and after chemoembolization in bladder cancer tissue,and the relation of its expression to the pathological grade and clinical stage was evaluated clinically.Results The positive rate of Survivin expression before chemoembolization raised with the rising of the pathological grade and clinical stage,there was statistical difference (P ＜ 0.05).The positive rate of Survivin expression before and after chemoembolization was 72％ (36/50) and 22％ (11/50),there was statistical difference (P ＜0.01).The positive rate of Survivin expression in high grade pathological grade and T2-T4 clinical stage after chemoembolization was significantly lower than that before chemoembolization,there was statistical difference (P ＜0.01).The survival rate 3 years after chemoembolization in Survivin negative expression patients was higher than that in Survivin positive expression patients [94.87％(37/39) vs.7/11],but there was no statistical difference (P ＞ 0.05).The Survivin positive expression in recurrence patients was significantly higher than that in non-recurrence patients [5/8 vs.5.56％ (2/36)],there was statistical difference (P ＜ 0.01).Conclusions Preoperative arterial chemoembolization can reduce the expression of Survivin,adjust malignancy of bladder cancer,could downgrade and downstage the tumor,reduce recurrence rate.The expression of Survivin can serve as predictive factor for prognosis of bladder cancer.
RESUMO
Objective To investigate the influence of preoperative arterial chemoembolization on expression of Ki-67,and clinical significance in bladder cancer. Methods Before and after chemoembolizafion of therapy,the expression of Ki-67 in 30 patients of bladder cancer tissue were examined by immunohistochemical staining.The rehtion of its expression to the pathological grade and clinical stage was evaluated clinically.Results Positive rate of Ki-67 expression in the bladder cancer tissue was 70.00% and 26.67% respectively.There was significant difference between the before and after therapy (P＜0.01). Follow-up for mean 24.6 months recurrence rate in 30 cases was 16.67%.The expression of Ki-67 correhted to the pathological grade, clinical stage and patient recurrence rates of bladder cancer.Conclusions Preoperative arterial chemeembelization can reduce the expression of Ki-67,adjust malignancy of bladder cancer,could downgrade and downstage the tumors,and cut down the postoperative metastasis,improve survival rate and reduce recurrence rate.Both of the Ki-67 labeling index are predictive factor for recurrence of superficial bladder cancer.
RESUMO
Objective To study the influence of transeatheter bladder arterial chemoembolization on neovascularization and vascular endothelial growth factor (VEGF) expression in bladder cancer treatment. Methods Thirty bladder cancer patients (Tis =1, Ta =2, T1 =6, T2 =11, T3 =9, T4 = 1; G1 = 9, G2=13, G3 = 8) were treated with transcatheter arterial chemotherapy with Mitomycin (20 mg) or Hydroxycamptothecin (10 nag) adding cisplatin (60 rag) and embolization with gelatine sponge particle gelform 1 week before surgery. Before and after the chemoembolization, the expression of VEGF and microvessel density (MVD) count in cancer tissue were examined by SP immunohistochemical staining. Tumor samples after chemoembolization were taken and sent for pathological examination. The over all survival rates were recorded and analyzed as well. Results Before and after the chemoembolization, positive rates of VEGF expression in bladder cancer tissue were 73. 3% and 43.3%, respectively and MVD were 69.8±3.4 and 56. 4±3.3, respectively. There were significant differences between the parameters before and after the treatment (P<0.05). After the intervention, tumor diameter decreased from 2.2±0.9 cm to 1.6±0. 9 cm (P<0.05) and tumor tissues were in severe necrosis and degeneration. During the follow-up of 24. 6 months (ranging from 12 to 36 months),there were 5 recurrent cases (G1 T1 =1, G2 T1=1, G2T3=1, G3T3 = 1, G3 T4 =1, primary transitional cell carcinoma= 4, admixture carcinoma= 1). In the recurrent group, VEGF expression were positive in 5 cases (100% strong positive) and 4 cases (80%, 3 positive, 1 strong positive) (P>0. 05) before and after the chemoembolization. However, it had significant difference in strong positive expression (P<0.05); MVD were 87.4±3.0 and 72.4±4.1 (P<0.05) before and after the treatment. The MVD in no recurrent group was 53.2±3. 5 after chemoembolization, and it had statistical significance comparing with the recurrent group (P<0. 05). Conclusions The chemoembolization can decrease the expression of tumor VEGF and MVD. Thus, it can adjust bladder cancer malignancy, downgrade and downstage the tumors and decrease the risk of postoperative metastasis. For the long-term, this treatment will improve the survival rate and reduce recurrence rate.