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Purposes: This study aimed to investigate the efficacy of ultrasound (US)-, computed tomography (CT)-, and magnetic resonance imaging (MRI)-guided radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). Materials and Methods: This retrospective study included 141 patients with HCC who were treated with US-guided (n = 29), CT-guided (n = 50), or MRI-guided RFA (n = 62). The primary endpoint was progression-free survival (PFS). The secondary endpoints included overall survival (OS), technique success (TS), and technique efficacy (TE). Cox model and logistic regression were used to determine the risk factors for tumor recurrence and TE. Results: The US, CT, and MRI groups did not show a significant difference in terms of baseline variables. The three groups did not differ significantly in PFS rate (P = 0.072) and OS rate (P = 0.231). The PFS rates at 3 years for the US, CT, and MRI groups were 40.90%, not reached, and 14.80%, respectively. The OS rates at 3 years were 94.70%, 97.50%, and 85.50% for US, CT, and MRI groups, respectively. No significant differences were observed between the three groups in terms of TS rate (P = 0.113) and TE rate (P = 0.682). In multivariate analysis, liver cirrhosis (P = 0.001), level of alpha-fetoprotein (AFP, P = 0.004), and number of tumors (P = 0.012) were independent risk factors for PFS. For TE, the level of AFP (P = 0.018) was an independent factor. Conclusion: US-, CT-, and MRI-guided RFA was effective for treating HCC patients. Liver cirrhosis, AFP level, and tumor number were associated with tumor recurrence, and the level of AFP was an independent risk factor affecting TE
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Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatobiliary cancer after hepatocellular carci-noma (HCC). Surgical resection is the main curative treatment for ICC. Patients with ICC exhibit poorer prognosis compared with those with HCC. A comprehensive individualized prognostic system must be developed based on specific factors of patients. Several distinct prognostic staging systems have been proposed for patients with ICC treated by surgery. These systems include six staging systems, two scoring systems, and three prognostic nomograms. However, all of these prognostic systems are based on data from patients un-dergoing surgery resection and have not been validated in patients receiving other therapies. In this review, we will discuss the prog-nostic accuracy and applicability of current available prognostic systems and provide directions for future investigations.
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Objective To evaluate the efficacy and safety of transcatheter hepatic arterial chemoembolization (TACE) combined with CT guided radiofrequency ablation (RFA) for primary liver cancer in the caudate lobe.Methods Sixteen patients with primary liver cancer in the caudate lobe were treated with combination therapy of TACE and RFA.Complet ablation rate,overall and recurrence-free survival,and complications were evaluated.Results A total of 15 cases achieved complet ablation,complet ablation rate was 93.75％ (15/16).Recurrence-free survival time was 19.35 months,overall survival time was 44.62 months.Overall survival rates were 88.23％,66.65％ and 33.18％ at 1,3,5 years after therapy,respectively.Conclusion TACE combined with RFA is a safe and useful therapeutic option for treatment of primary liver cancer in the caudate lobe.
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Objective To investigate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with CT-guided thermal ablation (radiofrequency ablation or microwave ablation) in treating intrahepatic cholangiocarcinoma.Methods The clinical data of 14 patients with pathologicallyproved intrahepatic cholangiocarcinoma,who were admitted to authors' hospital during the period from September 2009 to July 2013 to receive TACE with subsequent radiofrequency ablation (RFA) or microwave ablation (MWA),were retrospectively analyzed.A total of 18 lesions were detected in the 14 patients.The maximal diameter of the lesion (or the sum of maximal diameters if there were multiple lesions) ranged from 2.2 cm to 7.2 cm (mean 4.2±1.4 cm).After TACE,the lesion's complete ablation rate,surgical complications,tumor-free survival time and overall survival time were evaluated.Results Complete ablation was obtained in 15 lesions (83.3％,15/18).The incidence of moderate complications was 6.2％,and no severe complications or death occurred.After the treatment,the patients were followed up for 6-14 months,with a mean of (16.0±10.3) months.At the end of follow-up,6 patients (42.9％,6/14) died.The median tumor-free survival time in patients whose lesions obtained complete ablation was 17 months.The median survival time of all patients was 20 months.The 1-,2-and 3-year overall survival rates were 82.5％,41.3％ and 20.6％ respectively.Conclusion TACE combined with thermal ablation can be regarded as one of the treatment options for intrahepatic cholangiocarcinoma.
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Objective To study the effect of radiofrequency ablation (RFA) with sublethal temperature on the production of liver cancer stem cells (LCSCs) and on the expression of LCSCs-related transcriptional factors.Methods Mouse hepl-6 hepatoma cell line and clinical samples of patients with hepatocellular carcinoma (HCC) were used to test the expressions of LCSCs-related markers and transcriptional factors.Results Different temperatures were used to stimulate Hep1-6 cells,and it was proved that the temperature of 45℃ was a sublethal temperature that could not induce cell death.Flow cytometry testing showed that treatment with 45℃ could obviously increase CD13+,CD44+,CD90 and CD133+ Hep1-6 cells,suggesting that treatment with 45℃ could increase the production of above mentioned types of LCSCs in hep1-6 cells.Real-time quantitative polymerase chain reaction (RT-qPCR) assay indicated that the temperature of 45℃could cause significant increase in CD13,CD90 and CD133 mRNA.In all 5 HCC patients,CD13 mRNA in the recurrent HCC lesions was remarkably increased,CD133 mRNA was increased in 4 patients with recurrent HCC,and CD90 mRNA was increased in only one patient with recurrent HCC.Flow cytometry testing revealed that CD13+ LCSCs were strikingly increased in 4 recurrent HCC patients,while CD133+LCSC was increased in only one patient,suggesting that more close correlation existed between the increase of CD13+ LCSCs and the temperature of 45℃.RT-qPCR assay showed that in 4 recurrent HCC patients with increased CD13+ LCSC,the Sox2 and Stat2 among 13 LCSCs-related transcriptional factors were obviously increased.Flow cytometry testing showed that 45℃ treatment also increased the expression of Sox2 and Stat1 mRNA in Hep1-6 cells.Finally,Sox2 and Stat1 could be knockdown by siRNAs,indicating that both Sox2 and Stat1 transcriptional factors were involved in 45℃-induced production of CD13+ LCSCs in Hep1-6 cells.Conclusion In RFA therapy,the use of sublethal temperature of 45℃ can increase CD13+LCSCs,which is related to the promotion of Sox2 and Stat1 expression.The results of this study can be used for reference in the research of liver cancer recurrence.
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ObjectiveTo investigate the relevant risk factors for early recurrence after microwave ablation for primary hepatocellular carcinoma (HCC), and to provide a reference for predicting and preventing tumor recurrence. MethodsA retrospective analysis was conducted on the clinical data of 80 patients who had undergone microwave ablation for primary HCC at the Beijing You′an Hospital, Capital Medical University, Beijing, China (2010-2012). Factors possibly influencing early recurrence were selected for univariate analysis using logistic model. Risk factors for early recurrence of HCC after ablation were screened out for identifying the high-risk population and further guiding treatments against recurrence. ResultsThere were 30 cases of recurrence in 6 months after ablation, accounting for a recurrence rate of 375%. Univariate analysis showed that no significant differences occurred between the recurrence and non-recurrence groups in age, gender, tumor location and size, family history of HCC, drinking history, HCC resection history, preoperative alpha-fetoprotein level, liver function Child-Pugh grade, MELD score, or HCC-related causes (P＞0.05). In contrast, the number of tumors (≥2) significantly differed between the two groups (P=0.008). ConclusionThe number of tumors is an independent risk factor for early recurrence among patients after microwave ablation for HCC. High-risk population can be predicted according to the risk factors for early recurrence after microwave ablation for HCC. Targeted preventive measures should be taken for early detection and timely treatment of tumor recurrence.
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Since initial identification of astrocyte elevated gene -1 ( AEG-1 ) as a HIV-1-inducible novel oncogene in 2002 ,it has emerged as an important oncogene providing a valuable prognostic marker in pa-tients with various cancers.The present review discusses AEG -1 structure,function and localization.Further-more,we summarize the potential role of AEG -1 in the progression of hepatocellular carcinoma (HCC).This re-view can help us better understand the molecular mechanism in hepatocarcinogenesis .
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Objective To investigate the expressions of platelet activation-dependent granule membrane protein and platelet-derived growth factor receptor-αB, and the ultra-microstructure changes of platelets in patients with acute ST-segment elevation myocardial infarction(STEMI). Method The expressions of platelet activationdependent granule of glycoprotein (CD62P)and platelet derived growth factor receptor αβ subtype (PDGFR-αβ)of platelets in peripheral blood in 36 patients with acute ST-segment elevation myocardial infarction(STEMI) hospitalized and another 34 healthy subjects over the same period (control group) were investigated by flow cytometry and data were analyzed. The changes of ultra microstructure and activity of blood platelets in those patients and control group were observed under the scanning electron microscope. Results The expressions of CD62P and PDGFR-αβin patients with STEMI group before treatment were (3.65 ± 1.87) % and (0.43 ± 0.39) %, respectively, and those after treatment were (0.96 ± 0.79) % and (0.28 ± 0. 24) %, respectively, whereas those in control group were (0.67 ± 0.35) % and (0.27 ± 0.22) %, respectively, which were much lower in control than those in patients with STEMI before treatment (P ＜ 0.01 or P ＜ 0.05) respectively. There were statistically significant differences in the expressions of CD62P and PDGFR-αβ in patients group between pre-treatment and posttreatment (P ＜0.01 or P ＜0.05), respectively. Obvious ultra-microstructure changes of platelet surface in patients with STEMI group were observed. Conclusions Due to platelet activation in AMI, the expressions of CD62P can be used as effective indicators for monitoring coronary heart disease, and the PDGFR-αβ can be used as a reference indicator. The platelet surface ultra-microstructure changes during platelet activation in patients with AMI can be found by scanning electron microscopy.
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Objective To explore the dynamic expression of ROCK-Ⅰ,p-MBS Thr-697,α-SMA protein and their mRNA in the hepatic fibrogenesis and the changes of actin cytoskeleton.Methods ROCK-Ⅰ and p-MBS Thr-697 protein in liver were determined by Western blot and their mRNA was examined by reverse transcription-polymerase chain reaction (RT-PCR),while the distribution of ROCK-Ⅰ and α-SMA in liver was assessed immunohistochemis-tically.The change of actin cytoskeleton was shown by fluorescence.Results With the development of hepatic fi-brosis,the positive areas in model groups at week 1 to 4 of ROCK-Ⅰ and α-SMA of the rat livers were larger than that in control group respectively(P <0.05).ROCK-Ⅰ,p-MBS Thr-697 ,α-SMA protein and mRNA were increased than that in control group respectively.ROCK-Ⅰ mRNA expression correlated with α-SMA (r =0.718,P <0.05).With the development of liver fibrosis,the images of fluorescence were inhanced.Conclusion With the develop-ment of liver fibrosis,both protein and mRNA of ROCK-Ⅰ increased.
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Objective To evaluate the therapeutic effectiveness of treating adrenal gland neoplasms by CT-guided absolute alcohol injection. Methods Eleven patients with adrenal gland neoplasms were examined by CT to identify the lesion′s size, location, and the relationship with its surrounding tissue. The needling direction was first chosen, and the syringe needle was placed at the center of tumor or the destined position. Absolute ethyl alcohol was injected after rescanning to confirm the position of syringe needle was inerrant. The blood sugar and blood pressure were checked before operation. After operation, analysis of the clinical manifestations was performed and the blood sugar and blood pressure were measured at once, 24 h, 48 h, one week, one month, and two months, respectively. To observe the absorption of the lesions, postoperative follow-up CT scans were performed at one month and later on. Results Significant differences in blood pressures and blood sugar were observed between preoperation and 24 hours after the operation (P
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Objective To evaluate the safe ty and efficacy of CT-guided percuta neous ethanol injection (CT-PEI) in the treatment of thyroid adenoma. M ethods Fifty-four patients with 73 nodules were included in the study. Thyroi d adenoma was confirmed by pathology. The serum level T3, T4, and TSH were norma l in all cases. CT-PEI (0.3-2.5 ml ethanol/cm~3 nodular tissue) was given for 115 times (mean 1.58?078 times/nodule). Results Complete cu re was observed in 37 nodules (50.7%). In 28 nodules (38.3%) volume reduction was greater than 80%. A significant nodule reduction (50%-80%) was observed in 7 nodules. Only 1 (1. 4%) nodule volume reduction was 28.9%. Apart from 1 case of transient dysphonia and 2 cases of mild pain and burning sensation, no side effect was observed. Conclusion CT-PEI is a safe and effective therapeutic procedure with f ew side effects for thyroid adenoma.
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Objective To evaluate the efficacy of emergency transcatheter arterial embolization(TAE)for spontaneous rupture of hepatocellular carcinoma(HCC).Methods We retrospectively reviewed 16 cases of spontaneous ruptured HCC which had been treated in our hospital between 1997 and 2005.Emergency TAE was performed in the 16 patients,with 6 cases complicated by hypovolemic.Results Bleeding from the ruptured HCC was stopped at the end of the procedure in 16 patients who had undergone successful embolization.The time from the onset of clinical symprtom to TAE been completed was 1.5-5 hours(mean,3.6 hours),The shortest time was 1.5 hours in 3 patients.Following the achievement of hemostasis by TAE,transcatheter arterial chemoembolization(TACE)2-6 times for each case with average 3.7 and CT guided percutaneous ethanol injection(CT-PEI)5-9 times for every case with arerage 6.8 were performed in 12 cases.3 cases were given up for further treatment.The liver transplantation was carried out in 1 case 3 days after TAE.The average survival time was 14.3 months.Conclusions Emergency TAE is safe and effective for bleeding due to spontaneous rupture in HCC and would achieve better result by adding TACE and CT-PEI.Liver transplantation is one of the options for the patients with poor liver function.The combination of all methods above can prolong patients survival time.(J Intervent Radiol,2006,15:228-231)