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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world, and the new cases of HCC in China account for more than half of the global cases every year. High incidence mortality and limited treatment methods are the main challen-ges for HCC prevention and treatment in China. Immunotherapy has brought new treatment options and hope of prolonging the survival to patients with advanced HCC. Data from the IMbrave 150 study published in the New England Journal of Medicine in May 2020 showed that the median overall survival of all patients was 19.2 months, and the median overall survival of the Chinese subgroup was 24.0 months, which suggested significant efficacy in prolongating patient survival and controlling tumor. Interven-tional therapy has been playing an important role in the treatment of HCC, and more and more clinical studies have adopted systematic therapy combined with interventional therapy. Interven-tional therapy and systematic therapy have synergistic efficacy which lead to significant clinical efficacy. The authors introduce the diagnosis and treatment of an advanced HCC patient undergoing interventional therapy combined with bevacizumab plus attilizumab treatment, which lead to signifi-cant clinical efficacy of tumor controlling.
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BACKGROUND:Primates are considered to be the most appropriate animal model of lumbar intervertebraldisc degeneration, but the disc degenerated characteristics of monkeys were rarely reported. OBJECTIVE:To verify the degenerated regularity and characteristics of lumbar intervertebral disks in rhesus monkeys with magnetic resonance T2 mapping and T1ρimaging technology. METHODS:The sagittal lumbar intervertebral disc magnetic resonance T2 weighted imaging,T2 weighted mapping imaging and T1ρweighted imaging of 63 adult rhesus monkeys were acquired on 1.5T magnetic resonance equipment. The T2-map value and T1ρvalue of lumbar intervertebral disc regions of interest were calculated on the post-processing workstation. RESULTS AND CONCLUSION:(1) This study obtained 425 better magnetic resonance images of lumbar intervertebral disks in adult rhesus monkeys. T2-map value and T1ρvalue of nucleus pulposus were most consistent by different persons, and the Kappa coefficient was more than 0.93. (2) The T2-map value and T1ρvalue of nucleus pulposus were both negatively correlated significantly with Pfirrmann grades (r=-0.842, P<0.01;r=-0.896, P<0.01). The T1ρvalue and T2-map value of nucleus pulposus were significantly statistical y different between Pfirrmann grades I-IV (P<0.001, P<0.001). The T1ρvalue of nucleus pulposus was negatively correlated significantly with Pfirrmann grade II-III (r=-0.517, P<0.01) and Pfirrmann grade IV-V (r=-0.499, P<0.01). The T2-map value of nucleus pulposus was also negatively correlated significantly with Pfirrmann grade II-III (r=-0.617, P<0.01) and Pfirrmann grade IV-V (r=-0.652, P<0.01). (3) The T2-map value of L1-2 and L2-3 segments nucleus pulposus were significantly lower than that in L6-7 and L7-S1 segments (P<0.05). (4) There were significant differences in age among the T1ρvalue and T2-map value of nucleus pulposus (r=-0.702, P<0.001, r=-0.730, P<0.001). (5) It is concluded that magnetic resonance T2 mapping and T1ρimaging technology can objectively and sensitively assess the degenerated process of nucleus pulposus in rhesus monkeys. The degeneration in upper lumbar segments (L1-2 and L2-3) was earlier and more severe than that in lower lumbar segments (L6-7 and L7-S1) in rhesus monkeys. Age is one of the most important factors in lumbar intervertebral disc degeneration of adult rhesus monkeys.
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BACKGROUND:There are many animal models used for studying discogenic pain, but percutaneous puncture annulus is rarely reported. Minimal y invasive approach to establish a discogenic pain model in Spraque-Dawley rats could reduce the interference factors of surgical trauma. OBJECTIVE:To establish a Spraque-Dawley rat model of discogenic pain by percutaneous puncture annulus, with easy operations, high stability and obtaining large-scale productions, and to confirm the model by the results of behavior, MRI and molecular biology. METHODS:Eighty-eight male Sprague-Dawley rats, of specific pathogen free level, were randomly divided into three groups, model group (n=44), control group (n=10) and sham group (n=34). In the model group, the annulus was percutaneously punctured under X-ray guidance;while rats in the sham group were punctured at the paravertebral tissue, rather than the annulus. RESULTS AND CONCLUSION:The 50%mechanical withdrawal threshold of both hind paws in model group were reduced compared with control group and sham group. In the model group, the L 5/6 intervertebral disc degeneration was apparently visible, and the degree of degeneration was aggravated along the time. In the model group, the expression of calcitonin gene-related peptide in dorsal root ganglion of rats began to increase at 3 days post-operation and reached the peak at 21 days post-operation, then remained at high levels until the 35th day post-operation. The expression of tumor necrosis factor-αin dorsal root ganglion of rats increased at 3 days post-operation and reached the peak at 14 days post-operation, then remained at a higher level until the 35th day post-operation. The experiment result verifies that the discogenic pain model of Spraque-Dawley rats induced by percutaneous puncture annulus has the advantages of good stability and less trauma. The model can be used to study discogenic pain.
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BACKGROUND:The magnetic resonance molecular imaging used in the research of lumbar disc degeneration includes T2 mapping and T1ρtechnologies at present. OBJECTIVE:To evaluate the feasibility of 1.5 T MR equipment on T2 mapping of New Zealand white rabbits lumbar disc. METHODS:T2 mapping images of New Zealand white rabbit lumbar discs were obtained on 1.5 T MR equipment. The regions of interest T2 values of lumbar discs were measured with post-processing workstation. RESULTS AND CONCLUSION:Sagittal and coronal T2 maps of 3-month rabbit discs were obtained satisfactorily on 1.5 T MR equipment. The regions of interest T2 values of nucleus pulposus in L 4/5 , L 5/6 and L 6/7 discs were (104.6±14.0) ms, (109.1±13.8) ms and (109.5±15.1) ms respectively at Pfirrmann regions of interest T2 values of anterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs were (82.1±9.5) ms, (80.4± 11.2) ms and (79.9±10.6) ms respectively, and T2 values of posterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs were (85.8±11.9) ms, (85.1±12.1) ms and (85.3±9.3) ms respectively. There were no significant differences in T2 values of nucleus pulposus, anterior annulus fibrosus and posterior annulus fibrosus in L 4/5 , L 5/6 and L 6/7 discs at PfirrmannⅠP>g 0ra.0d5e).( However, the T2 values of nucleus pulposus were higher than those of annulus fibrosus in the same discs (P0.05). The T2 values of rabbit lumbar discs obtained on 1.5 T MR equipment can be used for quantitative assessment of intervertebral disc signal.
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[Objective]This study was designed to evaluate the effects of percutaneously puncturing vertebrate adjacent to cartilage endplate and injecting pingyangmycin on lumbar intervertebral disc and cartilage endplate in New Zealand Rabbits.[Methods]Thirty-six New Zealand white rabbits were enrolled in this study.The fifth lumbar vertebmte(L_5)was injected with pingyangrnycin as experimental group,and the fourth lumbar vertebmte(L_4)injected normal sodium as control group.Six rabbits were selected randomly,then MRI and histological observation was performed in the first,second,third,fourth,Fifth week and third month after operation respectively.Moreover,the correlation analysis was performed between MRI and histological measurements for areas of the lesion in L_5.[Results]There was no obvious changes on MRI and histological examination in control group.For experimental group,there were also no obvious changes in the first two weeks after bperation.However,in the third week,it demonstrated slightly hyperintense signal on T_2WI and fat-suppression T_2WI(FS T_2WI),while FS T_1WI was hypointense signal.The signal changed more obviously in the fourth week.Histologically,the structure of vertibrates arranged disordedy,chondrocyte of endplate decreased and architecture became disorder.Anulus fibrosus and nucleus pulposus did not change.The cartilage endplate and intervertebral disc degenerated in the fifth week.Both of them degenerated more obviously in third month.There was a strong correlation between MRI and histological measurements for areas of the lesion in the fourth week(r=0.965,P＜ 0.001).[Conclusion]Degeneration of lumbar intervertebral disc and cartilage endplate in New Zealand Rabbits can be induced by percutaneously puncturing vertebrate adjacent to cartilage endplate and injecting pingyangmycin.
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BACKGROUND: Currently, the widely used intervertebral disc degeneration models are induced by altering intervertebral disc biomechanics, damaging intervertebral disc structure or changing hereditary features with genetic technique. All these methods are vades from natural duration of intervertebral disc degeneration. OBJECTIVE: To evaluate the feasibility of the establishment of rabbit model of ischemic lumbar vertebrae adjacent to endplate by percutaneous puncture followed by pingyangmycin injection. METHODS: A total of 46 New Zealand white rabbits were selected and two vertebraes were divided as experimental group (L_5) and control group (L_4) in every rabbit. Vertebrae adjacent to endplate was punctured. Pingyangmycin (2 g/L) 1 mL was injected into rabbits in the experimental group. And 1 mL normal sodium was injected into the control group. Lumbar artery angiography was performed in 4 rabbits before operation. Six rabbits were randomly performed MRI and then were executed for vertebral histology at weeks 1,2, 3, 4, 5 and months 2, 3 after operation. Ischemic areas of L_5 were measured by the MRI and histological section at week 4 after operation. RESULTS AND CONCLUSION: MRI and histology of control group had not specific changes. MRI had not significant signal intensity changes in the first 2 weeks in the experimental group. At week 3 after operation, it demonstrated slightly hyperintense signal on T_2-weighted image (T_2WI) and fat-suppression T_2-weighted image (FS T_2WI), while fat-suppression T_1-weighted image (FS T_1WI) was hypointense signal. The signal changed more obviously at week 4. Histology of experimental group had not specific changes in the first 2 weeks. From weeks 3-4, bone trabecula arranged confusedly and disorderly, with gradually decreased osteocyte and marrow haemocytes, while adipocytes increased and coalesced. Cartilage corpuscle of endplate decreased and architecture became disorder. But the anulus fibrosus and nucleus pulposus had no obviously changes. The intervertebral disk of the experimental group degenerated at week 5, and the ischemia of lumbar vertebrae still existed and intervertebral disk degenerated more obviously at months 2-3 after operation. There was significant positive correlation of ischemic areas of experimental group between MRI and histology at week 4 (t-=0.965, P < 0.001). The rabbit model of ischemic lumbar vertebrae adjacent to endplate can be established successfully by peroutaneous puncture vertebrae adjacent to endplate followed by pingyangmycin injection. The operation is minimally invasive, simple and reproducible, with high success rate. This is a fairly ideal animal model to study the degeneration of the lumbar spine and intervertebral disc.
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BACKGROUND: By now, safety of collagenase application is still controvertible and some scholars believed that collagenase might induce the peripheral tissue injury. It attracts much attention in clinic that whether there is nerve injury induced by collagenase chemonucleolysis (CCN) around the injection sites.OBJECTIVE: To observe the effects of collagenase on spinal nerve conduction velocity (NCV) of rats detected with evoked potential method so as to probe into the safetyof collagenase application and further demonstrate the safety of percutaneous intervertebral disc CCN. DESIGN: Randomly grouping design, animal experiment.SETTING: Department of Interventional Radiology, Affiliated First Hospital of Sun Yat-sen University. MATERIALS: The experiment was conducted in the Basic Medical College of Sun Yat-son University from July to September 2002. A total of 57 male SD rats were randomly divided into normal group (n=9), acute sham-operation group (n=10), subacute sham-operation group (n=8), chronic sham-operation group (n=7), acute experimental model group (n=9), subacute experimental model group (n=7) and chronic experimental model group (n=7). METHODS: After being anaesthetized by intraperitoneal injection of continal (45 mg/kg) to separate and identify dorsal root ganglion (DRG),rats in the experimental group were locally dripped with 1 mL of collagenase (300 U/ML) and those in the sham operation group locally dripped with 1 mL of normal saline. Stimulating electrode was placed in the A point of sciatic nerve and recording electrode in the B point of ganglionic central process segment of DRG in L5 nerve root. Evoked potentials A and B were simulated to continuously record latency twice, and the average value was calculated; Distance between A and B were measured and recorded. NCV = distance between A and B / latency. Evoked potential of a segment ofnerve including DRG was measured in the acute group at one hour after administration, in the sub acute group at one week after administration and in the chronic group at one month after administration. MAIN OUTCOME MEASURES: NCV of each group. RESULTS: A total of 57 enrolled animals were involved in the analysis. NCV in normal group, acute experimental group, acute sham-operation group, subacute experimental group, subacute sham-operation group, chronic experimental group, chronic sham-operation group were (45.4±10.7), (43.4±5.9), (46.3±6.5), (52.4±10.4), (49.7±8.1), (46.7±11.0) and (44.6±6.5) m/s respectively. There were no remarkable differences in NCV among all the groups by using one-way analysis of variance (F=1.010,P=0.430); It was showed that there were no marked differences in NCV between each two groups by using multiple comparisons (P=0.336). CONCLUSION: Collagenase at the therapeutic concentration applied in clinical CCN has no remarkable effects on NCV of rat spinal nerve, and to a certain extent, percutaneous intervertebral disc CCN is relatively reliable.
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<p><b>OBJECTIVE</b>To evaluate the value of angiography and cholangiography on the diagnosis and interventional treatment of vascular and biliary complications after liver transplantation.</p><p><b>METHODS</b>Sixteen of 46 patients (15 men and 1 woman, 17 - 60 years old) after orthotopic liver transplantation received angiography due to abnormal ultrasonography or edema of lower limbs, or cholangiography due to progressing jaundice. Percutaneous transluminal angioplasty or drainage was performed in some patients.</p><p><b>RESULTS</b>Fifteen patients experienced vascular complications and 4 patients had biliary complications. Three of them appeared to have both vascular and biliary complications. Hepatic artery complications were the most common complications (9/16), including hepatic artery thrombosis or stenosis (6/9), bleeding (2/9) and hepatic artery-dissecting aneurysm (1/9). One patient with hepatic artery thrombosis received transcatheter thrombolysis and two patients with bleeding received coil embolization. Inferior vena cava and portal vein stenosis were observed in 6 and 2 patients, respectively. After balloon angioplasty or stent placement, clinical symptoms were alleviated. Biliary complications, including biliary stricture and anastomotic bile leak, occurred in 4 patients. Jaundice decreased after percutaneous transhepatic cholangiography and drainage.</p><p><b>CONCLUSIONS</b>Besides diagnosis, interventional methods include mini-invasive treatment for patients with vascular and biliary complications after liver transplantation. Balloon angiography and stent placement for venous stenosis are useful procedure for the treatment of these problems.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Biliary Tract Diseases , Diagnostic Imaging , Therapeutics , Cholangiography , Hepatic Artery , Diagnostic Imaging , Liver Transplantation , Portal Vein , Diagnostic Imaging , Vascular Diseases , Diagnostic Imaging , Therapeutics , Vena Cava, Inferior , Diagnostic ImagingABSTRACT
Objective To explore the mid to long term therapeutic efficacy of Graves′ disease after interventional embolization. Methods Twenty five patients of Graves′ disease treated with interventional embolization were followed up for 24-57 months. T 3 and T 4 were monitored at pre operation, six months, 12 months, 2, 3, and 4 years after operation, respectively. Other references included pulse, thyroid size, and vessel′s murmur. Results Twenty two patients completely relieved from the hyperthyroidism during the follow up. Only one patient suffered from recurrence. Other two patients were still on maintaining dosage of antithyroid drug therapy. No hypothyroidism or hypoparathyroidism was found during this term. Conclusion Mid to long term follow up showed satisfactory efficacy of interventional therapy, offering another alternative for treatment of refractory Graves′ disease.
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Objective To introduce the experience in endovascular stent graft repair (EVSGR) of thoracoabdominal aortic dissecting aneurysm (TAADA). Methods Retrospective analysis was made on the management of 6 patients with TAADA from October 2000 to June 2001. Results There were six male patients aged 42～72 in this series. Of them, 5 patients with Stanford type B TAADA and one with Stanford A TAADA. Of the 6 patients, The fissures were sealed and the dissections were disappeared completely in 5 cases; one case shifted to open surgery for abdominal aortic fenestration, Rupture of the iliac dissection occurred in 1 case 3 days after EVSGR, then the abdominal aortic fenestration and graft replacement of distal abdominal aorta were performed. One patient died of heart infarction on the third day postoperatively. Five cases were followed-up for 1～9 months, they all were alive and well. Conclusions Endovascular stent graft technique is safe and simple in repairing of TAADA, and abdominal aortic fenestration is an adjuvant procedure.
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Objective To study the pathological morphology of thyroid specimen after thyroid arteries embolization. In order to select appropriate size of embolizing granules, the diameters of thyroid arteries in Graves' disease were measured. Methods Multiple slides of embolized thyroid tissues from superior pole, body and inferior pole of the resected thyroid glands were made. After being embedded and stained, pathological morphology was observed and diameters of arteries in various parts of thyroid glands were measured under microscopy. Results Pathological examination of thyroid glands showed that superior and inferior thyroid arteries and most of their branches were embolized with ischemic necrosis and fibrosis in the embolized thyroid tissue. Follicular epithelium appeared as flat or cubic shapes with colloid reduction. Average diameter of main branches of superior artery was 440～550?m and that of inferior artery was 300～375?m. The diameters of capillary network in the thyroid body was 120～250?m, and the non embolized ones was 40～110?m. The diameter of isthmus was 130～150?m. Conclusions Pathological morphology of Graves' disease after thyroid arteries embolization showed that the excretion of thyroid glands would be decreased and equivalents to subtotal thyroidectomy.
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Objective To study the color doppler image characteristics of thyroid arteries pre and post interventional procedure and to assess the clinical efficacy in Gnaves' disease.Methods 11 from 31 patients diagnosed as Graves' disease undertaken thyroid arteries embolization, were analyzed. Color Doppler sonography was applied to monitor the pre and post procedure thyroid size and diameters of thyroid arteries. Power Doppler was used to detect the Vmax, Vmin, RI and blood flow. Results After thyroid arteries embolization, the size and vascularity of thyroids were reduced. The thyroid arteries showed shrinkage and stoppage blood flow at the embolized site. The changes of RI, blood parameters of Vmax, Vmin and diameters of the thyroid arteries pre and post procedure turned out to be statistically significant for clinical restriction.Conclusion The color Doppler sonography plays an important role for preoperative diagnosis and predicting the prognosis.
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Objective To retrospectively analyse the adverse reactions and complications of Graves' disease after thyroid arteries embolization.Methods 41 patients of Graves' disease underwent interventional embolization have been analysed with its adverse reactions and complications. Polyvinyl alcohol or bletilla microspheres and micro coils were used in these patients. Results Laryngopharyngeal and neck pain occurred in all patients. T 3 and T 4 increased in 3 days to one week after the procedure. Thirty of them showed fever. Dystopic embolism happened in two cases with one of transitory hypoparathyroidism. No hypothyroidism or hypoparathyroidism or hoarseness occur during long term follow up.Conclusions The adverse reactions and complications of Graves disease after thyroid arteries embolization may occur. Some of them are preventable and curable.