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In recent years,minimally invasive techniques,such as percutaneous cementoplasty,percutaneous cryoablation,magnetic-resonance-guided focused ultrasound surgery,radiofrequency ablation,microwave ablation,radioactive particle implantation,transcatheter arterial embolization and irreversible electroporation et al,play more and more important roles in the treatments of bone metastasis.Compare with traditional therapies like radiotherapy,drugs and surgery,the better efficacy and security of minimally invasive techniques have been demonstrated by voluminous animal experiments and clinical trials.However,the clinical application of minimally invasive techniques have still some controversial issues.
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Objective To compare of the clinical using effect of implantable venous -access port(VAP) among different methods and the postoperative complication.Methods From 2011 to 2014,a total of 359 patients with VAP were included in this study.All patients were divided into two groups according to the surgery approaches methods,307 cases were implanted through internal jugular vein,and other 52 cases were through subclavian vein intubation.Statistics of postoperative flow conditions and complication between the two groups were gathered and com-pared.Results There were 3 cases of postoperative infected,and 13 cases were not free of transfusion,while 2 cases catheter were shed and shifted in the 307 cases of implantation through internal jugular vein,the complication rate was 5.86%;In other group,which in total of 52 cases of implantation through subclavian vein,including 2 cases were post-operative infected,6 cases were not free of transfusion,2 cases are of catheter fracture and5 cases were local hemato-ma,the complication rate was 28.85%.There was difference in rate of catheter leakage,catheter tip dystopy and cath-eter related infection between two groups[the proportion of through internal jugular vein vs that the group through sub-clavian vein:5.86%(18 /307)vs 28.85%(15 /52),χ2 =28.140,P =0.000].Conclusion The study suggests that the two ways of different operation methods of VAP are safe and reliable for long term intermittent venous access.The internal jugular vein implanted group has a slight advantage over the group of subclavian vein implanted,when it comes to develop the patients′living quality.
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Objective To evaluate the effect of MRI in reflecting the pathological changes of VX2 carcinoma in rabbits after radiofrequency ablation (RFA) . Methods RFA was performed in the livers of 24 rabbits with planted VX2 carcinoma. The rabbits were divided into 4 groups. After RFA, the rabbits were killed after MR imaging on 0, 1, 2, and 4 weeks, respectively. The correlation between MRI and pathological findings was analyzed. Results In the acute phase, coagulative necrosis of the ablated tumors and inflammatory reaction with hyperemia around were detected at microscopic examination. The ablated tumor showed as hypointensity on T1WI and hyperintensity on T2WI, while rim of high signal intensity on T1WI and low signal intensity on T2WI was found. Gadolinium-enhanced MRI showed a thin high signal rim surrounding the central coagulative necrosis. In the subacute phase, extensive coagulative necrosis and marked infiltration by neutrophils, lymphocytes, macrophages and a peripheral fibrous generation rim were observed microscopically on the ablated tumor. The ablated tumor showed iso-or hyperintensity on T1WI and hypointensity on T2WI, while the periphery of ablated lesions was hypointensity on T1WI and hyperintensity on T2WI. There was prominent rim enhancement along the ablated margin. In the chronic phase, peripheral fibrous rim became obvious, more regular and thicker than at subacute phase as hypointensity on T1WI and T2WI, and unenhancement was observed. Residual or recurrence of tumor was found in 17 rabbits as hypointensity on T1WI and hyperintensity on T2WI, and irregular, thicker rim or nodular enhancing abnormalities. Conclusion MRI can effectively show the histopathological tissue changes of rabbit VX2 carcinoma after ablation and demonstrate the residual or recurrence of tumor.
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Objective To investigate the change of ATM phosphorylation in HepG2 cells following a condnuous low dose-rate irradiation.Methods Cells were pemistendy exposed to low dose-rate(8.28 cGy/h) irradiation.Indirect immunofluorescence and Western blot were used to detect the expression of ATM phosphorylated proteins.Colony forming assay Was used to observe the effect of a low dose-rate irradiation on HepG2 cell survival.Results After 30 min of low dose-rate irradiation.the phosphorylation of ATM occurred.After 6 h persistent irradiation,the expression of ATM phosphorylated protein reached the peak value,then gradually decreased.After ATM phosphorylation was inhibited with Wortmannin,the surviving fraction of HepG2 cells was lower than that of the irradiation alone group at each time point(P<0.05).Conclusions Continuous low dose-rate irradiation attenuated ATM phosphorylation.suggesting that continuous low dose-rate irradiation has a potential effect for increasing the radiosensitivity of HepG2 cells.
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Objective To investigate the X ray radiation protective measure during interventional procedure.Methods The X ray radiation dose at 1,2,3 meters from the X ray tube in front of and in the near of lead glass,plumbic suit were measured in 101 cases interventional procedure.The data were analyzed and evaluated.Results The shielding efficacy was 95% by the lead glass and plumbic suit double protection,the X ray radiation was reduced markedly.The X ray radiation attenuation was swift with the distance increasing.The X ray radiation attenuation was 53.8% from 1 meter to 2 meter,and 81% to 3 meter.The X ray radiation received by medical personnel increased significantly with the fluoroscopy and subtraction time adding.Conclusion The X ray radiation protection should be carried out from shielding protection,distance protection and radiation time reducing;That can reduce the damage of radiation to keep the operator healthy.
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Objective To evaluate the effectiveness of combined treatment with thrombolysis,PTA,and endovascular stent placement for malignant obstruction of vena cava.Methods The study included 29 patients with malignant obstruction of vena cava(superior,8 patients;inferior,21 patients).The patients underwent treatment of PTA and endovascular stent placement(for patients with complete vena cava obstruction or patients with incompletely expanding stent),or endovascular stent placement(for patients with incomplete vena cava obstruction),or endovascular stenting combined with thrombolysis(for patients with thrombosis in vena cava),respectively.Results A total of 29 stents was implanted,with a success rate of stent placement of 100%.Symptoms of SVC obstruction completely disappeared in the 8 patients.Scores of patients' IVC syndrome were declined from 4～5(median,4.2) preoperatively to 0～2(median,0.3) postoperatively,with statistically significant difference(Z=-55.245,P=0.000).Follow-up checkups for 1～20 months(mean,6.2 months) in the 29 patients found patent vena cava.There were no serious complications except for vena cava laceration in 1 patient and stent displacing to the right atrium on the third day after therapy in 1 patient.Conclusions The combined treatment of thrombolysis,PTA,and endovascular stenting is safe and effective in the treatment of vena cava obstruction.