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Objective To investigate the differences in the survival time and the occurrence of complications between esophageal cancer patients treated with fully-covered segmented esophageal internal irradiation stent and esophageal cancer patients treated with conventional esophageal internal irradiation stent.Methods The clinical data of 66 esophageal cancer patients,who had received esophageal internal irradiation stents placement,were retrospectively analyzed.The patients were divided into the study group (using fullycovered segmented esophageal internal irradiation stent,n=30) and the control group (using conventional esophageal internal irradiation stent,n=36).The postoperative complications,including restenosis,stent migration,chest pain,etc.,and the survival time of the two groups were recorded.The results were analyzed,and P＜0.05 was considered to be statistically significant.Results No statistically significant difference in the restenosis rate existed between the study group and the control group (20.0％ vs.30.6％,P=0.403);although the median time of restenosis in the study group was longer than that in the control group (161.5 d vs.138 d,P=0.025).The stent migration rate in the study group was higher than that in the control group (33.3％ vs.8.3％,P=0.014).The difference in the median time of stent migration between the two groups was not statistically significant (91.5 d vs.166 d,P=0.236).No statistically significant difference in the median survival time existed between the two groups (186 d vs.178 d,P=0.486).No statistically significantly differences in the incidence of other stent-related complications existed between the two groups.Conclusion Fully-covered segmented esophageal internal irradiation stent can delay the occurrence of restenosis,although it can increase the stent migration rate to a certain degree.
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Objective To compare the prognostic ability of Hong Kong Liver Cancer (HKLC) staging system with that of Barcelona Clinic Liver Cancer (BCLC) staging system for Chinese patients with hepatocellular carcinoma (HCC) after receiving transarterial chemoembolization (TACE).Methods The clinical data of 180 Chinese patients with primary HCC,who were treated with TACE during the period from August 2008 to December 2015,were retrospectively analyzed.HCC staging of each patient was scored by two staging methods separately.Kaplan-Meier analysis was adopted to separately calculate the median survival time of each stage that was judged by the two staging methods.The likelihood ratio (LR) x2 values,the Akaike information criterion (AIC) value and Harrell's C value of the two staging methods were calculated.Results Statistically significant differences in the survival time of each period existed between the two staging systems.AIC value,LRx2 value and Harrell's C value of HKLC staging system were 1360,66.6,and 0.813 respectively,while those of BCLC staging system were 1365,61.8,and 0.772 respectively.Conclusion Compared with BCLC staging,HKLC staging is more suitable for predicting the survival time of Chinese patients with primary liver cancer treated with TACE.
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Objective To investigate the feasibility and preventive effect of benign esophageal restenosis by binding 125I seeds to upper esophageal stent through animal experiments.Methods Eight 125I seeds were evenly bound to upper normal esophageal stents for the animal experiments.A total of 32 beagle dogs were randomly assigned to 2 groups:experimental group,implanted with esophageal stents with eight 125I seeds (33.3 MBq),and the control (stents without 125I seeds).Four dogs of each group were killed at the 1 st,2nd,4th,and 8th week after imaging studies.The tissue of 2 cm upper stent underwent pathology analysis.Results All the novel stents were successfully implanted.No radioactive leak was detected by ECT.The lumen diameter of the top stent showed the tract gradually narrowed and at the 4th and 8th weeks,the experiment group narrowed more seriously compared with the control group and the difference was statistically significant (P ＜ 0.05).PCNA,ot-SMA mean optical density were significantly different in the 4th week.Both hydroxyproline and total amino acid increased progressively,with significant difference at the 4th and 8th weeks.The macroscopic and optical findings of the trachea and major vessels were basically the same in both groups.Conclusion The novel stent is feasible and safe for preventing benign esophageal restenosis and preventing benign esophageal stent restenosis.
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Objective To evaluate the effects of low-dose 125I seeds to the esophagus fibroblast cell proliferation in vitro.Methods The titanium wire was implanted in the beagle dog's esophagus to induce fibroblast proliferation,and the esophageal tissue was removed after two weeks and cultured in vitro.The 125I seeds with different dose commonly used were chosen to irradiation fibroblast in group B (11.1 MBq × 9)、C (22.2 Mbq ×9) 、D (33.3 MBq ×9) for 72 hours,while in control group no 125I seeds were used.After irradiation,cells were collected.MTT and AnnexinV/PI double staining were performed respectively to evaluate the effects of 125I seeds in cell proliferation and apoptosis.Results The inhibition rate respectively:(26.81 ± 1.96) ％、(34.52 ± 3.21) ％ and (45.33 ± 2.59) ％ ; the apoptosis rate respectively:(6.73 ±0.57)％ 、(13.11 ± 1.39)％ and (15.23 ± 0.90)％.There were significant differences among the experimental groups and between every experimental group and the control group.Conclusion The three doses of 125I seeds could significantly inhibit the fibroblast proliferation and promote cells apoptosis,of which 33.3 MBq 12sI seed was the most significant.
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Objective To establish and observe the canine model with esophageal stent implantation for further study of the benign stenosis caused by proliferation.Methods According to orthogonal design,different combinations of two stents and six polytetrafluoroethylene (PTFE) patches were confirmed.Stent was designed as cylinder with mushroom shape on both ends.Beagle dogs (weight 10-12 kg) were adopted and cervical segment of esophagus were dissected.After PTFE patch was encircled around the esophagus,stent was delivered under fluoroscopy.The main body of the stent was located in accordance with the patch.Eating condition and position of the stent were followed on week 1,2,4,6 and 8.Gross specimen was harvested at the end point,and the degree of tissue hyperplasia was evaluated.Each animal model was given a mark according to the eating condition and tissue hyperplasia.Results Eight combinations of stent and patch were provided with orthogonal design.Three models failed for the following reasons:unable to eat in one dog,stent disgorged out in another,and the third died from esophageal necrosis between stent and patch.Four models had obvious tissue hyperplasia on the segment of stent,and weight loss or stent dislocation were observed in each model.One model developed appropriate tissue hyperplasia with normal diet,and stent dislocation was not found during the follow-up.Significant difference was confirmed among 8 models (F =14.7000,P =0.031).Conclusion Animal model with appropriate tissue hyperplasia could be established with following elements:beagle dogs weight from 10 kg to 12 kg; stent 50 mm in length,20 mm in diameter,with top mushroom 10 mm in length,30 mm in diameter,and end mushroom 10 mm in length,25 mm in diameter; PTFE patch 60 mm in length,15 mm in width.
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Objective To investigate the value of positron emisson tomography-computed tomography ( PET-CT) in monitoring the residual lesions in lipiodol sedimentary region and extrahepatic metastastic lesions of hepatocellular carcinoma ( HCC) with alpha fetoproteins ( AFP) positive after interventional therapy. Methods The data of 20 cases with primary HCC confirmed by histopathology were retrospectively analyzed. Their AFP levels decreased to normal range after interventional treatments, but rose to abnormal high level during following-up. After the abdominal routine imaging examinations, the definite diagnosis of the residual lesions in lipiodol sedimentary region or extrahepatic lesions can't be made confidently. All cases were scanned by PET-CT, and according to their PET-CT results, the further treatments were given and the therapeutic results were monitored with radiology and AFP tests. Results In all 20 cases, 10 of them were detected to have the extrahepatic metastastic lesions by PET-CT, including 4 with abdominal wall metastasis upon the liver, 3 with solitary pulmonary metastasis with diameter less than 1 cm, 2 with mesenteric mestastasis, 1 with mestastasis of operative incisions, but these lesions were neglected by abdominal routine imaging examinations. Eight cases showed the uneven lipiodol sedimentary region in the primary lesion by CT or MRI examination, but can't be diagnosed whether it was residual lesion with other examinations including DSA. A definite diagnosis was obtained by PET-CT. In 2 cases, lymph nodes less than 1. 5 cm were found in the hepatic portal area(PHA) and retroperitoneum on CT images,which was determined to be metastatic by PET-CT. All the detected lesions were given further treatments of surgery or interventional therapy. Most patients showed decreased AFP levels except the 2 patients with lymph node metastasis. The imaging examinations also indicated that the treatments had a good effect on lesions. Conclusion In the patients with HCC and abnormal high levels of AFP, in addition to abdominal routine imaging examinations, PET-CT is beneficial for those who is suspected of residual lesions in lipiodol sedimentary region or extrahepatic metastasis.
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Objective To investigate the effects of intratumoral implantation of ~(32)P-CP-PLLA seeds on the normal canine liver tissue and to exolore the metabolism of ~(32)P-CP-PLLA seeds implanted in the liver of experimental dogs.Methods Twelve beagles were enrolled in this study.The dogs were randomly and equally divided into four groups:group A(185 MBq),group B(370 MBq),group C(740 MBq)and group D(0 MBq).By using laparotomy procedure ~(32)P-CP-PLLA seeds were implanted into dog's liver.CT scan was performed before operation as well as before the dog was sacrificed.All dogs were sacrificed three months after the implantation.Before the procedure and 1,2,4,8 and 12 weeks after the procedure the blood tests and serum biochemical tests were conducted.One dog from group B and group C was selected respectively and was fed in a metabolic cage.Within one month after the procedure the cpm in feces and in urine was determined every 24 hours.One dog was picked out from each of the three groups and was punctured to get its liver tissue for pathologic exam each time at 1,2,4,8 and 12 weeks after the implantation,and SPECT imaging was also performed at the same time.Pathologic study,both macroscopic and microscopic(including optical and electronic microscopy)was made to observe the liver damage after the dog was sacrificed.The statistical analysis was processed by using SPSS 13.0 software and the measuring data were expressed with mean±standard deviation((x)±s).Results Two months after the procedure,serological examination found that the serum alkaline phosphatase(BKP)in both group Band group C was significantly higher than that in other groups,the difference was statistically significant (P ＜0.05),and the BKP levels returned to normal in three months.The postoperative 30-day inspection of the urine showed that the radioactive particles slowly released into the body and eliminated from the body with the urine and feces,mainly through the renal excretion.The 30-day cumulative percentage of eliminated radioactive dose in the urine and in the feces was 6.34% and 11.64% respectively.No sign of particle displacement was found on SPECT imaging.On autopsy three months after the implantation,the size of the radioactive seeds became smaller and fragile.With the radioactive dose used increasing,the area of liver damage at the site of seed implantation became bigger,which was demonstrated on CT scan,macroscopic exam and pathologic study.The local damaged focus of the liver caused by ~(32)P-CP-PLLA seeds was manifested as a spherical lesion which was encysted by a layer of fibrous tissue with an edematous zone peripherally.Conclusion The implantation of ~(32)P-CP-PLLA seeds in dog's liver causes only localized hepatic damage with no general adverse effects.The implanted seeds can slowly release the radioactive dose and will not immigrate to other organs in the body.Besides,the seeds possess excellent stability,targeted orientation and safety.
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Objective To investigate the trans-arterial delivery of p53 gene transfection efficiency and therapy effect on hepatic carcinoma in combination with transferrin mediated by liposome. Methods Twenty-five VX2 experimental rabbits were randomly divided into five groups, and the different doses of transferrin combined with p53-LipofectAMINE complex were delivered into the hepatic arteries of the VX2 hepatic carcinoma models. The tissue protein of the carcinoma was extracted after 48 h and the transfection efficiency and expression rate of p53 gene were analyzed by western blot and immune histochemical techniques, to inspect the expression proportion of p53 with different doses transferring. Another ten VX2 were divided into two groups, recombinant plasmid p53-LipofectAMINE complex and transferrin-p53-LipofectAMINE complex were delivered into the hepatic arteries in two groups respectively. The liver function, size of the tumor and survival time of the animals was compared between the two groups, and results were analyzed statistically. Results Semiquantitative analysis by Western Blot showed that the transfection and expression efficiency of p53 gene combined with transferrin were higher than those without it. By immune histochemieal techniques, the p53 gene's positive rate of highly expression with various doses of transferrin were found to be different, and there was remarkable difference between the groups with and without transferring. They were 58. 33%, 69. 44%, 80. 00%, 83.33%, 81.67% respectively, there was remarkable difference between the groups with and without transferring ( Totality: x2 = 42. 37, P < 0. 01 ). The p53 gene's positive rate of expression increased gradually as the doses of transferrin increasing from 0 up to 200 μg, but the differences of positive rate had no statistical significance as the doses of transferrin increasing from 200 up to 400 μg ( x2 section : 3 groups as former x2 = 4. 82, P < 0. 05,3 groups as latter x2 =0. 67 ,P <0. 05). There was no statistical difference in the liver function at points of time between VX2 rabbits with and without transferring. But the tumors' sizes had significant difference at various points of time. Conclusion Liposome-mediated p53 gene on treating hepatic carcinoma by trans-arterial gene delivery combined with transferrin is safe, and it can markedly enhance transfection efficiency and improve the therapy effect of p53 gene.
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Objective To explore the feasibility and value of treating esophageal thoracic fistula with covered esophageal stent through nasal esophagus drainage tube. Methods Seven patients with esophageal thoracic cavity fistula were enrolled and treated by 5F pigtail side-holes catheter inserting into thoracic cavity for drainage and then again through nasal esophagus and fistula, placing a covered stent in the esophagus to occlude the orifice of the fistula. The abscess cavities were washed and radiographied periodically through drainage tubes. Results The insertion of the drainage tube and the placement of covered stent were all successful. The drainage tubes were placed in abscess cavities for 12-22 days, average 15 days. The radiography through drainage tubes showed that the abscess cavities disappeared or shrank obviously with control of hydropneumothorax before the drainage tubes being pulled out. The esophagogram after withdrawal of the drainage tubes notified that the fistulae were occluded satisfactorily with stents expanded fully without displacement and stenosis. Conclusions Treating esophageal thoracic cavity fistula with covered esophageal stent through nasal esophagus drainage tube is feasible and safe with clinical efficiency.
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OBJECTIVE To investigate the distribution of nosocomial infection(NI) in patients after surgical procedures and antimicrobial resistant change of pathogens. METHODS A total of 195 strains of pathogenic bacteria isolated from the samples after surgical procedures from Jan 2006 to Dec 2006 were analyzed by WalkAway-40 system with NC31 system. RESULTS Among the 195 strains of pathogenic bacteria,there were Gram-negative bacilli(74.4%) and Gram-positive cocci(25.6%).The dominating microorganisms were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Staphylococcus aureus.The result showed that vancomycin and imipenem still had better activities to the bacteria. CONCLUSIONS Surgical incision infection should be monitored by some effective measures,and it is very important to prevent surgical infection and use antibiotics reasonably.
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Objective To investigate the value of transcatheter thrombolysis treatment of acute A V internal fistula thrombogenesis in hemodialysis patients. Methods The acute A V fistula thrombogenesis in 32 hemodialysis patients with chronic renal failure were treated with transcatheter pulse spray pharmacomechnical thrombolysis (PSPMT). Results Acute A V fistula thrombogenesis was verified in all 32 patients by angiography and treated with transcatheter PSPMT. The immediate clinical success rate of thrombolysis was achieved in 97% except for one case. The A V fistulas were proved to reopen by post treatment angiography. Recurrent thrombosis was found in 4 cases, reopenning with transcatheter PSPMT was achieved in 2 of them and the rest 2 cases were undergone PTA because of localized vascular stenosis. All the 32 A V fistulae, were reopened after treatment without serious complications such as hemorrhage, pulmonary embolism and others.Conclusions Transcatheter PSPMT is a safe, effective and microinvasive treatment for acute A V fistula thrombolysis with higher immediate reopenning rate. Transcatheter PSPMT combined with PTA and intravascular stent grafting can improve long term patency rate.