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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. Unfortunately, most of HCC patients were diagnosed at the intermediate or advanced stage, losing the chance to receive the surgical intervention. Locoregional interventional treatment is one of the major therapeutic options for inoperable HCC treatment and prolongs the survival of the patients. Evaluation of the efficacy of the treatment is the important to determine the further therapy strategies. Currently, the evaluation of patients’ response is mainly based on CT and MR anatomic morphological images, but characteristics of tumor biology changes can be observed earlier than the morphological changes. In the recent years, with the development of diffusion weighted imaging (DWI), its value in clinical application has been continuously explored, and it has been increasingly used for quantitative evaluation the diffusion of water molecular and microcirculation perfusion of blood flow in tumor tissue, with some progress in evaluating the tumor response. This paper mainly reviewed the recent research findings of DWI on locoregional interventional treatment for HCC, thereby providing guidance on clinical practice.
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Objective:To study the predictive value of pretreatment apparent diffusion coefficient (ADC) on prognosis in patients with isolated large hepatocellular carcinoma(SLHCC) treated by combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA).Methods:A retrospective analysis was performed on 40 patients with SLHCC who were treated at the Department of Interventional Radiology, the First Medical Center of PLA General Hospital from December 2014 to July 2018, with combined TACE and RFA. There were 34 males and 6 females, with an average age of 55.9 years. All patients underwent enhanced abdominal MRI within 1 week before and 1 month after treatment. The receiver operating characteristic (ROC) curve was used to assess the predictive efficacy value of ADC. The survival curves were plotted by the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate prognostic analyses were performed using the Cox proportional hazard models.Results:After treatment, there were 18 patients with complete response and 12 with partial response. The objective response rate was 75.0% (30/40). The area under ROC curve of ADC in predicting the effectiveness of TACE combined with RFA (complete response + partial response) was 0.86 (95% CI: 0.74-0.98). The optimal threshold was 1.32×10 -3 mm 2/s, the sensitivity was 0.63, and the specificity was 1.00. The progression-free survival rate and cumulative survival rate in the high ADC group (≥1.32×10 -3mm 2/s, n=19) were better than that in the low ADC group (<1.32×10 -3mm 2/s, n=21), with significant differences (both P<0.05). On multivariate analysis, ADC<1.32×10 -3mm 2/s ( HR=3.711, 95% CI: 1.705-8.074; P<0.05) was an independent risk factor for progression-free survival, while ADC < 1.32×10 -3mm 2/s ( HR=3.518, 95% CI: 1.016-12.185, P<0.05) was an independent risk factor for overall survival. Conclusion:Preoperative ADC was an independent risk factor for prognosis in patients with SLHCC undergoing TACE combined with RFA. It has value in prognostic prediction.
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The development of hepatocellular carcinoma is insidious and rapid.Most patients can not undergo surgery after diagnosis.Transcatheter arterial chemoembolization (TACE) is considered to be the best modality for treatment of advanced hepatocellular carcinoma.However,there are some bottlenecks in TACE,such as low targeting of chemotherapy drugs and incomplete treatment.How to improve the curative effect of TACE has become a key issue in the interventional treatment of hepatocellular carcinoma.In recent years,the study of nano-drug delivery systems has been expected to solve these problems,and has become a hot spot in the field of targeted therapy for hepatocellular carcinoma.In this paper,the current research status of nano-drug delivery systems and its application in the interventional-targeted therapy of hepatocellular carcinoma are reviewed.
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Objective To study the clinical efficacy of Dyna computer tomography (Dyna CT) guided radiofrequency ablation (RFA) followed immediately by transcatheter arterial chemoembolization (TACE) in the treatment of large solitary hepatocellular carcinomas (HCC),and to provide the basis for the rational use of Dyna CT.Methods A retrospective analysis was performed on 23 patients with a large solitary hepatocellular carcinoma (tumor diameter ≥5 cm) who were admitted to Chinese PLA General Hospital from January 2014 to October 2015 and treated with Dyna CT guided RFA followed immediately by TACE.After treatment,the success rate of the combined technique,the treatment time,the radiation dose received by the patient,the complication and the efficacy of the combined therapy were evaluated.Results The success rate of the combined technique was 100％.The treatment time was (45.3 ± 4.8) min.The radiation exposure dose was (730.5 ± 78.8) mGy.There was no serious complication after treatment.The complete remission rate of the targeted lesion was 91.3 ％ (21/23),the partial remission rate was 8.7 ％ (2/23).On follow-up,5 patients had died.The 6,12,18 month survival rates were 100％,81.5％ and 48.0％,respectively.Conclusions Dyna CT guided RFA for a large solitary HCC was efficacious and safe.The immediate combination of TACE with RFA provided a new alternative strategy for the treatment of a large solita-ry HCC.Dyna CT has important clinical values.
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Objective To investigate weight, ghrelin changes following transcatheter left gastric artery embolization in rabbit model of obesity, and evaluate its safety. Methods Thirty New Zealand rabbits were randomly divided into three groups, ten New Zealand rabbits in each group, group A:left gastric artery embolization using gelatin sponge, group B:left gastric artery and gastroduodenal artery embolization using gelatin sponge, group C (control group): left gastric artery and gastroduodenal artery perfusion using normal saline. Ghrelin, weight and liver and kidney function were measured at preoperative and postoperative 1, 2, 3, 4 weeks. T test was used to compare the differences in the levels of preoperative and postoperative average ghrelin, weight, alanine transaminase (ALT), aspartate transaminase (AST), creatinine and urea in each group. The ANOVA of repeated measurement was used to compare the difference of preoperative and postoperative each time points between the three groups. Results The preoperative and postoperative ghrelin levels in group A were (4057±61)and (3708±141) pg/ml with statistically significant differences (t=4.5, P<0.05). The preoperative and postoperative ghrelin levels in group B were (4137 ± 89) and (3608 ± 239) pg/ml with statistically significant differences (t=6.8, P<0.05). The preoperative and postoperative ghrelin levels in the control group were (3986 ± 82)and (4044 ± 72) pg/ml with no statistically significant differences (t=0.7, P>0.05). The level of ghrelin in group B decreased significantly compared with group A and the difference was statistically significant (t=3.8, P<0.05). There was a statistically significant difference in postoperative ghrelin levels between the three groups (F=15.6, P<0.05). The preoperative and postoperative weight in group A were (6.12±0.38)and (5.66±0.39) kg with statistically significant differences (t=2.7, P<0.05). The preoperative and postoperative weight in group B were (5.99 ± 0.57)and (5.24 ± 0.61) kg with statistically significant differences (t=3.1, P<0.05). The preoperative and postoperative weight in the control group were (5.94 ± 0.45)and (6.24 ± 0.42) kg with no statistically significant differences (t=1.2, P>0.05). The weight loss of group B was significantly greater than that of group A and the difference was statistically significant (t=5.2, P<0.05). There was a statistically significant difference in postoperative weight between the three groups (F=5.1, P<0.05). There were no statistically significant differences in ALT, AST, creatinine and urea levels at preoperative and postoperative each time points in each group (P>0.05). Conclusion Left gastric artery embolization can become a safe and effective minimally invasive treatment for obesity and left gastric artery and gastroduodenal artery embolization at the same time could achieve more weight loss.
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Hepatocellular carcinoma is a commonly-seen malignant tumor with high morbidity and mortality all over the world.With the rapid development of molecular biology and scientific technology,in treating HCC the use of nano knife technology,which is developed on the principle of irreversible electroporation,has come into clinicians' consideration.The authors are hereby making a comprehensive review about nano knife,focusing on the principles of nano knife therapy for liver cancer,the advantages of nano knife,and the latest developments in clinical practice and researches,etc.
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Large hepatocellular carcinoma,of which diameter is considered to be ≥ 5 cm,has mostly invaded vascular system or been liver function reserve loss when found,resulting in opportunities to surgical therapy are lost.Combined interventional therapy based on transcatheter arterial chemoembolization (TACE) has become one of the main treatments for the surgically unresectable large hepatocellular carcinoma.In particular,TACE combined local ablation has gradually replaced the interventional therapy model of TACE alone.The current combination therapy is mainly sequential combination.With the development of imaging equipment,real-time synchronization is becoming increasingly important and has become one of the current research hotspots.This article focuses on the research status and perspectives of image guidance,local ablation methods,the order of the joint,the number of times and the timing of the joint situation of TACE combined local ablation in treatment of large hepatocellular carcinoma.
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Objective@#To investigate the clinical effect of ultraselective transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) originating from the caudate lobe.@*Methods@#A retrospective analysis was performed for 13 patients with solitary HCC originating from the caudate lobe who were admitted to Department of Interventional Radiology in PLA General Hospital from March 2013 to December 2016. A 2.6-F microcatheter was used to perform ultraselective TACE, and the embolization material was ultra-liquefied iodinated oil. The number of tumor-feeding arteries, success rate and short-term efficacy of ultraselective technique, and long-term survival were evaluated after surgery.@*Results@#Of all patients, 8 (61.5%) had a single tumor-feeding artery and 5 (38.5%) had multiple tumor-feeding arteries. The success rate of ultraselective technique was 84.6% (11/13). The complete remission rate at 1 month after ultraselective TACE was 63.6% (7/11). During the follow-up period after the expiration date, 10 out of 11 patients who underwent successful ultraselective TACE survived, and one out of two patients who underwent failed ultraselective TACE survived.@*Conclusion@#Ultraselective TACE has good feasibility, clinical effect, and safety in the treatment of HCC originating from the caudate lobe, with an important clinical significance in the prognosis of such disease.
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The contents and methods of library reference service have changed due to the changing views of people on the value of data and the way of thinking and the influence of big data thinking in the era of big data, libraries should thus innovate in their reference service with new ideas, new orientations and new methods.
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After the impact of MOOC on traditional literature retrieval course was studied based on the comparison between cMOOC and xMOOC, a framework for the teaching of literature retrieval course was constructed according to the personal MOOC study model , and the literature retrieval course-based recycling pathway of teachers-MOOC technology-students-interactive MOOC study environment-teachers was proposed for innovating the teaching of literature retrieval course and improving the teaching quality of literature retrieval course .
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Objective To evaluate the advantage of transabdominal modified Sugiura procedure Methods We retrospectively analyzed 45 cases undergoing transabdominal modified Sugiura procedure from May 1997 to May 2003 The procedure included devascularization of near half gastric and inferior part of esophagus after splenotomy The left and right vagus nerves, the anterior and posterior Latarjet nerves and paraesophageal collateral veins were left intact The gastric submucous vasculature was sutured on the plane 3～5 cm distal to cardia (suture group); or the esophagus 3 cm above cardia was cut and reanastomosed with pipe anastomat Results There was no inhospital mortality Free portal veinous pressure and portal vein flow speed did not change significantly The flow volume of portal vein decreased ( P