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Objective To study the clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with agitation thrombolysis in treatment of acute portal vein thrombosis (PVT) in patients with liver cirrhosis.Methods The clinical data of 37 cirrhotic patients with acute PVT treated from January 2014 to December 2017 at the First Affiliated Hospital of Henan University of Science and Technology was analyzed.There were 20 males and 17 females with age ranging from 29 to 71 years.The patients were divided into the combined group (n =15) and the anticoagulation group (n =22).The combined group was treated with TIPS combined with agitation thrombolysis anticoagulation.The anticoagulation group was treated with anticoagulation.The changes in liver function and hemodynamics of portal vein of the two group were compared.Follow-up studies included postoperative portal vein patency,bleeding and survival rates of patients.Results The postoperative portal vein pressure and maximum burden of PVT in the combined group were significantly lower than those before operation,and the portal vein maximum blood volume and flow velocity of portal vein were significantly higher than those before operation (all P ＜ 0.05).At 2 weeks,6 months and 12 months after operation,the maximum burden of PVT of the combined group was (13.9 ±5.4)％,(16.1 ±5.5)％ and (13.8 ±6.2)％,respectively,which was significantly lower than that of the anticoagulant group (84.1±31.3)％,(85.9±27.6)％ and (88.2±39.5)％ (all P＜0.05).At 2 weeks,6 months and 12 months after operation,the flow velocity of portal vein of the combined group was (21.6 ± 5.7) cm/s,(16.1 ± 6.3) crn/s and (17.6 ± 4.9) cm/s,respectively,which was significantly higher than that of the anticoagulation group (9.7 ± 4.6) cm/s,(8.1 ± 4.3) cm/s and (8.2 ± 3.5) cm/s (all P ＜ 0.05).After operation,3 patients in the combined group developed recurrence of portal vein thrombosis,while the remaining patients had smooth blood flow in the portal vein and shunt.In the anticoagulation group,only 3 patients had unobstructed portal vein blood flow.The cumulative rate of no gastrointes tinal bleeding in the combined group was significantly better than the anticoagulant group.The cumulative survival rate of the combined group was also significantly better than the anticoagulation group (P ＜ 0.05).Conclusion TIPS combined with agitation thrombolysis was more effective than the traditional anticoagulant therapy in treatment of acute portal vein thrombosis in cirrhotic patients.
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Objective:To compare the preliminary clinical efficacy of iodized oil embolization and improved microspheres injection embolization in patients with hepatic metastasis from gastrointestinal tumors.Methods:In total 100 patients with hepatic metastasis from gastrointestinal tumors were perspective enrolled from July 2015 to July 2017 in the First Affiliated Hospital of Henan University of Science and Technology. The patients were randomly divided into iodized oil group (45 cases) and microspheres group (55 cases) using random number table. The patients in iodized oil group were firstly received regular perfusion chemotherapy, then underwent the embolization with Iodized oil and epirubicin emulsifier. As for the microspheres group, the patients were received epirubicin and microspheres perfusion and embolization alternately after the same regular perfusion chemotherapy. The post-operation complications were observed. The effective rate of tumor controling at each time point was compared between two groups using χ 2 test. Kaplan-Meier method was used to perform the survival analysis. Log-rank test was used to compare the survival rate between two groups. Results:The operation was successfully performed in all the patients, without severe complications found. The follow up time was 18.7±3.4 months. The tumor control rates of 1, 3, 6, 12 and 24 months after operation in the iodine oil group were 71.1% (32/45), 68.9% (31/45), 51.1% (23/45), 28.9% (13/45), 6.7% (3/45) respectively; while in microspheres group were 90.9% (50/55), 89.1% (49/55), 72.7% (40/55), 49.1% (27/55), 23.6% (13/55), respectively. The tumor control rate in microspheres group was superior to that in iodine oil group ( P<0.05). The median lifetime was 12 months and 17 months for iodine oil group and microspheres group respectively, with significant difference (χ2=8.238, P=0.004) found between two groups. As for the microspheres group, the liver abscess was found in one week after operation in 4 patients, who were cured after drainage and anti-inflammatory treatment. Conclusion:The improved microspheres injection embolization is an effective method for the hepatic metastasis from gastrointestinal tumors and superior to iodized oil embolization in tumor controlling, which may prolong the median survival time.
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Objective To evaluate the efficacy and safety of treating liver cancer using 131I-anti-CD147-monoclonal-antibody (131I-anti- CD147-McAb) by transcatheter hepatic arterial infusion (TAI) in a rabbit liver cancer model. Methods Forty-five rabbit models were randomly divided into three groups evenly. Transcatheter hepatic artery infusion under general anesthesia were performed in all three groups. Group A:control group, saline. Group B:pure 131I solution. Group C: 131I-anti-CD147-McAb solution. About 2 ml blood sample was obtained from all rabbits for liver, kidney,and thyroid function at pre-TAI and post-TAI 1 day, 3 days ,7 days, 14 days, 21 days. The rabbits were scanned by single photon emission computed tomographic (SPECT) to monitor radionuclide bio-distribution and tumor size on 1 day, 7 days, 14 days, 21days after procedures in group B and C. On 14 days after procedure, five rabbits were randomly selected to be sacrificed in each group for pathological and immunological investigations. The remaining rabbits continued to be fed, and survival rates were measured. Results The TAI and SPECT-CT/CT procedures were successfully performed in all rabbits. Test results showed that AST and ALT levels tended to increase transiently 1 day after TAI (P 0.05) 7 days after TAI. FT3 and FT4 mean values of rabbits in group B and C continued to decline 7 days after TAI, while thyroid stimulating hormone (TSH) showed corresponding increase (P0.05). SPEC-CT imaging of rabbits shows that most of the radionuclide was gathered in the gastrointestinal tract and thyroid in Group B, however, radionuclide was mainly concentrated in the tumor lesions in Group C. Fourteen days after procedures, radionuclide imaging of all rabbits disappeared in group B and C. The VX2 liver tumors increased rapidly after treatment in group A and B;but the tumors gradually reduced their size in group C. At 14 days after TAI: The proportion of tumor necrosis in group C was significantly greater than that in groups A and B (P<0.05). The microvessel density (MVD) number of residual tumor in group C was less than groups A or B (P<0.05).TUNEL analysis suggested that more apoptosis bodies was displayed in the residual tumor tissue in group C than that in groups A and B, but the expression of MMP-2 and vessel endothelial grouth factor (VEGF) was significantly reduced in group C than group A and group B. Median survival time of the rabbits in groups A, B, C was 22 days, 26 days and 54 days respectively. Survival time of the rabbits in group C was significantly prolonged than other two groups (P<0.01). Conclusions Radioimmunotherapy with 131I-anti-CD147-McAb by TAI can inhibit the growth and metastasis of liver cancer, and prolong the survival of experimental animals. The method is effective and safe in this animal study.
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Objective To discuss the health education effect of a self-made health education video for patients with hepatic carcinoma who are receiving transcatheter arterial chemoembolization (TACE)therapy.Methods Based on the needs of patients,a TACE health education video was designed and produced,which was input into the tablet personal computer,such as iPad,to let patients watch.A total of 451 patients with liver cancer,who were admitted to the Department of Intervention,First Affiliated Hospital of Henan University of Technology and Science,China,to receive TACE during the period from June 2014 to June 2016,were included in this study.By using the random number table method,the patients were divided into the observation group (n=226) and the control group (n=225).The self-made health education video together with regular education was used to educate the patients of the observation group,while routine oral and written education was executed for the patients of the control group.The cognition to TACE-related knowledge,the compliance with postoperative treatment and nursing,and the patient's satisfaction were assessed and the results were compared between the two groups.Results The cognition in the following three aspects,including TACE-related knowledge,perioperative education and discharge education,in the patients of the observation group was significantly higher than that in the patients of the control group (P＜0.05).The compliance with postoperative treatment and nursing in the patients of the observation group was remarkably higher than that in the patients of the control group (P＜0.01).The patient's satisfaction in the patients of the observation group was strikingly higher than that in the patients of the control group (P＜0.01).Conclusion Health education by using a self-made health education video can improve liver cancer patient's cognition to TACE as well as the patient's compliance with postoperative treatment and nursing.The health education in the form of watching video can significantly improve health education effect and the satisfaction of the patients.Thus,it is worthy of clinical application.
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Objective To evaluate the efficacy and safety of 125I seed implantation combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary hepatocellular carcinoma (PHC).Methods 156 patients who had unresectable PHC seen from January 2012 to December 2015 in our unit were randomly assigned into the study group (76 patients) and the control group (80 patients).The study group of patients were treated with intra-hepatic implantation of 125I seed + TACE,and the control group of patients were treated with three dimensional conformal radiotherapy (3DCRT) + TACE.After ra diotherapy the two groups of patients underwent 2 to 3 times TACE treatment.The biomarker levels were compared between the two groups before and after treatment,and the short-term efficacy,clinical safety and 1 year survival rates were assessed.Results The success rates of the treatment for the two groups were both 100％.Patients in the study group were implanted with 1 016 125I seeds,with an average of (13.7 ± 2.5) seeds per patient.The two groups had no significant difference on short-term efficacy (P ＞ 0.05).The DCR,ORR and 1 year survival rates in the study group were 63.2％,92.1％,55.5％,and they were 61.3％,90.0％,58.1％ in the control group,respectively.There were no significant differences between these 2 groups (P ＞ 0.05).At 1 month after treatment,the two groups had no significant differences onAFP,IGF-Ⅱ and IGFBP-2 [(5.08±0.85) μg/L vs.(5.12 ±0.79) μg/L,(4.77 ±0.58) μg/L vs.(4.86 ±0.53) μg/L,(4.98 ±0.67) μg/L vs.(5.04 ±0.71) μg/L] (P＞0.05).There were no signif-icant differences on chemotherapy drug toxicities between the two groups (P ＞ 0.05).The incidence of radi-ation hepatitis in the study group was 1.3％,while the incidences of radiation dermatitis,hepatitis,gastriculcer in the control group were 5.0％,8.8％,2.5％,respectively.The radiation dermatitis incidence inthe study group was significantly lower than that of the control group (P ＜ 0.05).In the study group,2 pa-tients (2.6％) had their 125I seed slightly moved.Conclusion The short-term efficacy of 125I seed implan-tation plus TACE in the treatment of PHC is no less than the 3DCRT + TACE regimen,but with less radia-tion side effects.
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Objective: To investigate the clinical effect of fallopian tube obstruction recanalization by ozone
Methods: Total 116 cases of patients undergoing the fallopian tube obstruction were randomly divided into the experimental group and control group, with 58 cases in each group. All patients underwent the interventional fallopian tube recanalization. The patients in the experimental group underwent the fallopian tube perfusion by the ozone water. Meanwhile, the patients in the control group were treated with the conventional anti-inflammatory and anti-adhesion drugs. After the follow-up visit for 6 months, the pregnancy rate and fallopian tube re-occlusion rate were counted and compared between the two groups. Meanwhile, the symptoms were evaluated and compared between the two groups after the operation for two weeks
Results: The success rate of fallopian tube recanalization was 93.1% [54/58], the pregnancy rate was 79.3% [46/58] and the recurrence rate was 5.2% [3/58] in the experimental group. While the success rate of fallopian tube recanalization was 91.4% [53/58], the pregnancy rate was 60.3% [35/58] and the recurrence rate was 17.2% [10/58] in the control group. Analysis showed that there was no significant difference in the recanalization success rate between the two groups [P>0.05]. However, the pregnancy rate and re-occlusion rate in the experimental group were significantly lower than those of the control group [P<0.05], and the difference was statistically significant. There was no significant difference in the discomfort symptoms between the experimental group and control group [P>0.05]
Conclusion: Fallopian tube recanalization by ozone perfusion can effectively increase the postoperative pregnancy rate and reduce the fallopian tube re-occlusion
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Objective To discuss the nursing care for patients with advanced hepatocellular carcinoma (HCC) who are receiving transcatheter arterial chemoembolization (TACE) combined with sorafenib. Methods A total of 23 consecutive patients with advanced HCC who met the inclusion criteria were enrolled in this study. TACE was carried out in all patients. Three-five days after TACE the patients started to orally take sorafenib. During the treatment course, the patients were kept under close observation for adverse reactions and complications. After leaving the hospital the patients were followed up by the extended care team members, and health education as well as appropriate nursing intervention was carried out. Results All patients with advanced HCC took sorafenib orally after TACE. The major adverse events and complications were gastrointestinal adverse reactions (n = 22) and transient liver dysfunction (n = 23). After leaving the hospital all the patients received regular follow- up examination and extended nursing care. Conclusion Usually, the incidence of adverse reactions is higher in patients with advanced HCC after TACE combined with sorafenib treatment. Careful in-hospital observation and extended out-hospital nursing can reduce the incidence of adverse reactions and thus improve the patient’s quality of life.
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Objective To study the effect of basic fibroblast growth factor(bFGF) on neuron-like differentiation of superparamagnetic iron oxide nanoparticles (SPIONs)-labeled amniotic membrane-derived mesenchymal stem cell.Methods Cells were cultured from enzymatic-digested amniotic membrane tissue.After that,the following steps were taken:(1) Mesenchymal stem cells derived from amniotic membrane were identified by using cell morphology,MTT method and flow cytometry.(2)SPIONs were used to label amniotic membrane-derived mesenchymal stem.(3)bFGF was imported to induce the neuron-like differentiation of SPIONs-labeled amniotic membrane-derived mesenchymal stem cell.Results (1) Primary cultures of P3,amniotic membrane-derived mesenchymal stem cell were fibroblast-like and expression of surface molecules CD29,CD44,CD90 and CD105 was detected,while expression of CD31,CD34,CD45 and CD106 was negative.(2) SPIONs of no more than 14.0 μg/ml are safe to label amniotic membrane-derived mesenchymal stem cells.Cell activity is more than 80％ and expression of surface molecules CD29,CD44,CD90 and CD105 is positive.(3)RT-PCR and immunocytochemistry analysis showed that 10.0 ng/ml bFGF induced neuron-like differentiation of amniotic membrane-derived mesenchymal stem cell (14 μg/ml SPIONs-labeled).Conclusions Enzymatic digestion and cell adherent culture method can be used to isolate mesenchymal stem cells from amniotic membrane.SPIONs of no more than 14.0 μg/ml are safe to label amniotic membrance-derived mesenchymal stem cells and have no effect on the cell activity.Neuron-like differentiation of amniotic membrane-derived mesenchymal stem cell can be induced with 10.0 ng/ml bFGF.
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Objective To investigate feasibility and clinical application value of improved percutaneous transhepatic biliary internal-external drainage (PTBIED).Methods Consecutive patients from April 2007 to April 2010 with malignant obstructive jaundice were diagnosed by medical imaging or pathological confirmation whenever possible.The patients with proximal malignant biliary obstruction and intact inferior common bile ducts ＞ 3 cm in length,and a bilirubin of 70 μmol/L or higher,were included in the experimental group.The control group included patients with low malignant biliary obstruction,and those who met the criteria for the experimental group but refused to receive the altered method of PTBIED.The patients underwent traditional PTBIED in control group.The patients in the experimental group received the procedure as following:according to percutaneous transhepatic cholangiography,a biliary external drainage catheter was modified by adding side-holes.Then under fluoroscopic guidance,the loop tip of the modified biliary drainage catheter was positioned in the inferior common hepatic duct/common bile duct,while the additional side-holes were located in the expanded hepatic duct.Technical success rate,complications,hepatic function and white cell count (WBC) were recorded pre- and post-procedure.All patients were followed-up until death.A t-test was used to compare continuous variable data changes,the Chi-square test was used to compare categorical variable data in two groups,and survival time was assessed using the Kaplan-Meier method.Results Forty-six patients were included in the study,with 21 in the experimental group and 25 in the control group.The procedures were successfully performed in all patients in the two groups.There was no procedure-related death in the two groups.Symptoms were improved similarly after procedures in the two groups.The mean quantity of drained bile per day [experimental group (521 +136) ml/d,control group (606 + 159 ) ml/d,t =1.930,P ＞ 0.05],decrease of the serum total bilirubin after the procedures [ experimental group (87 ± 51 ) μmol/L,control group( 105 ± 66 ) μmol/L ( t =1.061,P ＞ 0.05 ) ] and the median survival time ( experimental group 7.7 months,control group 6.9 months,x2 =0.610,P ＞0.05 ) of the patients showed no statistically significant difference between two groups.The mean WBC amount of patients was higher after the traditional procedure [ ( 10.9 ±5.2) × 109/L] than before the procedure [ (7.8 ±2.9) × 109/L] in the control group ( t =3.606,P ＜ 0.05 ),but the converse change occurred in the experimental group [ pre-procedure (8.2 ± 3.4) × 109/L ],post-procedure [ (7.4 ± 2.6) × 109/L] ( t =2.649,P ＜ 0.05 ).No reflux of duodenal juice was observed in all patients of the experimental group,and 1 patient had infection of biliary tract.The reflux was observed in 11 patients of the control group after conventional PTBIED.Of them,8 patients had infection of biliary tract.Incidence rate of infection of biliary tract in the control group was higher than that in the experimental group( x2 =5.381,P ＜ 0.05 ).Conclusions Improved PTBIED is convenient and feasible,and compared with traditional PTBIED,it can reduce the complications of infection of biliary tract.
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Objective To investigate the changes in function of liver and kidney of the rabbits bearing VX2 liver tumor after transarterial embolization and hyperthermia with magnetic nanoparticles suspended in lipiodol(MN-L) and its therapeutic effect Methods Thirty-two rabbits bearing VX2 liver tumor were randomly divided into four groups and each group contained 8 rabbits The four groups were MN-L embolization hyperthermia group (Group A), MN-L embolization group(Group B),Lipiodol embolization group(Group C), and Control group (Group D), Each rabbit in Group A and B was embolized with 0.5-0.8 ml MN-L through hepatic artery, while each rabbit in Group C was embolized with 0.5-0.8 ml lipiodol.Hyperthermia in alternating magnetic field was performed in Group A after embolization.The remaining groups did not undergo hyperthermia.The rabbits in control group were not treated.The function of liver and kidney of all the animals was measured 1d before embolization,and 1,7,and 14 d after embolization/hyperthermia respectively.Alanine aminotransferase (ALT) and aspartate aminotransaminase (AST) were used to reflect the function of liver,and blood urea nitrogen(BUN) and creatinine (Cr) were used to reflect the function of kidney.CT was performed on all of subjects before and after embolization to determine the embolization effect and the tumor size, and follow-up CT was performed weekly.All of subjects were sacrificed 14 days after embolization/hyperthermia, and their livers, spleens, kidneys and lungs were removed for histopathology examination.The data from every group were analyzed using analysis of variance of repeated measure data.Results On 1 day before embolization and 1,7, and 14 d after embolization/hyperthermia, the function of liver of the rabbits was as follows:Group A:ALT was (43.9±19.0),(795.1±327.1),(67.0±9.3), and(41.9±10.8) U/L respectively,and AST was (50.2±13.6),(1011.2±655.9),(62.4±24.1),and(51.6±7.9) U/L respectively; Group B: ALT was(45.0±19.1),(580.8±160.4),(67.2±31.0),and(47.6±7.8) U/L respectively, and AST was (52.9±20.3),(735.2±186.1),(57.9±24.8),and (50.9±9.8) U/L respectively; Group C: ALT was (47.4±14.6),(558.5±167.8),(63.5±21.9),and (48.0±9.3) U/L respectively, and AST was (51.8±9.5),(752.5±112.0),(56.5±20.6),and(51.4±8.6) U/L respectively.Both ALT and AST mean values of the rabbits were significantly elevated 1 d after embolization/hyperthermia in Group A, B and C, and the data showed statistically significant difference comparing with that before therapy and that of Group D 1 d after therapy (P<0.01).The function of liver showed no statistically significant difference between 7 or 14 days after embolization and 1 day before embolization in Group A,B and C. BUN and Cr mean values in pre-embolization and post-embolization rabbits revealed no statistically significant difference in group A, B, C and D.The MN-L /lipiodol were deposited in the tumor when it was injected, which was validated by CT.To compare with immediate CT after embolization, the MN-L deposited in tumors was not significantly different on CT 7 d after embolization .On the 14 th day after treatment,the MN-L deposited in tumors became concentrative and compact in Group A, while the MN-L/lipiodol deposited at the rim of tumors disappeared on CT in five rabbits of Group B and C.And the tumor size decreased by 21.7% compared to that before treatment in Group A [from (7.8±1.4)cm~3 to(6.1±0.6) cm~3,F=17.56, P<0.01], but tumor size increased by 16.2% and 18.9% in Group B and C respectively [from (7.9±1.1)and (7.8±0.9)cm~3 to (9.1±0.8) and (9.3±1.0)cm~3, F =25.23,55.50, P<0.01].Histopathologically, the tumor of Group A was necrotic for at least 80% 14 day after embolization, while the tumor of Group B and C was necrotic for 30% to 50% .Conclusion Transarterial embolization and hyperthermia with MN-L is safe, effective and feasible on the rabbits bearing VX2 liver tumor.
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Objective To investigate the growth and expression of PDGF of VSMCs in response to stimulation of autologous serum and mechanical injury. Methods An vitro model simulating the condition as possible as that after PTA.PDGF of every medium sample from every group was detected by ELISA,and the values of MTT of every cellular sample was measured by MTT to show the growth and proliferation of every group. Results After stimulation by autologous serum and mechanical injury,SMCs of the experimental group showed the value of MTT increasing,but SMCs in control group reached on 3rd day.At the same time,the expression of PDGF also increased gradually,obtaining peak gradually up to peak on day 4/5 nearly 2.0-fold as much as that of SMCs in the control group. Conclusions After on the 5th day,stimulation with autologous serum and mechanical injury,VSMCs of rabbit showed the stronger ability of growth/proliferation,and autocrine of PDGF also increased gradually,reaching peak on 4-5 d,probobly simulating to those in vivo.