Value of Contrast-enhanced Ultrasound in Sentinel Lymph Node after Primary Breast Cancer Resection / 中山大学学报(医学科学版)

ObjectiveTo investigate the value of percutaneous and intravenous contrast-enhanced ultrasound（P-Ⅳ-CEUS） in sentinel lymph nodes（SLNs） after resection of early-stage primary breast cancer. MethodsA retrospective analysis was done on the clinical and imaging data of 42 early breast cancer patients. Following primary tumor resection， all these patients underwent reoperation in our hospital. SLNs were examined by preoperative P-Ⅳ-CEUS and intraoperative sentinel lymph node biopsy（SLNB） was performed by using Methylene blue as a tracer. Then we analyzed the detection and false-negative rate in CEUS and SLNB respectively. By using the surgical pathological results as the gold standard， the diagnostic efficacy of CEUS for SLNs was explored. ResultsThe detection rate and false negative rate of SLNs in percutaneous contrast-enhanced ultrasound （P-CEUS） were 92.9% （39/42） and 7.1% （3/42）， respectively. The detection rate in methylene blue staining was 100% （41/41） and one patient underwent neoadjuvant therapy due to biopsy-confirmed metastasis. The sensitivity， specificity， positive predictive value， negative predictive value and accuracy of P-Ⅳ-CEUS were 66.7% （2/3）， 100% （37/37）， 100% （2/2）， 97.3% （36/37） and 97.4% （38/39）， respectively. ConclusionsP-Ⅳ-CEUS after resection of early-stage primary breast cancer can accurately detect SLNs and characterize their status， which is a reliable clinical basis for reducing invasive SLNB.

Effect of Qingzao Jiufei Tang on JAK2/STAT3 Signaling Pathway and Expression of Downstream Apoptosis-related Proteins in Lung Cancer / 中国实验方剂学杂志

Objective::To observe the effect of Qingzao Jiufei Tang on apoptosis of lung cancer, Janus protein tyrosine kinase 2/signal transducers and transcriptional activator protein 3 (JAK2/STAT3) signaling pathway, as well as the expressions of downstream apoptosis-related proteins Bcl-2-associated X (Bax) and Cyclin D1. Method::Totally 50 male C57BL/6J mice were randomly divided into five groups: chemotherapy group (CTX), model group, high-dose Qingzao Jiufei Tang group, middle-dose Qingzao Jiufei Tang group and low-dose Qingzao Jiufei Tang group, with 10 mice in each group. The model of lung cancer was established by injecting Lewis lung cancer cells into the right axillary of mice. High-dose, middle-dose and low-dose Qingzao Jiufei Tang groups were orally given drugs (11, 5.5, 2.75 g·kg-1·d-1) two weeks before the modeling. Chemotherapy group was administered intraperitoneally at a dose of 50 mg·kg-1·(2 d)-1, while model group was administered intragastrically with the equal volume of normal saline. After inoculation, the mice in each group were continued to be administered. Two weeks later, the mice in each group were killed, and the tumors were collected. Then the JAK2 protein phosphorylation level was detected by immunohistochemistry (IHC). STAT3, Bax and Cyclin D1 protein expression levels were detected by Western blot, and apoptosis of lung cancer cells was observed by transmission electron microscopy. Result::Compared with model group, the phosphorylation levels of JAK2 and STAT3 protein in lung cancer cells were significantly decreased, the expression of Bax protein was significantly increased, and the expression of Cyclin D1 protein was significantly decreased in high-dose Qingzao Jiufei Tang group, middle-dose Qingzao Jiufei Tang group and chemotherapy group, with statistically significant differences (P<0.05, P<0.01). The results of transmission electron microscopy showed significant apoptotic phenomena in high-dose Qingzao Jiufei Tang group, middle-dose Qingzao Jiufei Tang group, low-dose Qingzao Jiufei Tang group and chemotherapy group compared with the model group. Conclusion::Qingzao Jiufei Tang had an obvious effect in promoting the apoptosis of lung cancer cells. Its mechanism may be related to the inhibition of the phosphorylation of JAK2 and STAT3 protein, the promotion of its downstream Bax protein expression and the inhibition of its downstream Cyclin D1 protein expression.

Anti-lung Cancer Mechanism of Qingzao Jiufei Tang / 中国实验方剂学杂志

Lung cancer is currently the leading malignant tumor in China, which seriously endangers people's health. Nowadays, traditional Chinese medicine (TCM) has played an increasingly important role in the comprehensive treatment of lung cancer. It has unique advantages in promoting postoperative recovery, reducing the side effects of radiotherapy and chemotherapy, and effectively prolonging the lifetime of patients. Qingzao Jiufei Tang is mainly used to treat the syndrome of Qi-Yin deficiency due to dryness-heat injury to the lungs. The experimental and clinical studies have confirmed that Qingzao Jiufei Tang has a good anti-lung cancer effect and broad application prospects. In this paper, we reviewed relevant literatures through China National Knowledge Infrastructure (CNKI), Weipu Data, Wanfang Data, PubMed and other databases in recent years, and found a few reports on the anti-lung cancer effect of Qingzao Jiufei Tang. There was still a lack of systematic and comprehensive explanation for its specific mechanism of action against lung cancer. This paper systematically summarized the clinical application of Qingzao Jiufei Tang against lung cancer in recent years, as well as its effects through cell-related signaling pathways and energy metabolism against lung cancer cells. It is clear that this decoction can significantly inhibit the signaling pathways of epithelial growth factor receptor (EGFR), nuclear transcription factor kappa B (NF-κB)/intercellular cell adhesion molecule-1 (ICAM-1), and Janus kinase 2 (JAK2)/signal transducers and activators of transcription 3 (STAT3) of the lung cells. It could also inhibit energy metabolism of tumor cells, and reduce the production of relevant metabolites. This will provide new ideas for the clinical application of Qingzao Jiufei Tang against lung cancer.

Application of digital subtraction angiography and interventional treatment in gastrointestinal arterial hemorrhage / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical value of digital subtraction angiography (DSA) and interventional treatment in gastrointestinal arterial hemorrhage.</p><p><b>METHODS</b>DSA data and experiences of interventional treatment of 78 cases with gastrointestinal arterial hemorrhage were retrospectively analyzed.</p><p><b>RESULTS</b>The positive rate of DSA diagnosis was 74%(58/78). Contrast media overflow direct sign was found in 33%(26/78) patients. Contrast media overflow direct sign of postoperative anastomotic stoma was found in 83%(15/18) patients. Hemorrhage causes of 15 cases were duodenal ulcer, 5 stomach ulcer, 2 gastric cancer, 1 Dieulafoy disease, 9 vascular malformation and dysplasia, 8 in anastomotic stoma bleeding after gastrointestinal operation, 10 hepatic artery blow out and bleeding after operation of liver disease, 5 Crohn disease, 6 intestinal tract diverticulum hemorrhage, 6 enteritis or ulcer and 3 polyp of small intestine, 1 midrange malignant small intestinal interstitial tumor, 2 well differentiated small intestine leiomyosarcoma, 5 colon and rectal cancer. Fifteen cases received arterial drug infusion and 36 received arterial embolization. Twenty-seven cases underwent operation after DSA and interventional treatment, whose coincidence with pathology was 78%(21/27). Technical success rate of arterial embolization was 86%(31/36) and clinical success rate was 72%(26/36). Technical success rate of arterial drug perfusion was 60%(9/15) and clinical success rate was 40%(6/15). Rebleeding rate was 16%(8/51) after intervention treatment. During follow-up for 2-36 months, 1 rebleeding patient received gastroscope treatment after embolization, but failed and died later. There were no severe complications,such as ischemic necrosis,in all the cases.</p><p><b>CONCLUSION</b>DSA is very important for the location and qualitation of gastrointestinal arterial hemorrhage. Transarterial drug infusion and embolization are safe and effective, and available to selective operation and complication handling.</p>

Early to mid-term results of endovascular repair of aortic dissection: report of 165 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early and midterm outcomes of endovascular repair of aortic dissection (AD).</p><p><b>METHODS</b>Between January 2001 and December 2006, 165 patients (145 male and 20 female) with AD were treated with endovascular repairing. The mean age of the patients was 52.8 years (range, 30-82 years). Among them, 36 patients had Stanford type A dissection, 121 had type B dissection and 8 had aortic ulcer. Among the dissection patients, 47 were acute AD (the interval between onset and surgery was < or = 7 days), 69 were subacute AD (the interval between onset and surgery was 8-30 days) and 41 were chronic AD (the interval between onset and surgery was > 30 days).</p><p><b>RESULTS</b>The stents were placed technically successfully in 164 patients (99.4%). The rate of endoleak within 30 days after placement of stents was 7.3% (12/165) and neurologic complication rate was 2.5% (4/165). The mortality rate within 30 days was 6.1% (10/165), and the mortality of acute, subacute and chronic AD was 12.8%, 1.4% and 7.3%, respectively. One hundred and forty-five cases were followed up for 6 to 75 months (median, 28.2 months). Complete thrombosis in false lumen was achieved in 62 patients (42.8%), while partial thrombosis was achieved in 83 patients (57.2%). Nine patients died during fellow-up.</p><p><b>CONCLUSION</b>It's indicated that endovascular repair of AD is a microinvasive, safe and effective methods for aortic dissection. However, the long-term efficacy needs to be evaluated further.</p>

Endovascular stent-graft treatment for DeBakey I aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To study endovascular treatment of DeBakey type I aortic dissecting aneurysm.</p><p><b>METHODS</b>Seven patients with DeBakey I aortic dissecting aneurysms were treated. Diagnoses were confirmed by MRA, CT and angiography. The intimal tear entry was in the ascending aorta, 2.5 approximately 6.0 cm from the ostia of the coronary arteries, and 0.5 approximately 4.0 cm from the brachiocephalic trunk opening. Endovascular stent-grafts were deployed via a left common carotid artery (LCCA) approach in 2 cases and right femoral artery (RFA) approach in 5 cases. Prior to treatment, a left subclavicular artery (LSA)-LCCA shunt was established to ensure blood supply to the LCCA during surgery in 2 cases via LCCA approach, and a LSA-LCCA-right common carotid artery (RCCA) synthetic bypass was established to ensure blood supply to the brain in 2 cases in RFA approach.</p><p><b>RESULTS</b>The operative success rate was 100%. In 3 cases, endoleak persisted after the first stent was placed, but this was eliminated by placement of a second stent. All patients survived except one who died of acute massive hemorrhage from the upper gastrointestinal tract one month postoperatively. The false lumen in all 6 cases became thrombosed and no endoleak or new aortic dissecting aneurysms developed.</p><p><b>CONCLUSIONS</b>Endovascular treatment of DeBakey type I aortic dissecting aneurysm is feasible, minimally invasive, and effective. Case selection depends on the distance of the coronary artery ostia from the tear entry.</p>

Endovascular stent-graft repair for Stanford type A aortic dissection with extra-anatomic bypass / 中华外科杂志

<p><b>UNLABELLED</b>OBJECTIVE To evaluate the effects of endovascular stent-graft repair for Stanford type A aortic dissection combined with extra-anatomic bypass.</p><p><b>METHODS</b>To perform endovascular repair for Stanford type A aortic dissection, we tried to extend the landing zone by extra-anatomic bypass to reconstruct the innominate artery, the left common carotid artery or the left subclavian artery, and then achieved the process immediately or at a secondary stage via either the carotid or the femoral approach.</p><p><b>RESULTS</b>Thirty-four patients with ascending aortic dissection (n=8) and aortic arch dissection (n=26) were treated with this technique. Thirty three patients were successfully done aortic endovascular repair, only one died during the operation. The thirty-day mortality rate was 8.8% (3/34), endoleak incidence rate was 11.8% (4/34) and incidence rate of cerebral infarction was 5.9% (2/34). Twenty-nine patients were followed-up for 6-70 months (mean, 24. 5 months). Complete (n=16) and partial (n=13) thrombosis of the false lumen were showed with CT angiography and/or vascular color Doppler ultrasound scanning.</p><p><b>CONCLUSIONS</b>Endovascular stent-graft repair combined with extra-anatomic bypass can be a novel option for Stanford type A aortic dissection; it is safe, less invasive, and with fewer complications. Nevertheless, indications need further consideration.</p>

Hepatic perfusion changes after interventional disconnection evaluated by CT perfusion imaging / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the changes in hepatic perfusion after interventional obliteration in patients with cirrhosis and portal hypertension by means of spiral CT perfusion imaging.</p><p><b>METHODS</b>Twenty-three patients who suffered from cirrhosis and portal hypertension were selected to undergo interventional disconnection. Partial spleen embolization (PSE) was performed in 15 patients and PSE combined with percutaneous transhepatic obliteration (PTO) was carried out in 8 patients. Hepatic perfusion was carried out pre- and post-operation. The density-time curve was obtained from the interest region of liver, abdominal artery, portal vein. The parameters of perfusion were calculated by the means of deconvolution simultaneously.</p><p><b>RESULTS</b>The portal vein perfusion (PVP) decreased in patients with PSE, but total hepatic blood perfusion was not statistically different from that of pre-operation. After treatment, the hepatic artery perfusion increased obviously. PVP decreased from 0.862 to 0.722 ml x min(-1) x ml(-1) but was not statistically different from that of pre-operation. Hepatic arterial perfusion and total hepatic blood perfusion increased from 0.128, 0.990 ml x min(-1)x ml(-1) pre-operatively to 0.290, 1.021 ml x min(-1) x ml(-1) postoperatively in patients with PSE combined with PTO.</p><p><b>CONCLUSIONS</b>Spiral CT perfusion could objectively reflect the hemodynamic change in hepatic parenchyma after the interventional vascular obliteration.</p>

The veracity and reproducibility of hepatic CT perfusion imaging:an animal experiment and clinical study / 中华放射学杂志

0.9). Conclusions CT perfusion imaging could quantify the hepatic blood flow.The accuracy is similar to electromagnetic flowmeter,and it could effectively reflect physiological or pathological hemodynamies of liver.CT perfusion is noninvasive,high reproducible and convenient,which could be widely used in clinical practice.

Hemodynamic changes in liver measured by multi-imaging methods before and after transjugular intrahepatic portosystemic stent-shunt / 中华放射学杂志

Objective To evaluate hemodynamic changes in liver treated by transjugular intrahepatic portosystemic stent-shunt(TIPSS)with hepatic computed tomography(CT)perfusion,Doppler ultrasound and portal vein pressure measurement,as well as the correlation among these methods.Methods Hepatic CT perfusion was performed in 9 cirrhotic patients one week before TIPSS and 72 hours after TIPSS. Intraoperative portal vein pressure was measured before and after portosystemic shunt establish.The follow- up hepatic CT perfusion were carried out in 3 cases at 3 months and 6 months postoperatively.The hemodynamic surveillance by Doppler ultrasound were performed in 48 hours and 3 months after TIPSS for 9 cases,and in 6 months after TIPSS for 6 cases.Two cases underwent venography and portal vein pressure measurement in 6 months after TIPSS treatment.Results The mean of portal vein perfusion(PVP),total hepatic blood flow(THBF),hepatic perfusion index(HPI)and portal vein free pressure(PVFP)before TIPSSwere(0.92?0.18)ml?min~(-1)?ml~(-1),(1.28?0.17)ml?min~(-1)?ml~(-1),(28?8)%,and (23.92?0.86)mmHg,respectively.In 72 hours after TIPSS,the mean of PVP,THBF,HPI and PVFP were(0.21?0.15)ml?min~(-1)?ml~(-1),(0.74?0.18)ml?min~(-1)?ml~(-1),(74 +13)%,and (12.62?1.54)mm Hg,respectively.After treatment,the mean of PVP was(0.49?0.05)ml?min~(-1)? ml~(-1)at 3 months and(0.57?0.03)ml?min~(-1)?ml~(-1)at 6 months,respectively.There was negative correlation between PVP and PVFP before TIPSS(r=0.678,P0.05).Moreover,a signifieant correlation was found between the degree of portal vein pressure decrease and portal vein perfusion decrease(r=0.867,P

Experimental study on effect of dexamethasone to the in-stent restenosis after vascular intervention / 介入放射学杂志

Objective To evaluate the effect of dexamethasone to the cultured rat thoracic aortic smooth muscle cells(SMC)in vitro,and explore the role on it's prevention and cure for the in-stent restenosis after vascular intervention.Methods The rat thoracic aortic SMC were harvested and cultured for six to ten passages.The cultured SMC were synchronized and then restimulated to enter the cell cycle,and treated with incremental concentrations of dexamethasone or without dexamethasone as control.The proliferative assay was performed with MTT method in the different time points after treatment.RT-PCR was performed to assay the level of proliferating cell nuclear antigen(PCNA)mRNA.Results 1.Dexamethasone progressively inhibited rat aortic SMC proliferation in a concentration-dependent fashion.The A value was statistically significant for different concentrations(F=36.02,P＜0.001).The effect was not significant for dexamethasone concentrations either between 10~(-6)and 10~(-5)mol/L(P=0.065)or between 10~(-11)mol/L and control group(P= 0.567).2.RT-PCR suggested dexamethasone significantly decreased rat aortic SMC PCNA mRNA transcription in a concentration-dependent fashion.Statistical analysis indicated F=15.407 and P＜0.001 by ANOVA. Comparing to the control,the corrected A value was not statistically significant at 10~(-9)or 10~(-11)mol/L groups by post hoc analysis.Conclusions Dexamethasone inhibits rat aortic SMC proliferation in a concentration- dependent fashion.The data suggest that effective action concentration is 10~(-7)mol/L with persistent time up to 96 hours or more.Dexamethasone may play the inhibit role to SMC at lower concentration with prolonging action time.