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A young female patient with acute necrotizing encephalopathy (ANE) is reported,who aged 15 years,with a history of upper respiratory tract infection,main clinical manifestations of seizures and consciousness disorders,and brain MRI examination showing characteristic symmetrical bilateral abnormal signals at both thalamic area,pons,and cerebellar hemisphere.Imaging changes corresponded to pathophysiological changes.The initial manifestations were found to be brain swelling and edema.In the acute phase,hemorrhage and necrosis of the affected brain tissues were observed.The recovery period was characterized by hemosiderin deposition and cystic space formation,which was consistent with ANE diagnosis.By early use of high-dose gammaglobulin and methylprednisolone,the prognosis of the patient was good,proving that immunosuppressive therapy by corticosteroids and gammaglobulin is effective for ANE.
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Objective@#To detect the expression level of YES-associated protein 1 (YAP) in hepatocellular carcinoma (HCC) cell lines and investigate its effects on the proliferation activity and the sensitivity to sorafenib in HCC cells.@*Methods@#Western blot was used to detect the protein expression levels of YAP in SMMC-7721, SK-Hep-1, HepG-2, Huh7 and the normal liver cell line L-O2. YAP specific small interfering RNA (si-YAP) or YAP expression plasmid were transfected in SK-Hep-1 or Huh7 cells, respectively. Cell counting kit-8 (CCK-8) test was used to detect the cell proliferation activity and the cell cycle test was conducted by flow cytometry. SK-Hep-1 and SK-Hep-1 si-YAP cells were subcutaneously injected into the nude mice which were sequentially treated by intragastric administration of sorafenib, and the tumor growth in vivo were observed and compared.@*Results@#The expression of YAP was upregulated in HCC cell lines. Deletion of YAP expression significantly decreased the survival rate of SK-Hep-1 cells [(78.5±0.3)% vs (92.3±0.2)%, P=0.025]. Knockdown of YAP significantly increased the percentage of G0/G1-phase cells [ (65.4±3.3) % vs (55.7±3.4) %, P=0.039]. On the contrary, upregulation of the YAP expression in Huh7 cells significantly increased the cell survival rate [(81.2±1.3)% vs (62.5±1.1)%, P=0.013] and reduced the percentage of G0/G1-phase cells [(38.2±3.8)% vs (48.8±2.9)%, P=0.019]. The survival rate of SK-Hep-1 cells treated by si-YAP combined with sorafenib was (31.13±1.79)%, significantly lower than (48.87±0.58) % of SK-Hep-1 cells treated by sorafenib alone (P=0.001), while overexpression of YAP attenuated the inhibitory effect of sorafenib on the survival of Huh7 cells [(69.98±2.94) % vs (53.53±1.93)%, P=0.001]. The tumor weights of SK-Hep-1 group, sorafenib alone group, SK-Hep-1 si-YAP group and SK-Hep-1 si-YAP combined with sorafenib group were (0.96±0.08) g, (0.62±0.08) g, (0.70±0.06) g and (0.27±0.02) g, respectively. The tumor weights of sorafenib alone group and SK-Hep-1 si-YAP group were significantly lower than that of SK-Hep-1 group (P=0.012 and P=0.031, respectively). The tumor weight of SK-Hep-1 si-YAP combined with sorafenib group was significantly lower than that of SK-Hep-1 si-YAP group (P=0.001).@*Conclusions@#The expression of YAP is upregulated in HCC cell lines, which regulates the proliferation, cell cycle, and sensitivity to sorafenib of HCC cells. YAP is a potential molecular target for HCC treatment.
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Objective@#To explore the factors affecting the prognosis of patients with hepatocellular carcinoma (HCC) combined with portal vein tumor thrombosis (PVTT), and to analyze the clinical value of transcatheter arterial chemoembolization (TACE) combined with iodine-125 seed implantation in such patients.@*Methods@#A retrospective analysis of 53 patients with HCC combined with PVTT was performed. In the study group, 32 cases were treated with TACE combined with iodine-125 seed implantation, and 21 cases in the control group were treated with TACE combined with sorafenib. Survival analysis was carried out on eight factors such as gender, age, Child-Pugh classification, alpha fetoprotein level, portal vein tumor thrombosis (PVTT) type, forms of liver tumor, extra-hepatic metastasis and treatment modalities. The efficacy of TACE combined with iodine-125 seed implantation and TACE combined with sorafenib was further compared. The χ 2 test was used to evaluate the efficacy of the two groups. A single factor survival analysis was calculated by Kaplan-Meier estimator and multifactor survival analysis by Cox proportional hazards model.@*Results@#All 53 patients were successfully treated. The median tumor progression time (mTTP) and median overall survival (mOS) were 8 months and 11 months, respectively. The disease control rate (DCR) of the study group for PVTT was 93.8%, which was significantly higher than that of the control group (61.9%, χ 2 = 6.448, P = 0.011). The difference was statistically significant; the objective remission rate of the study group for PVTT was 75.0%. Significantly higher than 9.5% in the control group, P < 0.05, the difference was statistically significant; the DCR of the primary tumor in the study group was 50.0%, which was lower than the 70.0% of the PVTT in the control group, P = 0.231, the difference was not statistically significant. The progression of primary HCC lesions in patients with multivariate survival analysis: Child-Pugh grade A patients were compared to grade B [Hazard ratio (HR) = 0.236, P = 0.003]; no extra-hepatic metastasis (HR = 0.258, P = 0.002); and TACE combined with iodine-125 seed implantation group compared with TACE combined sorafenib group (HR = 0.372, P = 0.002), the differences were statistically significant. Multivariate survival analysis of patients with overall survival: AFP < 400 ng/mL vs. AFP≥400 ng/mL (HR = 0.389, P = 0.030); Child-Pugh grade A vs. B (HR = 0.263, P = 0.006); and no extra-hepatic metastasis (HR = 0.306, P = 0.006), the differences were statistically significant.@*Conclusion@#TACE combined with iodine-125 seed implantation for the treatment of HCC with PVTT can effectively control the progression of PVTT and intrahepatic lesions and improve the prognosis of patients.
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Objective To investigate the regularity of abdominal pain and its influence factors in patients with primary hepatic carcinoma (PHC) after receiving transcatheter arterial chemoembolization (TACE).Methods A total of 121 patients with PHC were enrolled in this study.All patients were admitted to the Department of Interventional Radiology of Zhejiang Provincial Cancer Hospital from December 2012 to June 2013,and all patients were suffered from PHC.The occurrence,duration and severity of the abdominal pain as well as the used dosage of morphine within 48 hours after TACE were documented.The results were statistically analyzed.Results A total of 96 patients (96/121,78.5％) complained of different degrees of abdominal pain after interventional therapy,and 72 patients (72/121,59.5％) showed moderate to severe pain,with the VAS score being more than 4 points.The average dosage of morphine used each time for one patient was 19.7 mg.Statistical analysis indicated that these patients were more prone to develop abdominal pain after TACE if they carried more than one of the following risk factors:age ≥60 years (when compared with patients ＜60 years,OR:0.307,P=0.008),preoperative ECOG score ＞2 (when compared with a ECOG score of 0-1,OR:0.195,P=0.006),the distance between tumor and liver capsule ＞1 cm (when compared with the distance ≤ 1 cm,OR:0.296,P=0.007),the use of THP in performing chemoembolization (when compared with other chemotherapeutic drugs,OR:0.232,P＜0.003 4).Conclusion After TACE abdominal pain is a high-frequency event.The independent factors affecting the occurrence of abdominal pain are age＜60 years,preoperative ECOG score ＞2,tumor located close to liver capsule,and the use of THP-lipiodol mixture as embolic agent.Therefore,for patients carrying moderate-high risk of abdominal pain,routine use of analgesics before TACE as well as within 12 hours after TACE to prevent the occurrence of abdominal pain is quite necessary.
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Objective To evaluate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treating hepatocellular carcinoma (HCC) under liver capsular. Methods Forty three patients with 62 lesions of HCC under liver capsular received TACE followed by CT?guided percutaneous RFA after 1 to 2 weeks were analyzed retrospectively. The subjects were observed and follow?up imaging with enhanced MRI was performed to evaluate the therapeutic efficacy after combined treatment. The patients were followed up for 10 to 69 months. The patients with residual lesions received a second RFA, the patients with recurrence or new lesions received another TACE combined with RFA. The overall survival rates, median survival time and median time to progression were calculated by using Kaplan?Meier. Results A total of 55 TACE and 68 ablations were performed in 43 patients with 62 lesions. The procedure was successfully accomplished in all patients. The complete ablation rate after the first ablation was 90.3%(56/62). The 1, 3, 5?year overall survival rates were 95.3%, 78.1%and 43.9%, the median survival time was 58 months and the median time to progression was 32 months. Conclution For the treatment of hepatocellular carcinoma under liver capsular, TACE combined with RFA is safe and effective.
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Objective To observe the clinical efficacy of acupoint application withChan Wu gel cream plus five notes therapy in treating cancer pain.Method Eighty patients with cancer pain were randomized into a treatment group and a control group, 40 cases in each group. The treatment group received acupoint application withChanWu gel cream at the corresponding acupoints of the affected organ in association with the five notes therapy; the control group was intervened by the three-step analgesic ladder recommended by World Health Organization (WHO). The quality of life and pain intensity were scored before and after the intervention.Result The quality of life and pain degree were significantly changed after the treatment in the two groups (P<0.01). The quality of life and pain intensity of the treatment group were significantly different from that of the control group (P<0.05).Conclusion Acupoint application withChan Wu gel cream plus five notes therapy is effective in mitigating cancer pain and improving the quality of life.
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Objective To investigate the efficacy and safety of CT-guided radiofrequency ablation (RFA) in treating lung tumors. Methods A total of 33 patients with lung cancer (35 lesions in total), who were admitted to authors’ hospital during the period from May 2007 to August 2013 to receive treatment, were enrolled in this study. RFA was carried out in all patients. After RFA the patients were followed up regularly (once every 3 months) to evaluate the therapeutic efficacy and the adverse reaction. The deadline for the following-up was November 2013, or to the time when tumor progression occurred. Results Of the total 34 lesions in 32 patients who had received RFA and had complete follow-up data, the one-year local control rate was 85.3%. The average one-year progression-free survival rate was 75.0%, among them 15 cases with primary lung cancer had a mean one-year progression-free survival rate of 80.0% and 17 cases with metastatic lung cancer had a mean one-year progression-free survival rate of 70.6%. The overall median progression-free survival (PFS) was(18.0±1.3) months. No obvious correlation existed between PFS and age, sex, tumor size, pathological type, clinical stage (P<0.05). The main adverse reactions of RFA were pain, hydrothorax and pneumothorax; no serious life-threatening complications occurred. Conclusion RFA is a safe, effective and minimally-invasive treatment for lung cancer, regardless of early stage or late stage of the tumor.
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Objective To evaluate the safety and clinical efficacy of CT-guided 125I seeds interstitial implantation in treating the refractory liver cancers that show poor response to commonly used therapies. Methods A total of 40 patients with refractory clinically or pathologically-proved liver cancer were enrolled in this study, the diseases included primary liver cancer (n = 27, with coexisting portal vein cancerous thrombus in 2) and metastatic liver cancer (n = 13). CT-guided 125I seeds interstitial implantation was performed in all patients. Preoperative plan of seeds implantation protocol was formulated by using the treatment plan system (TPS); the 125I seed activity was 0.6 -0.8 mCi and the peripheral matching dose (MPD) was 100 -140 Gy. The procedure of 125I seeds interstitial implantation was performed under local anesthesia in all patients. By using percutaneous trans-hepatic puncturing and single-or multiple-needle technique, the 125I seeds were implanted along a line parallel to the long axis of the tumor and/or tumorous thrombus with an interval of 0.5 -1.0 cm. The short-term efficacy was evaluated by modified response evaluation criteria in solid tumors (mRECIST), and the median time to tumor progression (mTTP) and the median overall survival time (mOS) were calculated by Kaplan and Meier method. Results The technical success rate was 100%. The diameter of the tumor was 1.5 -12.0 cm (mean 4.0 cm), and a total of 1 748 125I seeds were implanted in 40 patients (mean 44 seeds per patient). The short-term effective rate was 37.5%(n = 15), including complete remission in 8 cases and partial remission in 7 cases, the stable disease was seen in 15 cases (37.5%), and the disease control rate was 75%. The mTTP was 7.0 months (95%CI:4.524-9.476 months), while mOS was 10 months (95%CI: 6.901 -13.099 months). The procedure-related adverse reactions included small amount of subcapsular hemorrhage (n =2, 5%), intrahepatic migration of 125I seeds (n=2, 5%), pain at liver area (n=1, 2.5%); and no special treatment was needed in these patients. One patient developed high fever with chills 3 hours after the procedure, which was relieved after symptomatic and antipyretic treatment. Conclusion For the treatment of refractory liver cancers, CT-guided 125I seeds permanent interstitial implantation, used as a remedial therapy, is safe and effective. This technique is worth popularizing in clinical practice.
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OBJECTIVE@#To investigate the factors that influence the curative effect in patients with HBeAgpositive chronic hepatitis B (CHB) treated with peg-interferon α-2a, and to explore whether such factors might predict the therapeutic effect.@*METHODS@#HBeAg-positive CHB patients treated with peg-interferon α-2a (180 μg once a week) were divided into a standard therapy group (48 weeks) and an extended therapy group (>48 weeks). The rates of HBsAg loss, HBeAg loss, HBeAg seroconversion, HBV DNA clearance, and ALT normalization were all evaluated in the two groups at the end of treatment and after 24 weeks follow up.@*RESULTS@#A total of 81 patients were enrolled in the study. The standard therapy group included 37 patients, and the extended therapy group included 44 cases, with durations ranging from 52 to 92 (median 72) weeks. The baseline clinical data were comparable between the two groups (P>0.05). At the end of treatment and at 24 weeks of follow-up, the HBeAg seroconversion rate of the extended therapy group was significantly higher than that of the standard therapy group (54.5% vs 29.7%, P=0.025, at 24 weeks; 76.9% vs 52.9%, P=0.008, after follow-up). In the standard therapy group, age and half-quantification of HBeAg at 24 weeks of treatment were the predictive factors for HBeAg seroconversion at 24 weeks of follow-up. Using a logistic regression model, the area under the receiver operating characteristic curve was 0.872, taking the optimum cut-off point of -1.299, with 100.0% sensitivity at 66.7% specificity. COX multi-factor analysis (of the two groups) showed that age and therapy duration were predictive factors for HBeAg seroconversion at 24 weeks of follow-up.@*CONCLUSION@#HBeAg-positive CHB patients treated with peg-interferon α-2a may have a better curative effect at a young age or with extended therapy. Age and half-quantification of HBeAg at 24 weeks of treatment may predict HBeAg seroconversion at 24 weeks of follow-up after completion of the standard therapy.
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Adult , Female , Humans , Male , Young Adult , Age Factors , Antiviral Agents , Therapeutic Uses , Hepatitis B Surface Antigens , Blood , Hepatitis B e Antigens , Blood , Hepatitis B, Chronic , Drug Therapy , Virology , Interferon-alpha , Therapeutic Uses , Polyethylene Glycols , Therapeutic Uses , Recombinant Proteins , Therapeutic Uses , Treatment OutcomeABSTRACT
Objective To study the CT findings of small thyroid carcinoma. Methods The CT findings of 40 patients with histology-proven small thyroid carcinoma (diameter, 1.0 to 2. 0 cm) were retrospectively reviewed. Results (1)The single lesion was detected in 38 cases and two lesions in bilateral thyroid in 2 cases. Two cases were combined with contralateral nodular goiter and I case with contralateral thyroid adenoma. ( 2 ) Eight lesions showed smooth edge and complete envelope. Thirty-four lesions demonstrated foggy edge and incomplete envelope,but they didn't invade the surrounding soft tissues and important organs. ( 3 ) The density of all lesions were homogeneous or comparatively homogeneous without obvious hemorrhage or necrosis area on non-enhanced CT. Thirty lesions showed varied shape calcifications,with granular calcifications in 20 lesions being the most common. Irregular nodular,eggshell-like or mulberrylike calcifications were also detected. (4)Forty-one lesions showed marked enhancement on post-contrast CT and the amplitude of enhanced CT value was greater than 40 HU(range,90 to 140 HU). Thirty-eight lesions exhibited homogeneous enhancement, and other 3 lesions showed marked enhancement center with a ring-like low density edge and manifested as a characteristic damascene-like appearance. (5)Enlarged cervical lymph nodes were found in 24 cases ( 60. 0% ), which displayed solid, cystic-solid or cystic appearances on nonenhanced CT. They showed markedly homogeneous,irregular ring or wall-node enhancement on post-contrast CT. In 8 cases there were granular, nodular or eggshell-like calcifications within the enlarged lymph nodes.Conclusion A solid thyroid nodule with granular calcification, incomplete envelope and marked enhancement, companied with enlarged lymph nodes with calcification, cystic degeneration and obviously enhanced solid part are the relatively characteristic CT features of small thyroid carcinoma.
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Objective To evaluate the feasibility and efficacy of percutaneous intratumor injection of gene-immunotherapy combined with capacitive radio-frequency hyperthermia treatment for advanced lung carcinoma under CT guided.Methods Thirty-one unresectable peripheric lung carcinomas(29 men and 2 women,10 squamous carcinomas,15 denocarcinoma and 6 alveolus carcinomas) in clinical Ⅲ~Ⅳ stage were undergone percutaneous intrastumor injection of H101 and ⅠL~Ⅱ under CT guided,and repeated at 8,29,35,57 and 64 d respectively as one course.During interventional therapy,radio-frequency hyperthermia carried out twice one week,totally 12 times per-patient.After one course 4 weeks later,the blood TSGF levels and CT changes of the tumors were observed.Results The short period effect included:CR in 0 case,PR in 22 cases,NC in 6 cases and PD in 3 cases,the total short-term efficacy rate was 71 percent(22/31).Significant statistical difference was found in the positive rate and quantitative level of the blood TSGF after on cycle(P
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Objective To evaluate the efficacy of percutaneous CT guided interstitial 125Ⅰ seeds implantation treatment for refractory pelvic malignant tumors and discuss the procedure of technique.Methods Twenty-three patients with refractory pelvic malignant tumors(25 lesions,diameter 3.5-7.0 cm,mean 4.5 cm) showing failure response to full chemotherapy and/or radical radiotherapy after tumors resection were undergone percutaneous CT guided intratumoral 125Ⅰseed implantation.Treatment plan system(TPS)was used to design the distribution and number of 125Ⅰ seeds according to matched peripheral dose(MPD)1-3 days before the procedure.Of which 6 cases received combined internal iliac arterial infusion chemotherapy before or after the 125Ⅰ seed implantation procedure.Results 9 ～ 75(mean 27)125Ⅰ seeds were implanted into a single tumor at first time including 6 patients with intraarterial chemotherapy for 14 cycles(mean 2.3 cycles),showed relief of clinical pain symptoms in 16 of 23 cases,72 h ～ 4 w after the seeds implantation;with the an effective rate of 69.6%.Follow up for 2-34 months(median,21 months),CT or MRI performed 2 months after the seeds implantation showed no CR,but PR in 18 cases,SD in 4 cases,and PD in 1 case,with overall response rate of 78%(18/23),and no serious complication.In addition,20 cases survived,with the longest one of 34 months and the other 3 died.Conclusions Intratumoral 125Ⅰ seeds implantation under CT guidance for pelvic refractory malignant tumors is safe,minimally invasive,and effective.
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Objective To explore a safe and effective hyperthermia interventional therapy temperature for hepatic carcinoma. Methods Eight swines were divided into four groups according to trans-arterial hyperthermic perfusion temperature, 45 ?C , 50 ?C ,55 ?C , and 60 ?C (catheter flowing temperature) groups. The hepatic and renal functions and blood coagulation function were examined before and after the procedur and then all swines were sacrificed and the livers were pathologically analysed,simultoneously with the evaluation of the safe hyperthermic temperature 35 hepatic carcinomas were carried out under this interventional hyperthermochemotherapy via the arterial catheter (80 cm, 5F) placed into the tumoral artery with the perfusion agents warmed to 60～65 ?C (catheter flowing temperature was 47.55?0.44 ?C ). Results The hyperthermic coagulation necrosis, hepatic dysfunction level and fever were found after 55 ?C and 60 ?C hyperthermic perfusion while those of 45 ?C and 50 ?C groups basically remained normal. The tumor growth rate and total efficacy rate were -(0.35?0.32) and 79.2%, respectively, and 0.5, 1, 1.5 year survival rates were 100%, 80%, 60% respectively after follow-up. The adverse effects of the interventional hyperthermochemotherapy was similar to the routine TACE. Conclusions 45 ?C and 50 ?C (catheter flowing temperature) hyperthermochemotherapy for hepatic carcinoma is safe and effective.
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Objective To investigate the clinical value of indwelling hepatic arterial catheter in splitting fullfilling of lipiodol treatment for giant primary hepatic carcinomas. Methods Sixteen patients with giant primary hepatic carcinomas under DSA guidance,splitting lipiodol embolizations were carried out through indwelling hepatic arterial catheter everyday until the lipiodol with fulfilling the tumors. Total forty times (average 2.5 individually)of interventional treatment were accomplished in these patients. Liver function and short-term effect after interventional therapy were observed. Results None of these 16 patients had serious liver function damage and recovered uneventfully after general protective care. PR and SD were achieved in 9 and 7 cases respectively,3 months after this interventional procedure. PD was not found. Conclusions Indwelling hepatic arterial catheter in fulfilling of lipiodol treatment for giant primary hepatic carcinomas is not only unlikely to cause serious liver function damage,but also can completely embolize the tumor quickly,therefore worthy to be recommended clinically.