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ObjectiveTo investigate the psychological tendency characteristics of vocational selection for college students with disabilities. MethodsA total of 155 college students with disabilities in four colleges and universities were investigated using Psychological Tendencies of Vocational Selection for College Students with Disabilities (PTVS). ResultsA total of 151 questionnaires returned finally. The principal component analysis extracted four factors, namely profession, capability, parental occupation and parental education, with a cumulative contribution rate of 74.98%. Clustering analysis clustered three categories, namely vocational capability and parental education dominated, profession and capability dominated, and profession dominated, which accounted for 20.5%, 31.1% and 48.3%, respectively. There were significant differences among the three categories in the dimensions of personal cognition, employment tendency, employment affect and employment will of PTVS (F > 7.021, P < 0.01). ConclusionThere are four dimensions of PTVS, i.e., the dimension of profession, the dimension of capability, the dimension of parental occupation and the dimension of parental education; while the PTVS could be divided into three categories, i.e., vocational capability and parental education dominated, profession and capability dominated, and profession dominated. For college students with disabilities, accurate career counseling and guidance should be provided according to the psychological structure of vocational selection and PTVS.
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Objective:To investigate the effects of dexamethasone-assisted ademetionine and ursodeoxycholic acid on pregnancy outcome and serum thyroid peroxidase antibody (TPOAb) and interleukin-12 (IL-12) expressions in patients with intrahepatic cholestasis (ICP) during pregnancy.Methods:A prospective randomized controlled study of 80 patients with ICP in Pingyang Hospital Affiliated of Wenzhou Medical University from April 2017 to April 2020 was selected. The patients were divided into the observation group and the control group using random number table, with 40 cases in each group. On the basis of conventional treatment, the control group was given ademetionine and ursodeoxycholic acid, and the observation group was given dexamethasone-assisted ademetionine and ursodeoxycholic acid. All patients were treated for 1 week. The efficacy, time of disappearance of symptoms, maternal and infant outcomes and liver function indexes aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bile acid (TBA), immune function indexes immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin G (IgG), serum TPOAb and IL-12 levels before and after treatment were compared between the two groups.Results:After treatment, the total effective rate in the observation group was higher than that in the control group: 95.0% (38/40) vs. 80.0%(32/40), the difference was statistically significant ( χ2 = 4.114, P<0.05). The disappearance time of jaundice and itching were shorter than those in the control group ( P<0.05). After treatment, the levels of serum AST, ALT, TBA, TPOAb, and IL-12 in the two groups were lower than before treatment, and the levels of above index in the observation group were lower than those in the control group: (57.49 ± 11.45) U/L vs. (83.70 ± 13.57) U/L, (87.61 ± 29.03) U/L vs. (126.24 ± 33.28) U/L, (13.24 ± 5.48) μmol/L vs. (21.39 ± 7.20) μmol/L, (9.18 ± 2.41) kU/L vs. (12.97 ± 2.73) kU/L, (11.37 ± 2.05) ng/L vs. (18.26 ± 2.54) ng/L; the levels of serum IgM, IgA and IgG in two groups were higher than before treatment, the levels of above index in the observation group were higher than those in the control group: (1.40 ± 0.09) g/L vs. (1.28 ± 0.11) g/L, (1.96 ± 0.14) g/L vs. (1.82 ± 0.12) g/L, (11.53 ± 2.80) g/L vs. (9.37 ± 2.59) g/L, the differences were statistically significant ( P<0.05). The incidence of cesarean section, premature delivery, postpartum hemorrhage, neonatal asphyxia, and intrauterine distress in the observation group were lower than those in the control group. Conclusions:Dexamethasone-assisted ademetionine and ursodeoxycholic acid treatment of ICP patients can improve liver function and immune function, reduce serum TPOAb and IL-12 levels, alleviate clinical symptoms and improve maternal and infant outcomes.
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Objective@#To explore the effect of pulsatile lavage on wound healing in diabetic foot ulcer patients.@*Methods@#The random number table method was used to divide 86 patients of diabetic foot ulcers into two groups with 43 patients in each group. The control group disinfected and cleaned the wound by routine methods, while the experimental group received closed pulse irrigation with sewage collection unit. The two groups were debridement, dressing selection and wound dressing in a unified way. The frequency of dressing change, time of dressing change, efficacy, cost of dressing changes, score of wound pain and wound healing were observed.@*Results@#The frequency of dressing change, dressing change time, wound healing time and total effective rate of the experimental group were (10.42±1.92) times, (12.19±2.37) min, (32.53±6.91) d and 86.04% (37/43), respectively, while those of the control group were (19.47±3.13) times, (21.65±3.99) min, (43.17±13.72) d and 51.16% (22/43), with statistically significant differences (t values were 4.545-16.127, χ2 value was 13.214, all P < 0.01). However, the cost of dressing change in the experimental group was (3 278.78±220.92) yuan, and that in the control group was (3 195.75±206.54) yuan. There was no significant difference between the two groups (t value was -1.814, P > 0.05). The pain scores were (1.47±1.09), (0.57±0.72), (0.06±0.23), (0.003±0.01) points in the experimental group at the 2nd week,the 4th week,the 6th week and the 8th week after intervention, and they were (3.83±1.16), (2.73±1.41), (1.92±1.06), (1.43±0.70) points respectively in the control group, the differences were statistically significant (Ftime=390.663, Fintergroup=76.011, Finteraction=4.210, all P < 0.01). The wound healing rates were (49.34±9.34)%, (86.26±13.33)%, (95.01±8.56)%, (97.28±3.62)% respectively in the experimental group in the 2nd week,the 4th week,the 6th week and the 8th week after intervention,while in the control group they were (26.64±5.19)%, (50.37±10.53)%, (64.84±12.27)% and (72.04±12.96)%. The differences between the two groups were statistically significant (Ftime=354.487, Fintergroup= 921.230, Finteraction =23.154, all P < 0.01).@*Conclusions@#Pulsatile lavage can effectively clean the wound, reduce the frequency of dressing change, shorten the time of dressing change and wound healing, reduce the wound pain, improve the wound healing rate of diabetic foot ulcers, and did not increase the economic burden of patients, which was worthy of clinical application.
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Objective:To analyze the auxiliary application strategy and efficacy of radiofrequency ablation (RFA) in laparoscopic anatomical hemihepatectomy (LAH).Method:The clinical data of consecutive patients who underwent RFA-assisted LAH from 5 hospitals including Beijing Chaoyang Hospital, Capital Medical University between January 2016 and January 2020 were retrospectively reviewed.Results:Among the 32 patients, there were 21 males and 11 females. The age range is 32 to 77 years, with a median age of 52 years. There were 18 cases of hepatocellular carcinoma, including 16 cases of single lesion and 2 cases of two lesions, with the maximum tumor diameter of (5.6±1.2) cm. There were 12 cases of metastatic liver cancer, including 8 cases of single lesion, 3 cases of two lesions, 1 case of three lesions, and the maximum tumor diameter (4.7±1.6) cm. Primary hepatolithiasis: 2 cases. Right hemihepatectomy was performed in 23 cases and left hemihepatectomy in 9 cases. No conversion to laparotomy. The operation time of right hemihepatectomy was (310.0±22.0) min, and left hemihepatectomy was (285.0±25.0) min. Intraoperative hemorrhage (330.0±28.0) ml. No patients received intraoperative infusion of human red blood cell suspension. Postoperative reactive pleural effusion occurred in 6 cases, biliary fistula in 3 cases, wound infection in 1 case, and cross section effusion in 1 case, all of which recovered after conservative treatment. No postoperative abdominal bleeding and liver insufficiency. Postoperative hospital stay (9.5±3.2) d. The follow-up time was 1-42 months, and the median follow-up time was 20 months. During the follow-up period, 17 (56.7%) of the 30 patients with malignant tumor experienced tumor recurrence, no sectional tumor recurrence, and no death.Conclusions:RFA has a variety of auxiliary applications in LAH, including prevention and treatment of liver cancer rupture during mobilization of liver, treatment of small bleeding blood vessels during liver transection, and help in securing safe and adequate resection margins.
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Objective:To study the timing of radiofrequency ablation (RFA) in treatment of complicated pyogenic liver abscesses (PLA).Methods:A retrospective analysis was performed on 49 patients with complicated PLA who were treated with the RFA-based treatment modality from August 2010 to January 2020 at Beijing Chaoyang Hospital, West Campus, Capital Medical University, Institute of Hepatobiliary, Pancreas and Spleen Surgery and the Second Hospital, Binzhou. The patients were divided into the early RFA group (≤ 72 h, n=27) and the delayed RFA group (>72 h, n=22) according to the timing of RFA. RFA was guided by laparoscopy combined with Ultrasound or CT. The safety and effective rates of RFA, and the total expenses were evaluated. Results:All patients in both the early and the delayed RFA groups were successfully cured (100%). No serious complications, including biliary leakage and massive hemorrhage, happened in the 2 groups. Significantly longer operating time and hospital stays [(8.1±1.6)d vs. (9.5±1.5)d], and higher hospital costs [(3.4±0.2) ten thousand yuan vs. (3.8±0.4) ten thousand yuan] were found in the delayed RFA group when compared with the early RFA group ( P<0.05). Conclusion:RFA treatment of complicated PLA should be completed within 72 hours of onset of PLA.
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Objective:To explore the influencing factors of long-term survival for hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA).Methods:A retrospective analysis of 255 patients who underwent RFA as the main treatment modality for HCC from May 1, 2004 to Feb 28, 2015 was performed. All patients were divided into two groups according to the postoperative survival time: the 5-year or more survival group and the less than 5-year survival group. Clinical indicators such as age, maximum tumor size and number, and frequency of radiofrequency ablation were compared between the two groups. Cox single factor and multiple factors were used to analyze the influencing factors of long-term survival.Results:The median overall survival of all the 255 patients was 4.3 years (range 0.5-15.5 years). There were 115 patients (45.1%) who survived for 5 years or more and 140 patients (54.9%) who survived for less than 5 years. The 1-, 3-, 5-, and 10-year survival rates of all the patients were 86.7%, 61.2%, 44.8% and 34.8%, respectively. There were no significant differences in gender, age, accompanying symptoms, aetiology of liver disease, level of alpha fetoprotein and treatment ( P>0.05), but there were significant differences in Child-Pugh class, liver cirrhosis, maximum diameter of tumor, tumor number, tumor stage, and frequency of RFA ( P<0.05) between the 2 groups of patients. Multivariate analysis showed that age ≥70 years old, Child-Pugh class B, maximum diameter of tumor >5.0 cm, multiple tumor were independent risk factors of long-term survival, but the number of sessions of RFA was a protective factor. Conclusions:For medium sized HCC and solitary large HCC, RFA combined with other therapeutic modalities could achieve satisfactory therapeutic results. Age, Child-Pugh class, maximum diameter of tumor, tumor number and RFA frequency were influencing factors for long-term survival of HCC patients.
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Objective:To explore the effect of pulsatile lavage on wound healing in diabetic foot ulcer patients.Methods:The random number table method was used to divide 86 patients of diabetic foot ulcers into two groups with 43 patients in each group. The control group disinfected and cleaned the wound by routine methods, while the experimental group received closed pulse irrigation with sewage collection unit. The two groups were debridement, dressing selection and wound dressing in a unified way. The frequency of dressing change, time of dressing change, efficacy, cost of dressing changes, score of wound pain and wound healing were observed.Results:The frequency of dressing change, dressing change time, wound healing time and total effective rate of the experimental group were (10.42±1.92) times, (12.19±2.37) min, (32.53±6.91) d and 86.04% (37/43), respectively, while those of the control group were (19.47±3.13) times, (21.65±3.99) min, (43.17±13.72) d and 51.16% (22/43), with statistically significant differences ( t values were 4.545-16.127, χ2 value was 13.214, all P < 0.01). However, the cost of dressing change in the experimental group was (3 278.78±220.92) yuan, and that in the control group was (3 195.75±206.54) yuan. There was no significant difference between the two groups ( t value was -1.814, P > 0.05). The pain scores were (1.47±1.09), (0.57±0.72), (0.06±0.23), (0.003±0.01) points in the experimental group at the 2nd week,the 4th week,the 6th week and the 8th week after intervention, and they were (3.83±1.16), (2.73±1.41), (1.92±1.06), (1.43±0.70) points respectively in the control group, the differences were statistically significant ( F time=390.663, F intergroup=76.011, F interaction=4.210, all P < 0.01). The wound healing rates were (49.34±9.34)%, (86.26±13.33)%, (95.01±8.56)%, (97.28±3.62)% respectively in the experimental group in the 2nd week,the 4th week,the 6th week and the 8th week after intervention,while in the control group they were (26.64±5.19)%, (50.37±10.53)%, (64.84±12.27)% and (72.04±12.96)%. The differences between the two groups were statistically significant ( F time=354.487, F intergroup= 921.230, F interaction =23.154, all P < 0.01). Conclusions:Pulsatile lavage can effectively clean the wound, reduce the frequency of dressing change, shorten the time of dressing change and wound healing, reduce the wound pain, improve the wound healing rate of diabetic foot ulcers, and did not increase the economic burden of patients, which was worthy of clinical application.
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Benign occupations of the liver (BOL) are a heterogeneous group of benign hepatic lesions,a minority of which may need active management.It's reported that radiofrequency ablation (RFA) can be used to treat BOL,such as hepatic haemangioma,focal nodular hyperplasia (FNH),hepatocellular adenoma,simple hepatic cyst,liver abscess and hepatic echinococcosis.RFA has exhibited a potentiality to replace resection as the first-line treatment option for hepatic haemangioma.For multiloculated intractable simple hepatic cyst or liver abscess,when patients are not suitable for or refuse surgical resection,RFA may be an alternative option for the resection;and it also has many advantages over resection,including effectiveness,safety,minimal invasiveness and repeatability in the treatment of FNH,hepatocellular adenoma,and hepatic echinococcosis.A review will be presented on the current situation and latest progression of RFA therapy for BOL in this article.
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Objective To evaluate the efficacy of radiofrequency ablation (RFA) in treatment of complicated pyogenic liver abscess (PLA).Methods A retrospective analysis was conducted on 20 patients with complicated PLA treated from August 2010 to January 2018 in the West Campus of Beijing Chao-yang Hospital which is Affiliated to the Capital Medical University and Rizhao Central Hospital of Shandong Province.These patients were treated with RFA based treatment modalities using CT-guided or laparoscopy combined with Ultrasound-guided RFA.The successful rate,efficacious rate and safety of RFA were respectively analyzed.Routine follow-up was carried out after treatment.Results The successful rate of RFA was 100％.The median operation time was 45 minutes.All the 20 patients were cured by one session of RFA.The multilocular lesion in one patient was converted to a unilocular lesion after one session of RFA.The patient was then cured by percutaneous hepatic abscess drainage.No serious complications were observed.Conclusions RFA was safe and efficacious.It should be considered as an alternative treatment for patients with complicated PLA who were not responsive to,or not applicable to antibiotics treatment and radiological intervention.
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Objective To evaluate the efficacy and clinical outcomes of early laparoscopic radiofrequency ablation(RFA) forspontaneously ruptured hepatocellular carcinoma (HCC).Methods A retrospective analysis was conducted on 12 patients with spontaneously ruptured HCC treated by laparoscopic RFA from April 2005 to June 2018 in the West Campus of Beijing Chao-yang Hospital,Capital Medical University.The successful rate,safety,peritoneal recurrence rate,complete ablation rate and survival rate of RFA were respectively analyzed.Results The median size of the 12 HCC cases was 5.85 cm (4.0-10.1 cm) in the maximal dimension.Procedures of laparoscopic RFA ablation were performed successfully for all patients.Complete ablation was achieved in 58.3％patients (7/12).Five patients with incompletely ablated tumors received repeated RF ablation to achieve completeablation.Four patients (33.3％) developed minor complications(Dindo-Clavien grade Ⅰ).The mean follow-up of 36.8 months,4 patients (33.3％) were alive and 8 (66.7％) died.Of the 12 patients,the 1-and 3-year survival rates were 90.0％ and 60.0％,respectively.No patient had peritoneal recurrence.Conclusion Early laparoscopic RFA therapy is an minimally invasive,safety and effective treatment measure for spontaneouslyruptured HCC in selected patients,which presents an advantage of achieving simultaneous hemostasis,tumorelimination,and rinsing of peritoneal cavity to minimize the risk of peritoneal metastasis.
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Objective To investigate the effect of the balloon Bionic midwifery on the delivery outcomes and to analyze the clinical value.Methods 1 683 parturients from June 2014 to May 2015 were selected.They were randomly divided into observation group (832 cases,applied balloon Bionic Midwifery) and control group 851 cases.We compared the labor,the postpartum hemorrhage,the outcomes of pregnancy and the rate of survival of neonates of the two groups.Results The first and second stage as well as the total stage of labors of the observation group were lower than the control group (P＜0.01);Also,the rate of cesarean delivery and the hemorrhage together with the asphyxia of neonates were lower than the control group (P＜0.01).However,the rate of vaginal delivery was higher than the control group (P ＜0.05).The differences between them had a great statistical significance.Conclusions The balloon bionic midwifery technology has an advantage in reducing the rate of cesarean delivery and the maternal pain of pregnant women as well as the maternal complications.It is an effective and safe midwifery technology.So it has a great value of spreading in clinical trials.
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Objective To assess the safety and efficacy of radiofrequency ablation (RFA) for the treatment of large (≥5 cm in diameter) hepatic hemangiomas.Methods Clinical data of 50 patients with large hepatic hemangiomas (≥5 cm in diameter) treated with RFA between October 2007 and December 2012 were analyzed.Patients were divided into two groups (5-10 cm and ≥ 10 cm) according to tumor size.Results Thirty-two patients had 36 hemangiomas of 5-10 cm in diameter and 18 patients had 19 hemangiomas of ≥ 10 cm in diameter.Technical success,complications related to RFA,completed ablation,symptom relief,change in size of ablation zone and recurrence of the residual tumor were analyzed.The average diameters of the two groups were 7.1 ± 1.2 cm and 13.2-± 2.4 cm separately (t =-12.57,P ＜ 0.01) ; the technical achievement ratios of the two groups were both 100％ ; Seven of 32 patients with hemangiomas 5-10 cm and all the 18 patients with hemangiomas ≥ 10 cm had 13 and 61 complications related to RFA,the incidence of complications were 21.88％ and 100％ respectively (x2 =28.13,P ＜ 0.01); 94.55％ hemangiomas (52/55) acquired complete ablation,the complete ablation rates of 5-10 cm hemangiomas and ≥10 cm hemangiomas were 100％ (36/36) and 84.21％ (16/19) respectively (P =0.014).The mean diameters of ablation zone were respectively decreased to 5.3 ± 1.0 cm and 10.62±1.8 cm (t =-14.30,P ＜0.01).Conclusions RFA for hepatic hemangiomas 5-10 cm in diameter is safe and effective; while its complication for ablation of hemangiomas ≥ 10 cm is high.
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A rarely reported postoperative complication following biliary surgery,and to discuss its possible mechanism.This article summarizes I reported HSB case that developed after laparoscopic cholecystectomy in our department and 9 other cases reported in literature.HSB occurred most frequently after simple cholecystectomy in addition to post operative bile duct exploration with cholecystectomy or endoscopic retrograde cholangiopancreatography.The main clinical presentation of HSB was paroxysmal colic in the upper abdomen early in the postoperative period,which could be induced after a meal.Imaging revealed subcapsular hepatic fluid collection,and successful treatment involved placement of a percutaneous drain in the biloma.The mechanism of HSB still needs to be clarified even though it is a rarely reported postoperative complication following biliary surgery.We hypothesize,after analyzing these 10 cases,that sphincter of Oddi dysfunction after biliary surgery and the subsequent persistence of high biliary system pressure may be the root cause of HSB formation.More awareness should be paid to the changes of the sphincter's motility after biliary surgery and its related complications (biliary colic,HSB etc.).
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Objective To observe the clinical effect of singulair (montelukast sodium chewable tablets) combined with Zithromax(Azithromycin for Suspension) in treatment of children with asthma.Methods 86 children with asthma were randomly divided into control group and observation group,each group 43 cases,observation group was treated with singulair and zithromax,and control group was only treated with singulair.Before and after treatment,pulmonary function and clinical efficacy were observed.Furthermore,clinical symptoms disappearance time and the incidence of adverse reactions were also observed.Results After teratment,FEV1 and PEF in observation group were significantly higher than control group(P ＜ 0.05).The total effective rate in observation group and control group were 97.7％ and 88.9％,respectively.The difference between two groups was statistically significant(P ＜0.05).Observation group coughing,shortness of breath and wheeze and other symptoms disappeared time were shorter than the control group(P ＜ 0.05).Adverse reactions between the two groups had no significant difference (P ＞ 0.05).Conclusion Singulair combined with zithromax in the treatment of chronic pelvic inflammatory disease with a better therapeutic effect.It was worthy of clinical application.
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ObjectiveTo summarize the occurrence of missed diagnosis of periampullary diverticulum (PAD) with pancreatobiliary diseases and analyze its underlying reasons.MethodsWe conducted a retrospective analysis of 194 patients with PAD complicated with pancreatobiliary diseases from January 2006 to December 2011 in our hospital ResultsAt the first onset of pancreatobiliary diseases,the diagnosis of PAD was made in 48 patients (correct diagnosis group) and missed in 146patients (missed diagnosis group),with a rate of missed diagnosis of 75.3％.At the second,third and fourth onsets of pancreatobiliary diseases in the missed diagnosis group patients,the rates of missed diagnosis were 37.7％,21.8％,and 0％ respectively.There were no significant differences between the correct diagnosis group and the missed diagnosis group with respect to sex,age or the kinds of pancreatobiliary diseases (P＞0.05).But there were significant differences in the two groups with respect to different medical groups,period of admission,the frequency of application of CT,magnetic resonance (MRI) and magnetic resonance cholangiopancreatography (MRCP),duodenal endoscopy/endoscopic retrograde cholangiopancreatography (ERCP) and upper gastrointestinal contrast radiography (P＜0.05).The accuracy rates of CT,MRI,MRCP,upper gastrointestinal contrast radiography and duodenal endoscopy/ERCP for the diagnosis of PAD were 30.0％,31.5％,36.3％,64.5％ and 100.0％ respectively.At the first,second,third and fourth onset of pancreatobiliary diseases,the application rates of duodenal endoscopy/ERCP were 18.0％,33.6％,70.9％ and 91.7％,respectively.Compared with the missed diagnosis group,recurrence rate of symptom were lower significantly in the diagnosis group 1,2,and 3 years post-treatmnet.ConclusionsThe missed diagnosis of PAD complicated with pancreatobiliary diseases is rather common,mainly due to insufficient understanding for PAD.As a result,for PAD patients with pancreatobiliary diseases,the correct diagnosis rates of CT,MRI,MRCP and upper gastrointestinal contrast are low and the use of duodenal endoscopy/ERCP is insufficient.
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Objective To explore experimently the effect of tumor angiogenesis on rapid progression of residual tumor of liver cancer after radiofrequency ablation ( RFA). Methods A rabbit VX2 hepatoma model was established. Inoculated tumors were treated by using RFA at 55 ℃ , 70 ℃ and 85 ℃ respectively to establish the residual VX2 hepatoma model. Rabbits implanted with VX2 hepatoma but receiving no RFA treatment served as controls. The expression of vascular endothelial growth factor (VEGF)was determined in tumors to assess the relationship between VEGF and the focal tumor volume and distant metastasis. The expression of VEGF and microvessel density ( MVD) in tumor tissues was assessed by immunohistochemistry. The protein expression of VEGF was assessed by Western blot. The expression of VEGF mRNA was detected by RT-PCR. Results There were significant differences of the local tumor volume between the control group (9.91 ±0.98) cm3 and the other groups (respectively t = -17.43,-10.11, -8.79,all P<0. 05). Compared with the 70 ℃ group (17. 08 ±2. 28 ) cm3 and the 85 ℃ group (15.95 ±4.95) cm3, the focal tumor volume of 55 ℃ group was the largest (21.26 ±2.32) cm3,( respectively t = 4. 69,6. 78, all P<0. 05). Much more metastatic lesions of lung were observed in the RFA treated groups in comparison to the control group. Moreover, the lung metastasis in 55 ℃ group was the most serious among the three RFA treated groups (respectively t = -21.65, -30. 15, all P<0. 05 ).Immunohistochemical staining indicated that the expression of VEGF and MVD in the RFA treated groups was much higher than those in control group ( MVD respectively t = -13.01, -5. 46, -5. 63, all P<0. 05), ( VEGF respectively t = 8. 00,4. 92,4. 21, all P<0. 05 ). Furthermore, the expression of both VEGF protein and VEGF mRNA in 55 ℃ group was the highest among the three RFA treated groups.Conclusions The over-expression of VEGF accelerating the tumor angiogenesis may be one of the mechanisms inducing rapid progression of residual liver tumor after RFA.
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Radiofrequency ablation (RFA) has been recognized as a curative therapeutic modality for hepatocellular carcinoma (HCC) for its increasing efficacy in the recent more than ten years. However, RFA has not been generally carried out in our country and the efficacy still waits for improvement. This paper presents a systemic discussion on the technical measures to promote the efficacy of RFA for HCC from the surgeon's perspective, aiming to provide technical standard and reference for the further popularization and application of RFA in China. The 13 measures include clarification of the tumor location and extent, following the indications and contraindications of RFA, scientific application of pretreatments, selection of the best approach of RFA and of the reasonble guiding method for percutaneous RFA, selection of suitable RFA probe, adequate analgesia, sufficient ablative margin to guarantee pathological complete ablation,optimization of ablaiton strategy, active prevention, diagnosis and treatment of complications, correct evaluation of complete ablation, standadized follow-up and selection of RFA to treat the local tumor progression and intrahepatic occurrence.
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Objective To retrospectively evaluate the role of consolidative repeat radiofrequency ablation (CRRFA) based on safety margin (SM) analyses in local tumor control for alpha-fetoprotein (AFP) negative hepatocellular carcinoma (HCC) patients who had been shown to have radiological complete ablation (CA) with radiofrequency ablation (RFA). Methods From July 2002 to July 2009,152 AFP negative HCC patients who were shown to have radiological CA with RFA therapy were retrospectively analyzed. Among them, 110 patients had a SM of less than 1 cm and the other 42 patients had a SM of 1cm or more. Among 110 patients with SM less than 1 cm, fifty nine patients accepted CRRFA within 6 months after the first RFA and 51 did not. From these patients, a narrow SM-CRRFA group (n=41) and a narrow SM-single RFA group (n=37) were enrolled respectively. The wide SM-single RFA group (n= 30) was enrolled from the 42 patients with a SM of 1 cm or more.The LTP (local tumor progression)-free survival rate of the 3 groups were compared with a log-rank test. Results One-, two-, three-, four-, and five-year LTP-free survival rates respectively were 97. 1%, 90.9%, 69.6%, 47.2%, and 33. 0% in the narrow SM-CRRFA patients. 85.9%, 66. 5%,43.5%, 15.8%, and 0. 0%, in the narrow SM-single RFA patients, and were 92.7%, 83.7%,59.3%, 36. 9%, and 9.2% in the wide SM-single RFA patients. There were statistically significant differences (χ2 = 14. 789, P= 0. 001) between the groups. Conclusions An ablation zone with an SM of 1 cm or greater was the most important factor for local control of AFP negative HCC ranging from 3 to 5 cm in diameter. For these patients with a SM of less than 1 cm, CRRFA improved the overall local control outcomes.
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Objective To summarize the reasons of mis-diagnosis and mis-treatment of autoimmune pancreatitis (AIP). Methods Clinical data of 17 patients with AIP,who were admitted to the hospital from May 2005 to July 2010 and experienced mis-diagnosis and mis-treatment, were retrospectively analyzed. Results The main clinical manifestations included epigastric pain (13 cases),progressive obstructive jaundice (12 cases), fever (6 cases) and weight loss (9 cases). Fifteen patients had extrapancreatic organ involvemnet, including allergic rhinitis, swelling of lymphoglandulae submaxillares, swelling of submaxillary gland, allergic asthma, rheumatoid arthritis, Sjogren syndrome, diabetes mellitus, primary sclerosing cholangitis and autoimmune hepatitis. Of these 17 cases, 11 cases presented with high serum globulin, 14 cases with high serum IgG, 13 cases with high serum γ-globulin, 13 cases with positive anti-nuclear antibody and 2 cases with positive anti-insulin IgG antibody. The abdominal imaging demonstrated that 15 patients had diffuse enlargement of the pancreas with diffuse or segmental narrowing of main pancreatic duct, narrowing of the intrapancreatic common bile duct, dilation of the proximal biliary duct and gallbladder enlargement. Focal enlargement of the pancreas was found in 2 cases. Thirteen cases were misdiagnosed as pancreatic carcinoma. Among them, 4 cases underwent pancreaticoduodenectomy and 7 cases underwent choledochojejunostomy. Two cases were misdiagnosed as end stage of cancer that lost therapeutic chance. Another 4 cases were misdiagnosed as chronic pancreatitis. Steroid therapy was administered in all patients with satisfactory response. All patients were followed-up for 15 months (ranged from 6 months to 45 months), and recurrence was found in 4 cases. Satisfactory response was found in patients treated with steroid for the second time. No pancreatic cancer was found in these patients in the follow up period. Conclusion The main causes of mis-diagnosis and mis-treatment of AIP may be contributed by difficulty in differentiating AIP from pancreatic carcinoma based on clinical manifestations and inadequate knowledge of AIP as well as insufficient attention to AIP in China.
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Objective To compare short-term therapeutic outcomes and the safety of percutane-ous radiofrequency ablation (PRFA) with left single lung ventilation (LSLV) for liver cancer of the hepatic dome (LCHD) and that of PRFA for right liver carcinoma in favorable location. Methods Thirty one patients with hepatocellular carcinoma (belonging to LCHD) receiving PRFA with LSLV (Group LCHD) between January 2006 and January 2009 in our hospital were selected, and 45 control patients with right lobe HCC ≥1 cm away from the liver capsule, gallbladder, and main portal bran-ches were also included. One month after PRFA, residual tumors were followed up with contrast en-hanced CT and alpha fetal protein and PRFA was repeated in the presence of residual foci. Tumor-free survival time was defined as the duration from complete ablation to diagnosed local tumor progression.The Mann-Whitney test was used to compare age, tumor diameter, and average number of punctures between LCHD patients and controls. A χ2 test was used for comparison of the incidence of complica-tions and incomplete tumor ablation rate. The Kaplan-Meier's method was used for calculation of local tumor-free survival rate compared with a log-rank test. Results The incidence of right shoulder pain was significantly higher in LCHD patients than in controls (87. 1% vs 11. 1%, P<0. 01). LCHD pa-tients showed no difference from controls in the average number of punctures (2. 8±. 5 vs 3. 2±. 5,P>0. 05). Meanwhile, there was no difference between the 2 groups in average duration of treatment and hospitalization, and the complete tumor ablation rate at first PRFA. No differences were observed in the 1-, 2- and 3-year local tumor-free survival rates between LCHD patients (85. 5% , 65. 8% , and 36. 4% ,respectively) and controls (87.7%, 62. 3% , and 34.0% , respectively). Conclusion PRFA with LSLV for LCHD seems to promise comparable short-term outcomes and safety to PRFA for right liver carcinoma of fa-vorable location and should be preferred as one of the therapeutic options for LCHD patients with tumor di-ameters≤5 cm regardless of its unique location.