Intrahepatic arterioportal shunts：an annotation of the functional shunts / 介入放射学杂志

In this paper, all the intrahepatic arterioportal shunts (IHAPSs) that result from the functional redistribution of hepatic arterial and portal venous blood flow are defined as functional IHAPSs (F-IHAPSs) so as to make the differentiation from organic IHAPSs (O-IHAPSs) that result from the intrahepatic arterioportal fistula or direct communication, such as those IHAPSs that are associated with advanced hepatocellular carcinoma (HCC) and other malignant hepatic tumors as well as those IHAPSs that are accompanied by congenital hepatic vascular malformations, hereditary hemorrhagic telangioectasia (HHT) and liver trauma (including iatrogenic injury), etc. In F-IHAPSs, the most common one is formed by the compensatory (or secondary) increase of arterial blood flow that is caused by the decrease of hepatopetal portal blood flow due to a variety of reasons; its formation mechanisms can be divided into three categories:(1) trans-sinusoidal type, such as the F-IHAPSs that is associated with cirrhosis;(2) post-sinusoidal type, such as the F-IHAPSs that is accompanied with the acute stage of Budd-Chiari syndrome; and (3) pre-sinusoidal type, such as the F-IHAPSs that occurs along with the gastrointestinal hemorrhagic shock. Another kind of F-IHAPSs has been commonly seen in some hepatic diseases that have primary increase of hepatic arterial blood flow, including hypervascular hepatic cavernous hemangioma, small hepatocellular carcinoma that has rich blood supply, hepatobiliary inflammatory diseases, etc.;and in this paper they are all classified as F-IHAPSs category, however, the formation mechanisms of such F-IHAPSs vary with their basic diseases. Clinically, imaging diagnosis of F-IHAPSs can be made based on the following three signs:(1) all kinds of hepatic diseases that have concomitant intrahepatic arterioportal fistula or direct communication, as mentioned above, have been definitely excluded:(2) hepatic artery DSA reveals early visualization of portal vein in arterial phase, known as the characteristic sign of F-IHAPSs;and/or: (3) hepatic dynamic enhanced CT/MR scanning demonstrates transient enhancement of liver parenchyma in arterial phase, especially early visualization of portal vein is also present; in this case the diagnosis of F-IHAPSs can be undoubtedly confirmed. However, in making differential diagnosis, F-IHAPSs must be carefully differentiated from O-IHAPSs, local hepatic parenchymal perfusion caused by hepatic aberrant vein or by abnormal hepatopetal draining vein from systemic circulation, etc. In addition, when cirrhosis-related transient hepatic parenchymal enhancement presents as a solitary small nodule, differentiation with small HCC should be taken into consideration. In order to provide the readers with a complete and up-to-date understanding of F-IHAPSs, the relevant example illustrations, figures and graphics are accompanied with the text.

The new generation drug- eluting stents and their effects of anti- thrombosis / 介入放射学杂志

This paper aims to make a comprehensive review about the new generation drug-eluting stents and their effects of anti-thrombosis to decrease stent thrombosis (ST), which are very helpful for interventional radiologists, especially for cardiologists who are engaged in percutaneous coronary interventional therapy. Based on the review of recently published academic papers and the investigation of the manufacturers and market of stent, the main factors related to ST complication which is associated with new generation drug-eluting stents are retrospectively and briefly analyzed. Besides, a variety of new generation drug-eluting stents with anti-thrombosis effect that are being successfully developed recently with new technology and new materials, including the renewal or improvement of the stent platform, loaded drug, carrier and its loading technology, etc. are comprehensively described in this paper in a combination way of vivid pictures with corresponding essay. In addition, the development and the prospect in clinical application of biodegradable drug-eluting stents are also briefly discussed in this paper.

Experimental study on pulp revitalization of Beagle dog's immature permanent teeth after pulpectomy / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To observe the process of pulp revitalization of immature permanent teeth after pulpectomy.</p><p><b>METHODS</b>Thirty-two single-rooted teeth with open apices from 4 Beagle dogs aged 4 months were included in the study. The pulpal tissues of 8 front teeth with single root of each dog were removed, and a blood clot was produced to the level of the cementoenamel junction followed by a double seal of mineral trioxide aggregate and composite resin. At day 7, 14, 21 and 28, respectively after operation, the dog was sacrificed, and then longitudinal paraffin sections were made for histologic investigation.</p><p><b>RESULTS</b>After 7 days, about one thirth of the pulp chamber had an ingrowth of new tissue. After 14, 21, 28 days, there were more and more new tissue in the chamber. This new tissue consisted of well-organized and well-vascularized connective tissue. Hard tissue was too observed in the root canal. In some cases, the newly generated hard tissue even deposited against the canal dentinal walls.</p><p><b>CONCLUSIONS</b>The pulp of immature permanent teeth can revitalize after removal of the original pulp tissue under suitable conditions.</p>

Nanoleakage at the resin-dental interface of four self-etching adhesives / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the nanoleakage and ultramorphology of four self-etching adhesives.</p><p><b>METHODS</b>Sixteen freshly extracted, caries-free human third molars were selected. A flat dentin surface was exposed by removing occlusal enamel. All teeth were randomly divided into four groups acorrding to four different self-etch adhesive: Adper Prompt (A), iBond (B), Xeno III (C) and SE Bond (D). The dentin were bonded with dentin adhesive system according to manufacturer's directions. Composite layers were built up incrementally. The specimens were sectioned longitudinally across the resin-dentin interface into 4.0 mm×0.9 mm sticks and then traced with ammoniacal silver solution. Epoxy resin-embedded sections were prepared for transmission electron microscope (TEM) to observe nanoleakage. The images were qualitatively compared by NIH software, and data was analyzed by SPSS.</p><p><b>RESULTS</b>Different thickness of hybrid layer and adhesives layer were observed for each adhesive. The hybrid layer of A, C was thicker than that of B, D, and adhesive layer of D was thicker than the others. The extent of nanoleakage varied among different adhesives: A (45.02 ± 9.49), B (43.97 ± 8.55), C (27.02 ± 10.86), D (12.94 ± 2.07). D presented significantly less silver deposition than any of the others did (P < 0.05).</p><p><b>CONCLUSIONS</b>The thickness of hybrid layer and adhesive layer vary among the four adhesives. The shape and extent of nanoleakage of each adhesive are also different. Two-step system shows less nanoleakage than one-step systems do.</p>

Evaluation of long-term effect of hepatic arterial embolization with pingyangmycin-lipiodol emulsion in patients with hepatic cavernous hemangiomas / 中华放射学杂志

Objective To evaluate the long-term effect of hepatic arterial embolization with pingyangmycin-lipiodol emulsion (PLE) in patients with cavernous hemangiomas of the liver (CHL)and its influence factors.Methods One hundred and fifty-six hemangiomas that were diagnosed by imaging examinations or confirmed pathologically by surgery in 105 patients with integral follow-up data were analyzed retrospectively in this paper.All hemangiomas were divided into 4 groups according to their size (the largest size of hemangioma)by the authors as follows; A group(≤3 cm, n=25); B group(>3 cm and<5 cm, n =32) ;C group(≥5 cm and<10 cm, n=58); and D group(> 10 cm, n=41) .According to the number of abnormal sinusoids filled with the contrast medium in the angiography, 156 hemangiomas of this series were further classified as three types: abundant type (n=90) ; sparse type (n=9) and the middle type (n=57) .Hepatic arterial embolization with PLE was performed in the 105 patients with total 135 procedures (including single procedure in 75 patients, twice procedures in 30 patients).All of the 105 patients were followed up 3 to 8 years(mean 4 years) using US, CT or MRI or DSA.The criteria for the evaluation of curative effect were classified as best, good, recovery and no change in this series, and the sum of best and good effects were defined as the total effective rate.Then, the total effective rate of single procedure between the A, B groups and C, D groups; and the total effective rate of single procedure and twice procedures in the D groups, were compared statistically by X~2 test respectively.And the influence factors, included of the variant size of hemangiomas, abundant or sparse of abnormal sinusoids and the number of treatment procedures, were also analyzed and evaluated respectively.Results The total effective rate of the 156 hemangiomas in 105 patients was 92.95% (145/156).After single procedure of hepatic arterial embolization with PLE, the total effective rate of A and B groups were 100% (57/57), that of C and D groups were 85.86% (85/99), and the difference reach significant (X ~2=8.8553, P<0.01).In the D group, the total effective rate in group with twice procedures (100.00%,30/30) was significant higher (X~2 =5.2642,P<0.05) than those of group with single procedure (72.73%,8/11).Of this series, during the period of following-up, no recurrent or severe complications were observed.Conclusions A best long-term curative effect (complete cure) is usually obtained in the small hemangiomas with abundant abnormal sinusoids, and a satisfactory long-term curative effect can also be achieved in the larger or multiple hemangiomas, particularly in those hemangiomas with abundant abnormal sinusoids by using the repeat procedures of hepatic arterial embolization with PLE.

Effects of body mass index and age on the treatment of in vitro fertilization-embryo transfer among patients with non-polycystic ovarian syndrome / 中华流行病学杂志

Objective To investigate the impacts of body mass index (BMI) and age on in vitro fertilization-embryo transfer (IVF) and intracytoplasmic sperm injection (ICSI) treatment in infertile patients without polycystic ovary syndrome (PCOS). Methods A retrospective study of 1426 patients during Jun. 2001 - Nov. 2009 was carried out. Multiple regression was used to analyze the effects of BMI (low weight: BMI＜18.5 kg/m2, normal weight:BMI 18.5-23.99 kg/m2 and over weight-obesity: BMI≥24 kg/m2) and age (young: 20-34 years old, eld: 35-45 years old) on controlled ovarian stimulation (COH)[including:dose and duration of Gn, E2 level on day of human chorionic gonadotropin (HCG) administration, number of oocytes collected and full-grown follicles ],number of fertilization, cleavage, two-pronucleus, normal embryos and cryopreserved embryos and clinical pregnancy outcome. Results ( 1 ) Gn dose for the patients whose age were 35 and the above,had a positive correlation with age (P＜0.001), 12.70% of the total variation of Gn dose was related to age (standardized partial regression coefficient was 0.343). (2) Estradiol level on day of HCG administration had a negative correlation with BMI in overweight-obesity patients, and so were the patients whose age were 35 and above (P value respectively lower than 0.037 and 0.018). 0.80% of the total variation of estradiol (HCG day) is related to age and overweight-obesity while age took greater proportion (standardized partial regression coefficients were 0.066 and 0.058 respectively). (3)For older patients, age appeared to have negative relationships with duration of Gn and number of oocytes collected, full-grown follicles, fertilization, cleavage, two-pronucleus, normal embryos and cryopreserved embryos (P＜0.05). (4)Compared to young-normal weight patients, the odds ratio of pregnancy in eld-low weight and eld-overweight-obesity patients were 0.482 and 0.529 (P＜0.05)respectively. Conclusion Age, but not the BMI, had significant effects on IVF/ICSI treatment. It seems that factors as losing weight before IVF or ICSI treatment effective in reducing the dose of Gn.

Evaluation of sealing ability of three kinds endodontic materials as root canal sealers / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To compare the apical microleakage of Vitapex (calcium hydroxide based paste) with that of AH-plus and zinc oxide eugenol sealer when used with laterally condensed gutta percha obturation technique.</p><p><b>METHODS</b>One hundred single rooted human anterior teeth were instrumented and randomly divided into three experimental groups (A, B, C) of 30 teeth each and two control groups (D, E) of 5 teeth each. Group A was filled with laterally condensed gutta-percha using Vitapex as sealer. Group B was filled with laterally condensed gutta-percha using AH-plus as sealer. Group C was filled with laterally condensed gutta-percha using zinc oxide eugenol as sealer. Group D was the positive control. Group E was the negative control, which were coated with nail polish to entire root surface. Teeth were then suspended in 2% methylene blue. After this, teeth were demineralized dehydrated and cleared. Linear dye penetration was determined under stereomicroscope with calibrated eye piece.</p><p><b>RESULTS</b>The mean dye penetration for group A, B, C were respectively (0.57 +/- 0.56) mm, (0.79 +/- 0.96) mm and (1.07 +/- 1.12) mm. Group D demonstrated maximum dye penetration. Group E showed no dye penetration. There was no statistically significant difference between group B and group C (P > 0.05). However, there was statistically significant difference between group A and group B, C (P < 0.01).</p><p><b>CONCLUSION</b>This study showed that Vitapex used as endodontic sealer material are better than AH-plus sealer and zinc oxide eugenol sealer.</p>

Severe complications associated with transcatheter hepatic arterial chemoembolization / 介入放射学杂志

Transcatheter hepatic arterial chemoembolization (THACE)has been widely used in the treatment of advanced primary hepatic carcinoma (PHC)and metastatic hepatic carcinoma (MHC). Although the incidence of severe complications associated with THACE is unusual (0% ～ 5% ),its prognosis is generally worse and mortality is higher than that of postembolization syndrome.Therefore,to minimize the risk associated with THACE has to be achieved through the understanding of these severe complications related to the selection of indication,the use of chemoembolic agents and manipulation of a cathether or guide wire,etc. In this paper,according to the involved anatomic organs,these severe complications are divided into six categories as follows:(1)complications of the liver,including acute hepatic failure,liver infarction (necrosis),liver abcess and liver (or tumor)ruptrure;(2)complications of the celiac artery and its branches,included of iatrogenic dissection,stricture or occlusion,perforation or pseudoaneurysm and multiple intrahepatic aneurysms; (3)complications of intrahepatic biliary system,included of cholecystitis and gallbladder infarction,bile duct necrosis and intrahepatic biloma formation; (4)complications of extrahepatic structures,included of nontarget embolism or infarction of the brain,spinal cord,lung,spleen,gastroduodenum and pancreas; (5)bleeding of upper digestive tract; (6)the orthers. And the incidence,pathogenesis,predisposing factors,clinical and imaging manifestations of these complications are also discussed in detail,it may be of great advantage to its correct diagnosis promptly and appropriate management.

Controversy and discussion on blood supply and interventional therapy of cavernous hemangiomas of the liver / 中华放射学杂志

Objective To further explore the blood supply and interventional therapy of adult cavernous hemangiomas of the liver (CHL).Methods Recently some authors reported that a satisfactory effect resulted from transcatheter portal venous embolization was obtained in few cases of CHL with blood supply of portal vein,and raised an objection to the standpoint that CHL was commonly supplied by hepatic artery completely.In order to get a scientific and reasonable explanation for it,this paper reviewed the vascular embryology and histology of the liver,the pathologic features of CHL as well as the relative literature,and combined with the investigation results of blood dynamic changes of CHL that had been performed in 2000～2002 by us.Results CHL was caused by the arrested development of hepatic sinusoids at the embryonic stage.Pathologically,CHL was consisted of a lot of enlarged abnormal sinusoids,which were variant in size and closely related with the hemodynamic changes of CHL (in inverse proportion).The CHL consisted of even and tiny abnormal sinusoids (diameter less than 50 ?m) pathologically usually presented a high flow.During the hepatic artery angiography or CTHA,it was rapidly filled by the arterial blood containing contrast media and frequently showed dense opacification or enhancement.Simultaneously this could result in increased pressure of abnormal sinusoids.When the sinusoidal pressure exceeded that of the connecting portal venules,the arterial blood containing contrast media filled in the abnormal sinusoids could lead to retrograde flow in the portal venules.That was arterial-portal venous shunts (APVS).These appearances described as above could also occur in some CHL with intermediate flow,in which many tiny abnormal sinusoids located in the peripheral area were identified pathologically.On the contrary,the CHL consisted of larger abnormal sinusoids (diameter more than 500 ?m) pathologically usually presented a low flow.During the hepatic artery angiography or CTHA,it was filled very slowly by the arterial blood containing contrast media and was difficult to opacify or enhance.Simultaneously this could result in a low pressure of abnormal sinusoids.When the sinusoidal pressure was lower than that of the connecting portal venules,the portal venous blood containing contrast media could easily flow into the abnormal sinusoids and make it enhanced during the direct or indirect portography (or CTAP).Conclusion CHL is really a congenital venous malformation.All the CHL with high flow and some CHL with intermediate flow are surely supplied by the hepatic artery and drained primarily by the peripheral branches of portal vein.However,in few CHL with marked lower flow,the portal vein should become a primary supply vessel,so a direct or indirect portography (or CTAP) must often be taken to identify the diagnosis.Thereby,the technique of transcatheter embolization of CHL including the aim,indication,approach,and the used sclerotic or embolic drugs,etc,should also be reconsidered in order to improve its therapeutic efficacy.

Adverse Drug Reactions of Ionic & Nonionic Contrast Media and Rationale for Use / 介入放射学杂志

In this paper,adverse drug reaction(ADRs)of two groups using ionic contrast media(ICM)and nonionic contrast media(NICM)respectively for conventional an- giography(CA),DSA and contrast enhanced CT(CTE)were analysed and compared with the recent literature. The results of this study indicated that(1)using ICM for CA,DSA and CTE,the in- cidence of ADRs is higher than that of NICM because of its high osmolarity,the effect of electric charge and chemotoxicity;however,even in the at-risk patients the incidence of ADRs; can be significantly decreased by using NICM.(2)the incidence of ADRs in patients with rapidly intraarterial injection is higher than that of intravenous injection;(3)the patients with ADRs to ICM previously could be reexamined by using NICM without inducing the ADRs (4)using lower concentration or/and volume of NICM than that of ICM may obtain superior images than the equivalent ICM because of the little influence of NICM on the plasma volume and the concentration of intravascular contrast midia;and(5)though NICM is surely a safe and ideal contrast midia,it still must be careful to use in at-risk patients. Because of its high cost limiting its universal use,a selective use in at-risk patients for the intavenous examinations is proposed by us.Excluding the usual high risk factors describ- ed in literature,we suggested that if the patients with the following factors,NICM should be the preferred choice for the angiography and CTE:(1)the post-operative patients of biain disease;(2)the patients with coma or shock;(3)the patients with peripheral aterial of ve- nous thrombosis and(4)the patients for interventional procedures of cardioascutlar system (CVIR). In addition to,the authors pointed out that some new problems concerning with the con- trast media(CM)must be noticed in the procedures of CVIR:the overdose of CM,he ad- verse effects resulted from the mixing of CM with other pharmaceutical products injected and the evaporated hyperc oncentatian decomposition,or carbonization of the CM resulted from the interaction within high energy equipment or under high temperature.

Main problem impeding the development of interventional radiology in China and its countermeasures / 介入放射学杂志

Based on the review of development course of interventional radiology in China during the period of more than twenty years, to analyse emphatically the main problems impeding the continuous development of interventional radiology, included the branch position of "Interventional Radiology" not be defined clearly in the medicines, the professional association not to do its best in the management and guidance, the professional quality of the personnel not to be properly trained, as well as the insufficiencies of foundation and experimental studies, etc. And in this paper, the corresponding countermeasures of solving those problems have been primarily explored by the authors, and pointed out as follows: to improve perfectly the branch construction of the "Interventional Radiology" and the training system of special personnel; to raise the grade and function of the professional association and periodical; to lay stress on the foundation and experimental studies; to further deepen the clinical study and correctly deal with the relation between this branch and the other clinical departments, etc.

Laying stress on study of interventional lung volume reduction / 介入放射学杂志

The interventional lung volume reduction is developed from the lung volume reduction surgery and endoscopically non-surgical lung volume reduction. It is a X-ray guided transcatheter therapeutic technique, involving intra-bronchial embolization of the target pulmonary lobes with bleomycin(or pure alcohol)-lipiodol emulsion and the proximal target bronchial occlusion with PMMA simultaneously. A stable effect of pulmonary fibrosis and lung volume reduction could thus be obtained with the name of functional pulmonary lobectomy. Although this interventional therapeutic technique is now still on progress of animal experiment but having special potency of clinical application and fruitful furture.

Influence of Operative Technique on Therapeutic Effect of TAI/TAE in HCC / 介入放射学杂志

Fifty cases of HCC with 105 procedures of TAI/TAE performed by DSA system were analysed retrospectively.Improperly operative technique used in the procedure of TAI/TAE was found in sixteen cases of this series,included:unsuccessfully superselec- tive catheterization of the hepatic artery in 6 cases,resulting from the unskillful catheteriza- tion or the abnormality of target arteries,etc.Failure recatheterizations of the hepatic arter- ies in the initial or subsequent procedures of TAI/TAE were occurred in the other 6 cases. (because of the stenosis/obstruction of hepatic artery resulted from the intimal injury of the target artery by repeated catheterization,the infusion of anticancer drugs(MMC,5-Fu)and excessive embolization of hepatic artery with gelatine sponge,ete);In the remaining 4 cas- es,the tumor's parasitic vessels-inferior phrenic arterier were neglected due to no abdominal aortography was performed.The results of 16 cases with improperly operative technique of TAI/TAE showed that the decrease of tumor's size was frequently less than 50 per cent,or no change,and in few cases the size of tumor became larger than before.Comparing the de- crease rate of tumor in this 16 cases with the comparative group also confirmed the presence of the significant difference(P