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Objective To analyze three-dimensional imaging characteristics and advantages for severe portal vein stenosis after liver transplantation, and to evaluate clinical efficacy of portal vein stent implantation. Methods Clinical data of 10 patients who received portal vein stent implantation for severe portal vein stenosis after liver transplantation were retrospectively analyzed. Imaging characteristics of severe portal vein stenosis, and advantages of three-dimensional reconstruction imaging and interventional treatment efficacy for severe portal vein stenosis were analyzed. Results Among 10 patients, 3 cases were diagnosed with centripetal stenosis, tortuosity angulation-induced stenosis in 2 cases, compression-induced stenosis in 2 cases, long-segment stenosis and/or vascular occlusion in 3 cases. Three-dimensional reconstruction images possessed advantages in accurate identification of stenosis, identification of stenosis types and measurement of stenosis length. All patients were successfully implanted with portal vein stents. After stent implantation, the diameter of the minimum diameter of portal vein was increased [(6.2±0.9) mm vs. (2.6±1.7) mm, P<0.05], the flow velocity at anastomotic site was decreased [(57±19) cm/s vs. (128±27) cm/s, P<0.05], and the flow velocity at the portal vein adjacent to the liver was increased [(41±6) cm/s vs. (18±6) cm/s, P<0.05]. One patient suffered from intrahepatic hematoma caused by interventional puncture, which was mitigated after conservative observation and treatment. The remaining patients did not experience relevant complications. Conclusions Three-dimensional visualization technique may visually display the location, characteristics and severity of stenosis, which is beneficial for clinicians to make treatment decisions and assist interventional procedures. Timely implantation of portal vein stent may effectively reverse pathological process and improve portal vein blood flow.
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Hypersplenism is a common complication caused by liver cirrhosis and portal hypertension, and at present, splenectomy and partial splenic artery embolization (PSE) are the main methods for the treatment of hypersplenism. Splenectomy has a marked effect in the treatment of hypersplenism and can significantly improve the clinical symptoms of patients with hypersplenism. Compared with splenectomy, PSE causes partial splenic parenchymal infarction and thus achieve similar clinical efficacy as partial splenectomy while preserving the spleen and its function. Although PSE is an effective method for the treatment of hypersplenism, there are few reports on the effect of PSE on liver fibrosis, immunity, and liver regeneration in China and globally. This article summarizes the common causes of hypersplenism, the mechanism of PSE in the treatment of hypersplenism, the therapeutic effect of different embolization methods and materials, and the effect of PSE on liver fibrosis, immunity, and liver regeneration, so as to provide a theoretical basis and new ideas for the clinical treatment of hypersplenism.
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Hepatocellular carcinoma (HCC) is one of the most common tumors of primary hepatic carcinoma, and one of the major causes of cancer related deaths worldwide. HCC has high incidence and mortality, with limited treatment. The prevention and treatment of HCC faces great challenges. At present, interventional therapy combined with immune plus targeted therapy has a synergistic effect and a significant effect in prolonging the survival time of patients and controlling tumors, which brings a brand-new therapeutic hope to patients with advanced HCC. The authors report a case of advanced HCC with lung metastasis who underwent hepatic arterial infusion chemotherapy combined with immune plus targeted therapy, with a result of good clinical effect on tumor controlling in a short time.
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Objective:To investigate the imaging characteristics on contrast-enhanced ultrasound(CEUS)of carotid plaque instability and their correlation with histopathological changes in elderly patients.Methods:Twenty-three patients undergone carotid endarterectomy(CEA)at the Department of Neurosurgery of Beijing Hospital from June 2018 to November 2020 were retrospectively enrolled, including 27 males and 5 females, aging from 60 to 87(68.1±6.3)years.They were diagnosed with moderate to severe carotid artery stenosis(50%-99%)based on digital subtraction angiography(DSA).Carotid artery CEUS was conducted before surgery, and HE staining and CD34 immunohistochemical staining were used to record histopathological scores and microvessel density(MVD)counts.Results:The mean pathological score and MVD count were 2.46±0.66 and 37.17±12.88 for 32 cases with hypoechoic patterns, 22.42±0.55 and 38.06±13.66 for 18 cases with mixed echo patterns, and 2.75±0.35 and 23.50±9.192 for 2 cases with strong echo patterns, respectively.CEUS grading was positively correlated with histopathology score and MVD count( r=0.53、0.76, all P<0.01). Conclusions:Low echo and mixed echo plaques are more unstable than strong echo plaques.CEUS can be used to comprehensively assess the vulnerability of atherosclerotic plaques and to decide the optimal surgical time for patients with carotid atherosclerotic plaque stenosis.
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The incidence and mortality of abdominal aortic aneurysm in the elderly are high.The poor prognosis of ruptured abdominal aortic aneurysm is in sharp contrast to the good survival after planned surgery.Endovascular repair is the first choice and maybe the only treatment for elderly patients with abdominal aortic aneurysm.Ultrasound is the preferred imaging method for screening and monitoring abdominal aortic aneurysm, with high accuracy and repeatability, and is an effective means for accurate diagnosis and follow-up monitoring in elderly patients with abdominal aortic aneurysm.This paper reviews research progress on ultrasonic diagnosis and postoperative evaluation of abdominal aortic aneurysm in the elderly, and discusses the important application value and prospect of conventional ultrasound combined with new ultrasound technology in this field.
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Objective:To establish and validate a prognostic model of a contrast-enhanced ultrasound scoring(CEUS)system for evaluating renal artery stenosis(RAS)in the elderly.Methods:This was a single-center retrospective study.A total of 324 elderly RAS patients admitted to Beijing Hospital from October 2017 to July 2020 were randomly assigned into the model group(n=174)and the validation group(150)in a 1∶1 ratio.Clinical and imaging data of patients on admission including general conditions, previous medical history, blood pressure, blood creatinine, renal artery stenosis and cortical blood perfusion in the affected kidney and renal function(GFR)at 1-year follow-up were collected.Univariate and multivariate logistic regression was used to establish a model of the CEUS scoring system.The receiver operating characteristic(ROC)curve and area under the ROC curve(AUC)were used to evaluate prediction accuracy.Clinical application value of the CEUS scoring system model was evaluated via decision curve analysis using a nomogram.Results:Baseline clinical and radiomic data had no significant difference between the model group and the validation group( P>0.05). Multivariate logistic regression analysis results showed that age( OR=1.242, 95% CI: 1.081-1.427, P<0.01), diabetes( OR=1.545, 95% CI: 1.107-2.156, P<0.05), blood pressure( OR=1.328, 95% CI: 1.056-1.670, P<0.05), renal function( OR=2.374, 95% CI: 1.216-3.887, P<0.01)and cortical blood perfusion parameter( OR=2.646, 95% CI: 1.553-6.369, P<0.01)were risk factors for the deterioration of renal function during 1 year follow-up.Based on these results, a nomogram for the CEUS scoring system model was drawn, and its consistency index, the C-Index, was 0.725(95% CI: 0.653-0.776). The AUC of the CEUS scoring system was 0.824 and the Youden index was 0.711 in the model group, with a specificity of 0.774 and a sensitivity of 0.837.The AUC of the CEUS scoring system was 0.853 and the Youden index was 0.715 in the validation group, with a specificity of 0.684 and a sensitivity of 0.889.There was no significant difference in ROC curve between the two groups( D=1.387, P>0.05). In addition, calibration charts of the two models showed that the calibration curve of the CEUS scoring system was close to the standard curve, with no statistically significant difference( P>0.05). Conclusions:The CEUS scoring system model can be used to predict the risk of worsening renal function in elderly RAS patients during 1-year follow-up.
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Objective:To investigate the application value of dynamic scintigraphy single-photonemission computed tomography (SPECT) 99m-technetium-galactosyl human serum albumin diethy-lenetriamine pentaacetic ( 99Tc m-GSA) scintigraphy in assessing liver function of perihilar cholangio-carcinoma after portal vein embolization (PVE). Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 16 patients with perihilar cholangiocarcinoma who underwent 99Tc m-GSA scintigraphy after PVE in Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University from October 2019 to January 2021 were collected. There were 8 males and 8 females, aged from 46 to 78 years, with a median age of 64 years. Observation indicators: (1) liver volume after PVE; (2) liver function after PVE; (3) typical case analysis. Measurement data with normal distribution were represented as Mean± SD. Count data were represented as absolute numbers or percentages. Comparison of data of the same patient was analyzed using the paired t test. Results:(1) Liver volume after PVE:the morphological liver volume and functional liver volume for the 16 patients were (1 420±211)mL and (389±112)mL. The morphological liver volume and functional liver volume were (636±143)mL and (234±106)mL of planning reserved lobe, (784±210)mL and (151±106)mL of planning resection lobe, respectively. The functional liver density (FLD) of planning reserved lobe and planning resection lobe were 0.36±0.12 and 0.19±0.11, showing a significant difference between them ( t=3.794, P<0.05). The planning resection rate of morpholo-gical liver volume and functional liver volume were 37.8%±0.6% and 54.8%±0.2%, showing a significant difference between them ( t=?3.720, P<0.05). (2) Liver function after PVE: 13 of 16 patients completed the indocyanine green (ICG) test, and 3 patients didn't complete the ICG test due to intolerance. For the 13 patients undergoing ICG test, the total ICG-K value was (0.15±0.03)/minutes, and the ICG-K value of planning reserved lobe was (0.07±0.02)/minutes. The total GSA-K value of 16 patients was (0.14±0.10)/minutes, and the GSA-K value of planning reserved lobe was (0.08±0.06)/minutes. (3) Typical case analysis: a 46-year-old male patient with type Bismuth Ⅲa perihilar cholangiocarcinoma was planned to perform perihilar hepatectomy combined with right hepatectomy. The imaging evaluation showed that the volume of reserved liver lobe accounted for 27% of the total liver volume. The serum total bilirubin was 256 μmol/L when admitted and decreased to 118 μmol/L on the day 5 after percutaneous transhepatic biliary drainage. The right anterior and right posterior branches of PVE was performed. SPECT 99Tc m-GSA examination was performed on the day 37 after PVE. The morphological liver volume was 559 mL of planned reserved lobe and 1 461 mL of the whole liver. The planned morphological liver volume resection rate was 61.7%. ICG-K was 0.12/minutes of the whole liver, and 0.04/minutes of planned reserved lobe. The functional liver volume was 134 mL of planned reserved lobe and 309 mL of the whole liver. The planned resection rate of functional liver volume was 56.6%. The GSA-K was 0.20/minutes of the whole liver and 0.09/minutes of planned reserved lobe. R 0 resection was achieved in perihilar hepatectomy combined with right hepatectomy and no liver failure occurred. The survival time of patients was 11 months. Conclusion:Dynamic SPECT 99Tc m-GSA scintigraphy can effectively evaluate the regional function of the reserved liver lobe in patients with perihilar cholangiocarcinoma after PVE.
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Context: Owing to the increasing age of the population, the incidence of hepatocellular carcinoma (HCC) in the elderly is increasing annually. Aims: This study aims to investigate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with low-dose apatinib for unresectable HCC treatment in elderly patients (≥65 years). Settings and Design: The clinical data from 61 elderly patients with unresectable HCC who were retrospectively analyzed. Subjects and Methods: Of these 61 patients, 27 received TACE combined with low-dose (250 mg/qd) apatinib (experimental group), and 34 patients received the standard TACE treatment (control group). The short-term efficacy was evaluated according to the mRECIST1.1 standards, and the mid- and long-term efficacy and safety in the two groups of patients were evaluated. Statistical Analysis Used: Statistical analyses were performed using the Statistical Package for the Social Sciences software (version 20.0; SPSS). Results: Both the objective response rate and disease control rate of the experimental group were significantly higher than those of control group (P < 0.05). The 6-month and 12-month survival rates of the experimental group were significantly higher than those of control group too (P < 0.05). The median survival in the experimental group was longer than in the control group (26.0 months vs. 20.0 months). The adverse reactions related to the intake of apatinib were higher in the experimental than the control group, but were generally alleviated after symptomatic treatment. Conclusions: TACE combined with low-dose apatinib provides an alternative treatment option for elderly patients with unresectable HCC. Our clinical study has proven its safety and efficacy.
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Objective@#To evaluate the characteristics of renal cortical blood perfusion assessed by contrast-enhanced ultrasound (CEUS) in elderly patients with renal artery stenosis (RAS) and its relationship with renal function.@*Methods@#Ninety-three elderly patients diagnosed with RAS, who were admitted in Beijing Hospital during June 2017 and December 2018, were retrospectively enrolled. According to the degree of RAS, 186 renal arteries were divided into normal renal artery group (n=79), mild RAS group (30% to 49%, n=59), moderate RAS group (50% to 70%, n=33), and severe RAS group (70% to 99%, n=15). Renal cortical blood perfusion and renal glomerular filtration rate (GFR) were measured by CEUS and radionuclide renal dynamic imaging. According to the renal GFR, 186 kidneys were divided into normal renal function group (GFR≥35 ml/min, n=42) and mild renal insufficiency group (35 ml/min>GFR≥25 ml/min, n=51), moderate renal insufficiency group (25 ml/min>GFR≥15 ml/min, n=75) and severe renal insufficiency group (GFR<15 ml/min, n=18). The renal cortical blood perfusion time-intensity curve (TIC) and related parameters were analyzed, including the area under the curve (AUC), the slope of the ascending branch (A), the peak intensity (PI), the peak time (TTP) and the mean transit time (MTT), the kidneys of different RAS groups and patients with different renal function groups were analyzed. Pearson correlation analysis was used to evaluate the correlation between renal cortical blood perfusion parameters and renal GFR.@*Results@#(1) Renal cortical blood perfusion and GFR: CEUS showed that parameter A of TIC was significantly reduced, while TTP was prolonged in the mild renal artery stenosis group compared with the normal renal artery group (both P<0.05), GFP was similar between the two groups. Cortical perfusion parameters, such as AUC, A, PI and GFR were significantly lower, while TTP and MTT were significantly prolonged in the moderate and severe renal artery stenosis group than in the normal and mild stenosis groups (all P<0.05). Compared with the moderate stenosis group, AUC, A, PI and GFR were significantly lower while TTP, MTT were significantly prolonged in the severe renal artery stenosis group (all P<0.05). (2) TIC showed that the renal perfusion parameters, AUC, PI and A were significantly lower, while TTP was significantly longer in the mild renal dysfunction group than in the normal renal function group (all P<0.001). The changes aggravated in proportion with renal dysfunction. (3) Correlation between perfusion parameters and GFR: Pearson correlation analysis showed that the AUC (r=0.774, P<0.05), A (r=0.815, P<0.05) and PI (r=0.772, P<0.05) were positively correlated with GFR; serum creatinine level (r=-0.841, P<0.05), renal function grading (r=-0.731, P<0.05), TTP (r=-0.803, P<0.05) and MTT (r=-0.741, P<0.05) were negative correlated with GFR. The degree of stenosis was negatively correlated with GFR (r=-0.427, P<0.05).@*Conclusion@#Cortical perfusion parameters differ significantly among patients with various degree of RAS and renal dysfunction. The renal cortical blood perfusion parameters are correlated with renal GFR.
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Objective To investigate the renal cortical perfusion parameters assessed by contrast-enhanced ultrasound(CEUS)in elderly patients with moderate-to severe renal artery stenosis (RAS),and relationship of those with glomerular filtration rate(GFR).Methods A total of 59 elderly patients with unilateral moderate to severe RAS(50％-99％)admitted into Beijing Hospital during June 2017 to December 2018 were consecutively enrolled in the cross sectional and self-control study.Based on the GFR assessed by radionuclide renal dynamic imaging,patients were divided into the mild-(35＞GFR≥25 ml/min,n=18),moderate-(25 ＞ GFR≥ 15 ml/min,n =37) and severe renal dysfunction(GFR＜ 15 ml · min-1,n =4) groups.CEUS evaluated-renal cortical perfusion parameters,including area under curve (AUC),ascending slope (A),derived peak intensity (DPI),time to peak (TTP) and mean transit time(MTT),were compared among different levels of severity of renal dysfunction groups.Pearson correlation analysis was used to evaluate the relationship between CEUS imaging-evaluated renal cortical perfusion parameters and radionuclide renal dynamic imaging-assessed GFR.Results Compared with the mild renal dysfunction group,the moderate renal dysfunction group showed a reduced AUC and A(P＜0.05),and the severe renal dysfunction group showed more markedly reduced AUC,A,DPI,TTP and MTT (P ＜ 0.05).Compared with the moderate renal dysfunction group,the severe renal dysfunction group showed a reduced AUC,A and GFR(P ＜0.05),while no significant differences in TTP and MTT were found.As far as relationship between renal cortical perfusion parameters and GFR were concerned,Pearson correlation analysis demonstrated that AUC(r =0.804),A(r =0.813) and DPI(r =0.733) were significantly and positively correlated with GFR(all P ＜ 0.05).However,renal function (r =-0.721),TTP(r =-0.744) and MTT(r =-0.743)were negatively correlated with GFR(P＜0.05).And the degree of renal artery stenosis was poorly correlated with GFR (r =-0.462).Conclusions For elderly patients with unilateral moderate to severe RAS,contrast-enhanced ultrasonography can display the changes of renal cortical blood perfusion parameters along with the aggravation of renal function impairment.AUC and A are strongly positively correlated with GFR.The degree of renal artery stenosis is poorly correlated with renal function.And more studies are needed to confirm these findings.
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Objective@#To evaluate the prognostic value of 18F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) in patients with diffuse large B cell lymphoma (DLBCL) undergoing autologous hematopoietic stem cell transplantation (auto-HSCT).@*Methods@#Forty-eight patients with DLBCL treated at Peking University Cancer Hospital between November 2010 and December 2014 were assessed. All patients underwent PET/CT scanning prior to or after auto-HSCT. Correlation analysis was done based upon patients characteristics, PET/CT scan results and survival.@*Results@#①Among 48 patients, 27 was male, 21 female, median age was 43 (17-59) years old. ② Patients with negative pre-auto-HSCT PET/CT assessment demonstrated significantly better 3-year progression free survival (PFS) (87.1% vs 53.3%, χ2=7.02, P=0.019) and overall survival (OS) (90.3% vs 60.0%, χ2=6.51,P=0.022) than patients with positive pre-auto-HSCT PET/CT assessment. Three-year PFS (94.1% vs 30.0%, χ2=22.75, P=0.001) and OS (97.1% vs 40.0%, χ2=21.09, P=0.002) were also significantly different between patients with negative and positive post-auto-HSCT PET/CT assessment. ③ Multivariate analysis indicated a significant association of PFS (HR=13.176, P=0.005) and OS (HR=20.221, P=0.007) with post-auto-HSCT PET/CT assessment. Number of prior treatment regimens was associated with PFS (HR=10.039, P=0.040). ④ Harrell’s C index revealed that the value of combined use of number of prior treatment regimens and post-auto-HSCT PET/CT assessment was superior to either one used alone in PFS (Harrell’s C values were 0.976, 0.869 and 0.927 in combined use, number of prior treatment regimens and post-auto-HSCT PET/CT assessment, respectively), and the combined use of ECOG performance status and post-auto-HSCT PET/CT assessment significantly increased the Harrell’s C index in OS (Harrell’s C values were 0.973, 0.711 and 0.919 in combined use, ECOG performance status and post-auto-HSCT PET/CT assessment, respectively).@*Conclusions@#Post-auto-HSCT PET/CT assessment is the main predictor of outcomes in DLBCL patients receiving auto-HSCT. Combined use of post-auto-HSCT PET/CT assessment and number of prior treatment regimens and ECOG performance status is a better prognostic tool in patients with DLBCL undergoing transplantation.
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Objective To investigate the application value of dynamic single-photon emission computed tomography (SPECT) 99m-technetium galactosyl human serum albumin diethylenetriamine pentaacetic acid injection (99 Tcm-GSA) scintigraphy assessing regional liver function changes before and after portal vein embolization (PVE).Methods The retrospective cross-sectional study was conducted.The clinical data of 11 patients with Bismuth Ⅲ a hilar cholangiocarcinoma who were admitted to the General Hospital of People's Liberation Army (10 patients) and Beijing Tsinghua Changgung Hospital (1 patient) from October 2010 to October 2016 were collected.B ultrasound-guided percutaneous transhepatic ipsilateral exbolization was performed before radical resection of hilar cholangiocarcinoma.Dynamic SPECT 99 Tcm-GSA scintigraphy was performed to calculate and compare the changes of functional liver volume (FLV),morphological liver volume (MLV) and functional liver density (FLD) in embolized lobe and non-embolized lobe before PVE and 2 weeks after PVE.Observation indicators:(1) the changes of serum indexes in 2 weeks before and after PVE;(2) the changes of FLV,MLV and FLD in the whole liver,embolized and non-embolized lobes in 2 weeks before and after PVE;(3) surgical and postoperative situations of hilar cholangiocarcinoma;(4) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative serum toal bilirubin (TBil) level,with or without peritoneal effusion and survival up to June 2017.Measurement data with normal distribution were represented as x-±s.The comparisons of pre-and post-operative data were analyzed by the paired t test.Results (1) The changes of serum indexes in 2 weeks before and after PVE:11 patients underwent successful right PVE.The alanine aminotransferase (ALT),TBil,albumin (Alb),Platelets (PLT) and prothrombin time (PT) were respectively (113±20) U/L,(73± 8) μmol/L,(35.0±2.5) g/L,(209±58) × 109/L,(11.4±0.7) seconds in 2 weeks before PVE and (120± 18) U/L,(36± 7) μmol/L,(34.4± 3.2) g/L,(224± 82) × 109/L,(11.2±0.8)seconds in 2 weeks after PVE,with a statistically significant difference in TBil level (t=-10.592,P＜0.05) and no statistically significant difference in ALT,Alb,PLT and PT (t=0.981,-0.350,-0.591,0.533,P＞0.05).(2) The changes of FLV,M LV and FLD in the whole liver,embolized and nonembolized lobes in 2 weeks before and after PVE:the FLV,MLV and FLD of the whole liver were respectively (894±255) mL,(1 552±504) mL,0.59±0.14 in 2 weeks before PVE and (812±206) mL,(1 521±422) mL,0.55±0.16 in 2 weeks after PVE,with no statistically significant difference (t =1.569,0.666,1.980,P＞ 0.05).The FLV,MLV and FLD of the embolized lobe were respectively (623±275) mL,(1 047± 394) mL,0.62±0.14 in 2 weeks before PVE and (375±240) mL,(865±337) mL,0.44±0.24 in 2 weeks after PVE,with statistically significant differences (t =5.909,3.736,3.359,P ＜ 0.05);the descending percentages were respectively 38.1％,9.8％ and 24.6％.The FLV,MLV and FLD of the non-embolized lobe were respectively (274±152)mL,(530±176)mL,0.52±0.21 in 2 weeks before PVE and (436±149) mL,(656±133)mL,0.68± 0.24 in 2 weeks after PVE,with statistically significant differences (t =-6.019,-6.345,-3.933,P＜0.05);the elevated percentages were respectively 80.1％,19.9％ and 23.8％.(3) Surgical and postoperative situations of hilar cholangiocarcinoma:of 11 patients,10 received successful peri-hilar right hemihepatectomy,the right hepatic atrophy and an obvious demarcation line between left and right liver were found intraoperatively;1 stopped operation due to detect intraoperatively peritoneal metastasis of tumor.The operation time,volume of intraoperative blood loss and time of postoperative abdominal drainage-tube removal were respectively (585± 194)minutes,(472± 274)mL and (8±5)days.Of 10 patients undergoing operations,2 were complicated with massive peritoneal effusion at 2 days postoperatively,volume of peritoneal effusion remained more than 500 mL up to 7 days after drainage,and were improved by 1-month conservative treatment;other 8 patients were not complicated with hepatic dysfunction.Duration of hospital stay of 11 patients was (16± 4) days.(4) Follow-up and survival situations:10 patients were followed up for 4-72 months,with a median time of 39 months.During the follow-up,there was no evaluated TBil level and peritoneal effusion in 10 patients.The median survival time,1-,3-and 5-year overall survival rates were 88.8％,74.6％ and 36.8％,respectively.Conclusions The dynamic SPECT 99Tcm-GSA scintigraphy can effectively evaluate liver function changes of embolized and non-embolized lobes before and after PVE.The increased rate of FLV of non-embolized lobe is higher than that of MLV.
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The 8th Japan-China Hepato-Pancreato-Biliary Symposium was held in Tokyo,Japan from 22nd to 23rd November 2018.The meeting was convened coincidently with the 80th Annual Congress of Japanese Surgical Association,which attracted the participation of Chinese and Japanese hepatobiliary and pancreatic surgeons.The symposium aimed to explore the latest achievements and clinical issues of diagnosis and treatment for hepato-pancreato-biliary diseases.In this article,authors reviewed the up-to-date research information in order to share the experience,achievements and new information in the field of hepatobiliary and pancreatic diseases with colleagues.
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Liver cancer is one of the most common malignant tumors in the world, and traditional liver cancer treatment methods have their own limitations.Glypican-3 (GPC3) is a cell-surface heparan sulfate proteoglycan and is involved in the regulation of individual development and cell proliferation and differentiation.It is also a hepatoma-specific carcinoembryonic antigen.The mechanism of action of GPC3 in the development and progression of liver cancer has become a hot research topic.GPC3 not only has a unique value in the diagnosis of liver cancer, but also plays an important role in the treatment of liver cancer.This article also introduces the application of GPC3-derived tumor vaccines, GPC3 antibodies, GPC3 gene therapy, and targeted therapy and brings new ideas for the treatment of liver cancer.
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Objective To investigate the current status of preoperative skin preparation in abdominal surgery in China,and put forward suggestions for improvement.Methods From April to May,2016,187 secondary and above hospitals in China were selected,questionnaires were used to investigate the methods for hair removal,skin disinfection on operative field,and application of surgical adhesive drape in abdominal surgery.Results A total of 187 hospitals in 14 provinces were investigated,of which 108 and 79 were tertiary and secondary hospitals respec-tively.87.70% of hospitals performed conventional preoperative hair removal in abdominal surgery,the percentage of conventional depilation in secondary hospitals was higher than tertiary hospitals(93.67% vs 83.33%,χ2 =4.520,P =0.033).85.98% of hospitals selected blade-shaving,7.93% and 23.78% applied chemical depilation and electric depilation respectively.Most hospitals (98.17%)performed skin preparation in the wards,mainly by ward nurses (98.17%),and conducted on the day of surgery (56.10%).86.63%,29.95%,and 3.74% of hospi-tals used iodophor,iodine plus alcohol,and chlorhexidine respectively for disinfecting skin on operative field. 92.51% of hospitals used skin incision/surgical adhesive drape (74.57% used selectively).Conclusion Most hos-pitals in China conventionally perform preoperative hair removal in abdominal surgery,and the primary method for depilation is blade-shaving,nearly half of the hospitals performed depilation on the day of surgery.Iodophor is the major skin antiseptic,surgical adhesive drape is widely used,but it is utilized in limited types of surgery.
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Interim fluorine 1 8 fluorodeoxyglucose (1 8 F-FDG)positron emission tomography (PET) integrated with computed tomography (CT) provides both metabolic and morphologic information,which becomes one of the most sensitive tools to evaluate the efficacy of the therapy and predict the prognosis of patients with lymphoma.Meanwhile,it is the basis for guiding trial design and changing clinical practice.How-ever,it is still a controversial issue in the ideal utilization of interim 1 8 F-FDG PET-CT imaging for the patients with lymphoma.
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<p><b>OBJECTIVE</b>To investigate the prognosis value of early and interim ¹⁸F-FDG-PET/CT scan in patients with diffuse large B- cell lymphoma （DLBCL） to establish the suitable criteria for evaluating posttherapeutic lesions in scans.</p><p><b>METHODS</b>Fifty- six newly diagnosed DLBCL patients were enrolled in the study, and underwent baseline, early and interim ¹⁸F- FDG PET/CT scans. Five- point and % ΔSUVmax criteria were used separately to interpret ¹⁸F- FDG PET/CT images. Interobserver reproducibility was assessed with the kappa test（κ）, and thresholds of %ΔSUVmax were calculated via receiver operating characteristic curve（ROC）. Survival curves were obtained using Kaplan-Meier curves and log-rank test. Cox regression analysis was used for multi-factor analysis.</p><p><b>RESULTS</b>Median follow-up was 24 months（6 to 42 months）. The kappa value of the five- point scale was above 0.600 with the reference background set in the liver（Score≥4）. The optimal threshold of %ΔSUVmax was 81% for early PET/CT and 74% for interim PET/CT. Survival analysis showed both early and interim PET/CT scans could predict the outcome of 56 patients with DLBCL, and 3-year PFS and OS of PET-negative patients were significantly higher than those of PET-positive ones（P<0.05）. Five-score criteria were more accurate in evaluating 3- year PFS of DLBCL patients in the interim PET/CT scan（76.79%）. %ΔSUVmax criteria were better for interpreting 3-year OS（76.79% and 83.93%）. Multi-factor analysis demonstrated that early and interim PET/CT were solid predicting factors for DLBCL patients.</p><p><b>CONCLUSION</b>Early and interim PET/CT scans could predict the outcome of patients with DLBCL, treated with R-CHOP/CHOP. Three-year OS was more accurate in early and interim PET/CT using 66 %ΔSUVmax criteria as an interpretation, while 3-year PFS was more accurate in interim PET/CT by five scores criteria.</p>
Subject(s)
Humans , Antibodies, Monoclonal, Murine-Derived , Antineoplastic Combined Chemotherapy Protocols , Cyclophosphamide , Doxorubicin , Fluorodeoxyglucose F18 , Lymphoma, Large B-Cell, Diffuse , Diagnosis , Drug Therapy , Positron-Emission Tomography , Prednisone , Prognosis , ROC Curve , Reproducibility of Results , Survival Analysis , Tomography, X-Ray Computed , VincristineABSTRACT
Objective To discuss interventional procedures before feeding tube placed in the DSA guidance,influence postoperative enteral nutrition support for the presence of nutritional risk of clinical outcomes in elderly patients with hepatocellular carcinoma. Methods 33 patients acquired with interventional therapy of hepatic carcinoma were selected as the study group.All of patients un-derwent preoperatively the nutritional risk screening and insertion of nasogastric feeding tube under DSA.Enteral nutritional support by the nasogastric feeding tube was used after interventional therapy.33 similar patients underwent parenteral nutritional support af-ter international therapy were selected as the control group.The change of the nutritional indexes,the incidence of the systemic in-flammatory response syndrome,the incidence of infection,and the length of hospital stay after operation were compared between the two groups.Results There were no significant differences in the plasma albumin levels and body weight changes compared between the two groups (P >0.05).However,the incidence of infection and the length of hospital stay were lower significantly in the study group than in the control group (P >0.05).Conclusion The nutritional risk screening before interventional treatment is necessary for the elder patients with hepatic carcinoma.The patients with nutritional risk can be placed the nasogastric feeding tube preopera-tively under DSA,and perform combined nutritional support to promote the recovery of nutritional state after operation.
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Pancreatic cancer is a common malignant neoplasm of digestive system with a fairly poor prognosis, the diagnosis rate in its early stage is low, and in recent years its incidence rate has become more and more high. Surgical remove is the only radical means, whereas only 20% of patients can get the oppotunity of surgery when the diagnosis is confirmed. More unfortunately, the five-year overall survival rate after the surgery is as low as 15 - 20%. Therefore, it is of clinical significance to improve the survival rate and to prolong survival time. Comprehensive interventional therapy has many advantages, as the technique is safe and mini-invasive with satisfactory short-term efficacy. Nowadays, interventional therapy has become the hot point in the research of pancreatic cancer. This paper aims to make a review about the current situation and progress of interventional treatment for advanced pancreatic cancer.
ABSTRACT
Objective To evaluate the safety and efficacy of combined transcatheter intraarterial chemoembolization with 350-560 μm gelatin sponge particles and lobaplatin (GSPs-TACE) and oral Chinese herb medication Huaier granules in patients with hepatocellular carcinoma (HCC).Methods This is a case-control,single-institution clinical trial.31 HCC patients receiving GSPs-TACE (group A) were matched with 31 patients receiving GSPs-TACE and Huaier granules (group B).Tumor response was evaluated by CECT using response evaluation criteria in solid tumors at 1 month after initial GSPs-TACE.The overall survival was calculated from the data of initial GSPs-TACE using the Kaplan-Meier method.Results The overall mean follow-up period was 28.7 (range 12-42) months.The overall 6-and 12-month survival rates in group A and group B were 90.3％ and 80.6％ vs 100％ and 93.5％,respectively.There was statistically significant difference in 12-month survival rates (x2 =5.213,P ＜0.05).Median survival time respectively was 17.1 and 20.6 months(x2 =0.745,P ＞0.05).The average TACE times were (4.1 ±7.3) and (2.9 ±8.7) respectively in group A and group B (P =0.01).Tumor objective response rate was statistically different in 6-and 12-month in two arms(x2 =5.945,6.384,P ＜0.05).There was no statistically significant difference in complications (respectively x2 =0.435,0.485,2.037,0.137,0.325,all P ＞ 0.05).Conclusions Huaier granules combined with transcatheter intraarterial chemoembolization with 350-560 μm gelatin sponge particles and carboplatin for HCC is safe and effectively prolongs patients' survival.