Fluid shear stress regulates epithelial-mesenchymal transition (EMT) in Hep2 cells / 医用生物力学

Objective To examine the effects of fluid shear stress (FSS) on epithelial-mesenchymal transition (EMT) in Hep2 cells. Methods Hep2 cells were exposed to 140 mPa FSS. The morphologic changes of Hep2 cells exposed to FSS at different durations were observed using inverted microscope. The migration ability of Hep2 cells after FSS loading was investigated using scratch wound assay. The distribution and expression of cytoskeleton protein F-actin were examined by confocal microscope. The expression of the EMT marker proteins were detected by Western blotting. Results Most of Hep2 cells changed their morphology from polygon to elongated spindle with well-organized F-actin under FSS. After removing FSS, Hep2 cells recovered their initial morphology with flat polygon. FSS regulated Hep2 cells to enhance their migration capacity in a time-dependent manner. FSS promoted the rearrangement of cytoskeletal protein F-actin，which enhanced the migration behavior of Hep2 cells. In addition, FSS induced a time regularity of expression of the EMT marker proteins in Hep2 cells. Conclusions FSS as an important physical factor can induce EMT in Hep2 cells.

Intrahepatic portosystemic shunt assisted by percutaneous transhepatic approach for treatment of portal vein thrombosis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To retrospectively analyze the safety and efficacy of mechanical thrombectomy combined with pharmacologic thrombolysis to treat non-acute and symptomatic portal vein thrombosis (PVT) using an intrahepatic portosystemic shunt (IPS) assisted by percutaneous transhepatic approach.</p><p><b>METHODS</b>From April 2006 to May 2012, 18 patients with non-acute and symptomatic PVT were treated with balloon dilation, sheath-directed thrombus aspiration and continuous infusion of urokinase using the IPS assisted by percutaneous transhepatic approach. The significance of differences in the portosystemic gradient measured before and after therapy was assessed by paired samples t-test, and survival analysis was made by the Kaplan-Meier method.</p><p><b>RESULTS</b>IPS was successfully created in all patients. The mean duration of the thrombolytic therapy was 65.3 +/- 29.5 h, and the mean concentration of urokinase used for the thrombolysis was 2324000 +/- 945000 U. Comparison of the mean portosystemic gradients showed a significant improvement in response to the therapy (before: 33.8 +/- 4.9 mm Hg vs. after: 15.4 +/- 2.1 mm Hg; P less than 0.001). The overall rate of clinical improvement was 94.4%. One patient died on day 2 post-therapy and another two patients experienced mild hepatic encephalopathy or right hemothorax, respectively, on day 5 post-therapy, with conservative medical management achieving complete recovery for both. The mean follow-up time was 18.6 +/- 17.5 months, during which only one patient died and five others experienced shunt dysfunction; all remaining patients showed maintenance of shunt patency without symptoms of recurrence.</p><p><b>CONCLUSION</b>Mechanical thrombectomy combined with pharmacologic thrombolysis via the IPS assisted by percutaneous transhepatic approach is a safe and effective therapeutic option for patients with non-acute and symptomatic PVT.</p>

Comparative study of portal vein stent and TACE combined therapy with or without endovascular implantation of iodine-125 seeds strand for treating patients with hepatocellular carcinoma and main portal vein tumor thrombus / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To compare the efficacies of portal vein stenting and transcatheter arterial chemoembolization (TACE) combined therapy performed with or without endovascular implantation of iodine-125 (125I) seeds strand in patients with hepatocellular carcinoma (HCC) and main portal vein tumor thrombus (MPVTT).</p><p><b>METHODS</b>One-hundred-and-six patients with HCC complicated by MPVTT who were treated with portal vein stents and TACE, either with (Group A, n=56) or without (Group B, n=50) endovascular implantation of 125I seeds strand, between July 2005 and April 2011, were retrospectively analyzed. Overall survival, stent patency, and procedure-related adverse events were compared between the two groups.</p><p><b>RESULTS</b>The technical success rate was 100% for placement of 125I seeds strands and stents in the obstructed main portal vein. No serious procedure-related adverse events were recorded. Group A had significantly higher median survival (335 days vs. group B: 146 days; P=0.001, hazard ratio (HR)=2.244). Additionally, group A had significantly higher median stent patency (400 days vs. group B: 190 days; P=0.005, HR=2.479).</p><p><b>CONCLUSION</b>The combination therapeutic strategy of portal vein stenting and TACE with endovascular implantation of 125I seeds strands improves the survival of HCC patients with MPVTT complication.</p>

Endovascular placement of iodine-125 seed strand and self-expandable stent combined with transcatheter arterial chemoembolization for hepatocellular carcinoma with tumor thrombus in the main portal vein / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of endovascular placement of iodine-125 seed strand and stent combined with transcatheter arterial chemoembolization (TACE) to treat hepatocellular carcinoma (HCC) with tumor thrombus in the main portal vein (MPVTT).</p><p><b>METHODS</b>Fifty patients with HCC complicated by MPVTT were enrolled into this study. There were 46 men and 4 women with a mean age of 53.9 years. TACE was performed after the iodine-125 seed strand and self-expandable stent placement in the obstructed segment of the main portal vein (MPV).</p><p><b>RESULTS</b>Technical success rate was 100% for placement of iodine-125 seed strand and stent in the target segment of MPV. No serious procedure-related complications occurred. The mean follow-up duration was 208.5 d. The mean and median survival time was 370.1 d and 223.0 d, respectively. The 90-, 180-, 360-day cumulative survival rates were 97.5%, 59.3%, and 38.4%, respectively. The mean and median patent time of stent was 524.2 d and 407.4 d, respectively. The 90-, 180-, 360-day cumulative patency rates of stent were 94.9%, 75.2%, and 64.5%, respectively.</p><p><b>CONCLUSION</b>Endovascular placement of iodine-125 seed strand and stent combined with TACE is an effective therapy for HCC with tumor thrombus in the main portal vein.</p>

Features of blood supply and results of transarterial infusion and embolization in spinal metastases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the features of blood supply and results of transarterial infusion and embolization in spinal metastases.</p><p><b>METHODS</b>Forty-one patients with spinal metastasis received transarterial infusion and embolization between March 2001 and June 2008. The inclusion criteria were: The metastatic lesion caused back pain; The metastatic lesion involved vertebra at or below T3 level. There were 29 males and 12 females with a mean age of 56.0 (33 - 71) years. Epirubicin was used as the chemotherapeutic agent. Lipoid Ultra-Fluid, Contour SE or gelfoam particles were used as embolitic material.</p><p><b>RESULTS</b>The technical success of therapy was achieved in 52 vertebrae (100%) including 14 thoracic, 35 lumbar and 3 sacral vertebrae. 105 arteries were used for infusion and embolization (16 intercostal arteries, 78 lumbar arteries, 4 iliolumbar arteries, 4 branches of iliac arteries, and 3 median sacral arteries). Lipoid Ultra-Fluid (2 - 8 ml) was used in 15, Contour SE (300 approximately 500 microm, 20 - 100 mg) in 20, and gelfoam particles in 33 arteries. Three days after treatment, complete pain relief (CR) was achieved in 17 patients, partial pain relief (PR) in 20, and moderate pain relief (MR) in 4, with an effective rate of 90.2%. Two weeks after treatment, CR was achieved in 17 patients, PR in 21, and MR in 3, with an effective rate of 92.7%. No adverse nervous system effect occurred. 16 patients developed swelling and pain of normal tissues which were alleviated after symptomatic treatment.</p><p><b>CONCLUSION</b>Transarterial infusion and embolization is an effective therapy in relieving pain resulting from spinal metastases.</p>

Regulatory effect of bushen jianpi recipe on cellular immunity of patients with primary liver cancer after intervention therapy / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the regulatory effect of Bushen Jianpi Recipe (BSJPR) on cellular immunity the of primary liver cancer patients of Gan-Shen yin-deficiency and Pi qi-deficiency syndrome type after intervention therapy.</p><p><b>METHODS</b>According to the multi-center randomized controlled principle, 117 patients after transcatheter arterial chemoembolization (TACE) were assigned to two groups, 60 in the treated group and 57 in the control group, who were treated respectively with BSJPR and liver protecting remedy (silymarin and vitamin c) for 12 weeks. Changes in TCM syndrome, quality of life (QOL), immediate effect on tumor size and survival time were observed. Meantime, the cellular immune function was also observed, including the T lymphocyte response determined by 3H-TdR, expression of MHC class I/II and B7 molecule detected by FACS, and interleukin 10 and 12 (IL-10, IL-12), interferon-gamma (IFN-gamma) tested by ELISA.</p><p><b>RESULTS</b>In the treated group after treatment, the efficacy for improving TCM syndrome reached 73.33% (44/60 cases), their half-year survival rate being 83.33% (50/60 cases); while those in the control group were 52.63% (30/57 cases) and 70.18% (40/57 cases) respectively, significant difference was shown between the two groups (P <0.05). The patients' QOL was improved in the treated group after treatment, with no obvious adverse reaction. However, the clinical benefit rate in the control group (92.7%, 51/55 cases) was higher than that in the treated group (78.0%, 46/59 cases, P =0. 035). Laboratory examination showed increases of MHC class II (CD14+/HLA-DR) expression on monocyte surface as well as IFN-gamma and IL-12 production in the treated group.</p><p><b>CONCLUSION</b>Using BSJPR together with TACE could enhance patients' cellular immune function to elevate the clinical curative effect on primary liver cancer.</p>

Survival of patients with liver metastasis from colorectal cancer by different modes of therapy: a report of 363 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the correlation between different therapies and survival of liver metastasis from colorectal cancer ( LMCC) , and to compare the clinical outcome of synchronous liver metastasis (SLM) with that of metachronous liver metastasis (MLM).</p><p><b>METHODS</b>The clinical data of 363 patients with LMCC were retrospectively reviewed with focus on the correlation between different therapy and survival.</p><p><b>RESULTS</b>Of these 363 patients, 160 had SLM and 203 had MLM. Between the SLM and MLM group, there was no significant difference in age, or gender or primary cancer site (P > 0. 05 ), but significant differences were observed in condition of liver metastasis including liver lobe involved, focus number, maximum focus diameters and level of serum CEA and CA199 before therapy(P <0. 05). Ninety-one patients underwent curative hepatic resection, 22 of them in the SLM group and 69 in the MLM group. Mortality rate related to operation was 4. 5% (1/22) in SLM group and 2. 9% (2/69) in MLM group( P < 0.05). All patients were followed until 31/6/2005. The 3-year survival rate was 5. 2% with a median survival time of 10 +/- 1 months for the SLM group, and it wasl6. 4% and 17 +/- 1 months for the MLM group (P<0.01). Regarding to the treatment modalities, the 3-year survival rate was 30. 2% with a median survival time of 26 months for curative hepatic resection group, and it was 0% - 16. 7% and 10 - 17 months for non-operation groups treated by intervention, chemotherapy, radiofrequency therapy, percutaneous ethanol injection and Chinese traditional drugs (P <0. 05, P <0. 01 ).</p><p><b>CONCLUSION</b>Curative hepatic resection is still the first choice for liver metastasis from colorectal cancer improving the survival significantly. Other non-operative methods also can improve phase II resection rate. Metachronous liver metastasis has higher resection rate and better survival than the synchronous liver one.</p>

Transhepatic arterial chemoembolization by epirubicin mixed with microspheres for hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the safety and efficacy of transhepatic arterial infusion of the mixture of epirubicin and microspheres as the embolization materials for treatment of patients with hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>The mixture was made of 10-60 mg epirubicin (Pfizer) mixed with 300-500 microm microspheres in 0.5-2 ml (Contour SE Boston Scientific), which was used for embolizating the artery supplying HCC. Changes of leucocyte counts, liver function, serum AFP level, response of tumor to TACE and complications related to embolization were analyzed before and after TACE.</p><p><b>RESULTS</b>136 HCC patients (male/female: 91/45, mean age: 54.8 +/- 13.3 years) were studied. After TACE, the liver function was damaged and tumor size shrunken significantly (P < 0.05).</p><p><b>CONCLUSION</b>Transhepatic arterial chemoembolization using the mixture of epirubicin and microspheres for embolizating is safe and effective for the treatment of HCC, but the amount of embolization material should be chosen carefully in order to avoid liver function failure.</p>

The interventional management for early hepatic arterial thrombosis after liver transplantation / 介入放射学杂志

Objective To summarize the interventional management for early hepatic arterial thrombosis(HAT)after liver transplantation.Methods 32 patients suspected of HAT or HAS after liver transplantation in 502 cases from April 2001 to September 2006 were done hepatic arterial angiography.Among them,20 patients were confirmed as HAT immediately through hepatic arterial angiography,and were further treated by transarterial thrombolysis,pereutaneous transluminal angioplasty(PTA)and stent-graft placement. Results HAT was identified in 20 patients(3.98%),occurring in the median 4.5 days(2～19 days)after liver transplantation.The sites of all the thrombosis were found at the anastomotic point of the hepatic artery.5 cases were treated by PTA and 3 cases by stent placement during the transarterial thrombolysis.Coil and stent-graft were used in 2 cases with hepatic arterial anastomostic hemorrhage.Hepatic arterial recanalization was obtained in 20 cases.The period of thrombolysis was 2.5 clays(2-11 days).Conclusions Continuous infusion of urokinase through hepatic artery with catheter,PTA and stent placement are effective modalities for hepatic arterial thrombosis after liver transplantation.(J Intervent Radiol,2007,16:799-802)

Analysis of paraplegia during transarterial chemoembolization in liver cancer / 介入放射学杂志

Objective To evaluate the pathophysiology of paraplegia during transarterial chemoembolization in liver cancer and investigate effective management and prevention for improving clinical situation and relieve major symptoms.Method 2758 patients accepted TACE procedure because of liver cancer(and/or combined with remote metastasis),demonstrated 4 cases suffering from paraplegia(3 males,1 female)since Mar.2003 to Feb.2005,with mean age of(51?14)years old,The operative records and the clinical features after chemoembolization were summarized in detail.Results The incidence of paraplegia was 0.145%,with major symptoms of dysesthesia and hypokinesise emerging within 4 hours after TACE,and most symptoms aggravating gradually within 24-48 hours untill paraplegia appeared,and then turned to stabilization about 5-7 days,with their body functions partial recovery in 2 months.Conclusion More attention should be paied to prevent ectopic embolization of spinal cord vessels originating from extrahepatic collateral arteries during TACE or TAE.

Epirubicin in the treatment of malignant obstructive jaundice / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficiency of epirubicin in the treatment of malignant obstructive jaundice (MOJ).</p><p><b>METHODS</b>Thirty-nine patients with diagnosis of MOJ, whose serum total bilirubin (TB) had not dropped to normal level after stent placement or percutaneous transhepatic biliary drainage, received trans-arterial chemoembolization (TACE). During TACE, epirubicin emulsion containing pharmorubicin at dose of 30 mg/m(2) was used. The toxicity and hepatic injury was observed according to WHO anticancer drug toxicity criterion and Child-Pugh classification criterion, respectively. The time of jaundice recurrence and survival were also observed during follow-up.</p><p><b>RESULTS</b>Median total serum bilirubin in 39 patients was 72.7 micromol/L (range: 52.1 - 91.4 micromol/L) before TACE. The dose of pharmorubicin was 40 - 60 mg with a median of 55.0 mg and the amount of lipiodol was 2 - 25 ml. Decrease in white blood cell count was observed: grade I in 41.0% of patients, grade II in 35.9% and grade III - IV in 15.4%. Grade III - IV nausea and vomiting developed in 100% of the patients. Hepatic injury became aggravated in 8 from A to B class patients, in one from A to C class, and in 3 from B to C class according to Child-Pugh classification criterion. No cardiac toxicity was observed in this series. The median survival time was 6.0 months with a range of 2 to 72 months. Jaundice recurred in 19 patients (48.7%) with a medium jaundice recurrence time of 9.0 months (range: 2 - 20 months).</p><p><b>CONCLUSION</b>Epirubicin-lipiodol emulsion at a dose of 30 mg/m(2) is safe and efficient in the management of patients with malignant obstructive jaundice with total serum bilirubin between 51 and 100 micromol/L after biliary drainage.</p>

A comparative study of MRI manifestations and pathological changes in hepatocellular carcinoma treated by transcatheter arterial chemoembolization with lipiodol / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To analyze the MRI manifestations and pathological changes of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) with lipiodol.</p><p><b>METHODS</b>23 patients with 31 HCC lesions treated by TACE underwent MRI examination within 1 week before their surgical resections. MRI was performed with SE sequence (T1WI and FSE T2WI) and FMPSPGR sequence dynamic multi-phase contrast scans. All resected specimens were cut into 5-10mm thick slices, corresponding to the same plane as that of MRI scans. The specimens were wholly embedded in paraffin, serial sections made and stained with hematoxylin and eosin. The MRI findings were thus compared with the pathology of the specimen sections.</p><p><b>RESULTS</b>(1) MRI findings: In all 31 lesions, the signal intensity of lesions varied and was mostly heterogeneous on SE T1WI and T2WI images. Three lesions were inhomogeneous hyper-intensity and the other 28 lesions were iso- or hypo-intensity on FMPSPGR plain scannings. Twenty-two lesions were enhanced on early-phase dynamic scanning, and no enhancement was found in the other 9 lesions. Partial enhancement was also seen in 6 lesions on delay-phase dynamic scanning. (2) Pathologically, no coagulation necrosis was found in 2 specimens, but 6 lesions showed complete coagulation necrosis and 23 showed various degrees of it. The other pathological changes found included intra-tumoral hemorrhage (n=10), intra-lesional fibrotic septa formation (n=5), capsule-like fibrotic tissue proliferation around the lesions (n=12), inflammatory infiltration (n=28), focal mucoid degeneration (n=2), focal hyaline degeneration (n=2), and lipiodol retention (n=6). (3) Radiological-pathological correlation study: hyper-intense areas on T1WI corresponded to areas of coagulation necrosis with or without hemorrhage and of residual viable tumor; iso- and hypo-intense corresponded to areas of coagulation necrosis or residual viable tumor. Hyper-intense areas on T2WI corresponded to those of residual viable tumor or coagulation necrosis with hemorrhage, and iso-intense areas corresponded to those of coagulation necrosis, small residual viable tumor or intra-lesional fibrotic septa formation, and hypo-intense areas corresponded to those of coagulation necrosis or intra-lesional fibrotic septa formation. Areas of enhancement within the lesions on the early-phase dynamic-contrast images corresponded to areas of residual viable tumors, while areas of no enhancement were those of coagulation necrosis, hemorrhage, intra-lesional fibrotic septa formation or small residual viable tumors. Areas of enhancement on the delay-phase dynamic scanning were those of residual viable tumors or intra-lesional fibrotic septa formation, while no enhancement corresponded to the areas of residual viable tumors, coagulation necrosis, and hemorrhage. Areas of enhancement on the delay-phase dynamic scanning corresponded to those areas of fibrosis tissue or residual viable tumors. Inflammatory infiltration was found in areas of different signal intensity on MRI images.</p><p><b>CONCLUSIONS</b>(1) Different pathological changes in HCCs after TACE are represented by various signal intensities on SE sequence images. The only area of hypo-intensity on T2WI has a specificity in representing coagulation necrosis. (2) FMPSPGR sequence dynamic MRI is superior to SE sequence in demonstrating and determining the necrosis and residual viable tumor. Enhanced areas within the lesions on the early-phase dynamic-contrast images represent residual viable tumors and the enhancement of capsule on early-phase dynamic-contrast images also represent subcapsular residual viable tumors. (3) MRI can demonstrate accurately the areas of necrosis and residual viable HCC tissues after TACE and evaluate the effect of TACE.</p>

The value of high-resolution contrast-enhanced three-dimensional magnetic resonance angiography in the evaluation of hepatic arterial anatomy / 中华放射学杂志

Objective Compared with digital subtraction angiography(DSA),to evaluate the value of high-resolution contrast-enhanced three-dimensional magnetic resonance angiography(3D MRA) in defining hepatic arterial anatomy.Methods The data about abdominal high-resolution contrast-enhanced 3D MRA and DSA of 26 patients (24 patients with primary liver cancer,2 patients with metastatic liver tumor) was retrospectively analyzed.The display quality of different segmental hepatic artery was scored with 4 grades and the agreement between high-resolution 3D MRA and DSA was determined with the weighted Kappa statistic.The depiction of hepatic arterial anatomy/anomalies and vascular pathology on high- resolution 3D MRA was assessed and compared with DSA.Results With respect to display quality,there was good or fair correlation between high-resolution 3D MRA and DSA for the common hepatic artery (the mean score respectively was 3.96,3.96 and Kappa value 0.99),gastroduodenal artery (the mean score respectively 3.85,3.88 and Kappa value 0.85 ),right hepatic artery(the mean score respectively 3.92, 3.96 and Kappa value 0.65 ),left hepatic artery (the mean score respectively 3.77,3.92 and Kappa value 0.43 ),left gastric artery(the mean score respectively 3.73,3.85 and Kappa value 0.43 ),right anterior artery (the mean score respectively 3.35,3.70 and Kappa value 0.53),right posterior artery (the mean score respectively 3.31,3.73 and Kappa value 0.46)and 1V segment artery (the mean score respectively 2.92,3.46 and Kappa value 0.51 );Poor correlation was found for the Ⅱsegment artery (the mean score respectively 2.15,3.35 and Kappa value 0.18)and Ⅲsegment artery (the mean score respectively 2.19, 3.35 and Kappa value 0.21 ).Compared with DSA,18 normal hepatic arterial anatomy and 7 arterial anomalies were accurately demonstrated(accuracy ratio 96.1% (25/26)),the obliteration of gastroduodenal artery correctly depicted in 1 patient on high-resolution 3D MRA image.Conclusions High-resolution 3D MRA can provide accurate evaluation of hepatic artery and has the capacity of depicting hepatic segment artery.

Budd-Chiari syndrome:diagnosis with three-dimensional contrast-enhanced MR angiography / 中华放射学杂志

Objective To assess the various features of Budd-Chiari syndrome(BCS)on three- dimensional contrast-enhanced magnetic resonance angiography(3D CE MRA)and to evaluate the potential value of this new technique.Methods Thirty-three patients with BCS underwent 3D CE MRA examination. In 23 cases,BCS was secondary to hepatocellular carcinoma(21 patients)or right adrenal carcinoma (1 patient)or thrombophlebitis(1 patient).Ten patients had primary BCS.The patency of the hepatic veins,inferior vena cava(IVC)and portal veins were assessed.The presence of intra-and extrahepatic collaterals,liver parenchymal abnormalities and porto-systemic varices were evaluated.The diagnosis on 3D CE MRA was correlated with that on inferior vena cavography and right hepatic venography,which were available in 10 and 2 cases respectively.Results Various features of BCS were displayed on 3D CE MRA. Hepatic venous findings included tumor thrombosis(19 patients),tumor compression(2 patients), nonvisualization(4 patients)and focal stenosis(4 patients)of the hepatic veins.IVC findings were severe stenosis or occlusion(10 cases),tumor direct invasion(2 cases),tumor thrombosis(3 cases), thrombophlebitis(1 case)and web formation(3 cases).Intrahepatic collaterals were demonstrated in 9 patients including 2 with "spider web" sign.Detected extrahepatic collaterals included dilated azygos and hemiazygos veins(13 cases)and left renal-inferior phrenic-pericardiophrenic collaterals(2 cases).The occlusion of the left portal vein and the presence of porto-systemic varices were depicted in 2 and 10 patients respectively.Liver parenchymal abnormalities identified by 3D CE MRA consisted of caudate lobe enlargement(7 cases),heterogenous enhancement(18 cases)and associated tumors(18 cases). Compared with inferior vena cavography and hepatic venography,the accuracy of 3D CE MRA in the diagnosis of IVC obstruction or hepatic venous stenosis was 100%.Conclusion 3D CE MRA can display various features of BCS and has the potential to provide an accurate diagnosis.

Clinical analysis of 56 cases of primary liver cancer of over 5 years survival after comprehensive interventional therapy / 介入放射学杂志

Objective To analyze the key factors on long-term effect for comprehensive interventional therapy of primary liver cancer.Methods The clinical data,therapeutic protocols and follow-up of 56 patients with primary liver cancer survived for more than 5 years after comprehensive interventional therapy were analyzed retrospectively.Results Before TACE,20 patients were in clinical stageⅠ,35 were in stageⅡand one was in stageⅢ,including hepatic function of grade A(36 cases),grade B(20 cases),and grade C (0 case).The tumor patterns were consisted of mononodular type(32 cases),multinodular type(24 cases),and diffuse type(0 cases).The diameter of tumor demonstrated less than 3 cm(10 cases),3-5 cm(20 cases), 5-10 cm(19 cases)and more than 10 cm(7 cases).Thirty-three cases(58.9%)were treated by only TACE for the original lesions,while 23 cases(41.1%)were treated by TACE combined other treatment including TACE combined PEt(11 cases),TACE combined RFA(4 eases),TACE combined radiotherapy(one case),and TACE combinedⅡ-staged resection(7 cases).During follow-up,24 patients with hepatic recurrence and 17 cases of distal metastasis were treated by TACE and other anti-tumor treatment.Complications after interventional therapy in 20 cases were also treated.All cases survived for more than 5 years after interventional therapy including 3 more than 10 years.Conclusions Tumor factors,liver function, standardized TACE,combination of TACE with other anti-tumor therapy,treatment of hepatic recurrence and distal metastasis and complications are the key points to improve the long-term survival rate for primary liver cancer treated by comprehensive interventional therapy.

The portal venous pressure change due to metallic stents implanted into portal veins in HCC patients / 介入放射学杂志

Objective To research the change of the portal venous pressure after the stents implanted into portal vein in HCC.Methods Twelve HCC patients receiving portal venous stem embolization were included in this study.The portal venous pressures were recorded before varices embolized(P1),after embolized(P2)and after stents implanted(P3),respectively.Four groups were formed according to the pressures within portal vein stem(PV),portal vein branch without tumor invasion(PVB),splenic vein(SV) and superior mesenteric vein(SMV).Results In PV group,P1 was(45:17?2.25)cm H20,and P2 was (48.33?2.20)cm H_2O,P＜0.05,P3 was(39.33?2.44)em H_2O,thus P＜0.05 in comparing with P2.for PVB group,P1 was(38.08?2.97)cm H_2O,and P2 was(38.83?2.94)cm H_2O,P＞0.05,P3 was(37.41?2.37)cm H_2O,comparing with P2,P＞0.05.In SV group,P1 was(44.67?2.13)cm H_2O,and P2 was(48.17?2.20)cm H_2O,P＜0.05,P3 was(41.67?2.20)cm H_2O,comparing with P2,P＜0.05.Finally,the SMV group,P1 was(45.25?2.21 )cm H_2O,P2 was(48.42?2.19)cm H_2O,P＜0.05,P3 was(41.25?2.24)cm H_2O, in comparison with P2,P＜0.05.Conclusions In portal vein stem embolization,portal venous pressure would be higher after varices embolized,but lower after stents placement.

Preliminary experience of HCC treated by embolization of microspheres combined with lipiodol / 介入放射学杂志

Objective To study the safety and efficacy of transhepatic arterial infusion embolization using microspheres combined with lipiodol for treatment of hepatocellular carcinoma(HCC).Methods Transhepatic arterial chemoembolization(TACE)was performed with 1-2 ml 300-500?m mierospheres and 10-20 ml lipiodol for treatment of HCC.Changes of liver function,AFP,responses of tumor and complications related to embolization were analyzed before and after TACE.Results Thirty six patients with HCC were enrolled into this study.After TACE,patients' liver function got worsen and tumor size decreased significantly(P＜0.05).Conclusion TACE with use of microspheres combined with lipiodol is an effective treatment for HCC,but should be taken carefully to avoid hepatic failure.

Stenting in malignant obstruction of inferior vena cava caused by hepatic carcinoma / 介入放射学杂志

Objective To evaluate the effectiveness of endovascular deployment of metallic Z-type self- expandable stents in treating the patients with inferior vena eava(IVC)obstruction caused by hepatic malignant tumour.Methods One hundred and fifty six patients with IVC obstruction due to malignant compression were enrolled.Venography was performed via femoral vein before and after metallic Z-type self-expandable stent deployment across the stenotic segment of IVC.The diameter of stenotic segment,collateral vessels,venous pressures and the scores of patients IVC syndrome were compared before and after stent placement.Results One hundred and seventy nine stents were implanted in 156 patients successfully.The average obstructive length of IVC was(6.1?2.2)cm.The pressure gradient of stenotie segments of IVC declined from(2.1?0.5)kPa to (0.5?0.11)kPa.The diameters of stenotic segment of IVC increased from(0.33?0.11 )cm to(1.6?0.4) cm.After operations,the main clinical symptoms and physical signs relieved quickly.During 2～24 month follow-up,the pateney of IVC stents reached 86.7%.Conclusion Endovascular deployment of metallic Z-type self-expandable stent is an effective palliative treatment for patients with malignant obstruction of IVC.

Preliminary study on therapeutic effect of poly(N-isopropylacrylamide)adriamycin magnetic nanoparticles via transarterial embolization on liver VX2 tumor in rabbits / 介入放射学杂志

Objective To evaluate the therapeutic effects of poly(N-isopropylacrylamide)adriamycin magnetic nanoparticles(ADM-PNIPAM-Fe_3O_4)on liver VX2 tumor in rabbits via transcatheter arterial chemoembolization.Methods VX2 tumor pieces were successfully implanted into liver lobes of rabbits with liver tumors formation.All the animals were randomly divided into 4 groups of 8 each.Group A(control group)injected with 10 ml physiologic saline,Group B(ADM group)treated with free adriamycin (1 mg/kg)via arterial infusion,Group C(ADM-PNIPAM group)ADM-PNIPAM(1.5 mg/kg)was infused through arterial route,Group D(ADM-PNIPAM-Fe_3O_4+M group)ADM-PNIPAM-Fe_3O_4(2 mg/kg)was infused through arterial route;all were in individual doses,respectively;meanwhile an persistant magnet with intensity of 0.4 T was stabilized at the tumor region.Spiral CT scans were performed to measure size of liver tumors and evaluate lung metastasis at 1 day before operation and 14 days after operation.All experimental animals were sacrficed on the 15th days after operation and followed by pathologic and histologic examination of the tumor and lung specimens including changes befor and after the operation with correlative comparisons.Results There were no significant difference in volumes of tumors among 4 groups at 1 day before operation.The average tumor volume in the group A was(23.87?7.02)cm~3 at 14 days after operation;(7.70?1.53)cm3 in group B;(4.29?0.25)cm~3 in group C;(2.05?0.18)cm~3 in group D. The average tumor volumes in the group B,group C and group D were significantly smaller than that in the control group A at same time after operation and there was significant difference among the three experimental groups.According to the order of tumor sizes from small to large was as follows:group D＜group C＜group B＜group A.It showed that the average size of group D(ADM-PNIPAM-Fe_3O_4+M group) was the smallest among the 4 groups.Lung metastatic rates were 100%,66.7%,37.5% and 12.5% in group A,group B,group C and group D at 14 days after operation,respectively.Lung metastatic rates of group D was lower than that of group A,but there were no significant differences among group A,B and C.But pathological examination showed that there were lesser number of lung metastatic tumors in group B and C than that of group A .The intratumoral necrotic degrees showed as group D＞group C＞group B＞group A. Conclusions ADM-PNIPAM-Fe_3O_4 treatment for liver tumor via vascular interventional method combined with magnetic field localized in the lesion possesses significant inhibitory effect on tumor growth of liver VX2 tumor in rabbits.ADM-PNIPAM-Fe_3O_4 is thus initially confirmed as a kind of effective praeputium in interventional chemoembolization.

The treatment effect of As_2O_3-PLGA microspheres on VX2 rabbits liver tumor models / 介入放射学杂志

Objective To assess the treatment effects of As_2O_3-PLGA microspheres on VX2 rabbits liver tumor models.Methods Thirty-two New Zealand white rabbits were involved with formation of VX2 rabbits liver tumor models,and randomly divided into 4 groups of 8 each.(a)As_2O_3 plus 0.9% NaCl solution group:3 F co-catheter was plugged into hepatic artery,and then As_2O_3(3 mg/kg)plus 10 ml 0.9%NaCl solution was injected into the tumor through the feeding artery;(b)As_2O_3-PLGA microspheres group :As_2O_3- PLGA microspheres(3 mg/kg)was injected into the tumor through the feeding artery;(c)PLGA mierospheres group:Injection of PLGA microspheres(3 mg/kg)injected into the tumor through the feeding artery;(d) control group:0.9% NaCl solution(10 ml)was injected into the feeding artery.Dual phase helical CT scans were performed the day before treatment,20 days after treatment and finally the rabbits were sacrificed.The sizes of the tumor were measured and followed by histopathological analysis and HE staining.Results The volumes of tumors post operatively of group a,b,c and d were(31.08?11.15)cm~3,(3.82?2.537)cm~3, (13.22?4.665)cm~3 and(115.8?62.01)cm~3 respectively.The most significant treatment effect was available in group b,with more coagulation necrosis and fibrotic tissue formation.Statistical analysis indicated that the treatment effects of group a,b,c were better than that of group d with significant difference which can be also seen between group a and b,group b and c.Conclusion As_2O_3-PLGA microspheres shows rather excellent chemoembolization effects on VX2 rabbit liver tumor model with safely.