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Objective:To explore the value of cell division cycle 42 (CDC42) in the efficacy and prognosis evaluation of arterial infusion chemotherapy for pancreatic cancer.Methods:The clinical data of 100 patients with pancreatic cancer who underwent arterial infusion chemotherapy from January 2018 to January 2020 at Second People's Hospital of Wuhu were retrospectively analyzed, and all patients were divided into effective group (the complete remission and partial remission) and ineffective group (the stable disease and the progressive disease) according to the chemotherapy efficacy determined by CT. The clinicopathological characteristics of both groups were compared. The influencing factors of chemotherapy efficacy were determined by using multivariate logistic regression model analysis. The efficacy evaluated by CT examination was treated as the gold standard. The receiver operating characteristic (ROC) curve was used to analyze the value of CDC42 level predicting the efficacy of arterial infusion chemotherapy for pancreatic cancer patients before infusion chemotherapy. Survival analysis was performed by using Kaplan-Meier and log-rank test was also performed.Results:Among 100 patients with pancreatic cancer, there were 13 cases of complete remission, 30 cases of partial remission, 20 cases of stable disease, 37 cases of progressive disease; 43 cases in effective group and 57 cases in ineffective group. The proportions of tumor long diameter > 4 cm, TNM staging Ⅲ-Ⅳ, carcinoembryonic antigen (CA)199 > 37 U/ml, carcino-embryonic antigen (CEA) > 5 ng/ml, neutrophil-to-lymphocyte (NLR) > 2.8, serum total bilirubin > 34.2 μmol/L before infusion, CDC42 ≤ 1.11 μg/L, low differentiation degree and vascular invasion in ineffective group were higher than those in effective group (all P < 0.05). Tumor long diameter > 4 cm, TNM staging Ⅲ-Ⅳ, CA199 > 37 U/ml, CEA > 5 ng/ml before infusion, low differentiation degree, vascular invasion, and CDC42 ≤ 1.11 μg/L were independent risk factors for effectiveness of arterial infusion chemotherapy (all P < 0.05). The area under the ROC curve of CDC42 predicting the ineffectiveness of arterial infusion chemotherapy was 0.810 (95% CI 0.781-0.839, P <0.01), and the optimal cut-off value was 1.11 μg/L, the sensitivity was 96.25%, and the specificity was 63.13%. Survival curve analysis showed that the 2-year overall survival rate of patients with CDC42 > 1.11 μg/L was 58.93% which was greater than that of patients with CDC42 ≤ 1.11 μg/L (22.73%), and the difference was statistically significant ( χ2 = 14.99, P<0.001). Conclusion:CDC42 level is an independent influencing factor for the efficacy of arterial infusion chemotherapy in patients with pancreatic cancer, and it can effectively predict the prognosis of patients.
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Objective To evaluate the clinical value of subclavian vein puncture with 16 G arteriovenous indwelling needle for emergency treatment of hemorrhagic shock,so as to provide a new approach for the rapid establishment of deep venous passage.Methods 80 patients with acute hemorrhagic shock were randomly divided into patients with arteriovenous indwelling needle group (catheter group) and conventional guide wire deep vein puncture group(routine puncture group),40 cases in each group.The two groups were treated with supraclavicular subclavian vein puncture.The operation time,success rate of the first puncture,puncture times and rehydration rate,incidence of complications were observed in the two groups.Results The operation time of indwelling needle group was (62 ±22)s,which was significantly shorter than (672 ± 178)s of the conventional puncture group,there was significant difference between the two groups (t =15.062,P =0.000).The first time success rate of puncture in the indwelling needle group was 70％ (28 cases),which in the conventional group was 80％ (32 cases),the difference was not statistically significant(x2 =1.067,P =0.439),all patients were in 3 attempts in successful puncture.The velocity of infusion of 500 mL hydroxyethyl starch in the indwelling needle group was (198 ± 51)s,which was better than (456 ± 86)s in the conventional puncture group,the difference between the two groups was statistically significant (t =9.318,P =0.000).The two groups had no deep vein puncture related complications.Conclusion Arteriovenous indwelling needle by supraclavicular subclavian vein puncture with conventional guide wire supraclavicular subclavian vein puncture catheter can be used for emergency treatment of hemorrhagic shock,but the indwelling needle group in the operation time and velocity is superior to conventional guide wire group,more suitable for the rescue of patients with acute hemorrhagic shock time is pressing,stay with stable circulation can be through the guide wire inserted catheter indwelling subclavian vein catheter.
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Objective To compare the recent adverse reactions caused by 131I-Metuximab (licartin) treatment via two different routes and to assess the safety and advantages of peripheral intravenous bolus of licartin for the treatment of advanced HCC.Methods Clinical data of 54 patients (45 males,9 females,age 33-80 years) with advanced HCC treated with Licartin in Tianjin Medical University Cancer Institute and Hospital from October 2010 to March 2013 were collected and analyzed.The patients were divided into vein group (n=33) with Licartin injected through peripheral vein and artery group (n =21) with Licartin injected through hepatic artery.The results of blood routine examination,liver and kidney function and thyroid function between the two groups (1 week before treatment,4 and 12 weeks after treatment) were compared.The adverse reaction rate (ARR) and adverse reaction progression rate (ARPR) were also compared between the 2 groups.Ten days after Licartin treatment,all patients underwent gamma imaging to access the drug distribution in vivo.x2 test and two-sample t test were used to analyze data.Results There were no significant differences on age,gender and TNM staging between the vein group and the artery group (t =0.721,x2=0.561 and 4.769,all P＞0.05).The vein group showed temporary drug-related leucopenia (x2=7.041,P＜0.05) and increased level of serum total bilirubin (STB;x2 =10.297,P＜0.05) 4 weeks post-treatment.Twelve weeks later,the above parameters returned to baseline.In artery group,no influence on liver and kidney functions was observed,but the numbers of WBC and PLT decreased significantly (x2 =8.949 and 8.778,both P＜0.05) and returned to baseline 12 weeks post-treatment.The ARR in patients who had normal ALT levels before treatment between the two groups was significantly different(3.33％(1/30) vs 5/19,x2=5.718,P＜0.05).No significant difference was observed on ARR in patients with normal level of other parameters,and on ARPR in patients with abnormal preoperative parameters between the two groups (x2 =0.000-2.500,all P＞0.05).The drug's in vivo biodistribution and the thyroid function between the 2 groups showed no significant difference.Conclusion The peripheral intravenous bolus administration of Licartin is safe to treat patients with advanced HCC.
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BACKGROUND:Hyperbranched cationic amylopectin is a kind of nonviral gene vectors with low toxicity and good transfection efficiency. However, searching for more efficient methods to delivery it into the body and making the genes expressed are being explored. OBJECTIVE:To study the expression of DMAPA-Amp wrapped green fluorescent protein (GFP) transferred by modified carotid injection into cerebral ischemic area. METHODS:Male Sprague-Dawley rats subjected to middle cerebral artery infarction were randomly divided into two groups after 24 hours:experimental group (injected with GFP entrapped DMAPA-Amp via the internal carotid artery) and control group (injected with GFP entrapped DMAPA-Amp via the tail vein). These rats were put to death and their brain tissue was removed after 7 days. The expression of GFP was detected by quantitative PCR and western blot assay, and immunofluorescence staining was performed to detect the expression of GFP located near cerebrovascular endothelial cel s by frozen section. RESULTS AND CONCLUSION:Compared with the control group, the expression of GFP was much higher in the experimental group detected by quantitative PCR and western blot (P< 0.05). Additional y, the expression of GFP located near cerebrovascular endothelial cel s by frozen section was also higher than that in the control group. Modified carotid injection could significantly promote the expression of hyperbranched cationic amylopectin derivates and GFP in the brain tissue of Sprague-Dawley rats undergoing middle cerebral artery infarction compared with tail vein injection, which indicates DMAPA-Amp and modified carotid injection may cast new lights on the therapy for angiogenesis of ischemic stroke.
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Objective In the context of worldwide shortage of amytal,explore the intracarotidpropofol test for lateralizing language area and assessing hemispheric memory function.Methods Fourteen patients with refractory partial epilepsy who were candidates for surgical intervention were included in the study.With guide under a digital subtraction angiography,propofol was injected in bilateral intracarotidsequentially.Muscle power deceasing to level 0 at the contralateral limb and eyes gazing to contralateral side were used as the mark of hemispheric anesthesia completely.The immediate language alterations were recorded.To evaluate the bilateral language and memory functions,the visual and auditory memory tasks were performed sequentially once patient could concentrate his attention ; and after limb muscle power recovering to normal level,patients were required to perform a free recall test.Any abnormal responses were recorded.Results Language dominant hemisphere was determined in 14 patients.Nine patients were confirmed as left language dominance,2 patients were right language dominance.The remained 3 patients were considered as bilateral language dominance.Meanwhile,the hemispheric memory function was able be evaluated in 13 patients.More than 67％ memory function was sustained in hemisphere contralateral to mesial temporal lesions.Transient responses including eye pain,facial muscle spasms,laughers and involuntary movements were observed.Conclusion Hemispheric language and memory functions can be assessed with direct intracarotidpropofol injection,and propofol could be an alternative drug to amobarbital used in the Wada test.
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Objective To investigate the effect of ketamine injected via the radicular arteries on spinal cord. Methods Twenty healthy mongrel dogs of both sexes weighing 12-18 kg were randomly divided into 2 groups ( n = 10 each): control group (group C) and ketamine group (group K). The animals were anesthetized with intravenous pentobarbital 30-35 mg/kg, fentanyl 50-100 μg and vecuronium 0.2 mg/kg and maintained with propofol ically ventilated after tracheal intubation. A catheter was inserted into T8 poster intercostal artery and advanced toward the opening of radicular artery which supplies the spinal cord. Ketamine 100 mg (in 2 ml of normal saline)was injected via the catheter in group K. Three hours after ketamine administration, the animals were sacrificed. A 1.5 cm long segment of spinal cord at the level of T8 was removed for microscopic examination and determination of the expression of NSE, S100β and Tau protein by immuno-histochemistry. Results There was no significant difference in the number of Nissl' s staining-negative neuronal cells and the expression of NSE, S100β and Tau protein in the spinal cord between the 2 groups ( P ＞ 0.05 ). Conclusion Ketamine injected via the radicular arteries does not induce spinal cord injury.
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Objective: To study the pharmacokinetics and factors influencing consecutive internal iliac arterial and intravenous infusion of 5-fluorouracil 5-FU and 4′ -O-tetrahydropyranyladriamycin (THP) and provide the experimental evidence to optimize intra-artery chemotherapy for pelvic malignant tumor. Methods:Mature female New Zealand rabbits were divided randomly into two groups. One group was consecutively infused by 5-FU and THP via internal iliac artery for 6 h. The other group was consecutively infused by 5-FU and THP via ear vein. The blood samples and the uterus tissue specimens were collected at various time points during the infusion period. At the end of infusion, the rabbits were sacrificed via intravenous air embolism and the heart, lung, and the node-rich pelvic adipose tissues were collected. The drug concentrations in plasma and tissue specimens were determined by high performance liquid chromatography methods. Results: The peak plasma concentration and AUC (area under curve) of intra-arterial infusion of 5-FU were a little lower than those via intravenous infusion. The peak concentration of intra-arterial infusion of 5-FU were 2-3 fold increased in uterus tissues and 5-fold increased in pelvic lymph node and adjacent tissues compared with those via intravenous infusion. The peak plasma concentration and AUC of intra-arterial infusion of THP were lower than those via intravenous infusion. The peak concentration and AUC of intra-arterial infusion of THP were not significantly different in uterus tissues between the two infusion forms. The peak concentration of THP was decreased by 50% in heart and lung tissues but increased to 5-fold in pelvic peripheral lymph node tissues by intra-arterial infusion than those by intravenous infusion. The serum to tissue vein distribution ratio of THP was several hundred times. Conclusions: Consecutive intra-arterial infusion of 5-FU and THP had some advantages compared with continuous intravenous infusion at different degrees. These advantages depended on the drugs' pharmacological properties.
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Objective To investigate the clinical value of iPass in three dimensional contrast enhanced MR angiography (3D-CE-MRA). Methods iPass were performed in 32 cases, including cervical vessel (4 cases), pulmonary vessel (7 cases), abdominal vessel (18 cases), and femoral vessel (3 cases). iPass bolus tracking was run before 3D-CE-MRA. The tracking sequence was operated repeatedly with real time display of image. The peak of bolus arrival time(Tp), identified with signal of target vessel increased 30% over baseline, was automatically loaded in the timing page of 3D-CE-MRA, and the time of scan delay(Td) was computed by the system with Tp. The acquired images were subtracted and reconstructed by MIP. The quality of MIP image was evaluated. Results The iPass bolus tracking sequence and 3D-CE-MRA were completed successfully in 29 cases. The bolus tracking couldn′t detect the bolus arrival time in 3 cases, but they were completed through changing ROI and bolus tracking repeatedly. The average score of 3D-CE-MRA MIP image was 3.81?0.59. Conclusion iPass can provide the exact Tp and automatically control Td of 3D-CE-MRA. iPass is a useful procedure to improve the image quality and provide the specific scanning scheme for 3D-CE-MRA.
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Objective To investigate the efficiency and targeting of the GE7 system mediated gene transfer in the chemically induced ovarian tumor by intraarterial route. Methods Animal models were chemically induced by 7,12-dimethylbenz [ a] anthracene ( DMBA ) . GE7-polylysine/p-galactosidase ( ?-gal)/polylysine-HA20 complexes were constructed. Fifteen rats with induced ovarian tumor were divided into three groups, the complexes were injected through ovarian artery and tail vein, respectively. The tumor, heart, liver, spleen, lung and kidney were obtained at 72 h. X-gal staining was used to check expression of ?-gal. Results ?-gal was expressed strongly and well-distributed in tumor in the first group, and stained blue in the liver, spleen, lung and kidney, but much weaker than that of tumor. In the second group, ?-gal was expressed in the tumor,and weakly expressed in the liver, none was detected in the other organs. In the third group ?-gal was detected in the lung slightly, none was detected in the tumor and other organs. Conclusions When GE7 complexes were administrated through ovarian artery, the introduced gene expressed preferentially in ovary. This result was the basis of intraarterial administration of therapeutic gene to treat ovarian cancer.
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Objective To observe the patency and the rate of arterial spasm in different time periods following segmental hydrolic dilation during the course of tissue transplantation; also the influence of arterial dilation to arterial structure was studied with histological examinations. Methods Fifty seven patients with thumb or finger defects were treated with thumb reconstruction using thumb nail flap free transplantation in 41 cases, thumb reconstruction using free transplantation of the second toe in 6 cases and 10 cases had finger reconstruction using the second and third toe free transplantation. Following complete tissue isolation, and prior to vascular anastomosis, heparin+normal saline was injected into the dorsal pedal artery, the first metatarsal artery and the digital artery of the big toe or the second for segmental dilation with the pressure of 300 mmHg. The dorsal pedis arteries were taken for histologic studies after hydrolic dilation. Results 1)The temperature of transplanted tissues were 0.16 ℃ higher than the health side. 2)The immediate arterial patency rate was 100% after anastomosis and the rate of spasm was 0. Vascular crisis took place in one case 24 hours after the operation, and was relieved after removal of the hematoma. There was one failure due to the extensive thrombosis formation in the capillaries. 3)Histologic study showed: there were 15% of the arterial endothelium exfoliated following hydraulic dilatation, resulting in looseing of the internal elastic membrane, a basically normal muscular layer of different thickness; without hydraulic dilatation, 7% of the arterial endothelial cells exfoliated, with homogeneous thickness of the internal elastic membrane and intact muscular layer. Conclusion 1)Segmental hydrolic dilation is one of the effective methods to prevent and treat vascular spasm and it is a safe and effective method to increase the successful rate of free tissue transplantation. 2)Hydrolic dilation within a certain range(300 mmHg) had no obvious effect on arterial structure.