Overlapping Stents-Assisted Coiling for Vertebral Artery Dissecting Aneurysm : LVIS Stent within Neuroform EZ Stent

Objective@#: To evaluate the safety and efficacy of an overlapped stenting-assisted coiling technique in treating vertebral artery dissecting aneurysm (VADA) via Low-profile Visualized Intraluminal Support (LVIS) stent-within-Neuroform EZ stent. @*Methods@#: From January 2017 to June 2019, 18 consecutive patients with VADAs (ruptured : unruptured=5 : 13) were treated with the overlapping stents assisted-coiling technique in our center. The overlapping manner was a Neuroform EZ stent being deployed first, followed by LVIS stents placement using the ‘shelf’ technique. The patients’ clinical characteristics, technical feasibility and safety, and immediate and follow-up angiographic results were retrospectively reviewed. @*Results@#: Seventeen (94.4%) procedures were technically successful with an exact deployment of the stents and patent parent or perforator arteries. The immediate angiographies after procedure confirmed Raymond class I, II, and III occlusion of VADAs were in 12 (66.7%), two (11.1%), and four cases (22.2%), respectively. Post-procedural complications developed in one patient (5.6%) with minor brainstem infarctions, which resulted from an in-stent thrombosis during the procedure. Angiographic follow-up at 5.7 months (range 3 to 9 months) demonstrated Raymond class I and II occlusion were in all cases (100%). The modified Rankin Scale scores at 21.3 months (range 15 to 42 months) 0–2 in 17 cases (94.4%) and three in one case (5.6%). @*Conclusion@#: Overlapping stents via LVIS stent-within-Neuroform EZ stent combined with coiling is safe and effective for patients with VADA in the midterm results.

Expression and clinicopathological significance of Bcl - 2 and Bax genes in colorectal cancer patients complicated with schistosomiasis / 中国血吸虫病防治杂志

Objective To investigate the expression and clinicopathological significance of Bcl-2 and Bax genes in colorectal cancer (CRC) patients complicated with schistosomiasis. Methods The CRC patients receiving surgical treatment in the First Affiliated Hospital of Dali University from June 2016 to June 2020 were recruited as the study subjects, and 30 subjects were randomly sampled from the CRC patients complicated with schistosomiasis (CRC-S group) and 30 subjects were randomly sampled from the CRC patients without schistosomiasis (CRC group) using a random number table method. The cancer specimens were sampled from subjects in the CRC-S and CRC groups, and the peri-cancer specimens were sampled from subjects in the CRC group. The Bcl-2 and Bax expression was quantified in cancer and peri-cancer specimens using a real-time fluorescent quantitative PCR (qPCR) assay and immunohistochemistry at transcriptional and translational levels, and the cell apoptosis was detected in cancer specimens using HE staining. Results A total of 60 subjects were enrolled, including 30 cases in the CRC group and 30 cases in the CRC-S group. There were no significant differences between the two groups in terms of gender distribution (χ2 = 0.271, P > 0.05), mean age (t = -0.596, P > 0.05), tumor growth pattern (χ2 = 0.275, P > 0.05), tumor location (χ2 = 4.008, P > 0.05), tumor invasion depth (χ2 = 0.608, P > 0.05), degree of tumor differentiation (χ2 = 0.364, P > 0.05), or presence of vascular metastasis (χ2 = 1.111, P > 0.05), while significant differences were seen between the two groups in terms of histological type, presence of lymph node metastasis and TMN staging (χ2 = 5.963, 8.297 and 5.711, all P values < 0.05). qPCR assay and immunohistochemistry quantified significantly higher Bcl-2 and Bax expression in cancer specimens from the CRC and CRC-S groups than in the peri-cancer specimens from the CRC group at both translational and transcriptional levels (all P values < 0.05), and higher Bcl-2 and lower Bax expression were seen in the cancer specimens from the CSC-S group than that from the CRC group (all P values < 0.05). In addition, the cell apoptotic rate was significantly greater in the cancer specimens in the CRC group than in the CRC-S group (42.00% vs. 23.35%; χ2 = 41.500, P = 0.000). Conclusion Schistosomiasis may be involved in the development and progression of CRC through affecting Bcl-2 and Bax gene expression in the apoptosis signaling pathway.

Balloon dilation of epidermolysis bullosa-related esophageal strictures: A report of two cases

Epidermolysis bullosa (EB) is a very rare inherited disease featured with skin blistering resulting from minor trauma. Sometimes the esophageal mucosa could also be involved, which leads to esophageal strictures. Here we report two cases of EB-related esophageal strictures who were successfully treated with esophageal balloon dilations. The two cases with EB had severe dysphagia. Clinical examination showed signs of malnutrition, skin blisters and loss of toenails due to EB. They underwent careful fluoroscopic balloon dilation with 10- and 16-mm-sized balloon catheters, respectively. They could ingest soft and some solid foods after the procedure and maintained during the 20 months and 16 months follow-up periods.

A Whole-Tumor Histogram Analysis of Apparent Diffusion Coefficient Maps for Differentiating Thymic Carcinoma from Lymphoma

OBJECTIVE: To assess the performance of a whole-tumor histogram analysis of apparent diffusion coefficient (ADC) maps in differentiating thymic carcinoma from lymphoma, and compare it with that of a commonly used hot-spot region-of-interest (ROI)-based ADC measurement. MATERIALS AND METHODS: Diffusion weighted imaging data of 15 patients with thymic carcinoma and 13 patients with lymphoma were retrospectively collected and processed with a mono-exponential model. ADC measurements were performed by using a histogram-based and hot-spot-ROI-based approach. In the histogram-based approach, the following parameters were generated: mean ADC (ADCmean), median ADC (ADCmedian), 10th and 90th percentile of ADC (ADC10 and ADC90), kurtosis, and skewness. The difference in ADCs between thymic carcinoma and lymphoma was compared using a t test. Receiver operating characteristic analyses were conducted to determine and compare the differentiating performance of ADCs. RESULTS: Lymphoma demonstrated significantly lower ADCmean, ADCmedian, ADC10, ADC90, and hot-spot-ROI-based mean ADC than those found in thymic carcinoma (all p values < 0.05). There were no differences found in the kurtosis (p = 0.412) and skewness (p = 0.273). The ADC10 demonstrated optimal differentiating performance (cut-off value, 0.403 × 10−3 mm2/s; area under the receiver operating characteristic curve [AUC], 0.977; sensitivity, 92.3%; specificity, 93.3%), followed by the ADCmean, ADCmedian, ADC90, and hot-spot-ROI-based mean ADC. The AUC of ADC10 was significantly higher than that of the hot spot ROI based ADC (0.977 vs. 0.797, p = 0.036). CONCLUSION: Compared with the commonly used hot spot ROI based ADC measurement, a histogram analysis of ADC maps can improve the differentiating performance between thymic carcinoma and lymphoma.

Utility of Readout-Segmented Echo-Planar Imaging-Based Diffusion Kurtosis Imaging for Differentiating Malignant from Benign Masses in Head and Neck Region

OBJECTIVE: To compare the diagnostic performance of readout-segmented echo-planar imaging (RS-EPI)-based diffusion kurtosis imaging (DKI) and that of diffusion-weighted imaging (DWI) for differentiating malignant from benign masses in head and neck region. MATERIALS AND METHODS: Between December 2014 and April 2016, we retrospectively enrolled 72 consecutive patients with head and neck masses who had undergone RS-EPI-based DKI scan (b value of 0, 500, 1000, and 1500 s/mm2) for pretreatment evaluation. Imaging data were post-processed by using monoexponential and diffusion kurtosis (DK) model for quantitation of apparent diffusion coefficient (ADC), apparent diffusion for Gaussian distribution (Dapp), and apparent kurtosis coefficient (Kapp). Unpaired t test and Mann-Whitney U test were used to compare differences of quantitative parameters between malignant and benign groups. Receiver operating characteristic curve analyses were performed to determine and compare the diagnostic ability of quantitative parameters in predicting malignancy. RESULTS: Malignant group demonstrated significantly lower ADC (0.754 ± 0.167 vs. 1.222 ± 0.420, p < 0.001) and Dapp (1.029 ± 0.226 vs. 1.640 ± 0.445, p < 0.001) while higher Kapp (1.344 ± 0.309 vs. 0.715 ± 0.249, p < 0.001) than benign group. Using a combination of Dapp and Kapp as diagnostic index, significantly better differentiating performance was achieved than using ADC alone (area under curve: 0.956 vs. 0.876, p = 0.042). CONCLUSION: Compared to DWI, DKI could provide additional data related to tumor heterogeneity with significantly better differentiating performance. Its derived quantitative metrics could serve as a promising imaging biomarker for differentiating malignant from benign masses in head and neck region.

Correlation between Intravoxel Incoherent Motion Magnetic Resonance Imaging Derived Metrics and Serum Soluble CD40 Ligand Level in an Embolic Canine Stroke Model

OBJECTIVE: To determine the relationship between intravoxel incoherent motion (IVIM) imaging derived quantitative metrics and serum soluble CD40 ligand (sCD40L) level in an embolic canine stroke model. MATERIALS AND METHODS: A middle cerebral artery occlusion model was established in 24 beagle dogs. Experimental dogs were divided into low- and high-sCD40L group according to serum sCD40L level at 4.5 hours after establishing the model. IVIM imaging was scanned at 4.5 hours after model establishment using 10 b values ranging from 0 to 900 s/mm². Quantitative metrics diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) of ischemic lesions were calculated. Quantitative metrics of ischemic lesions were normalized by contralateral hemisphere using the following formula: normalized D = D(stroke) / D(contralateral). Differences in IVIM metrics between the low- and high-sCD40L groups were compared using t test. Pearson's correlation analyses were performed to determine the relationship between IVIM metrics and serum sCD40L level. RESULTS: The high-sCD40L group showed significantly lower f and normalized f values than the low-sCD40L group (f, p 0.05). Both f and normalized f values were negatively correlated with serum sCD40L level (f, r = −0.789, p 0.05). CONCLUSION: The f value derived from IVIM imaging was negatively correlated with serum sCD40L level. f value might serve as a potential imaging biomarker to assess the formation of microvascular thrombosis in hyperacute period of ischemic stroke.

MR early evaluation of microwave ablation extent of liver: a clinical study / 介入放射学杂志

Objective To discuss the application of MRI in making early assessment of the coagulation extent of liver tumor after microwave ablation(MWA).Methods From January 1,2015 to January 31,2016,CT-guided percutaneous MWA was employed in 46 patients with liver tumor.A total of 55 hepatic lesions were detected in the 46 patients,the mean diameter of the lesion was (26.0±5.3) mm.On the second day after MWA,MRI was performed to evaluate the ablation effect,the ablated extent (long axis×short axis) was calculated,the results were compared with the referential data provided by manufacturer.The MWA-related complications,including inadequate ablation and excessive ablation,were recorded and analyzed.Results MRI performed on the second day after MWA showed that successful MWA treatment was obtained in all the 55 hepatic lesions,and no serious complications occurred immediately after ablation.The used parameter settings of microwave energy included 60 W-5 min (n=4),60 W-8 min (n=4),60 W-10 min (n=14),70 W-8 min (n=40),70 W-10 min (n=11) and 80 W-10 min (n=18);the corresponding ablated extents produced by the above parameter settings were 41.3 mm×31.2 mm,52.0 mm×36.3 mm,51.5 mm×34.3 mm,52.9 mm×35.5 mm,56.8 mm×36.1 mm and 64.0 min×44.0 mm respectively;all the above actual ablated values were larger than the referential data provided by manufacturer,and among them the real ablated extent of 80 W-10 min group carried the biggest difference with that provided by manufacturer (64.0 mm×44.0 mm vs.54.0 mm×37.0 mm,P＜0.01).No inadequate ablation of lesion was observed,and excessive ablation was seen in 12 lesions,presenting as the involvement of the hepatic capsule or even the subcutaneous muscle layer.Conclusion Early MRI examination after MWA can precisely evaluate the ablation extent.The results of this study indicate that the actual ablated value is bigger than the referential value provided by manufacturer.Accurate prediction of ablation range before MWA is helpful in ensuring a complete ablation as well as in improving the safety of MWA.

Diffusion Weighted Imaging for Differentiating Benign from Malignant Orbital Tumors: Diagnostic Performance of the Apparent Diffusion Coefficient Based on Region of Interest Selection Method

OBJECTIVE: To evaluate the differences in the apparent diffusion coefficient (ADC) measurements based on three different region of interest (ROI) selection methods, and compare their diagnostic performance in differentiating benign from malignant orbital tumors. MATERIALS AND METHODS: Diffusion-weighted imaging data of sixty-four patients with orbital tumors (33 benign and 31 malignant) were retrospectively analyzed. Two readers independently measured the ADC values using three different ROIs selection methods including whole-tumor (WT), single-slice (SS), and reader-defined small sample (RDSS). The differences of ADC values (ADC-ROI(WT), ADC-ROI(SS), and ADC-ROI(RDSS)) between benign and malignant group were compared using unpaired t test. Receiver operating characteristic curve was used to determine and compare their diagnostic ability. The ADC measurement time was compared using ANOVA analysis and the measurement reproducibility was assessed using Bland-Altman method and intra-class correlation coefficient (ICC). RESULTS: Malignant group showed significantly lower ADC-ROI(WT), ADC-ROI(SS), and ADC-ROI(RDSS) than benign group (all p 0.05). The ROI(SS) and ROI(RDSS) required comparable measurement time (p > 0.05), while significantly shorter than ROIWT (p < 0.05). The ROI(SS) showed the best reproducibility (mean difference ± limits of agreement between two readers were 0.022 [-0.080-0.123] × 10(-3) mm2/s; ICC, 0.997) among three ROI methods. CONCLUSION: Apparent diffusion coefficient values based on the three different ROI selection methods can help to differentiate benign from malignant orbital tumors. The results of measurement time, reproducibility and diagnostic ability suggest that the ROI(SS) method are potentially useful for clinical practice.

Comparison of Medical Education and Requirements for Training in the Interventional Neuroradiology in China, Japan and Korea / 신경중재치료의학

The interventional neuroradiology (INR, or neurointerventional surgery) became a rapidly emerging specialty since the first Working group in Interventional Neuroradiology (WIN) meeting was held in Santa Barbara in 1980 by 15 pioneers. Although the specialty has been led by neuroradiologists, other specialists of neurosurgery and neurology have become involved. Due to diverse background of the specialties with inadequate requirement of education and training, proper level of training standard and quality assurance may be achieved for outcomes of treated patients with neurovascular diseases. In East Asia, there are less inter-relationship of education and training among China, Japan and Korea when compared to the learning opportunities in western countries from the three nations. Therefore, we present the current status and difference of medical education system and compare INR training to improve understanding of INR development in the adjacent countries.

Multimodal magnetic resonance imaging for assessing lacunar infarction after proximal middle cerebral artery occlusion in a canine model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A new lacunar infarction model was recently established in beagle dogs through proximal middle cerebral artery (MCA) occlusion by thrombus. This study aimed to characterize the model by multimodal magnetic resonance imaging (MRI) and to investigate its potential role for the future stroke research.</p><p><b>METHODS</b>The left proximal MCA was embolized with an autologous thrombus in six beagles. Diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) were performed every half hour during the first six hours after occlusion, followed by three time points at 12 hours, 24 hours, and one week. Perfusion-weighted imaging (PWI) and magnetic resonance angiography (MRA) were carried out at six hours, 24 hours and one week. The PWI-DWI mismatch ratio was defined as (PWI-DWI)/DWI ischemic volume.</p><p><b>RESULTS</b>Lacunar infarcts induced by MCA occlusion were located in the left caudate nucleus and internal capsule. All the lesions could be detected within two hours by DWI. Lesion volume on DWI increased in a time dependent manner, from (87.19 ± 67.16) mm(3) at one hour up to (368.98 ± 217.05) mm(3) at 24 hours (P = 0.009), while that on PWI gradually decreased from (7315.00 ± 2054.38) mm(3) at six hours to (4900.33 ± 1319.71) mm(3) at 24 hours and (3334.33 ± 1195.11) mm(3) at one week (P = 0.002). The mismatch ratio was 41.93 ± 22.75 at six hours after ischemia, showing "extensive mismatch", and decreased to 18.10 ± 13.74 at 24 hours (P = 0.002). No MCA recanalization was observed within 24 hours after MCA occlusion.</p><p><b>CONCLUSIONS</b>Lacunar infarction induced by proximal MCA occlusion could be detected early by DWI and was characterized by extensive PWI-DWI mismatch. Multimodal MRI is useful to demonstrate the natural evolution of PWI-DWI mismatch. This ischemic model could be further used for investigating early thrombolysis in lacunar stroke showing extensive mismatch.</p>

Follow-Up of 58 Traumatic Carotid-Cavernous Fistulas after Endovascular Detachable-Balloon Embolization at a Single Center

BACKGROUND AND PURPOSE: This study evaluated the clinical value of detachable-balloon embolization for traumatic carotid-cavernous fistula (TCCF), focusing on the frequency, risk factors, and retreatment of recurrence. METHODS: Fifty-eight patients with TCCF underwent transarterial detachable-balloon embolization between October 2004 and March 2011. The clinical follow-up was performed every 3 months until up to 3 years postprocedure. Each patient was placed in either the recurrence group or the nonrecurrence group according to whether a recurrence developed after the first procedure. The relevant factors including gender, fistula location, interval between trauma and the interventional procedure, blood flow in the carotid-cavernous fistula, number of balloons, and whether the internal carotid artery (ICA) was sacrificed were evaluated. RESULTS: All 58 TCCFs were successfully treated with transarterial balloon embolization, including 7 patients with ICA sacrifice. Recurrent fistulas occurred in seven patients during the follow-up period. Univariate analysis indicated that the interval between trauma and the interventional procedure (p=0.006) might be the main factor related to the recurrence of TCCF. The second treatments involved ICA sacrifice in two patients, fistula embolization with balloons in four patients, and placement of a covered stent in one patient. CONCLUSIONS: Detachable balloons can still serve as the first-line treatment for TCCFs and recurrent TCCFs despite having a nonnegligible recurrence rate. Shortening the interval between trauma and the interventional procedure may reduce the risk of recurrence.

Value of percutanous catheter fragmentation in the management of massive pulmonary embolism / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute massive pulmonary embolism (PE) is a clinical emergency requiring rapid and supportive measures. Percutanous mechanical thrombectomy is considered as a treatment option. The purpose of this study was to evaluate the clinical efficacy and safety of peructaneous mechanical catheter fragmentation in the management of acute massive PE.</p><p><b>METHODS</b>From January 2003 to June 2007, 28 patients (20 men, 8 women; mean age 64 years) with acute massive PE initially diagnosed by computed tomography and confirmed by pulmonary angiography were treated with inferior vena caval filter placement and percutaneous catheter fragmentation. Twenty-six patients received thrombolytic agents after embolus fragmentation.</p><p><b>RESULTS</b>Technical success was achieved in all patients. The improvement of clinical status and restoration of blood flow in the main branches of the pulmonary artery were seen in 27 patients. Only one case did not benefit from the percutaneous therapy and died from the failure of the surgery. Oxygen saturation increased from (86.2 +/- 4.5)% to (96.1 +/- 3.2)% (P < 0.001) after the interventional procedure. The post-procedure mean pulmonary artery pressure decreased from (34.2 +/- 4.8) mmHg to (25.2 +/- 5.1) mmHg (P < 0.001). During clinical follow-up (range, 1 - 5 years), no patients had recurrence of PE.</p><p><b>CONCLUSION</b>Percutaneous catheter fragmentation combined with thrombolysis is an effective and safe therapy in the clinical management of acute massive PE.</p>

Changes of heme oxygenase-1 and inflammatory factors in patients with end-stage renal failure following hemodialysis / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the changes in heme oxygenase-1 (HO-1), C-reactive protein (CRP), interleukin-6 (IL-6), and malondialdehyde (MDA) levels in patients with end-stage renal failure (ESRF) following hemodialysis.</p><p><b>METHODS</b>The urea nitrogen and the blood creatinine levels were determined with an automatic biochemistry analyzer, HO-1 and IL-6 levels by enzyme linked immunosorbent assay (ELISA), CRP by chemoluminescence technique, and MDA by thiobarbituric acid assay.</p><p><b>RESULTS</b>HO-1, CRP, IL-6, and MDA levels were significantly elevated in patients with ESRF in comparison with the control group. After hemodialysis, HO-1 and CRP levels increased and IL-6 and MDA levels decreased significantly.</p><p><b>CONCLUSION</b>In ESRF patients who have elevated inflammatory factors and HO-1 levels, hemodialysis can increase HO-1 and CRP levels and lower IL-6 and MDA levels.</p>

Interventional therapy of complications after liver transplantation:hepatic artery stricture / 介入放射学杂志

Hepatic artery stricture (HAS) after liver transplantation can lead directly to transplanted liver function exhaustion and complications of biliary system. The early diagnosis and treatment are crucial for better prognosis. Doppler ultrasound is the first method of choice, and angiography can give further clear dignosis. The balloon dilatation is still effective for hepatic arterial stenosis. With the more adaptable usage of oronary stent, if possible, would reveal more promising result especially for tortuous stenotic hepatic artery. The vascular reconstruction or repeated liver transplantation is still the effective therapeutic methods.

Outcome Evaluation of Intra-arterial Infusion of Urokinase for Acute Ischemic Stroke

Pupose:To evaluate the results of intra-arterial urokinase thrombolysis in cases of acute ischemic stroke and to define the factors affecting prognosis. MATERIALS AND METHODS:Forty-eight patients with angiographically proven occlusion of the intracranial arteries were treated with local intra-arterial infusion of urokinase within six hours of the onset of symptoms. Neurologic status was evaluated on admis-sion and on discharge using the NIH(National Institute of Health) stroke scale score (SSS). When the SSS decreased by at least four points, this was considered indicative of an improved clinical outcome. RESULTS: Complete recanalization was achieved in 17/48 patients (35%), including 8 of 13 (62%) with occlusion of the vertebrobasilar artery (VBA), 9 of 20 (45%) with occlu-sion of the middle cerebral artery (MCA), and none of 15 with occlusion of the internal carotid artery (ICA). Neurologic status improved in 12 (60%) of patients with MCA oc-clusion, in five (38%) of those with VBA occlusion and in three (20%) of those with ICA occlusion (P<0.05). Patients in whom occluded MCA was completely recanalized showed greater clinical improvement than those with partial or no recanalization (P<0.05). The overall mortality rate was 21%, 43% (9/21) in patients in whom CT revealed signs of early infarct, but only 4% (1/27) in those without this sign (P<0.05). The mortality rate of patients with parenchymal hematoma (4/5) was higher than that of those with hemorrhagic infarct (3/9) or without hemorrhage (3/34) (P<0.05). CONCLUSION: In patients in whom occluded MCA was completely recanalized, the clinical outcome was better, while patients with VBA occlusion did not benefit from re-canalization. The presence on CT scans of signs of early infarct and of parenchymal hematoma after thrombolysis correlated with a high mortality rate.

System thrombolysis combined with percutaneous catheter fragmentation and thrombectomy in acute massive pulmonary embolism / 中华放射学杂志

Objective To evaluate the safety and clinical efficacy of system thrombolysis combined with percutaneous catheter thrombus fragmentation and thrombectomy for acute massive pulmonary embolism. Methods Ninteen patients with acute massive pulmonary embolism were treated with IVC filter placement, percutaneous catheter thrombus fragmentation and system thrombolysis combined with anticoangulation using low-molecular-weight heparin.Four of 19 patients underwent adjuvant Stranb Rotarex catheter thrombectomy.Results Twenty-one procedures were performed in 19 patients.Improvement of pulmonary artery patency and initial relief of symptoms immediately occurred in 18 of 19 patients after interventional therapy.The oxygen saturation increased from 86% to 97%.Pulmonary artery pressure decreased from 33? 5mm Hg(1mm Hg=0.133kPa)to 25?5mmHg after interventional therapy(t=13.2,P