The safety and efficacy of mechanical thrombectomy for anterior circulation small vessel occlusion / 中华神经科杂志

To evaluate the safety and efficacy of mechanical thrombectomy with stent-retriver for anterior circulation small vessel occlusion in patients with acute ischemic stroke (AIS).Methods:From a prospectively collected thrombectomy database of consecutive patients with AIS between January 2017 and November 2018, 311 angiographic images were analyzed to assess small vessel occlusions (A 2 and M 2 segments). Patients were categorized into alteplase with thrombectomy group and thrombectomy alone group. The primary outcome was a favorable outcome (modified Rankin Scale scores 0-2) at 90 days. Secondary outcomes were successful recanalization (modified thrombolysis in cerebral infarction 2b or 3), symptomatic intracranial hemorrhage, and 90-day mortality. Results:Small vessel occlusions were identified in 19 patients, including 14 M 2occlusions, two A 2occlusions, and three M 2+A 2 occlusions. Six patients were in the alteplase with thrombectomy group and 13 patients in the thrombectomy alone group. Favorable outcome was achieved in eight of 19 patients at 90 days. Successful recanalization was achieved in 18 patients (18/19), symptomatic intracranial hemorrhage was observed in one patient (1/19), and death was recorded in five patients (5/19). No statistically significant difference was detected between the two groups with regard to successful recanalization (6/6 in the alteplase with thrombectomy group vs 12/13 in the thrombectomy alone group), symptomatic intracranial hemorrhage (0/6 vs 1/13), favorable outcome (2/6 vs 6/13) and death (1/6 vs 4/13; all P>0.05). Conclusion:As to anterior circulation small vessel occlusions, the combination-therapy within 4.5 hours or mechanical thrombectomy alone in extended time window with perfusion evaluation may be both safe and effective.

Effect of oxycodone on percutaneous microwave ablation of liver cancer abutting capsule / 临床麻醉学杂志

Objective To evaluate the clinical effect and safety of oxycodone in the anesthesia for percutaneous microwave ablation (PMWA) in liver cancer when the scope of ablation involving liver capsule.Methods Thirty-eight patients scheduled for percutaneous microwave ablation of liver cancer abutting capsule, including 32 males and 6 females, aged 41-75 years, with ASA grade Ⅰ or Ⅱ.Patients were randomly divided into 2 groups:oxycodone group (group O,n=20) and fentanyl group (group F, n=18).Before the puncture, a loading dose of oxycodone 0.1 mg/kg was given intravenously in group O, a loading dose of fentanyl 1 μg/kg was given intravenously in group F.After successful puncture, both groups were induced by Propofol 1.5 mg/kg, followed by Propofol infusion at 4-7 mg·kg-1·h-1 in two groups.The changes of MAP, HR, SpO2 and RR before, during and after operation were recorded.Body movement and respiratory depression were recorded.The total amount of propofol,the postoperative recovery time, postoperative nausea and vomiting, and postoperative 4 h VAS scores were recorded.Results There was no significant difference in general condition and intraoperative condition of ablation operation between the two groups.The incidences of respiratory depression and body movement in group F were significantly higher than those in group O.There was no significant difference in the incidences of postoperative nausea and vomiting between the two groups.VAS score 4 h after operation in group F [(3.9±2.0) score] was significantly higher than that in group O [(1.7±0.9) score] (P＜0.01).There was no significant difference in HR between the two groups at each point.Compared with before surgery, the MAP during surgery in group F was significantly increased (P＜0.05),the RR during surgery in groups F and O were significantly lower (P＜0.01 or P＜0.05).The RR during surgery in group F was significantly lower than that in group O(P＜0.05),but there was no significant difference at the other points between the two groups.Conclusion Oxycodone can be used safely and effectively for percutaneous microwave ablation of liver cancer when the scope of ablation involving liver capsule.It has lower incidence of respiratory depression, effectively alleviates intraoperative pain and reduces postoperative pain.

Interpretation for MRI signal evolution of hepatic tumors after microwave ablation / 介入放射学杂志

Objective To make an interpretation for the time-related evolving process of magnetic resonance imaging (MRI) signal of hepatic tumors after microwave ablation (MWA) treatment.Methods A total of 56 patients with malignant hepatic tumors (56 lesions in total) were enrolled in this study.Upper abdominal MRI plain scan and enhanced scan were performed in all patients at the second day,one month and 6 months after MWA treatment.The MRI signal features of ablation zones at different time points on T1WI,T2WI,DWI as well as on contrast-enhanced T1WI were documented,and the judgment of whether there was tumor recurrence was made.Results Two days after MWA,the ablation zone was manifested as target-like structure on T1WI and T2WI,which was characterized by central high signal ablation zone with low signal band around on T1WI and low signal ablation zone surrounded by high signal band on T2WI.One and 6 months after MWA,the volume of ablation area was atrophied,the target-like structure could still be observed on T1WI and T2WI,and the signal of ablation zone became intensified.Contrast-enhanced MRI revealed that abnormal high perfusion sign could be observed around the ablation zone,and on MRI scans performed at two days,one and 6 months after MWA,the ablation zone showed no enhancement.DWI indicated that two days after MWA the signal around the ablation zone was heightened,which decreased gradually in one and 6 months after MWA.Conclusion The signal of the ablation zone of hepatic tumor after MWA is evolving over time.Correct interpretation of MRI signal of ablation zone is helpful for the judgment of curative effect and for the making of therapeutic plan.

Establishment of rabbit model of acute pulmonary embolism with right ventricular dysfunction / 中国介入影像与治疗学

Objective To establish an easily reproducible rabbit model of acute pulmonary embolism (APE) with right ventricular dysfunction (RVD).Methods Two gelfoam strips (5 rnm×5 mm× 10 mm) were squeezed and were introduced into the pulmonary arteries of each healthy rabbit (n=12).Pulmonary and systemic hemodynamic function were recorded.All rabbits underwent CT pulmonary angiography (CTPA) and pathological examination after the introduction of APE.Results All gelfoam strips located in the bilateral lower lobe arteries.Compared with baseline mean pulmonary artery pressure (mPAP) ([9.75±1.75] mmHg),mPAP increased to (20.58 ± 5.86) mmHg immediately after embolism (P ＜ 0.001),and then decreased to (18.78 ±4.80) mmHg 1 h after embolism (P＜0.001).Right ventricle/left ventricle diameter ratio (RV/LV) increased from baseline (0.67±0.09) to (1.90±0.28) 45 min after embolism (P＜0.001).Conclusion An easily reproducible rabbit model of APE with RVD are established and may be suitable for study of APE pathophysiology.

TACE combined with MWA versus simple TACE for the treatment of large hepatic cancers: a meta-analysis of curative effect / 介入放射学杂志

Objective To compare the curative effect of transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA) with that of simple TACE in treating large liver cancers.Methods A computer-based search assisted by manual searching for TACE+MWA vs simple TACE clinical control trials for large liver cancers was conducted.The patient survival,tumor response and complications were enrolled in the scope of analysis.Results A total of 16 papers met the inclusion criteria,which included 1199 patients in total.Meta-analysis indicated that one-,2-and 3-year survival rates of TACE+MWA group were better than those of simple TACE group,and the differences between the two groups were statistically significant (P＜0.01).The complete response (CR) rate and partial response (PR) rate of TACE+MWA group were higher than those of simple TACE group,and the differences between the two groups were statistically significant (P＜0.01).The stable disease (SD) rate and progressive disease (PD) rate of TACE+MWA group were lower than those of simple TACE group,and the differences between the two groups were statistically significant (P＜0.01).Conclusion For the treatment of large liver cancers,TACE +MWA is superior to simple TACE.(J Intervent Radiol,2017,26:225-231)

Effects of matriptase down regulation on invasion of human pancreatic cancer cells SW1990 / 中华胰腺病杂志

Objective To investigate the effect of the down regulation of matriptase expression on invasion of human pancreatic cancers cells SW1990.Methods Small interfering RNA targeting at matriptase (Ma-siRNA) was transfected into human pancreatic cancers SW1990 cells,and nonsense siRNA (NC-siRNA) group was used as control.Real time PCR assay and Western blot were used to detect the expression of matriptase mRNA and protein.Transwell assay was used to examine the invasion ability of cancer cells.The enzymatic activity of matriptase and MMP-9 was determined by gelatin zymography assay.Results The expression level of matriptase mRNA in NC-siRNA group,12.5,25,50 nmol/L Ma-siRNA group were 1.000,0.417 ± 0.006,0.233 ± 0.068,0.221 ± 0.092;and the protein expression of matriptase were 0.736 ± 0.066,0.498 ± 0.036,0.341 ± 0.118,0.239 ± 0.050,respectively.The matriptase mRNA and protein expression in Ma-siRNA groups was significantly lower than those in NC-siRNA group,and the difference between the two groups was statistically significant (P ＜ 0.05).The enzymatic activity of matriptase were 1.501 ±0.165,1.211 ±0.265,0.645 ±0.165,0.620 ±0.003,and the enzymatic activity of MMP-9 were 0.929 ± 0.260,0.484 ± 0.364,0.352 ± 0.113,0.346 ± 0.121,and the enzymatic activity of matriptase and MMP-9 in 25,50 nmol/L Ma-siRNA groups was significantly lower than that in NC-siRNA group,and the difference was statistically significant (P ＜ 0.05 or ＜ 0.01).The number of transmembrane cell was (256 ± 1)/per 200 power field,and it was (109 ± 3)/per 200 power field in 25 nmol/L Ma-siRNA group,and the invasion ability of the cells in 25 nmol/L Ma-siRNA group was decreased by (57.4 ± 5.4) ％ when compared with that of control group.Conclusions Down-regulation of matriptase inhibits invasion ability of pancreatic cancer SW1990 cells,and this result may be due to the down regulated enzymatic activity of matriptase and MMP-9.

Expression and its significance of receptor-interacting protein kinase 3 in ulcerative colitis / 中华消化杂志

Objective To explore the role of receptor‐interacting protein kinase 3 (RIP3)‐mediated necroptosis in ulcerative colitis (UC ) . Methods The colonic mucosa tissues of eighty‐five patients diagnosed with UC were collected .Disease staging and pathological classification of UC patients were evaluated according to Mayo standard and Truelove standard ,respectively .The expressions of RIP3 and tumor necrosis factor (TNF)‐α were detected by immunohistochemistry .The cell inflammation model in HT‐29 cells was induced by interferon (IFN)‐γ.The expression of RIP3 mRNA and interleukin (IL)‐1βmRNA was determined by real time polymerase chain reaction (RT‐PCR) .Twenty healthy individuals were studied as controls .A single factor analysis of variance was performed in the comparison among groups ,and Pearson correlation analysis was used for correlation analysis .Results Among 85 patients with UC , 27 cases were mild ,30 cases were moderate and 28 cases were severe;for pathological classification ,26 were gradeⅠ ,31 were gradeⅡ and 28 were grade Ⅲ .The Mayo score was positively correlated with pathological grade (r=0 .997 , P<0 .05) .The expression of RIP3 and TNF‐α in colonic mucosa tissues of UC group increased along with the pathological classification grade .The expression of RIP3 of gradeⅠto Ⅲ was 1 .81 ± 0 .98 ,2 .77 ± 1 .26 and 4 .86 ± 2 .77 ,respectively ,and the differences were statistically significant (F=26 .10 ,P<0 .05) .The expression of TNF‐αof gradeⅠto Ⅲ was 1 .35 ± 0 .69 ,2 .61 ± 1 .41 and 4 .43 ± 2 .17 ,respectively ,and the differences were statistically significant (F=31 .80 ,P<0 .05) .The expression of IL‐1β mRNA of IFN‐γ group ,IFN‐γ+ z‐VAD group and IFN‐γ+z‐VAD+ TNF‐αgroup was 0 .68 ± 0 .27 ,1 .47 ± 0 .12 and 1 .86 ± 0 .16 ,respectively ,and the differences were statistically significant (F=38 .45 , P<0 .05) .The expression of RIP3 mRNA of IFN‐γgroup ,IFN‐γ+z‐VAD group and IFN‐γ+z‐VAD+TNF‐αgroup was 0 .46 ± 0 .13 ,1 .21 ± 0 .29 and 2 .06 ± 0 .20 ,respectively , and the differences were statistically significant (F= 55 .15 , P< 0 .05) .Conclusions TNF‐α/RIP3 signal pathway is up‐regulated in UC .RIP3‐mediated necroptosis promotes the death of colonic epithelial cells and exacerbates inflammatory response .RIP3‐mediated necroptosis may be an important mechanism in UC .

Baseline value of fraction anisotropy and apparent diffusion coefficient in deep white matter of preterm / 中华实用儿科临床杂志

Objective To study the baseline level of fraction anisotropy (FA) and the normal value of apparent diffusion coefficient (ADC) in deep white matter of preterm and its application.Methods From Oct.2010 to Dec.2013,in Department of Neonatology,Jiangsu Province Hospital,magnetic resonance imaging (MRI) (T1,T2) and diffusion tensor imaging (DTI) were done on 13 preterm infants of less than 37 weeks of corrected gestational age (CA),42 preterm infants of term-matched age,and 15 term infants.ADC and FA were measured in genu and splenium of corpus callosum (CC),anterior limb and posterior limb of internal capsule (IC).Results 1.The ADC values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were higher than those in term-matched infants and in term infants.The ADC values in the 6 regions in term-matched infants and in term infants were significantly different with those in CA ＜ 37 weeks infant(F =5.559,5.775,21.948,19.462,30.586,15.452,all P ＜ 0.01).The differences of ADC values between CA ＜ 37 weeks infants and term-matched infants,between CA ＜37 weeks infants and term infants were significant(all P ＜0.05),except that in CC between CA ＜ 37 weeks infants and term-matched infants.2 The FA values in genu,splenium,anterior limb of right IC,posterior limb of right IC,anterior limb of left IC,posterior limb of left IC in CA ＜ 37 weeks infants were lower than those in term-matched infants and in term infants.The FA values in the 6 regions in term-matched infants and in term infants were significantly different from those in CA ＜ 37 weeks infants (F =9.835,7.500,4.811,11.430,8.674,12.666,all P ＜ 0.01).The differences of FA values between CA ＜ 37 weeks infants and term-matched infants (P ＜ 0.05),between CA ＜ 37 weeks infants and term infants were significant (all P ＜ 0.05).Conclusions The baseline values of FA and ADC in different deep white matters were obtained.As corrected gestational age of preterm babies' increased,FA values in brain white matter increased,while ADC values decreased.The myelination in most white matter of preterm infants at matched term can catch up with that of term infants.The diagnostic value of ADC and FA needs to be studied further.

Effects of hydroxychloroquine on the apoptosis of peripheral blood mononuclear cells and Th17 in systemic lupus erythematosus / 中华风湿病学杂志

Objective To observe the effect of Hydroxychloroquine (HCQ) on the apoptosis of peripheral blood mononuclear cells (PBMCs) of Systemic lupus erythematosus (SLE) patients and on the level of Th17 cells and IL-17.Methods The peripheral blood of 20 incipient SLE patients in active stage were taken,and PBMC were separated for cell culture.Using HCQ and Chlorambucil (CLB) as an intervention,and after cultured for 24 h and 48 h,the apoptosis of PBMC and the level of Th17 were tested using Flow cytometry (FCM),the supernatants were collected to test for the level of cytokine IL-17 by ELISA.One-way ANOVA was used and SNK-q was used in the comparison between every two groups.Results There was significant difference in the apoptosis rate of mononuclear cells between the HCQ and CLB group at 24 h [HCQ:(10.3±0.7)％,CLB:(8.5±1.1)％] and48 h [HCQ:(13.9±0.6)％,CLB:(11.8±0.8)％] (P＜0.05).There was significant difference between HCQ [24 h:(0.81±0.13)％,48 h:(0.73±0.45)％] and CLB group [24 h:(0.78±0.26)％,48 h:(0.68±0.20)％] in Th17 percentage (P＜0.05).The levels of IL-17 in the supematants of the HCQ group [24 h:(26.3±0.97)％,48 h:(24.2±0).91)％] and CLB group [24 h:(24.6±0.7)％,48 h:(22.6±1.1)％] were significandy different between the two groups(P＜0.05).Conclusion HCQ has apoptosis-induction effect on PBMC,and it can decrease the number of Th17 and IL-17 level in the PBMCs.

Dynamically observing carotid artery intimal injury in mice using 7T micro-MR imaging / 中华老年医学杂志

Objective To dynamically observe stenosis and wall thickness of carotid artery with endothelium injury in mouse using 7T micro-MR imaging in vivo. Methods A mouse model of carotid artery intimal injury was established by removing endothelium with a flexible wire. The lumen diameter, lumen area, wall thickness and wall area of the injured arteries were observed, and serial MR scanning was performed in different time points after operation. Results The injured arteries and perivascular parenchyma were clearly observed by MR imaging. Before and 1, 5, 10 and 15 days after artery injury, the lumen diameter were (0.57±0.07)mm,(0.41±0.19)mm, (0.44±0.10)mm, (0.43±0.10)mm and (0.47±0.11)mm respectively, and the lumen area were (0.30±0.06)mm2, (0.18±0.11)mm2, (0.18±0.06)mm2, (0.18±0.06)mm2 and (0.22±0.07)mm2. The thickness of artery wall was(0.23±0.12)mm, and the area of artery wall was (0.35±0.24)mm2 15days after artery injury. Conclusions Stenosis and wall thickening of carotid artery after the artery intimal injury of mouse can be dynamically observed on MR imaging in vivo.