The preparation of multimodal imaging embolization microspheres and its visualization experiment in vitro / 介入放射学杂志

Objective To develop a kind of gelatin microspheres which is capable of being visualized on radiography,CT and MR examinations.Methods Emulsion chemical cross-linking method was used to prepare gelatin microspheres that carried only solid Fe3O4 nanoparticles.Optical microscope was adopted to observe the morphology,particle diameter and the dispersity of the gelatin microspheres.Using thermogravimetric analysis method,the loading rate of Fe3O4 nanoparticles encapsulated in the gelatin microspheres was calculated.The multimodal visualization ability of the gelatin microspheres was evaluated by radiography,CT and MR examinations.The blood in rabbit heart and human vascular endothelial cells were used to make microsphere hemolysis test and in vitro cytotoxicity test.The elastic characteristics and the swelling characteristics of the gelatin microspheres were determined,and the sterile technique was tested.Results The optimal synthesis condition of microspheres was to use 2:1 of Fe3O4-to-gelatin quality ratio,under this situation,the microspheres showed a roundness appearance with satisfactory dispersion,the spherulization rate was high (up to 77％),the drug loading rate was very high (up to 73.27％),the particle diameter was moderate (199.78±142.90 μm),and the microspheres had multimodal visualization ability for radiography,CT and MR examinations.The optimization CT value of microspheres could be up to (1 028.0± 69.5) Hu (when concentration=25 mg/ml).Hemolysis test and in vitro cytotoxicity test showed that no statistically significant differences in the hemolysis rate and absorption value existed between the study group and the control group (P＞0.05).In acid solution,the microspheres exhibited swelling characteristics,while in ethanol the microspheres showed no swelling phenomenon.Conclusion Using solid Fe3O4 nanoparticles as visualization material as well as gelatin as polymer materials,a special gelatin microspheres can be prepared with emulsion chemical cross-linking method.This kind of microspheres carries the following features:high drug loading,regular in shape,smooth surface,not easy to agglomerate,stronger multimodal visualization ability (radiography,CT and MR),high biological safety and convenient disinfection.

Hepatic neuroendocrine tumors: its angiographic manifestations and the analysis of patient survival / 介入放射学杂志

Objective Todiscusstheangiographicfeaturesofhepaticneuroendocrineneoplasm(NEN),and to analyze the survival time of patients.Methods The clinical data of 60 patients with hepatic NEN were retrospectively reviewed.Transcatheter arterial chemoembolization (TACE),used as main therapy,was employed in 17 patients,22 patients received palliative treatment with no use of TACE,and 21 didn't receive any related treatment.The angiographic features of hepatic NEN were analyzed.Kaplan-Meier method was used to calculate the survival rate,and the survival prognostic factors were evaluated by Cox multivariate analysis method.Results Angiography showed that most neuroendocrine tumors (NETs) were characterized by hypovascular lesion,while neuroendocrine carcinomas (NECs) were manifested as hypervascular mass.The median overall survival time of 60 patients was 13.8 months.The 6-month,one-,2-and 3-year cumulative survival rates were 85.0％,52.0％,40.0％ and 33.8％,respectively.Cox regression analysis indicated that pathological grade of tumor (P=0.001) and treatment mode (P＜0.001) were the independent prognostic factors.Conclusion The rich or poor vascularity of hepatic NEN is helpful for the judgment of tumor grading.Patients whose hepatic NENs belong to high pathological grade (grade Ⅲ) usually have a poor prognosis.TACE is an effective therapy for hepatic NEN.

The complications due to inferior vena cava abnormality and their interventional management / 介入放射学杂志

Objective To discuss the clinical complications caused by inferior vena cava abnormality and their interventional management. Methods The clinical data and interventional therapeutic results of 4 patients with complications due to abnormalities of the inferior vena cava were retrospectively analyzed. Results Duplicate inferior vena cava deformity was confirmed in two cases; one of them was complicated by right inferior vena cava with deep venous thrombosis of right lower extremity;and the other case had bilateral inferior vena cava thrombosis secondary to tumor thrombus within the intrahepatic segment of inferior vena cava, for which interventional treatment was not employed. Left-sided inferior vena cava was observed in 2 cases; clinically, one showed microscopic haematuria and lower back pain, and interventional treatment was not adopted; the other case had abdominal pain, and the symptom showed no obvious improvement after receiving stent implantation in the crossing segment of the left-sided inferior vena cava. Conclusion Clinically, the complications caused by abnormalities of inferior vena cava are rare. The diagnosis and the treatment of its complications should be based on the imaging manifestations, the related clinical symptoms, blood flow dynamics, etc. and the misdiagnosis and mistreatment should be avoided.

The preventive transhepatic interventional therapy for primary liver cancer after surgical resection:comparison study between TACE and TAI / 介入放射学杂志

Objective To compare the therapeutic efficacy of preventive transcatheter arterial chemoembolization (TACE) with that of preventive transhepatic arterial infusion (TAI) for patients with primary hepatocellular carcinoma (HCC) after hepatectomy. Methods During the period from June 2011 to June 2012 at authors’ hospital, preventive transhepatic interventional therapy was employed in 79 HCC patients within three months after hepatectomy. The followed-up endpoint was in June 2013. The clinical data were retrospectively analyzed. The patients were divided into TACE group (n=41) and TAI group (n=38). No significant differences in age, sex, preoperative liver function, Child-Pugh scores, tumor size and AFP level existed between the two groups. During interventional procedure , catheterization of proper hepatic artery was performed first, which was followed by angiography in order to clarify that there were no newly-developed tumor vessels or tumor lesions in the residual liver, then the chemotherapeutic agents were infused through the catheter. The emulsion of iodized oil with chemotherapeutic agent was used in the patients of TACE group, while only chemotherapeutic agent was adopted in the patients of TAI group. By using Chi-square test the one-year recurrence rate was determined. Kaplan-Meier estimation method was used to calculate the disease-free survival time, and t test was adopted to estimate the mean hospitalization days. The results were compared between the two groups. Results Of the 79 patients, postoperative recurrence was confirmed in 11, and the overall one-year recurrence rate was 13.9%. The one-year recurrence rate of TACE group and TAI group was 12.20% and 15.79% respectively , and no significant difference in one- year recurrence rate existed between TACE group and TAI group (χ2= 0.213, P = 0.645). The average disease-free survival time of TACE group and TAI group was (21.60 ± 1.52) months and (17.38 ± 3.01) months respectively, the difference between the two groups was of statistical significance (P = 0.038). The mean hospitalization days of TACE group and TAI group were (6.30 ± 1.84) days and (5.89 ± 2.08) days respectively, and the difference between the two groups was not statistically significant (P = 0.522). Conclusion No significant difference in one-year recurrence rate exists between the patients receiving preventive TACE and the patients receiving preventive TAI after hepatectomy for HCC. Nevertheless , preventive TACE can probably improve the disease-free survival time after hepatectomy.

Risk factors of esophageal stent dys-seal phenomenon / 中国介入影像与治疗学

Objective To evaluate the conditions and risk factors of esophageal stent dys-seal phenomenon (ESDP) .Methods Ninety-eight patients with malignant esophageal obstruction underwent metallic stent placement and 7 patients with ESDP were analyzed.The possible contributing factors,including age,gender,obstruction segment,esophagorespiratory fistula,surgical intervention,radiotherapy,the degree of upper obstruction segment expansion,stent with bellmouth,application of covered stent were investigated.All factors mentioned above were analyzed with Logistic regression analysis.Results ESDP was observed in 7 patients (7/98,7.14%) and defined as a space between the esophageal wall and the proximal part of stent without contrast agent obstruction within stent.The clinical situations of patients with ESDP included dysphagia,bucking and constantly chest pain,especially at foodintake.The results of Logistic regression analysis indicated radiotherapy (P=0.005) and the degree of upper obstruction segment expansion (P=0.017) were significantly correlated with ESDP.Conclusion ESDP is one of the complications after esophageal stent placement.It is prudent to implant esophageal stent for those patients with radiotherapy and significant upper obstruction segment expansion.

Preliminary investigation of esophageal stent dys-seal syndrome / 介入放射学杂志

Objective To investigate the causes and managements of dys-seal syndrome (DSS) developed after esophageal stent placement. Methods From June 2001 to June 2008, esophageal stenting was performed in 98 consecutive patients with malignant esophageal obstruction. A total of 99 metallic stents were used. Of 98 patients. gastroesophageal anastomosis stricture was seen in 19, preoperative radiotherapy history in 26 and tracheoesophageal fistula in 34. Results DSS occurred in 7 patients, with an occurrence rate of 7.14% ,which was significant higher than that in patients with preoperative radiotherapy history and in patients showing marked dilated esophagus proximal to the obstructed site (X~2=0.017, 0.005, P=0.036, 0.013, respectively). After treatment, such as fasting, IPN or nasogastric feeding,only 1 case retumed to semi-liquid diet. Among the rest 6 cases of DSS, an additional stent was employed in one (but in vain), nasogastric feeding tube was used in 2, and removal of the stent under endoscopic guidance was carried out in 3. Conclusion DSS is one of the complications developed after esophageal stent placement, its prognosis is rather poor. Removal of the inserted stent may be the optimal treatment. The prevention of DSS includes proper pre-operation evaluation, selection of suitable stent, enhancement of perioperative nutritional support, etc.

Transcatheter arterial chemoembolizaion on the expression of nm23, Tissue inhibitor of metalloproteinase-2 and extrahepatic metastasis in hepatocellular carcinoma / 中华放射学杂志

Objective To investigate the effects of transcatheter arterial chemoembolization(TACE) on the expression of nm23, tissue inhibitor of metalloproteinase-2 (TIMP-2) and extrahepatic metastasis in hepatocellular carcinoma (HCC). Methods The specimens were collected from resectable HCC in 72 patients. Patients were divided into two groups. In one group, TACE was performed before tumor resection (Group A, n=36). In another group, the tumors were resected directly without preoperative TACE (Group B, n=36). The expression and distribution of nm23, TIMP-2 in the tumor tissue and liver parenchyma in the two groups were compared. All patients were followed up for 24 months,and the incidence of extrahepatic metastasis was compared between the two groups. Chi-square test was applied to compare the expression levels of nm23-H1 and TIMP-2. Results The number of cases of strong, moderate and no expression of nm23 were 24, 6 and 6 cases in group A respectively, and were 9, 6 and 21 cases in group B. Statistical differences were found between the two groups(X~2=15.52, P<0.01). The number of cases of strong, moderate and no expression of TIMP-2 were 21,3 and 12 cases in group A respectively, and were 9, 9 and 18 cases in group B. Statistical differences were demonstrated between them (X~2=9.00, P<0.05). There were 13 cases in group A and 15 cases in group B being diagnosed to have extrahepatic metastasis within 24- month period of follow up, but there was no significant difference between the two groups(X~2= 0.23, P>0.05). Conclusions TACE could enhance the expression of nm23-H1 and TIMP-2 in tumor tissues. Therefore, the potential of metastasis of tumor cells might be prohibited by TACE.

Evaluation of Fluency stent-grafts in transjugular intrahepatic portosystemic shunts / 中华放射学杂志

Objective To evaluate the efficacy of Fluency stent-graft (Bard Corp) in transjugular intrahcpatic portosystemic shunt (TIPS).Methods The clinical data of 21 consecutive patients treated by TIPS using Fluency stent-grafts were retrospectively reviewed.All of them were recurrent variceal bleeding secondary to portal vein hypertension,1 was bleeding secondary to primary hepatic carcinoma with port vein thrombns,and 1 was Budd-Chiari syndrome.They were followed-up after (10.1 ± 4.6) months (2.0 to 24.0 months).Stent-grafts patancy,portal vein pressure and liver function were recorded and compared.Results Twenty-five stent-grafts were successfully implanted in 21 patients,23 stent grafts were 8 mm 2 were 10 mm in diameter.The covered length of the stents varied from 6 to 8 cm.The bleeding was stopped and the portal vein pressure decreased significantly from (25.4 ± 3.5) mm Hg to (15.4 ± 2.8) mm Hg (t = 12.495,P < 0.01).During the follow-up period,The patient with primary HCC and portal vein thrombosis died 4 months after the procedure. One case had a new primary HCC during the follow-up and died 24 months after the procedure.One ease with variceal bleeding secondary to portal vein hypertension died of muhisystem organ failure.One case occluded in the hepatic vein and had another stcnt graft implanation.The other 17 cases had no stenosis after 7 to 17 months follow-up.Ultrasound showed that the stents were patent 1 week before the patients died.Three cases had transient symptoms of hepatic encephalopathy and recovered after treatment.The Child scores of the 19 patients survived more than 6 months were 6.3 ±1.4 before and 6.4 ± 1.9 after the procedure without significant difference (t = 0.645,P > 0.05).Conclusion The Fluency stent-grafts could increase the patency of the TIPS,but its efficacy on the long-term effect and hepatic encephalopathy need further investigation.

ATM phosphorylation in HepG2 cells following continuous low dose-rate irradiation / 中华放射医学与防护杂志

Objective To investigate the change of ATM phosphorylation in HepG2 cells following a condnuous low dose-rate irradiation.Methods Cells were pemistendy exposed to low dose-rate(8.28 cGy/h) irradiation.Indirect immunofluorescence and Western blot were used to detect the expression of ATM phosphorylated proteins.Colony forming assay Was used to observe the effect of a low dose-rate irradiation on HepG2 cell survival.Results After 30 min of low dose-rate irradiation.the phosphorylation of ATM occurred.After 6 h persistent irradiation,the expression of ATM phosphorylated protein reached the peak value,then gradually decreased.After ATM phosphorylation was inhibited with Wortmannin,the surviving fraction of HepG2 cells was lower than that of the irradiation alone group at each time point(P<0.05).Conclusions Continuous low dose-rate irradiation attenuated ATM phosphorylation.suggesting that continuous low dose-rate irradiation has a potential effect for increasing the radiosensitivity of HepG2 cells.

Preliminary Study of Transcatheter Arterial Chemoembolization for MalignantLimb Bone Tumor Before Limb-sparing Operation / 实用放射学杂志

Objective To evaluate the values of transcatheter arterial chemoembolization(TACE)for malignant limbs bone tumors before limb-sparing operation and the influence of TACE on operation.Methods TACE was performed in 10 patients with malignant limb bone tumor before limb-sparing operation.The complication of TACE,morphology and histology of neoplasm,incisional healing after TACE were observed.Results (1)The embolization syndrome (swelling,pain)appeared obviously in all patients at early stage and disppeared or alleviated greatly after 2 weeks of TACE.The severe complication-local skin necrosis appeared in 1 case;there was a subcrustal healing after 3 weeks.(2)In 6~28 days after embolization,all neoplasms underwent coagulation to variable extents,and the tumor cells was more than 60% necrosis in 8 cases.(3)All incisions had a good healing by first intention.Conclusion TACE is an effective and safe accessory therapeutic preecdure for malignant limbs bone tumors before limb-sparing operation.

Long term efficacy of partial splenic embolization for thalassanemia major / 中华放射学杂志

Objective To evaluate the long term efficacy of partial splenic embolization(PSE) for thalassanemia major. Methods 75 patients with thalassanemia major were treated with PSE and followed for 5 years,in which 30 patients with compelete data were studied.There were 8 patients with ? thalassanemia major,22 patients with ? thalassanemia major.The follow up indices included mean haemoglobin concertration,transfusion indices and blood transfusion consumption after embolization at 1,2,3,4,5 years. Results 26 of 30 patients showed a reduction in blood transfusion requirements and increase in haemoglobin level after embolization. The median blood transfusion requirements decreased from 1 200 ml/year before embolization to 200 ml/year; and the transfusion indices dropped from 6 times/year to 1 time/year. The mean of haemoglobin level increased from (60 9? 18 9)g/L to (82 3?17 4)g/L. The total effective rate was 86 7%,in which ? ,? thalassanemia major were 100 0%,81 8% respectively. Conclusion PSE is an effective therapeutic procedure for thalassanemia major, especially for ? thalassanemia major.

Study of immune function in children with thalassanemia major after partial splenic embolization / 介入放射学杂志

Objective To evaluate the changes of immunologic function in children with thalassanemia major after partial splenic embolization(PSE).Methods Immunoglobulins,T cell subsets were detected by immunologic turbidimetry and APAAP with monoclonal antibody respectively in 40 children with thalassanemia major and also in 20 healthy persons before and after PSE.These immunologic indexes were compared before and after PSE.Results The levels of IgG in serum were significantly lower one week after PSE than that before PSE.It turned to normal three weeks after PSE.The IgM,IgA levels remained unchanged during PSE.The levels of CD_3、CD_4、CD_4/CD_8 ratio in children with thalassanemia major were decreased(P