ChatGPT for shaping the future of dentistry: the potential of multi-modal large language model / 国际口腔科学杂志·英文版

The ChatGPT, a lite and conversational variant of Generative Pretrained Transformer 4 (GPT-4) developed by OpenAI, is one of the milestone Large Language Models (LLMs) with billions of parameters. LLMs have stirred up much interest among researchers and practitioners in their impressive skills in natural language processing tasks, which profoundly impact various fields. This paper mainly discusses the future applications of LLMs in dentistry. We introduce two primary LLM deployment methods in dentistry, including automated dental diagnosis and cross-modal dental diagnosis, and examine their potential applications. Especially, equipped with a cross-modal encoder, a single LLM can manage multi-source data and conduct advanced natural language reasoning to perform complex clinical operations. We also present cases to demonstrate the potential of a fully automatic Multi-Modal LLM AI system for dentistry clinical application. While LLMs offer significant potential benefits, the challenges, such as data privacy, data quality, and model bias, need further study. Overall, LLMs have the potential to revolutionize dental diagnosis and treatment, which indicates a promising avenue for clinical application and research in dentistry.

Clinical significance of expression of leptin in patients with biliary atresia and hepatic fibrosis / 中华肝胆外科杂志

Objective:To study the relationship and the role of leptin in children with biliary atresia and hepatic fibrosis to provide a treatment basis for these patients.Methods:The clinical data of children with biliary atresia or congenital biliary dilatation (CBD) who underwent surgical treatment at the Department of General Surgery of Tianjin Children's Hospital from August 2019 to August 2021 were retrospectively analyzed. Of 31 children included in this study, there were 14 males and 17 females, with age of 60 (30, 63) d. Children with biliary atresia served as the study group ( n=26) and children with CBD served as the control group ( n=5). Leptin protein, α-smooth muscleactin (α-SMA) and phosphorylation of extracellular-regulated protein kinase 1/2 (p-ERK1/2) in liver tissues were detectd by immunohistochemistry (IHC). The expression level of leptin mRNA in liver tissues were detected by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). Results:The average optical density values of leptin protein, α-SMA protein and p-ERK1/2 protein in the liver tissues of children in the study group were significantly higher than the control group ( P<0.05). The expression levels of leptin, α-SMA and p-ERK1/2 in liver tissues of children with biliary atresia significantly increased with increase in fibrosis degree ( P<0.05). The expression level of leptin in liver tissues of children with biliary atresia was positively correlated with the liver fibrosis grade ( rs=0.876), α-SMA ( r=0.723) and p-ERK1/2 ( r=0.725) ( P<0.01). The results of qRT-PCR showed that the content of leptin mRNA in liver tissues of children with biliary atresia was significantly higher than that of children with CBD ( P<0.05). Conclusion:Expressions of leptin increased with aggravation of degrees of hepatic fibrosis in biliary atresia. Leptin may be involved in activation of HSCs through the ERK1/2 signaling pathway in the process of hepatic fibrosis due to biliary atresia.

Clinical efficacy and prognostic factors analysis of radical hepatectomy of hepatocellular carcinoma in 760 patients / 中华消化外科杂志

Objective To investigate the clinical efficacy and prognostic factors of radical hepatectomy of hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 760 HCC patients who were admitted to the First Affiliated Hospital of Nanjing Medical University from August 2003 to June 2015 were collected.Surgical procedures were determined according to the location,number and size of tumors and anatomical relations among vessels.Observation indicators included:(1)intra-and post-operative situations:surgical procedures,operation time,volume of intraoperative blood loss,cases of intraoperative blood transfusion,postoperative complications,duration of postoperative hospital stay and pathological examination;(2) follow-up:1-,3-,5-year overall and tumor-free survival situations;(3) prognostic factors analysis of HCC patients.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to January 2016.Measurement data with normal distribution were represented as-x±s.The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method.The univariate analysis and multivariate analysis were done using the COX regression model.Results (1) Intra-and post-operative situations:all the 760 patients underwent successful operations,including 419 undergoing anatomical hepatectomy and 341 undergoing non-anatomical hepatectomy.R0 and R1 resections were respectively applied to 742 and 18 patients.Two patients were combined with portal vein resection and reconstruction and 1 was combined with resection and reconstruction of inferior vena cava.Operation time,volume of intraoperative blood loss and cases of intraoperative blood transfusion were (226± 115) minutes,(714±706) mL and 88,respectively.Fifty-five patients had postoperative complications,including 20 with abdominal effusion or abscess,16 with pleural effusion,9 with recurrent fever,8 with incisional infection,7 with intra-abdominal hemorrhage,6 with liver failure,3 with pyloric or intestinal obstruction and 2 with renal failure (some patients with multiple complications).Of the 55 patients with postoperative complications,7 with hemorrhage underwent reoperation or interventional therapy and other patients underwent conventional symptomatic treatment.Of 55 patients,5 patients died and other 50 patients were improved.Duration of postoperative hospital stay was (14±6) days.There were 457 patients with minimum margin of tumors ≤ 1.0 cm and 303 with minimum margin of tumors ＞ 1.0 cm.(2) Followup:all the 760 patients were followed up for 1-139 months,with a median time of 25 months.The overall and tumor-free median survival times were 59 months and 31 months,respectively.The 1-,3-,5-year overall and tumor-free survival rates were 81.7％,63.4％,47.9％ and 68.7％,44.9％,29.6％,respectively.(3) Prognostic factors analysis of HCC patients:results of univariate analysis showed that clinical symptoms,alpha-fetoprotein (AFP),Barcelona clinic liver cancer staging,surgical procedures,intraoperative blood transfusion,minimum margin of tumors,number and diameter of tumors,tumor capsule,tumor differentiation,vascular cancer embolus,macrovascular invasion and tumor staging of American Joint Committee on Cancer (AJCC) were related factors affecting prognosis of HCC patients after radical hepatectomy [HR =1.39,1.50,1.92,0.65,1.45,1.68,1.96,1.66,2.26,1.50,2.68,3.37,2.00,95％ confidence interval (CI):1.08-1.79,1.16-1.94,1.68-2.20,0.50-0.84,1.04-2.02,1.28-2.20,1.54-2.49,1.42-1.94,1.69-3.02,1.22-1.85,1.99-3.60,2.61-4.36,1.77-2.27,P＜0.05].Results of multivariate analysis showed that AFP,number and diameter of tumors,tumor differentiation and tumor staging of AJCC were independent factors affecting prognosis of HCC patients after radical hepatectomy (HR=1.61,1.62,1.31,1.40,1.78,95％CI:1.14-2.26,1.22-2.14,1.06-1.63,1.10-1.79,1.27-2.51,P ＜ 0.05).Conclusions The anatomical and non-anatomical hepatectomies are safe and feasible for optional HCC patients,with a good long-term outcome.AFP,number and diameter of tumors,tumor differentiation and tumor staging of AJCC are independent factors affecting prognosis of HCC patients after radical hepatectomy.

Evaluation on the chemosensitivity of hepatocellular carcinoma during mimetic transcatheter arterial embolization / 中华肝胆外科杂志

Objective To investigate whether 5 different chemotherapeutic drugs and their combination of either two drugs could further promote the inhibition on the cell growth of HCC cell line (HepG2) in vitro in the hypoxic and hyponutritional culture medium (HHCM) mimicking the different scenarios of transcatheter arterial chemoembolization (TACE).Methods The cells were treated by 5 drugs for 2 h, 4 h,6 h and 24 h, which include epirubicin (EPI), cisplatin (DDP), mitomycin-C (MMC), oxaliplatin (OXA) and 5-fluorouracil (5-FU) in four concentrations of HHCM (5％, 10％, 25％ and 50％) mimicking the scenarios during TACE and the cell viability was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay.The combinations of dual drugs treated for 24 h were also tested.Results The sensitive drugs with inhibition rates more than 30％ were EPI, MMC and OXA in 4 different concentrations of HHCM.The sensitivity of the drugs treated for 24 h was significantly increased compared with that for 2 h in 5％, 10％ and 25％ HHCM.The dual combinations did not increase the chemosensitivity of HepG2 cells.Conclusions EPI, MMC and OXA exhibited cytotoxic activity against HepG2 cells in various hypoxia and hyponutrition states.Prolonging the exposure time could increase the sensitivity of drug in HHCM, and the combination of dual drugs cannot enhance the cytotoxic effect.

Evaluation of cone-beam CT hepatic angiography in detecting the tumor-feeding arteries during the performance of TACE for HCC / 介入放射学杂志

Objective To accurately judge the tumor-feeding artery is the most important basis for a successful treatment of hepatocellular carcinoma (HCC) with super-selective hepatic arterial chemoembo lization therapy. This study aims to assess the clinical value of cone-beam CT hepatic arteriography (CBCT-HA) in detecting tumor-feeding arteries during the performance of conventional transarterial chemoembo lization (TACE), and to compare the diagnostic effects between CBCT-HA and non-selective hepatic DSA. Methods Twenty-three consecutive patients with inoperable HCC were enrolled in this study. TACE was carried out in all patients. During the performance of TACE, the DSA-HA, CBCT-HA, Lipiodol-TACE and Lipiodol-CBCT were performed separately. The imaging materials, including DSA-HA and CBCT-HA, were analyzed by two experienced interventional physicians together to judge the tumor-feeding arteries. Statistic analysis was conducted by using chi square test. Results Tumor stain and lipiodol accumulation were regarded as the “gold standard” of the presence of tumor-feeding artery, based on which the tumor-feeding artery was confirmed in 75 lesions. DSA-HA demonstrated positive tumor-feeding artery in 40 lesions, among which true-positive tumor-feeding artery was seen in 32 and false-positive one in 8. CBCT-HA showed positive tumor-feeding artery in 72 lesions, which included true-positive tumor-feeding artery in 68 and false-positive one in 4. The sensitivity of CBCT-HA in judging tumor-feeding artery was 90.7% (68/75), which was much higher than that of DSA-HA (42.6%, 32/75), the difference was statistically significant(P<0.001). The positive predictive value of CBCT-HA in detecting tumor-feeding artery was also higher than that of DSA-HA (94.4% vs. 80.0%; P=0.040). Conclusion Cone-beam CT hepatic arteriography is obviously superior to DSA hepatic arteriography in identifying tumor-feeding arteries, which is very helpful in guiding super-selective TACE for HCC.

A new thermosensitive embolic agent used for arterial embolization of primary hepatocellular carcinoma:preliminary clinical trial / 介入放射学杂志

Objective To investigate the clinical application of a new thermosensitive embolic agent in interventional arterial embolization treatment, and to evaluate its effectiveness and safety in treating inoperable advanced hepatocellular carcinoma (HCC). Methods Prospective, open and single center clinical study of a new thermosensitive embolic agent was conducted. A total of 10 patients with clinically confirmed inoperable advanced HCC were treated with percutaneous arterial embolization using thermosensitive embolic agent; a maximum of 4 therapeutic cycles were performed until the disease progressed. Objective effect was evaluated at (30 ±7) days after the treatment according to mRECIST standard; the progression free survival (PFS) time and the survival period (OS) were recorded. The adverse reactions and adverse events were determined by NCI-CTC 3.0 version standard. Results Ten patients (23 target lesions in total) were enrolled in this study. After the treatment, complete remission (CR) was obtained in one patient, partial remission (PR) in 3 patients, stable disease (SD) in 5 patients, and progress disease (PD) in one patient. The objective response rate (CR+PR) was 40%, and the disease control rate (CR+PR+SD) was 90%. The PFS of hepatic lesions was 18.4 weeks (95%CI:14.15-22.65), the cumulated median survival period was 46.2 weeks (95%CI:38.18-54.22). The most common adverse reactions included pain, fever, hepatic function damage, small amount of ascites, diarrhea, etc. Conclusion The new thermosensitive embolic agent is not sticky to vessel and is visible under X-ray; it has reliable embolization effect, and the therapeutic results can be easily evaluated. This embolic agent is not perfect, and it has some limitations in clinical use. The adverse reactions are mild, which can be easily tolerated by the patients. It is worth trying to carry out large sample and randomized controlled studies in order to open up more areas for arterial chemoembolization therapy of tumors.

Imaging characteristics and intervention therapy for hepatic artery-portal vein shunts in patients with primary liver carcinoma / 中国肿瘤临床

Objective:To investigate the onset of hepatic artery-portal vein shunts (HAPVS) in primary liver cancer (PLC) pa-tients through digital subtraction angiography (DSA) and to devise a suitable strategy for treating both lesions and shunt tracts. In the process, the therapeutic effect on such patients can be enhanced. Methods:A total of 769 PLC patients who accepted transarterial che-moembolization (TACE) were analyzed retrospectively. We examined the image characteristics of 112 cases with HAPVS based on shunt type. For patients with middle or severe fistula, we initially attempted to overpass the fistula. Then, we either embolized the tumor lesions or merely provided chemotherapy to the patients. For patients with mild peripheral fistula, we embolized the tumor and fistula si-multaneously. Then, the accompanying arterial-vein shunt and portal vein tumor thrombus (PVTT) were handled at the same time. Re-sults: DSA findings showed that portal veins were observed in the early stage of angiography. A total of 52 of the 112 cases with HAPVS involved mild shunts, 34 exhibited moderate shunts, and 26 reported severe shunts. Among these cases, 31 involved central-and central peripheral-type artery-portal vein fistula, whereas 81 involved peripheral-type artery-portal vein fistula. Seven cases were examined in combination with hepatic artery-liver vein shunts, and 50 cases were investigated in conjunction with PVTT. Tumor embo-lization was successful in 101 cases (90.1%). Moreover, catheters successfully overpassed shunt tracts and embolized the tumors in 48 cases (42.9%). Shunt tracts were successfully closed in 74 cases (66.1%), and no serious complication was observed. Conclusion:Pe-ripheral-type artery-portal vein fistula and mild-to-moderate shunts were easier to close than central-type artery-portal vein fistula and severe shunts were. Tumor embolization and shunt closure were successful in most patients. Therefore, TACE is a safe and reliable method for treating HAPVS in PLC.

Symptomatic pulmonary lipiodol embolism after transarterial chemoembolization for hepatic malignant tumor: clinical presentation and chest imaging findings / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pulmonary lipiodol embolism after transarterial chemoembolization (TACE) was rare and life-threatening, occasionally reported in previous literatures. We aimed to review the records of 11 patients with pulmonary oily embolism and analyze their characteristics of radiographic findings and risk factors.</p><p><b>METHODS</b>Records of 478 consecutive patients who underwent 1 026 percutaneous TACE procedures were retrospectively analyzed. Eleven cases with respiratory symptoms were identified as having symptomatic pulmonary lipiodol embolism after TACE. Data of these patients, including clinical presentation, techniques of TACE, imaging features of tumor and chest imaging findings, were assessed.</p><p><b>RESULTS</b>Eleven (2.3%) of 478 consecutive patients who underwent percutaneous TACE procedures had a pulmonary oily embolism after procedures. The mean size of target tumors embolized was (13.6 ± 2.0) cm. All were hyper-vascular. The mean volume of lipiodol was (21.8 ± 8.2) ml. Pulmonary oily embolisms were revealed within 12-48 hours after TACE. The most severe respiratory symptoms and imaging abnormalities of the eight patients who survived presented between 2 and 5 days after TACE, becoming normal between 12 and 35 days after TACE. Three patients died. Chest CT revealed retention of radiopaque lipiodol in lungs.</p><p><b>CONCLUSIONS</b>Pulmonary lipiodol embolism occurs easily in patients who have large hyper-vascular hepatic malignant tumor. The high-density lipiodol deposition in the lung field can be used as diagnostic feature.</p>

Transarterial chemoembolization as an adjuvant therapy in patients with hepatocellular carcinoma treated with hepatectomy / 中华放射学杂志

Objective To evaluate the role of transarterial chemoembolization (TACE) as an adjuvant therapy in patients with hepatocellular carcinoma (HCC) treated with hepatectomy. Methods Clinical data of 386 consecutive patients who underwent hepatectomy for HCC were analyzed retrospectively.Of the 386 patients, 156 patients did not undergo TACE served as controls (non-TACE group), the remaining 230 patients underwent TACE (TACE group) preoperatively (n=71), postoperatively (n=86), or both (n =73). For the purpose of comparison, patients who did not undergo preoperative TACE were assigned to group A (n=242), and those patients who underwent preoperative TACE were assigned to group B (n =144). Patients cumulative survival rates were calculated by survival table and analyzed using Kaplan-Meier survival curves. Results There were significantly higher complete necrosis rates in group B (18/144) than those in group A (0/242) ( P ＜ 0.01). The difference between the survival rate of patients with complete necrosis and those with incomplete necrosis was statistically significant (P＜0.01).The 1-,3-,5-and 10-year survival rates were 90.4%(66/73),72.9%(42/73),51.9%(22/73) and 25.4%(2/73) in combined TACE group, 74.0% (50/71) ,46.2%(28/71) ,27.3%(5/71) and 0(0/71) in preoperative TACE group, 88. 0% (73/86) ,59. 6% (39/86) ,36. 7% (11/86) and 0(0/86) in postoperative TACE group, and 75. 8% (110/156), 63.4% (48/156), 31.0% (13/156) and 23.9% (10/156) in non-TACE group,respectively. Combined TACE group got a significantly higher survival rate compared with non-TACE group or preoperative TACE group or postoperative TACE group (P＜0.05). The survival rates in either preoperative or postoperative TACE group were not significantly better than those in non-TACE group (P＞0.05).Conclusions As an adjuvant treatment, combined pre-and post-operative TACE can increase survival rate in patients with surgically resectable HCC. No significant benefit for patient's long term survival when either preoperative or postoperative TACE was performed in addition to surgery.

Balloon dilation and airway stenting for benign and malignant tracheal stenosis / 介入放射学杂志

Objective To assess the effectiveness of balloon dilation and airway stenting performed under fluoroscopic guidance for the treatment of benign and malignant tracheal stenosis. Methods Under fluoroscopic guidance,balloon dilation and airway stenting were performed in 45 patients with tracheobronchial stricture. Of the 45 patients, malignant tracheal stenosis was seen in 37, including mediastinal nodal metastases (n = 14), esophageal carcinoma (n=13), lung carcinoma (n = 4), adenocarcinoma of bronchus (n = 3), lymphoma (n = 2) and laryngocarcinoma (n = 1), and benign tracheal stenosis was seen in 8, including endobronchial tuberculosis (n = 6), retrosternal thyroid adenoma (n = 1) and endotracheal intubation (n = 1). Airway stenting with serf-expandable metal stent was employed in 38 patients and balloon dilation in 7 patients. All the procedures were performed under fluoroscopic guidance. Results A total of 53 self-expandable metal stents was implanted in 38 patients. The clinical symptoms were immediately relived after the procedure in all patients except for one patient who died from choking of sputum. No stent migration was observed. Restenosis developed in 4 patients, which was successfully treated with repeated stenting and balloon dilation. Nineteen times of balloon dilation procedure were accomplished in 7 patients. Marked remission of clinical symptoms was seen in most cases. During a follow-up period (ranged from 0 to 124 months with a mean of 24.5 months) 31 patients died. Conclusion For both benign and malignant tracheal stenosis, balloon dilation with airway stenting performed under fluoroscopic guidance is a safe and efficient therapy with instant curative effect in relieving clinical symptoms.

Clinical research progress on molecularly targeted therapy of primary hepatic carcinoma / 肿瘤研究与临床

With the development of molecular biology,molecular targeted therapy has become main direction and trend at the aspect of oneotherapy in the 21th century.Molecularly targeted agents which target VEGF/VEGFR,EGFR.Raf/MAPK-ERIC,HGFR,as well as associating with other therapies are available in the clinical treatment of primary hepatic carcinoma,and inspiring results have also achieved in some clinical trials.The review attempts to summarize the clinical research advancemem in molecularly targeted therapy of primary hepatic carcinoma.

Variation of hepatic artery on arteriogram and its clinical significance in interventional therapy for hepatic cancer / 吉林大学学报(医学版)

Objective To investigate the variations of hepatic artery and its extrahepatic arteries on hepatic arteriogram and to provide benefit for transhepatic arterical chemoemblization.Methods The hepatic arteriograms of 200 cases with unresectable hepatic malignant tumor before interventional therapy were analysed.Two interventional radiologists in common reviewed the incidences of various types according to Michels' classification,the absence of proper hepatic artery,and the variations of extrahepatic arteries originating from hepatic artery.Results The most common hepatic artery variation was Michels type Ⅲ(n=17,8.5%),followed by type Ⅱ(n=10,5.0%) and Ⅴ(n=9,4.5%).Proper hepatic absence was found in 25 cases and appeared as 5 subtypes.5 kinds of extrahepatic arteries were found.The most common extrahepatic artery was the right gastric artery(n=156,78.0%),followed by cystic artery(n=126,63.0%),accessory left gastric artery(n=19,9.5%),the hepatic falciform artery(n=5,2.5%),and accessory left inferior phrenic artery(n=4,2.0%).Conclusion There are some other variations of hepatic artery beside Michels' classification,and there are many variations of extrahepatic arteries originating from hepatic artery,it is important to assure interventional therapy effect for hepatic cancer and prevent complication.

Digital subtraction angiography manifestation and interventional therapy of arteriovenous shunting in primary hepatocellular carcinoma of advanced stage / 北京大学学报(医学版)

Objective:To explore the appearances o f digital subtraction angiograph y (DSA) and therapeutic efficacy of interventional therapy of hepatic carcinoma accompanied with arteriovenous shunting (AVS). Methods: To retro spectively analy ze clinical material of 97 patients with hepatocellular carcinoma with hepatic artery-portal vein shunting(HA-PVS) , of whom, 16 had upper gastrointestinal hemorrhage, 51 had middle to l arge amounts of ascites, and 53 had varices of esophagus and fundus gastricus . All the patients were treated with transcatheter arterial chemoembolization (TACE) or transcatheter arterial infusion chemotherapy (TAI). Shunts were embolized by lipidol i n 40 patients, by lipidol and spon-gia gelatinosa particle in 34 patients, and by coi l in 6 patients. The remaining 17 were treated only with TAI. Results:Twelve (12.4%) case s had hepatic artery-hepatic vein shunting (HA-HVS),while 32 (33%)cases had portal vein tumor thrombosis (PVTT). In 70(72.2%) patients, all shunts we r e completely closed successfully, in 15(15.5%) patients, the shunts were partly closed, and in 12(12.3%)patients, the shunts were not closed. In 12 patients, the shunts reopened in later therapy, their blood flow was smaller than before and they were closed after second embolization. In 17 patients, new shunts emerged. After TACE therapy,the tumors were smaller in 57(58.7%),bi gger in 24 (24.7%),and 16(16.5%) were the same in size before and after TACE. Ascit es disappeared in 29 patients, decreased in 18 patients and had no change in 4 pati ents. Five patients who had upper gastrointestinal hemorrhage pre-operation had n ew hemorrhage. Of the 47 patients who had diarrhea, 23 improved. In 67 alph a fetoprotein (AFP) positive patients, degree of AFP in 53 patients decreased. Eighty-one patients died and their Corresp onding author’s e-mail, renjieyang2007@163.commiddle survival period was 12.9 months. No serious dama ge to hepatic function due to the treatment was observed in most patients. Concl usion:Primary hepatic carcinoma with AVS increases difficulty of interv entional therapy,but as long as we take active and proper treating measure,we could ac quire satisfactory curative effect without serious syndrome. DSA can demonstrate the type, the site and the degree of AVS completely and directly, thus having import ant value in treating primary hepatic carcinoma and improving prognosis.

Long-term retrospective annlysis of metallic stents in malignant biliary obstruction / 北京大学学报(医学版)

Objective: To analyze and evaluate of the long-term follow-up data of 152 patients with inoperable malignant biliary obstruction who underwent percutaneous placement of metallic stents. Me-thods: From 2000 through 2006, 152 consecutive patients with malignant biliary obstruction were treated with PTCD or placement of metallic stents. The causes of obstruction were bile duct carcinoma (n=35),pancreatic carcinoma (n=32), hepatocellular carcinoma and metastatic (n=61), lymphadenopathy in the hepatoduodenal ligament (n=24). We used 86 stents: 31 Cook Zilver Stents,25 Sinus Superflex Stents,12 Wall Stents,3 Sinus-s Iliaca Stents,3 ZA-S Bliary Design Stents,5 Smart Stents and 7 other stents. Every three months we followed up all patients except those who died. Patient survival and stent patency rates were estimated by life-table analysis. The Kaplan-Meier method (log-rank test) was used to compare the patency and survival rates among different groups. And the COX regression model was established to compare the relative risks. Results: The overall median length of patency of all stents was 314 days. The median length of survival for the entire patient group was 215 days. The survival rate was 79.1%,51.7% and 26.8% after 3, 6, and 9 months, respectively. Six patients developed recurrent jaundice or cholangitis. The patients with hepatic hilar obstruction group indicated worse prognosis (P≤0.05). Conclusion: Metallic stents showed a favorable patency rate with regard to patient survival. In patients with hilar obstruction, the clinical prognosis was worse than that in patients with common bile duct (CBD) obstruction. We believe that the placement of metallic stents is the procedure of choice for palliation of malignant biliary obstruction.

Isolated hepatic perfusion for treatment of unresectable malignant tumor / 北京大学学报(医学版)

Isolated hepatic perfusion(IHP)is the best re gional chemotherapy modal ity for treatment of unresectable liver primary cancer and liver metastases.The main principle of isolated hepatic chemotherapy is to achieve higher regional d rug concentrations and thus higher exposure of tumor tissue to the agents,resul ting in increased response rates,while shielding the organism from the systemic toxicity because of the much lower concentrations in the systemic circulation.At present the methods of IHP include surgical methods and methods with balloon c atheter technique,which promise to provide a micro-invasive procedure,bu t are not fully mature.The key point of successful IHP is low leakage or leakage-free.The more beneficial aspect of IHP is that it can simultaneously apply hyperthe r my and biologic agent TNF to improve sensitivity of chemotherapy,which is not p ossible in other regional chemotherapy.From previous literatures this overview is to describe the principle,procedure techniques,leakage monitor methods,hyp erthermy application,administration agents,therapeutic reaction,complications and perspective of IHP.

Characteristics of satellite nodules of hepatocellular carcinoma and treatment strategy of interventional radiology / 第三军医大学学报

Objective To study the characteristics of satellite nodules of hepatocellular carcinoma (HCC) and the treatment methods by transcatheter hepatic arterial chemoembolization (TACE). Methods Forty one cases of massive HCC and single nodular HCC proved by pathology underwent the examination of spiral CT and angiography for observing the characteristics of satellite nodules. All the patients were treated by TACE and the results were analyzed. Results The satellite nodules were found in 17 out of 41 cases by CT and/or angiology of which 10 were hypervascular and 7 hypovascular. The satellite nodules located within 1 cm from the margin of the main HCC in 11 out of 17 cases. In the treatment of TACE, the tip of catheter was located on the proximal end of feeding artery of tumor so that the embolization area included the area of satellite nodules. After 6-19 months follow up, 5 patients were complete response (CR) and partial response (PR) in 17 cases but no progressive patients were found. Conclusion The satellite nodules extensively exist in HCC and can be effectively treated using reasonable methods.

Significance of temporary block of the gastroduodenal artery in hepatic artery chemotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the significance of temporary block of gastroduodenal artery in hepatic artery chemotherapy.</p><p><b>METHODS</b>Forty patients were randomized into two groups with 20 in each. In the trial group, when the catheter was introduced into the gastroduodenal artery, pituitrin was infused slowly (2 U/min) till the gastroduodenal artery became blocked, then the catheter was pulled back to the common hepatic artery to start chemotherapy. In the control group, saline (10 ml) was infused slowly (4 ml/min) instead of pituitrin.</p><p><b>RESULTS</b>In the trial group, all patients had temporary increase of blood pressure ranging from 20 to 50 mm Hg, which was tolerated with most recovered in 20 to 30 minutes. Two patients had pain in the upper abdomen and others only had slight gastrointestinal discomfort. In the control group, epigastric upset or pain during operation was present in 5 patients. In 9 patients, upper abdominal pain after the operation was present which was serious in two. One of these two patients was confirmed as having gastric antrum erosion by gastroscopy. There was statistically significant difference in the upper abdomen pain in these two groups by Chi-square test (P < 0.025). The relative and absolute risk reduction were 77.8% and 35.0% and the mean number of patients needed to treat was 2.86. The time of resuming preoperative appetite in the trial and control groups were 7.1 +/- 1.37 and 11.8 +/- 2.56 days, with the difference statistically significant (P < 0.01).</p><p><b>CONCLUSION</b>Temporarily block of the gastroduodenal artery, being simple, safe, and effectively reducing patients' untoward and finacial burden, is advised to be practiced in hepatic artery chemotherapy.</p>

Approach Artery Chemotherapy Dose on Primary Hepatic Cancer with Abnormal Liver Functions / 实用放射学杂志

Objective To find out how to choose the doses of hepatic artery chemotherapy(HAC)in hepatic cell carcinoma(HCC) cases with abnormal liver function.Methods There were 80 HCC patients with one or more liver function index(ALT,AST,TB,DB)above at least 2 times normal,who underwent 105 times HAC or hepatic artery chemoembolization(HACE) with routine chemotherapy doses,and their pre-and postoperative liver and kidney functions had been observing by the end of three weeks after HAC or HACE.Results 1.Postoperative ALT and AST took a favorable turn in preoperative ALT ≥80 U/L group(44 cases)(?

Clinical application of esophageal stent in the treatment of benign and malignant esophageal strictures / 介入放射学杂志

Objective To investigate the indications and complications in the treatment of benign and malignant strictures using esophageal stents in order to avoid abusing effects in clinical practice. Methods A series of 20 patients, 12 men, 8 women, aged from 45～72, with esophageal stricutre. There were 3 cases had stricture at the anastomosis site. 4 cases with esophago bronchial fistula. 1 case with esophago mediastinal fistula after surgical operation ten cases used imported stents and another 10 with domestic Nickel Titanium stents. Results Successful stent placement was achieved in all cases. Dysphagia were relieved in most of 20 cases. The fistula vanished in 5 cases of complications with esophago bronchial and esophago mediastinal fistulas. Conclusions The esophageal stent placement is an effective treatment for benign and malignant esphageal strictures. The domestic Nickel Titanium stents is well effective as the imported ones.

Experimental study of the mechanism in esophageal restenosis after balloon dilation of benign stricture / 介入放射学杂志

Objective Experimental study of the mechanism in esophageal restenosis after balloon dilation of benign stricture.Methods Esophageal stenosis model of the rats was created by 5ml of 50% NaOH solution burn with double balloon method, and esophageal restenosis (RS) model was developed by esophageal stenosis with dilation of PTCA balloon catheter. Quantitative and quanlitative analysis of esophageal stenosis and RS formation in the rats were observed and recorded by analytic measurements imaging and immunohistologic chemistry respectively. Results Esophageal benign stricture and RS model of 49 rats were developed. Cross section area and perimeter of esophageal mucosa layer, muscule layer and the whole layer had increased in experimental group. Comparing to control group, it had remarkable significance in statistics ( P