Chinese expert consensus on intra-arterial drug and combined drug administration for primary hepatocellular carcinoma / 中华内科杂志

Transarterial interventional therapy is one of the most widely used treatment methods in patients with primary hepatocellular carcinoma. With the progress in interventional technology and the use of new drugs, transarterial interventional therapy has achieved favorable results in the treatment of primary hepatocellular carcinoma and has become the first choice non-surgical treatment for advanced liver cancer. However, at present, there are great differences in the drugs used in transarterial interventional treatment and the combined application of other drugs among centers, and there is no uniform consensus or guideline. Based on the latest research data and clinical practice experience, as well as the characteristics of Chinese patients, the Specialist Group of Interventional Drugs, Interventionalists Branch of the Chinese Medical Doctor Association was organized to formulate the Chinese expert consensus on intra-arterial drug and combined drug administration for primary hepatocellular carcinoma. The purpose of this consensus is to explore the efficacy and safety of drugs and drug combinations related to intra-arterial interventional therapy, the use of drugs in special populations, the management of adverse reactions, and adjuvant drugs to provide a reference for clinical practice.

Experience in intra-arterial chemotherapy using two protocols for the treatment of OSCC over two decades at the University Hospital Vienna

OBJECTIVES: This retrospective study performed a comprehensive analysis of the usage of intra-arterial chemotherapy (iaCh) for locally recurrent UICC stage IV oral squamous cell carcinoma (OSCC) over two decades at the Department of Cranio-Maxillofacial and Oral Surgery at the University Hospital Vienna to assess the utility of its future use. METHODS: Between 1994 and 2014, iaCh was indicated in 48 OSCC cases. In these, the two most frequent iaCh schemes, cisplatin/5-fluorouracil (Cis/5-FU) and methotrexate/bleomycin (MTX/Bleo), were chosen for further analysis. The effect on survival of two distinct intra-arterial protocols and their covariates were analyzed with the Kaplan-Meier method as well as univariate and multivariate Cox proportional hazard regression models. RESULTS: The mean follow-up period was 29.91 months. The two intra-arterial chemotherapy groups did not differ significantly in sample size, demographic data or therapeutic covariates. The Cis/5-FU iaCh regimen was associated with significantly better overall survival (median OS 2.6 years vs. 1.3 years; p=0.002) and had a beneficial effect on survival (HR=3.62, p=0.015). Side effects occurred at a frequency similar to that described in the literature for intravenous chemotherapy (ivCh). CONCLUSIONS: These results suggest a preference for administering Cis/5-FU for iaCh. Nevertheless, due to economic considerations in healthcare expenditures, there is no future for iaCh in the treatment of head and neck carcinomas because ivCh is known to be equivalent.

Intra-arterial fibrinolysis for the management of acute ischemia on a below-knee amputation stump. Case report / Fibrinólise intra-arterial para tratamento da isquemia aguda em coto de amputação infrapatelar. Relato de caso

ABSTRACT Preservation of the knee joint has enormous advantages in terms of mobility and rehabilitation of an amputee. Any cause of breakdown requiring revision to an above-knee amputation is a major setback because it reduces the patient's rehabilitative potential. We report a case of intra-arterial thrombolysis use to save a below-knee amputation stump with acute ischemia. A 56-year-old man who sought the emergency department with 1-day history of acute pain on his right below-knee stump. The angiography confirmed popliteal artery occlusion. Pharmacomechanical thrombectomy, with Aspirex (rotational catheter to restore blood flow in occluded vessel, by removing occlusion material from the vessel) and recombinant tissue plasminogen activator, was performed. After 9 years of follow-up the patient remained asymptomatic, capable of independent ambulation with prosthetic limb. Intra-arterial fibrinolysis seems to be a safe and effective treatment for cases of acutely ischemic amputation stump.

RESUMO A preservação da articulação do joelho tem grandes vantagens para a mobilidade e a reabilitação de um amputado. Qualquer causa que exija revisão para uma amputação acima do joelho é um grande revés, porque reduz o potencial de reabilitação do paciente. O objetivo aqui foi descrever o uso de trombólise intra-arterial para salvar um coto de amputação abaixo do joelho com isquemia aguda. Homem, 56 anos, procurou pronto atendimento de nosso hospital com histórico de 1 dia de dor aguda em seu coto de amputação infrapatelar direito. A angiografia confirmou oclusão da artéria poplítea. Foi realizada trombectomia farmacomecânica com Aspirex (cateter rotativo para restabelecer o fluxo sanguíneo em vasos ocluídos, removendo material de oclusão do vaso) e ativador do plaminogênio tecidual recombinante. Após 9 anos de seguimento, o paciente permanecia assintomático, capaz de deambulação independente com membro protético. A fibrinólise intra-arterial parece ser um tratamento seguro e eficaz para casos selecionados de coto de amputação com isquêmica aguda.

Effect of arterial infusion with methylene blue during total mesorectal excision on urination function and sexual function in male patients with rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the effect of arterial infusion with methylene blue during total mesorectal excision (TME) for better preservation of pelvic autonomic nerve on urination function and sexual function in male patients with rectal cancer.</p><p><b>METHODS</b>A total of 68 male rectal cancer patients from Zhejiang Xiaoxing People's Hospital and 44 male rectal cancer patients from Guangdong Zhongshan Chenxinghai Hospital between June 2013 and June 2015 were prospectively enrolled. Patients were randomly divided into the trial group receiving arterial infusion with 8 ml of 1% methylene blue and the control group without artery infusion, with 56 cases in each group. All the patients underwent TME. Intra-operational lymph node removal and postoperative urination and sexual function (erection and ejaculation) were compared between two groups.</p><p><b>RESULTS</b>The baseline data of the two groups were not significantly different (all P>0.05). As compared to the control group, the trial group had shorter operation time [(3.28±0.63) hours vs. (4.01±0.94) hours, P<0.01], less blood loss[(92.5±36.4) ml vs. (174.1±61.4) ml, P<0.01], and more lymph nodes harvested per patient (15.8±7.6 vs. 11.9±4.3, P<0.01). One year after operation, classI(, II(, III(, IIII( of urination was observed in 33 cases (58.9%), 15 cases (26.8%), 6 cases (10.7%), 2 cases (3.6%) in the trial group, while 24 (42.9%), 15 (26.8%), 12 (21.4%), 5 (8.9%) in the control group, which indicated that trial group was superior to control group(P<0.05). ClassI(, II(, III( of erection was observed in 36 cases (64.3%), 18 cases (32.1%), 2 cases(3.6%) in the trial group, while 25(44.6%), 23(41.1%), 8(14.3%) in the control group, which indicated that trial group was superior to the control group (P<0.05). ClassI(, II(, III( of ejaculation was found in 36 cases (62.5%), 18 cases (32.1%), 3 cases (5.4%) in the trial group, while 24 (42.9%), 22 (39.3%), 10(17.9%) in the control group, which also indicated that trial group was superior to the control group(P<0.05).</p><p><b>CONCLUSIONS</b>In the treatment of male rectal cancer patients, TME combined with arterial infusion with methylene blue can facilitate the distinction of operation scope, which is beneficial to reduce damages to the pelvic nerve, leading to the protection of urinary function and sexual function. In addition, this procedure can result in shorter operation time, less operational blood loss and more lymph nodes harvested.</p>

Effects of intraoperative diltiazem infusion on flow changes in arterial and venous grafts in coronary artery bypass graft surgery / Efeitos da infusão intraoperatória de diltiazem sobre as mudanças do fluxo em enxertos arteriais e venosos em cirurgia de revascularização do miocárdio

AbstractObjective:This study aimed to show the effects of intra-operative diltiazem infusion on flow in arterial and venous grafts in coronary artery bypass graft surgery.Methods:Hundred fourty patients with a total of 361 grafts [205 (57%) arterial and 156 (43%) venous] underwent isolated coronary surgery. All the grafts were measured by intraoperative transit time flow meter intra-operatively. Group A (n=70) consisted of patients who received diltiazem infusion (dose of 2.5 microgram/kg/min), and Group B (n=70) didn't receive diltiazem infusion.Results:Mean graft flow values of left internal mammary artery were 53 ml/min in Group A and 40 ml/min in Group B (P<0.001). Pulsatility index (PI) values of left internal mammary artery for Group A and Group B were 2.6 and 3.0 respectively (P<0.001). No statistically significant difference was found between venous graft parameters.Conclusion:We recommend an effect of diltiazem infusion in increasing graft flows in coronary artery bypass graft operations.

ResumoObjetivo:Este estudo teve como objetivo mostrar os efeitos da infusão de diltiazem intraoperatória no fluxo arterial e enxertos venosos em cirurgia de revascularização do miocárdio.Métodos:Cento e quarenta pacientes com um total de 361 enxertos [205 (57%) arteriais e 156 (43%) venosos] passaram por uma cirurgia coronária isolada. Todos os enxertos foram medidos pelo medidor de fluxo de tempo de trânsito intraoperatório. Grupo A (n=70), formado por pacientes que receberam infusão de diltiazem (dose de 2,5 micrograma/kg/min), e Grupo B (n=70), por aqueles que não receberam infusão de diltiazem.Resultados:Os valores médios de fluxo de enxerto de artéria mamária interna esquerda foram 53 ml/min no grupo A e 40 ml/min no Grupo B (P<0,001). Valores do índice de pulsatilidade da artéria mamária interna esquerda para o Grupo A e do Grupo B foram de 2,6 e 3,0, respectivamente (P<0,001). Não houve diferença estatisticamente significativa entre os parâmetros do enxerto venoso.Conclusão:Sugerimos um efeito da infusão de diltiazem em aumentar os fluxos de enxerto em operações de bypass de artéria coronária.

Preliminary observation on hepatic arterial infusion under temporary hepatic circulation occlusion in rabbits / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the advantages, feasibility and limitations of hepatic arterial infusion under temporary hepatic circulation occlusion.</p><p><b>METHODS</b>Twelve rabbits were randomly divided into two groups: hepatic artery infusion group (HAI group) and hepatic artery infusion under temporary hepatic circulation occlusion group (HAI-THCO). Microcatheters were separately inserted into the proper hepatic artery and right hepatic vein. For the HAI group, 5-Fu (10 mg/ml and 100 mg/kg) was infused into the common hepatic artery with a high pressure injector for 10 minutes. For the HAI-THCO group, the common hepatic artery and hepatic portal vein were temporarily occluded for 15 minutes using artery clamp when 5-Fu was being infused. For the two groups, at 2, 5, 10, 15, 20 and 30 min after the start of infusion, blood samples of the hepatic flow were collected from the right hepatic vein and of the systemic blood flow from the inferior vena cava, 1 ml at each time point. The blood drug concentration of these blood samples was determined by high performance liquid chromatography (HPLC).</p><p><b>RESULTS</b>Except that at 20 and 30 min after infusion, in the HAI group, the blood drug concentration of hepatic circulation was significantly higher than that of systemic circulation (P < 0.05). But in the HAI-THCO group, the blood drug concentration of hepatic circulation was significantly higher than that of systemic circulation at all the time points (P < 0.05). The hepatic circulation blood drug level of the HAI-THCO group was always significantly higher than that of the HAI group (P < 0.05), but the systemic circulation blood drug concentration of the HAI-THCO group was always lower (P < 0.05). The hepatic circulation maximum concentration (Cmax) of blood drug concentration of the HAI-THCO and HAI groups was (23.057±3.270) µg/ml and (4.408±1.092) µg/ml, respectively, and the Cmax of HAI-THCO group was significantly higher (P < 0.001), being 5.23 times of that of HAI group. The systemic circulation Cmax of the two groups was (1.456±0.217) µg/ml and (2.335±0.669) µg/ml, respectively, and the Cmax of HAI group was 1.60 times higher than that of the HAI-THCO group (P = 0.022). The hepatic circulation AUC of HAI-THCO and HAI groups was (368.927±52.416) µg·min·ml(-1) and (65.630±14.928) µg·min·ml(-1), respectively. The AUC of HAI-THCO group was 5.62 times higher than that of the HAI group (P < 0.001). The systemic circulation AUC of the two groups was (27.193±3.948) µg·min·ml(-1) and (45.301±12.275) µg·min·ml(-1), respectively. The AUC of HAI group was 1.67 times higher than that of the HAI-THCO group (P = 0.014).</p><p><b>CONCLUSIONS</b>HAI-THCO is a simple and effective regional hepatic infusion chemotherapy technique. It can be performed through occluding the common hepatic artery and the hepatic portal vein by balloon catheter. HAI-THCO can not only increase the blood drug concentration in the hepatic circulation, but also decrease the blood drug concentration in the systemic circulation, therefore, distinctly lowering the systemic toxicity.</p>

Association between perineal trauma and pain in primiparous women / Associación entre el trauma perineal y dolór em primíparas / Associação entre trauma perineal e dor em primíparas

Objective To identify the association between perineal trauma and pain in 473 primiparous women. Method Cross-sectional study in which pain was measured by the numerical pain scale (0 to 10 - 0 being no pain and 10 maximal pain). Results The prevalence and mean intensity of pain were 33.0% and 4.7 points (standard deviation = 2.0) in the numeric scale, respectively. Episiotomy represented the most frequent trauma (46.7%). The occurrence and intensity of the pain were associated with perineal trauma and postpartum time. Having perineal trauma tripled the chance of pain. Each hour elapsed following the birth reduced the chance of pain by 4.8%. Conclusion Primiparous women are subject to a high frequency of perineal trauma, with episiotomy being the most prominent. Perineal pain affects approximately one-third of primiparous women and is associated with the postpartum time and perineal traumas. .

Objetivo Identificar la asociación entre el trauma y el dolor perineal en 473 primíparas. Método Estudio transversal, en el que el dolor se midió por medio de la escala numérica del dolor (0 a 10; 0 = ningún dolor y 10 = dolor máximo). Resultados La prevalencia y el promedio de intensidad del dolor fueron 33,0% y 4,7 (Desviación Estándar = 2,0) puntos en la escala, respectivamente. La episiotomía fue el trauma más frecuente (46,7%). La ocurrencia y la intensidad del dolor se asociaron con el trauma y el tiempo del postparto. Tener trauma perineal triplica la probabilidad de tener dolor. Cada hora transcurrida después del nacimiento reduce la posibilidad de dolor en 4,8%. Conclusión Las primíparas están sujetas a altas tasas de trauma perineal, especialmente episiotomía. El dolor perineal afecta aproximadamente a un tercio de las primíparas y se asocia con el tiempo de postparto y el traumatismo perineal.

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Objetivo Identificar a associação entre trauma perineal e dor em 473 primíparas. Método Estudo transversal, no qual dor foi mensurada por meio da escala numérica de dor (0 a 10 – sendo 0 ausência de dor e 10 dor máxima). A prevalência e a média de intensidade de dor foram 33,0% e 4,7 (Desvio Padrão = 2,0) pontos na escala numérica, respectivamente. Resultados A episiotomia foi o trauma mais frequente (46,7%). A ocorrência e a intensidade da dor foram associadas ao trauma perineal e ao tempo de pós-parto. Ter trauma perineal triplicou a chance de dor. Cada hora decorrida depois do parto reduziu a chance de dor em 4,8%. Conclusão As primíparas estão sujeitas a elevada frequência de trauma perineal, sobretudo episiotomia. A dor perineal afeta, aproximadamente, um terço das primíparas e está associada ao tempo de pós-parto e aos traumas locais. .

Risk factors associated to diabetes in Mexican population and phenotype of the individuals who will convert to diabetes / Factores de riesgo asociados con diabetes en la población mexicana y fenotipo de los individuos que desarrollarán diabetes

Objective. To describe risk factors associated to the incidence of type 2 diabetes (T2D) in Mexican population and to define phenotypic (clinical, anthropometric, metabolic) characteristics present in the individual who will convert to diabetes, regardless of time of onset. Materials and methods. The Mexico City Diabetes Study began in 1990, with 2 282 participants, and had three subsequent phases: 1994, 1998, and 2008. A systematic evaluation with an oral glucose tolerance test was performed in each phase. For diagnosis of T2D, American Diabetes Association criteria were used. Results. The population at risk was 1939 individuals. Subjects who were in the converter stage (initially non diabetic that eventually converted to T2D) had, at baseline, higher BMI (30 vs 27), systolic blood pressure (119 vs 116 mmHg), fasting glucose (90 vs 82mg/dl), triglycerides (239 vs 196mg/dl), and cholesterol (192 vs 190mg/dl), compared with subjects who remained non converters (p<0.05). Conclusion. The phenotype described represents a potentially identifiable phase and a target for preventive intervention.

Objetivo. Describir los factores de riesgo asociados con la incidencia de diabetes tipo 2 (T2D) en la población mexicana, así como el fenotipo de los sujetos que desarrollarán diabetes, independientemente del tiempo que lleve el desarrollo de esta nueva condición. Material y métodos. El Estudio de la Diabetes de la Ciudad de México inició en 1990 y tuvo un total de 2 282 participantes a los que se dio seguimiento en tres ocasiones: 1994, 1998 y 2008. Se realizó una curva de tolerancia a la glucosa para diagnosticar T2D, para lo cual se siguieron los criterios de la Asociación Americana de Diabetes. Resultados. La población en riesgo fue de 1939 sujetos. Los individuos en proceso de desarrollo (aquellos inicialmente no diabéticos que desarrollaron T2D) mostraron niveles más altos de IMC (30 vs 27), presión arterial sistólica (119 vs 116 mmHg), glucosa en ayuno (90 vs 82 mg/dl), triglicéridos (239 vs 196 mg/dl) y colesterol (192 vs 190 mg/dl), comparados con los sujetos que no desarrollaron T2D (p<0.05). Conclusiones. El estado de los individuos que se convertirán en diabéticos es discernible y representa una fase del padecimiento con potencial para la prevención.

Seroprevalencia de VIH en población mexicana de entre 15 y 49 años: resultados de la Ensanut 2012 / HIV seroprevalence among Mexicans age 15 to 49: results from the National Health & Nutrition Survey 2012

Objetivo. Estimar la seroprevalencia de VIH en población mexicana no institucionalizada de 15 a 49 años, y aspectos selectos del perfil de la población serorreactiva. Material y métodos. Estudio transversal con una muestra probabilística de la población del país de 15 a 49 años, con información sobre comportamientos obtenida por entrevista directa en los hogares y determinación de anticuerpos para VIH en sangre capilar. Resultados. Se identificó una seroprevalencia de 0.15% (IC95% 0.09-0.21) en la población de 15 a 49 años; de 0.07% (IC95% 0.03-0.11) en mujeres, y de 0.24% (IC95% 0.11-0.36) en hombres. La población serorreactiva a VIH son hombres jóvenes, de mayor nivel socioeconómico en relación con la población general y con información que sugiere una mayor cobertura por la seguridad social (49.9% en serorreactivos contra 34.5% en no serorreactivos). El 49.4% de los serorreactivos contra 18.5% de los no serorreactivos se había realizado al menos una prueba de detección de VIH. Conclusiones. La seroprevalencia de VIH estimada en la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012 sugiere que ésta se ha mantenido relativamente estable desde 2000. La estimación representa alrededor de 104000 personas (rango de entre 53000 y 126000) de 15 a 49 años que viven con VIH en México (75% de los cuales son hombres), de los que 50.6% desconocería su estatus serológico. Implementando un modelo de corrección de sesgo y agregando a los estimados en hogar, los casos estimados entre población de hombres que tienen sexo con hombres (tanto homosexual como bisexual), la estimación de la seroprevalencia alcanzaría 0.23%, con un total de 140000 personas de 15 a 49 años viviendo con VIH (con un intervalo estimado de entre 92000 y 201000 personas).

Objective. To estimate the HIV seroprevalence among Mexicans aged 15 to 49 years old and living in households, and to describe the profile of serorreactive individuals. Materials and methods. Cross-sectional study with a national probabilistic sample of individuals aged 15 to 49 years with behavioral data from direct interview (face-to-face) at households and HIV screening using capillary blood collected from the same individuals. Results. A seroprevalence of 0.15% (95%CI 0.09-0.21) was estimated for Mexicans aged 15 to 49; seroprevalence among women was 0.07% (95%CI 0.03-0.11) and 0.24% (95%CI 0.11-0.36) for men. HIV serorreactive population is composed of younger men, with a higher socioeconomic level compared to the general population, and with a higher insurance coverage-social protection on health in general and social security in particular. Only 50% of the serorreactive individuals may be aware of their status as living with HIV. Conclusions. The estimated HIV seroprevalence in the NHNS 2012 suggests a stable pattern since 2000. The estimated prevalence among individuals 15 to 49 years was adjusted both for selection bias correction and to include MSM estimations (under the assumption that MSM is a population hard to reach in a household survey), resulting in a total seroprevalence of 0.23% and an estimated number of people with HIV of 140000.

Transcatheter arterial embolization of acute gastrointestinal tumor hemorrhage with Onyx.

BACKGROUND: Endovascular embolization has been used to control gastrointestinal tumor bleeding. Lots of embolic agents have been applied in embolization, but liquid embolic materials such as Onyx have been rarely used because of concerns about severe ischemic complications. AIM: To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with Onyx for acute gastrointestinal tumor hemorrhage. MATERIALS AND METHODS: Between September 2011 and July 2013, nine patients were diagnosed as acute gastrointestinal tumor hemorrhage by clinical feature and imaging examination. The angiographic findings were extravasation of contrast media in the five patients. The site of hemorrhage included upper gastrointestinal bleeding in seven cases and lower gastrointestinal bleeding in two cases. TAE was performed using Onyx in all the patients, and the blood pressure and heart rate were monitored, the angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated after therapy. The clinical parameters and embolization data were studied retrospectively. RESULTS: All the patients (100%) who underwent TAE with Onyx achieved complete hemostasis without rebleeding and the patients were discharged after clinical improvement without a second surgery. No one of the patients expired during the hospital course. All the patients were discharged after clinical improvement without a second surgery. Postembolization bowel ischemia or necrosis was not observed in any of the patients who received TAE with Onyx. CONCLUSIONS: TAE with Onyx is a highly effective and safe treatment modality for acute gastrointestinal tumor hemorrhage, even with pre‑existing coagulopathy.

Clinical outcome of autologous hematopoietic stem cell infusion via hepatic artery or portal vein in patients with end-stage liver diseases / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the efficacy of hematopoietic stem cell (HSC) transplantation via the hepatic artery vs. the portal vein for end-stage liver disease (ESLD).</p><p><b>METHODS</b>Patients with hepatic decompensation were prospectively recruited from September 2010 to September 2012 to receive HSC transplantation via the hepatic artery or the portal vein. Liver function was examined at 3, 6, and 12 months after transplantation. Liver biopsy Results were analyzed using the Knodell score.</p><p><b>RESULTS</b>Eighty patients (58 males and 22 females) were enrolled in the study. The Child-Pugh score was grade B in 69 cases, and grade C in the remaining 11 cases. HSC transplantation was performed via the portal vein in 36 patients and via the hepatic artery in 44 patients. ALT levels decreased while serum albumin levels increased significantly in both groups at 6 and 12 months after HSC transplantation (P<0.05 compared with pre-transplantation levels). Total bilirubin levels decreased significantly in both groups at 3, 6, and 12 months after HSC transplantation (P<0.05 compared with pre-transplantation levels). Additionally, prothrombin time decreased in both groups at 12 months after HSC transplantation (P<0.05 compared with pre-transplantation level). There were no significant differences in ALT, total bilirubin and prothrombin time between the two groups either before or after transplantation. Moreover, Knodell score decreased significantly at 6 and 12 months. Histological examination showed that liver cell edema, degeneration, necrosis, and inflammation were significantly relieved at 3, 6, and 12 months after transplantation. The incidence of portal vein thrombosis, upper gastrointestinal bleeding, and hepatic encephalopathy were 1.25%, 3.75%, and 2.5% respectively. The one-year survival rate was 100%.</p><p><b>CONCLUSIONS</b>Autologous HSC transplantation improves liver function and histology in ESLD patients. The administration route of HSC has no significant impact on the efficacy of transplantation.</p>

Application of regional arterial infusion chemotherapy in short-term neoadjuvant chemotherapy for advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility of short-term neoadjuvant chemotherapy (NACT) in patients with advanced gastric cancer (AGC), and to compare clinical efficacy of short-term neoadjuvant chemotherapy with different ways.</p><p><b>METHODS</b>Clinical data of 310 AGC patients treated with one course of NACT using EOF regimen(epirubicin, oxaliplatin and fluorouracil plus calcium folinate) in our hospital from January 2008 to December 2011 were retrospectively analyzes. Efficacy was compared between regional arterial infusion chemotherapy and intravenously chemotherapy.</p><p><b>RESULTS</b>All the 310 AGC patients completed one course of NACT and none was interrupted by adverse events. Postoperative pathological remission rate was 33.9% (105/310) and 5 patients (1.6%) had complete pathological remission. The pathologic response rate in the regional arterial infusion chemotherapy group was higher than that in the intravenously chemotherapy group(42.4% vs. 23.6%, P = 0.001). Multivariate analysis revealed that chemotherapy method(HR=1.827, 95% CI:1.006-3.316, P = 0.048) was associated with significantly higher pathologic response.</p><p><b>CONCLUSIONS</b>Pathological response rate is quite low following short-term NACT. Regional arterial infusion chemotherapy with short-term NACT can improve the pathological response rate of advanced gastric cancer.</p>

Quality assessment of clinical research on liver cancer treated by intra-arterial infusion of Chinese medicine / 中国结合医学杂志

<p><b>OBJECTIVE</b>To assess the methodological quality of clinical research on Chinese medicine (CM) applied by intra-arterial infusion in treating primary liver cancer (PLC).</p><p><b>METHODS</b>Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and three Chinese databases, including Chinese BioMedical Database (CBM), China National Knowledge Infrastructure (CNKI) and China Academic Journal (VIP) were searched. Chinese articles were also searched manually in 16 journals. Two reviewers independently selected studies, the quality of literatures were assessed according to the Cochrane Collaboration method of quality assessment.</p><p><b>RESULTS</b>A total of 14 articles met the inclusion criteria for this review. Only three of these articles described the randomization method used. None of the studies was blinded. All of the articles didn't report the calculation of the sample size. Only six studies mentioned adverse reactions. All of the studies were of grade C according to the Cochrane Collaboration method. Six studies reported results of survival, and only two of these reported better efficacy in the treatment groups.</p><p><b>CONCLUSIONS</b>The quality of studies concerned intra-arterial infusion of CM in treating with PLC was poor and the exact effect of these medicines still need evaluation. Well designed RCTs with large sample sizes, adequate follow-up data and reliable methods of assessment are needed to better appraise the real effect of CMs in the treatment of PLC patients.</p>

Debulking treatment with CT-guided percutaneous radiofrequency ablation and hepatic artery infusion of floxuridine improves survival of patients with unresectable pulmonary and hepatic metastases of colorectal cancer / 癌症

The survival of most patients with both unresectable hepatic and pulmonary metastases of colorectal cancer is poor. In this retrospective study, we investigated the efficacy of computed tomography (CT)-guided radiofrequency ablation (RFA) and systemic chemotherapy plus hepatic artery infusion of floxuridine (HAI-FUDR). Sixty-one patients were selected from 1,136 patients with pulmonary and hepatic metastases from colorectal cancer. Patients were treated with RFA and systemic chemotherapy plus HAI-FUDR (ablation group, n = 39) or systemic chemotherapy plus HAI-FUDR (FUDR group, n = 22). Patients in the two groups were matched by sex, age, number of metastases, and calendar year of RFA or FUDR. Survival data were evaluated by using univariate and multivariate analyses. Clinical characteristics were comparable between the two groups. All patients in the ablation group underwent RFA and chemotherapy. Median follow-up was 56.8 months. The 1-, 3-, and 5-year overall survival (OS) rates were 97%, 64%, and 37%, respectively, for the ablation group, and 82%, 32%, and 19%, respectively, for the FUDR group. The 1-, 3-, and 5-year survival rates after metastasis were 97%, 49%, and 26% for the ablation group, and 72%, 24%, and 24% for the FUDR group, respectively. The median OS times were 45 and 25 months for the ablation and FUDR groups, respectively. In the multivariate analysis, treatment allocation was a favorable independent prognostic factor for OS (P = 0.001) and survival after metastasis (P = 0.009). These data suggest that the addition of RFA to systemic chemotherapy plus HAI-FUDR improves the survival of patients with both unresectable hepatic and pulmonary metastases from colorectal cancer.

A Comparative Study of Tissue Injury Grades, with Clinical Factors, in Patients with Hydrofluoric Acid Burns who Received Intra-arterial Infusion of Calcium Gluconate

PURPOSE: Hydrofluoric acid (HFA) causes injury via tissue penetration by the free fluoride ion. Methods for treatment of HFA burns include continuous intra-arterial infusion of calcium gluconate, which is especially useful for patients with dermal burns of the digits caused by HFA. However, no comparative study of tissue injury grade with clinical factors among patients with HFA burns treated with continuous intra-arterial infusion of calcium gluconate has been conducted in Korea. METHODS: We conducted a prospective study at the emergency department of a university teaching hospital between January 2011 and June 2013. The subjects enrolled in this study consisted of 33 patients with HFA burns. After completion of treatment, we divided the patients into three groups according to the type of skin lesions. Patients requiring a skin graft or surgical flap were included in the poor outcome group, those who had to undergo incision and drainage in the moderate outcome group, and those who did not require further treatment in the good outcome group. RESULTS: After completion of all treatments, 22 of the 33 patients were included in the good outcome group and seven in the moderate outcome group; the remaining four patients were included in the poor outcome group, as they met the above-mentioned criteria, experienced longer-lasting pain, and were more frequently treated with injection in comparison with the other patients. CONCLUSION: Patients with HFA burns with long-term pain who need frequent arterial injections despite undergoing intra-arterial calcium gluconate treatment are likely to have poor outcome; therefore, they require more proactive interventions.

Newer treatments for advanced hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. The only curative treatment modalities for HCC are surgery, percutaneous ablation, and liver transplantation. Unfortunately, the majority of patients have unresectable disease at diagnosis. Therefore, effective treatment options are needed for patients with advanced HCC. The current standard treatment for patients with advanced HCC, according to the Barcelona Clinic Liver Cancer staging system, is the multikinase inhibitor sorafenib. Other alternative therapies are required, due to the limited treatment response to, and tolerance of, this molecular target agent. Clinical trials of hepatic artery infusion chemotherapy, radioembolization, and multimodal treatments have shown favorable results in advanced HCC patients. This article introduces new treatment modalities for advanced HCC and discusses future therapeutic possibilities.

Lack of difference between continuous versus intermittent heparin infusion on maintenance of intra-arterial catheter in postoperative pediatric surgery: a randomized controlled study / Similitud entre infusion continua versus intermitente de solucion de heparina en el mantenimiento de cateter intra-arterial en post-operatorio de cirugia pediatrica: estudio randomizado controlado / Similaridade entre infusao continua versus intermitente de solucao de heparina na manutencao de cateter intra-arterial em pos-operatorio de cirurgia pediatrica: estudo randomizado controlado

OBJECTIVE: To compare two systems of arterial catheters maintenance in postoperative pediatric surgery using intermittent or continuous infusion of heparin solution and to analyze adverse events related to the site of catheter insertion and the volume of infused heparin solution. METHODS: Randomized control trial with 140 patients selected for continuous infusion group (CIG) and intermittent infusion group (IIG). The variables analyzed were: type of heart disease, permanence time and size of the catheter, insertion site, technique used, volume of heparin solution and adverse events. The descriptive variables were analyzed by Student's t-test and the categorical variables, by chi-square test, being significant p<0.05. RESULTS: The median age was 11 (0-22) months, and 77 (55%) were females. No significant differences between studied variables were found, except for the volume used in CIG (12.0±1.2mL/24 hours) when compared to IIG (5.3±3.5mL/24 hours) with p<0.0003. CONCLUSIONS: The continuous infusion system and the intermittent infusion of heparin solution can be used for intra-arterial catheters maintenance in postoperative pediatric surgery, regardless of patient's clinical and demographic characteristics. Adverse events up to the third postoperative day occurred similarly in both groups. However, the intermittent infusion system usage in underweight children should be considered, due to the lower volume of infused heparin solution [ClinicalTrials.gov Identifier: NCT01097031]. .

OBJETIVOS: Comparar dos sistemas de mantenimiento de catéteres arteriales en post-operatorio de cirugía cardíaca pediátrica, utilizando infusión continua o intermitente de solución de heparina, y analizar los eventos adversos relacionados al local de inserción del catéter y el volumen de solución de heparina infundido. MÉTODOS: Ensayo clínico randomizado controlado, con 140 pacientes seleccionados para el Grupo Infusión Continua (GIC) y el Grupo Infusión Intermitente (GII). Las variables analizadas fueron: tipo de cardiopatía, tiempo de permanencia y tamaño del catéter, local de inserción, técnica empleada, volumen de solución de heparina y eventos adversos. Se utilizó la prueba t de Student para variables descriptivas y la prueba del chi-cuadrado para variables categóricas, siendo significante p<0,05. RESULTADOS: La mediana de edad fue de 11 (0-22,1) meses, siendo 77 (55%) del sexo femenino. No hubo diferencia significativa en las variables analizadas, excepto por el volumen infundido en el GIC (12,0±1,2mL/24 horas), cuando comparado al del GII (5,3±3,5mL/24 horas), con p<0,0003. CONCLUSIONES: Tanto el sistema de infusión continua cuanto el sistema intermitente de solución de heparina pueden ser utilizados en el mantenimiento de catéter intra-arterial en post-operatorio de cirugía pediátrica, independiente de las características clínicas y demográficas de los pacientes, así como de la ocurrencia de eventos adversos hasta el tercer día del post-quirúrgico. Sin embargo, se debe considerar la utilización del sistema de infusión intermitente en niños de bajo peso, debido al menor volumen de solución de heparina infundido (registro en el Clinical Trials bajo el nº NCT01097031). .

OBJETIVOS: Comparar dois sistemas de manutenção de cateteres arteriais em pós-operatório de cirurgia cardíaca pediátrica, utilizando infusão contínua ou intermitente de solução de heparina, e analisar os eventos adversos relacionados ao local de inserção do cateter e o volume de solução de heparina infundido. MÉTODOS: Ensaio clínico randomizado controlado, com 140 pacientes selecionados para o Grupo Infusão Contínua (GIC) e o Grupo Infusão Intermitente (GII). As variáveis analisadas foram: tipo de cardiopatia, tempo de permanência e tamanho do cateter, local de inserção, técnica empregada, volume de solução de heparina e eventos adversos. Utilizou-se o teste t de Student para variáveis descritivas e o teste do qui-quadrado para variáveis categóricas, sendo significante p<0,05. RESULTADOS: A mediana de idade foi de 11 (0-22) meses, sendo 77 (55%) do sexo feminino. Não houve diferença significativa nas variáveis analisadas, com exceção do volume infundido no GIC (12,0±1,2mL/24 horas), quando comparado ao do GII (5,3±3,5mL/24 horas), com p<0,0003. CONCLUSÕES: Tanto o sistema de infusão contínua quanto o sistema intermitente de solução de heparina podem ser utilizados na manutenção de cateter intra-arterial em pós-operatório de cirurgia pediátrica, independentemente das características clínicas e demográficas dos pacientes, bem como da ocorrência de eventos adversos até o terceiro dia pós-cirúrgico. Entretanto, deve-se considerar a utilização do sistema de infusão intermitente em crianças de baixo peso, devido ao menor volume de solução de heparina infundido [registro no Clinical Trials sob o nº NCT01097031]. .

Progression of preoperative regional arterial infusion chemotherapy in advanced gastric cancer / 中华胃肠外科杂志

The outcome of surgery alone for advanced gastric cancer is unsatisfactory. Local recurrence rate and distant metastasis rate are still high in postoperative patients. In recent years, people have paid more attention to neo- adjuvant chemotherapy, because it can reduce tumor loading, degrade the staging, increase the surgery excision rate and improve the long-term survival. Preoperative regional arterial infusion chemotherapy can directly act on the tumor endothelial cells with higher local drug concentration, but with fewer systemic side effects. So it may offer an effective treatment for advanced gastric cancer. The indications, complications, therapeutic evaluation, timing of surgery, chemotherapy regimens and pathomorphological changes and so on of the preoperative regional arterial infusion chemotherapy are summarized in this review.

Recanalization of Acute Intracranial Artery Occlusion Using Temporary Endovascular Bypass Technique / 신경중재치료의학

PURPOSE: The purpose of this study is to present our preliminary experience of the temporary endovascular bypass (TEB) technique using an Enterprise stent for recanalization of acute intracranial artery (IA) occlusion. MATERIALS AND METHODS: Patients treated by TEB were enrolled in this retrospective study from January 2009 to May 2010. All the procedures consist of temporary partial deployment and subsequent retrieval of Enterprise stent, supplemented by intra-arterial infusion of urokinase (UK) and/or tirofiban. According to the thrombolysis in cerebral infarction (TICI) classification, recanalization was evaluated with initial and postprocedural angiography. Safety was evaluated related to the procedure and clinical outcomes were assessed by National Institute of Health Stroke Scale (NIHSS) score at discharge and modified Rankin scale (mRS) score at 3 months. RESULTS: Eleven patients (median NIHSS 12.8, mean age 61.6 years, male: female = 8:3) with acute IA occlusion were treated with TEB. All the patients presented with TICI 0, and the occluded vessel was the middle cerebral artery (n=7), the basilar artery (n=1), and the distal ICA occlusion (n = 3). IV infusion of tissue plasminogen activator (tPA) was done in 4 patients and mechanical thrombolysis with intra-arterial UK was performed in 9. Recanalization was achieved in 73% (8 patients; TICI > or = 2). There were no procedure-related complications except for two asymptomatic intracranial hemorrhages. Improvement (> or = 4 points on the NIHSS) and good outcome (mRS < or =2) after 90 days was shown in six patients (55%). One patient died 6 days after procedure. CONCLUSION: TEB may be a valuable treatment option in acute thromboembolic IA occlusion without stent implantation.