Efficacy and safety of computed tomography-guided microwave ablation with fine needle-assisted puncture positioning technique for hepatocellular carcinoma.

BACKGROUND: In microwave ablation (MWA), although computed tomography (CT) scanning can overcome gas interference, it cannot achieve real-time localization. Therefore, the puncture technique is more important in CT-guided ablation. AIM: To compare the fine needle-assisted puncture (FNP) positioning technique and the conventional puncture (CP) technique for the safety and efficacy of CT-guided MWA in treating hepatocellular carcinoma (HCC). METHODS: This retrospective study included 124 patients with 166 tumor nodules from February 2018 and June 2021. Seventy patients received CT-guided MWA under the FNP technique (FNP group), and 54 patients received MWA under the CP technique (CP group). Intergroup comparisons were made regarding local tumor progression (LTP), recurrence-free survival (RFS), overall survival (OS), and complications. The influencing variables of LTP and RFS were analyzed through univariate and multivariate regressions. RESULTS: The 1-, 2-, and 3-year cumulative incidences of LTP in the FNP group were significantly lower than those in the CP group (7.4%, 12.7%, 21.3% vs 13.7%, 32.9%, 36.4%; P = 0.038). The 1-, 2-, and 3-year RFS rates in the FNP group were significantly higher than those in the CP group (80.6%, 73.3%, 64.0% vs 83.3%, 39.4%, and 32.5%, respectively; P = 0.008). The FNP technique independently predicted LTP and RFS. Minor complications in the FNP group were lower than those in the CP group (P < 0.001). The difference in median OS was insignificant between the FNP and CP groups (P = 0.229). CONCLUSION: The FNP technique used in CT-guided MWA may improve outcomes in terms of LTP, RFS, and procedure-related complications for HCC.

Preoperative Acute Pain Is Associated with Postoperative Delirium.

BACKGROUND: Studies have provided some evidence that pain is a risk factor for postoperative delirium (POD). Therefore, we investigated the relationship between preoperative pain and POD after noncardiac surgery. METHODS: POD was assessed with the Montreal Cognitive Assessment, and preoperative cognition was assessed with the Mini-Mental State Examination. Plasma C-reactive protein (CRP) was detected by enzyme-linked immunosorbent assay before surgery. Preoperative pain was classified by its duration before surgery as chronic pain (lasting more than 1 month), acute pain (lasting less than 1 month), or no pain (no obvious pain). Multiple linear regression was used to adjust for confounding. RESULTS: From October 15, 2018, through August 12, 2019, a total of 67 patients were randomized; 7 were excluded because they were discharged before the seventh postoperative day. The prevalence of POD was significantly higher in the acute pain group (13 of 20; 65%) than in the chronic pain group (5 of 20; 25%) or the no pain group (6 of 20; 30%) (P = 0.019), indicating that delirium is associated with preoperative acute pain. The plasma level of preoperative CRP was also higher in the acute pain group than in the other two groups (mean [interquartile range]: 10.7 [3.3, 29.3] vs 1 [0.5, 3.8]mg/l; P < 0.001), suggesting that elevated preoperative plasma levels of CRP were associated with delirium. CONCLUSIONS: Preoperative acute pain was associated with POD, and increased plasma levels of CRP provide a marker. In addition, we found that illiteracy and advanced age were risk factors for POD.

Comparison of the efficacy and safety among apatinib plus drug-eluting bead transarterial chemoembolization (TACE), apatinib plus conventional TACE and apatinib alone in advanced intrahepatic cholangiocarcinoma.

This study aimed to compare the efficacy and safety of apatinib plus drug-eluting bead (DEB) transarterial chemoembolization (TACE), apatinib plus conventional TACE (cTACE) and apatinib alone in advanced intrahepatic cholangiocarcinoma (ICC) patients. We analyzed 35 advanced ICC patients retrospectively, including the apatinib plus DEB-TACE group (n=10), the apatinib plus cTACE group (n=12) and the apatinib group (n=13). Treatment response, survival data (including progression-free survival (PFS) and overall survival (OS)) and adverse events were assessed during the follow-up. Both the objective response rate (ORR) and the disease control rate (DCR) showed trends to be the highest in the apatinib plus DEB-TACE group (ORR: 84.6%/DCR: 100.0%), followed by the apatinib plus cTACE group (ORR: 75.0%/DCR: 91.7%) and then the apatinib group (ORR: 40.0%/DCR: 80.0%). PFS and OS were both the highest in the apatinib plus DEB-TACE group, followed by the apatinib plus cTACE group, and the shortest in the apatinib group, which was also confirmed by a multivariate Cox regression analysis. The incidences of adverse events were similar between the apatinib plus DEB-TACE group and the apatinib plus cTACE group but were higher in the apatinib plus DEB-TACE group and the apatinib plus cTACE than in the apatinib group; however, all of the adverse events were tolerable in the three groups. In conclusion, apatinib plus DEB-TACE is a promising therapeutic strategy for the treatment of advanced ICC.

Efficacy and Safety of Apatinib in Treatment of Unresectable Intrahepatic Cholangiocarcinoma: An Observational Study.

PURPOSE: Unresectable intrahepatic cholangiocarcinoma (ICC) has a poor prognosis. The aim of this study was to evaluate the efficacy and safety of apatinib for patients with unresectable ICC. PATIENTS AND METHODS: A total of 10 patients with unresectable ICC were enrolled for this single-center observational study between March 2, 2016, and August 27, 2019. Subjects received 500 mg apatinib on a daily basis. Tumor response was assessed by 1.1 response evaluation criteria in solid tumors. The progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. The drug-related adverse effects were also monitored. RESULTS: Based on the follow-up computed tomography and magnetic resonance imaging after treatment, 4 (40.0%), 4 (40.0%), and 2 (20.0%) patients achieved a partial response, stable disease, and progression of the disease, respectively. The response rate and disease control rate were 40.0% and 80.0%, respectively. The median PFS was 4.5 months (95% confidence interval: 3.157~5.843 months); the median OS was 6.5 months (95% confidence interval: 4.744~8.256 months). Furthermore, 3-, 6-, and 9-month OS rates were 77.5%, 61.7%, and 15.0%, respectively. The most common hematologic grade 3 adverse event was neutropenia (10%); the most common nonhematologic grade 3 adverse events were hypertension (20.0%) and hand-foot syndromes (20.0%). No treatment-related grade 4 or 5 adverse events were recorded. CONCLUSION: Apatinib revealed to have antitumour activity in unresectable ICC patients, with manageable toxicities, and thus might be used as a new treatment option for patients with unresectable ICC.

Transarterial chemoembolization for unresectable hepatocellular carcinoma: A comparison of the efficacy and safety of 2 embolic agents.

The aim of this study was to compare the efficacy and safety of 2 different embolic agents, namely gelatin sponge particle (GSP) and Lipiodol, for transarterial chemoembolization (TACE) of unresectable hepatocellular carcinoma (HCC).We retrospectively reviewed 87 consecutive patients with unresectable HCC who underwent Lipiodol TACE with lobaplatin and 87 consecutive patients with unresectable HCC who underwent GSP TACE with lobaplatin between January 2013 and June 2017 in our institution as the initial treatment. Both groups were compared considering the clinical and laboratory outcomes and imaging findings before and after TACE. Tumor response and adverse events were also evaluated.There was significant difference in the rate of complete and overall response between the groups (P = .029 and .001, respectively), specifically when the tumor size was >5 cm (P = .001). The disease control rate was significantly better in the GSP group than in the Lipiodol group (94.3% vs. 86.4%, P = .011). The response differences in higher stages were significant between the 2 groups (P = .035 and .007, respectively). The grades of adverse events were also significantly different between the groups (P = .000).GSP-as an embolic agent in TACE for HCC-could significantly increase the rate of tumor response 1 month after treatment, especially in large tumors, without any significant increase in severe adverse events, when compared to Lipiodol.

[CT measurement and clinical application of double-row suture anchor reconstruction for the treatment of Tossy type III acromioclavicular joint dislocation].

OBJECTIVE: To study feasibility and reliability of reconstruction of the acromioclavicular ligament with double-row suture anchor for the treatment of acromioclavicular joint dislocation through coracoid coronal CT measurement, and to provide a new operation method for treating acromioclavicular joint dislocation. METHODS: Total 60 healthy people received CT examination of shoulder joint, including 30 males and 30 females, ranging in age from 18 to 50 years old. The coronal width, thickness and 20 degree camber angle in the medial part of the toot of coronal were measured using CT scan. The results were applied to clinical treatment for 12 patients with acromioclavicular joint dislocation of Tossy III type. RESULTS: The width in the medial part of the root of the coracoid was(17.65±1.82) mm(left side) and (17.67±1.80) mm(right side) in males; (16.55±1.78) mm(left side) and (16.52±1.74) mm (right side) in females. The vertical thickness of the roots of the coracoid: (13.11±2.11) mm(left side) and (13.16±2.09) mm(right side) in males;(12.79±2.21) mm(left side) and (12.76±2.19) mm (right side) in females. The thickness of 20 degrees camber angle of the coracoid roots: (16.32±1.74) mm (left side) and (16.30±1.69) mm(right side) in males; (15.68±1.44) mm(left side) and (15.67±1.43) mm(right side) in females. Total 12 patients were treated with anchor nail with extraversion 20 degrees. The postoperative X-ray films showed bone anchors were located in the coracoid process, no bone splitting. CONCLUSIONS: Double-row suture anchor of 5 mm diameter nails can be placed into coracoid with extraversion 20 degrees, which is safety.

[Clinical safety and effectiveness of propofol medium and long chain fat emulsion in general anesthesia for cesarean section].

OBJECTIVE: To investigate the Clinical safety and effectiveness of propofol medium and long chain fat emulsion injection for cesarean section. METHODS: A retrospective analysis was conducted in 88 cesarean section surgeries performed between January, 2014 and June, 2015 with epidural anesthesia in 44 cases (control) and with total anesthesia with propofol/long chain fat emulsion injection in 44 cases (observation group). The maternal mean arterial pressure (MAP), SpO(2), and heart rate and neonatal umbilical dynamic venous blood gas analysis (pH, PO(2), pCO(2)) were compared between the two groups. RESULTS: Compared with the control group, heart rate and MAP significantly increased at skin incision in the observation group. At the other time points, heart rate, MAP, and SpO(2) were all comparable between the two groups. The time from skin incision to newborn delivery was significantly shorter in observation group (P<0.05), but the time from uterine incision to delivery and neonatal Apgar score were equivalent between the two groups (P>0.05); neonatal umbilical arteriovenous blood pH, PO2, and pCO2 were all comparable between the two groups. CONCLUSION: Propofol medium and long chain fat emulsion injection for general anesthesia induction in cesarean section is characterized by rapid metabolism of the anesthetics, rapid maternal postoperative recovery, and minimal adverse effects on the fetus, and is therefore safe and reliable in clinical use.

Efficacy of transcatheter arterial chemoembolization combined with cytokine-induced killer cell therapy on hepatocellular carcinoma: a comparative study.

BACKGROUND AND OBJECTIVE: Cytokine-induced killer (CIK) cells have high anti-tumor activity for hepatocellular carcinoma (HCC). Whether CIK cell therapy can eradicate residual cancer cells and prevent or postpone tumor relapse after transcatheter arterial chemoembolization (TACE) should be testified. This study was to evaluate the efficacy of CIK cell therapy combined with TACE on HCC. METHODS: A total of 146 consecutive patients with unresectable HCC were divided into combination group (72 patients treated with CIK cell therapy combined with TACE) and TACE group (74 patients treated only with TACE). The progression-free survival (PFS) and overall survival (OS) were analyzed. RESULTS: The 6-month, 1-year, and 2-year PFS rates were 72.2%, 40.4%, 25.3% in combination group, and 34.8%, 7.7%, 2.6% in TACE group. The median time to progression was 11 months [95% confidence interval (CI), 8-14 months] in combination group and 5 months (95% CI, 4-7 months) in TACE group. The estimated 6-month, 1-year, and 2-year OS rates were 90.3%, 71.9%, 62.4% in combination group, and 74.6%, 42.8%, 18.8% in TACE group. The median OS was 31 months (95% CI, 27-35 months) in combination group and 10 months (95% CI, 7-13 months) in TACE group. The times of TACE, ECOG performance status, and CIK cell therapy were independent prognostic factors for PFS and OS. CONCLUSION: Adjuvant immunotherapy with CIK cells could greatly improve the efficacy of TACE on HCC, and plays an important role in prolonging the PFS and OS of HCC patients after TACE.