Prophylactic uterine artery embolization assisted cesarean section for the prevention of intrapartum hemorrhage in high-risk patients.

PURPOSE: To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE)-assisted cesarean section for the prevention of intrapartum hemorrhage. MATERIALS AND METHODS: Twelve consecutive pregnant women (mean age 31 years; range 25-38) with uterine scarring and placenta previa and/or placenta accreta underwent UAE in conjunction with cesarean section to prevent intrapartum hemorrhage. For UAE, the left uterine artery was catheterized prophylactically under fluoroscopic guidance before the cesarean section incision was made. After the infant had been delivered, bilateral UAE was performed with the placenta still in situ. After successful bilateral UAE, the placenta was detached from the uterine wall. RESULTS: Technical success was achieved in all 12 cases. Ten patients retained their uterus, and the other 2 underwent hysterectomy. The mean operative blood loss was 1,391 mL (range 600-3,600 mL). The total mean fluoroscopy time and mean absorbed dose (air kerma) were 9 min 40 s (range 4 min 35 s-15 min 24 s) and 91.79 mGy (range 30.2-171), respectively. The average fetal fluoroscopy time was 1 min 42 s (range 41 s to 3 min 16 s) with an average X-ray dose of 17.66 mGy (range 6.04-23.90). CONCLUSION: UAE-assisted cesarean section is safe and effective in the prevention of intrapartum hemorrhage in patients with uterine scarring and/or placental abnormalities.

[Correlations between serum hypoxia inducible factor-1α, vascular endothelial growth factor and computed tomography perfusion imaging at pre-and post-TACE in patients with primary hepatic carcinoma].

OBJECTIVE: To explore the correlations between the serum levels of hypoxia inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) and computed tomography (CT) perfusion parameters at pre- and post-transcatheter arterial chemoembolization (TACE) in patients with primary hepatic carcinoma (PHC). METHODS: A total of 22 PHC patients were recruited.Their serum levels of HIF-1α and VEGF were measured and CT perfusion imaging (CTPI) was performed at Day 1 pre- and Days 32-40 post-TACE to compare and analyze the relevance of the changes of serum levels of HIF-1α, VEGF, tumor's hepatic artery perfusion (HAP), portal vein perfusion (PVP) and hepatic artery perfusion index (HPI) at pre- and post-TACE. RESULTS: They were divided into stable and tumor residual/recurrent groups according to the efficacy of TACE. No significant differences existed between two groups with respects to serum levels of HIF-1α, VEGF, tumor's HAP, PVP and HPI pre-TACE. The serum levels of HIF-1α and VEGF decreased in stable group and there was significant difference in serum level of VEGF at Days 32-40 post-TACE (P < 0.05). There was no perfusion signal of HAP or PVP in tumor tissue.The serum levels of HIF-1α and VEGF were significantly higher while HAP and HPI were significantly lower than that pre-TACE in tumor residual/recurrent group and had statistical significance (P < 0.05), but PVP had no change.Positive correlations existed between serum levels of HIF-1α, VEGF and tumor's HAP, HPI at 32-40 days post-TACE. CONCLUSION: Serum levels of HIF-1α and VEGF may indirectly reflect the status of neovascularization and CTPI acts as the intuitive and quantitative responses of hemodynamic changes at post-TACE.Positive correlations exist between serum levels of HIF-1α, VEGF, HAP and HPI. In short, a combination of serum levels of HIF-1α, VEGF and CTPI contributes to the efficacy evaluation of TACE and has great reference significance of determining timing of a second therapy.

[Relationship between genetic polymorphism in microRNAs precursor and genetic predisposition of hepatocellular carcinoma].

OBJECTIVE: To investigate the relationship between genetic polymorphism in microRNAs (miRNAs) precursor and genetic predisposition of hepatocellular carcinoma (HCC) in Chinese population. METHODS: A case-control study including 963 HCC cases and 829 HBsAg positive controls and 852 HBsAg negative controls was conducted. hsa-mir-146a rs2910164 C→G and hsa-mir-196-a2 rs11614913 T→C were selected, where the genotypes were determined by the primer introduced restriction analysis-PCR (PIRA-PCR) assay. Odd ratios (ORs) and 95% confidence intervals (CIs) were evaluated by logistic regression analysis to investigate the relationship between onset risk of HCC and different genotypes. RESULTS: The genotype frequencies of CC, CG and GG at rs2910164 gene locus were separately 34.5% (319/925), 48.6% (450/925) and 16.9% (156/925) in cases; 36.4% (274/753), 45.0% (339/753) and 18.6% (140/753) in HBsAg positive controls; and 36.1% (303/840), 46.0% (386/840) and 18.0% (151/840) in HBsAg negative controls. The genotype frequencies of TT, CT and CC at rs11614913 were respectively 29.7% (277/934), 48.1% (449/934) and 22.3% (208/934) in cases; 30.3% (238/785), 51.0% (400/785) and 18.7% (147/785) in HBsAg positive controls; and 28.6% (239/837), 49.8% (417/837) and 21.6% (181/837) in HBsAg negative controls. No significant relationships were observed between these two single nucleotide polymorphisms (SNPs) and onset risk of HCC after adjusting the factors as age, gender, smoking and drinking status in comparison with HBsAg positive controls: hsa-mir-146a rs2910164 (CG + GG vs CC): adjusting OR = 1.10, 95%CI: 0.90 - 1.36; hsa-mir-196-a2 rs11614913 (CC + CT vs TT): adjusting OR = 1.01, 95%CI: 0.81 - 1.25; as well as in comparison with HBsAg negative controls: hsa-mir-146a rs2910164 (CG + GG vs CC): adjusting OR = 1.06, 95%CI: 0.87 - 1.29; hsa-mir-196-a2 rs11614913 (CC + CT vs TT): adjusting OR = 0.94, 95%CI: 0.76 - 1.16. As well, no significant relationships were observed between these two SNPs and onset risk of HCC in the subgroups stratified by age, gender, smoking and drinking status. CONCLUSION: hsa-mir-146a rs2910164 C→G and hsa-mir-196-a2 rs11614913 T→C may not play an important role in the HCC predisposition among Chinese populations.

Serum HIF-1alpha and VEGF levels pre- and post-TACE in patients with primary liver cancer.

OBJECTIVE: To investigate the expression levels of serum hypoxia inducible factor 1 alpha (HIF-1alpha) and vascular endothelial growth factor (VEGF) pre- and post-transcatheter arterial chemoembolization (TACE) in patients with primary liver cancer (PLC), and correlations between prognosis factors and serum HIF-1alpha as well asVEGF levels. METHODS: Forty consecutive patients fulfilling diagnostic criteria for PLC undergoing TACE from March 2008 to May 2009 were enrolled into the study. The serum HIF-1alpha and VEGF levels of PLC patients pre- and 1 day, 1 week, 1 month post-TACE were analyzed using ELISA, and compared with that of 20 healthy volunteers. Patients were divided into complete response (CR) and partial response (PR), stable disease (SD), progressive disease (PD) groups according to the therapeutic efficacy. Pearson correlation was used to analyze the correlation between different clinical variables and serum HIF- 1alpha and VEGF levels before TACE, and correlation between serum HIF-1alpha and VEGF levels was also evaluated. RESULTS: The expression levels of serum HIF-1alpha and VEGF in PLC patients were 154.94 +/- 83.29 and 264.00 +/- 148.10 pg/mL pre-TACE, and both of them were significantly higher than those in control group (23.84 +/- 8.15 and 69.78 +/- 21.42 pg/mL, all P<0.01). One day after TACE, both serum HIF-1alpha (570.64 +/- 230.87 pg/mL) and VEGF levels (362.07 +/- 102.25 pg/mL) reached the peak values (all P<0.01). One week post-TACE, expression levels of them were decreased (198.62 +/- 92.11 and 283.52 +/- 145.46 pg/mL respectively), but still significantly higher than those before TACE (all P<0.01). The levels of both HIF-1alpha (133.96 +/- 57.02 vs. 255.74 +/- 123.44 pg/mL) and VEGF (150.96 +/- 84.89 vs. 368.95 +/- 161.90 pg/mL) in CR group 1 month post-TACE were significantly lower than those in PR+SD+PD group (all P<0.01). The level of serum HIF-1alpha was positively correlated with serum VEGF level (r=0.42, P<0.001). Both serum HIF-1alpha and VEGF levels were observed to be correlated with portal vein tumor thrombi (P<0.05) and metastasis (P<0.05). CONCLUSION: The HIF- 1alpha and VEGF might play an important role in relapse of PLC. They might be considered as predictors of the efficacy ofTACE and metastasis of PLC.

Value of percutanous catheter fragmentation in the management of massive pulmonary embolism.

BACKGROUND: Acute massive pulmonary embolism (PE) is a clinical emergency requiring rapid and supportive measures. Percutanous mechanical thrombectomy is considered as a treatment option. The purpose of this study was to evaluate the clinical efficacy and safety of peructaneous mechanical catheter fragmentation in the management of acute massive PE. METHODS: From January 2003 to June 2007, 28 patients (20 men, 8 women; mean age 64 years) with acute massive PE initially diagnosed by computed tomography and confirmed by pulmonary angiography were treated with inferior vena caval filter placement and percutaneous catheter fragmentation. Twenty-six patients received thrombolytic agents after embolus fragmentation. RESULTS: Technical success was achieved in all patients. The improvement of clinical status and restoration of blood flow in the main branches of the pulmonary artery were seen in 27 patients. Only one case did not benefit from the percutaneous therapy and died from the failure of the surgery. Oxygen saturation increased from (86.2 +/- 4.5)% to (96.1 +/- 3.2)% (P < 0.001) after the interventional procedure. The post-procedure mean pulmonary artery pressure decreased from (34.2 +/- 4.8) mmHg to (25.2 +/- 5.1) mmHg (P < 0.001). During clinical follow-up (range, 1 - 5 years), no patients had recurrence of PE. CONCLUSION: Percutaneous catheter fragmentation combined with thrombolysis is an effective and safe therapy in the clinical management of acute massive PE.