Analysis of factors associated with severe bleeding after percutaneous nephrolithotomy and evaluation of interventional embolization efficacy in male patients / 中华内科杂志

Objective:To explore the factors associated with severe bleeding after percutaneous nephrolithotomy (PCNL) in male patients and evaluate the efficacy of interventional embolization.Methods:A retrospective case series study was conducted at Nankai Hospital of Tianjin, China, from January 2018 to October 2021. The clinical data of 230 male patients with upper urinary tract stones were analyzed. The observation indicators included age, hypertension, diabetes, renal function abnormalities, history of preoperative anticoagulant use, stone size, stone type, number of puncture channels, operation time and degree of hydronephrosis. To describe the clinical characteristics of bleeding after percutaneous nephrolithotomy in men, and analyze the factors associated with severe bleeding after PCNL. Single factor analysis was performed using the Chi-square ( χ2) test, and multivariate analysis was performed using logistic regression analysis. Results:Univariate analysis showed that diabetes mellitus ( χ2=4.90, P=0.027), abnormal renal function ( χ2=18.32, P<0.001), history of preoperative oral anticoagulants ( χ2=5.10, P=0.024), abnormal bleeding and coagulation function ( χ2=8.22, P=0.004) and the number of puncture channels ( χ2=22.08, P<0.001) were the related factors affecting bleeding after PCNL. Multivariate logistic regression analysis showed that diabetes mellitus ( P=0.032), abnormal renal function ( P<0.001), and the number of puncture channels ( P<0.001) were the independent risk factors of bleeding after PCNL. Of the 28 patients with bleeding after PCNL, 25 were treated with interventional embolization, with a technical success rate of 100.0% and a clinical success rate of 89.3%. Conclusions:For patients with renal calculi and comorbid diabetes, renal function abnormalities, and multiple punctures, relevant preventive measures should be actively administered before PCNL to reduce the risk of postoperative bleeding. For patients with severe bleeding of the kidney after PCNL, TAE is a safe and effective minimally invasive treatment method.

Argon-helium cryoablation for the treatment of hepatic metastases from nasopharyngeal carcinoma:initial results in 16 patients / 介入放射学杂志

Objective To evaluate the efficacy and safety of CT-guided percutaneous argon-helium cryoablation in treating hepatic metastases from nasopharyngeal carcinoma. Methods The clinical data of 16 patients with hepatic metastases from nasopharyngeal carcinoma, who had received percutaneous argonhelium cryoablation therapy, were retrospectively analyzed. The quality of life before and after therapy, and the postoperative complications were recorded. After argon-helium cryoablation therapy, the progression-free survival (PFS), the overall survival (OS), and the one-month, 3-month, 6-month, 12-month postoperative tumor local control rates were calculated. Results In all 16 patients, no severe complications occurred and the quality of life was significantly improved after argon-helium cryoablation therapy. The one-month, 3-month, 6-month, 12-month postoperative tumor local control rates were 100％, 87.5％, 80.0％ and 58.3％respectively. The median PFS was 11 months (95％CI: 8.4-13.6 months), and the median survival time was19 months (95％CI: 9.2-28.8 months) . After argon-helium cryoablation therapy, the half-year, one-year and2-year survival rates were 93.8％, 75％ and 43.8％ respectively. Conclusion For the treatment of hepatic metastases from nasopharyngeal carcinoma, CT-guided percutaneous argon-helium cryoablation is minimally-invasive, safe and effective with reliable curative effect.

Enhanced immune response of cryoablation combined with anti-CTLA-4 mAb against murine tumor draining lymph nodes of prostate cancer / 中国肿瘤临床

Objective: To evaluate the effect of immune response of cryoablation combined with anti-CTLA-4 mAb against murine tumor draining lymph nodes (TDLNs) of prostate cancer (PCa). Methods: PCa-bearing murine models were established and mice were divided randomly into 4 groups-control (A), cryoablation treatment (B), cryoablation combined with anti-CTLA-4 mAb treatment (C), and anti-CTLA-4 mAb treatment (D). TDLN specimens were obtained from 5 mice of each group at 4 time points before treatment, and 7, 14, and 21 days after treatment. Tumor size was measured at each time point. Flow cytometry was utilized to detect changes inTreg and CTL proportions in TDLNs. LDH was utilized to detect killing activity for tumor cells of CTL. Overall survival (OS) of each group was recorded. Results: Fourteen days after treatment, compared with that of group A, Treg proportion in group B (9.78%±1.88% vs. 6.02%±0.44%) and C (9.78%±1.88% vs. 6.03%±0.45%) was decreased (both P<0.05); compared with that of group A, CTL proportion of group B (27.34%±2.13% vs . 34.23%±1.15%), C (27.34%±2.13% vs. 52.21%±2.53%), and D (27.34±2.13% vs. 33.99±1.21) was increased (P<0.05, P<0.001, P<0.05); compared with those of group A, CTL killing activities of group B (13.32%±3.39% vs . 26.36%±2.95%), C (13.32%±3.39% vs . 45.25%±3.27%), and D (13.32%±3.39% vs. 25.31%±3.24%) were improved (P<0.05, P<0.001, P<0.05). Survival analysis showed that the OS of PCa-bearing mice were prolonged (P<0.05, P<0.001) in group B (25.60 d±1.52 d vs. 34.20d±6.98 d) and C (25.60 d±1.52 d vs. 43.60 d±2.88 d) compared with that of group A; OS was prolonged (P<0.05) in group C compared with that of group B (34.20d±6.98 d vs. 43.60d±2.88 d). Conclusions: Cryoablation combined with anti-CTLA-4 mAb can reduce the proportions of Tregs in the TDLNs, increase the proportions of CTL as well as killing activities, and significantly prolong OS of mice. However, the specific mechanism needs further study.

The clinical progress of the local treatment for metastatic prostate cancer / 中国医师杂志

Recent clinical research shows that the local treatment of primary tumor can improve cancer-specific-survival and overall-survival for metastatic prostate cancer patients.Differ with lymph node metastasis,there is not enough high-level randomized controlled trial data to decide whether the prostate cancer patients with bone metastasis will be benefited from local treatment,meanwhile,it also needs to figure out the factors influencing prognosis of patients.How to efficiently combine multi local treatment with system treatment is a current research hot spot as well.

Clinical significance of neutrophil-to-lymphocyte ratio changes in patients with castration-resistant prostate cancer after receiving cryoablation / 介入放射学杂志

Objective To discuss the clinical significance of peripheral neutrophil-to-lymphocyte ratio (NLR) changes in patients with castration-resistant prostate cancer (CRPC) after receiving argon-helium cryoablation.Methods A total of 33 CRPC patients,who were treated with argon-helium cryoablation at Tianjin Medical University Cancer Hospital,were included in this study.The clinical and pathological data were collected and analyzed.The following factors that might affect the postoperative overall survival (OS) of patients were analyzed with univariate and multivariate analysis:age,baseline PSA level,hemoglobin,white blood cell count,platelet count,albumin,alkaline phosphatase,NLR,platelet-to-lymphocyte ratio (PLR),hormone sensitive time,chemotherapy,bone metastasis,Gleason score,ECOG score,PSA effective rate.Results A total of 33 patients were enrolled in this study,the average age was 69 years (50-82 years) and the median survival time was 28 months (6-55 months).Univariate analysis showed that the baseline PSA level,alkaline phosphatase,NLR,hormone sensitive time,chemotherapy,bone metastases,Gleason score and PSA effective rate were significantly correlated with OS of CRPC patients after receiving cryoablation (P＜0.05).Multivariate analysis showed that the baseline PSA level (P=0.003),NLR (P=0.009),Gleason score (P＜0.001) were independent predictive factors for OS of CRPC patients after cryoablation therapy.Conclusion NLR can be used as a prognostic predictor for CRPC patients undergoing argon-helium cryoablation,and the increased NLR indicates a poor prognosis.(J Intervent Radiol,2017,26:237-242)

The relationship between the remnant tumor and the epithelial-mesenchymal transition after cryoablation:an experimental study / 介入放射学杂志

Objective To investigate the effect of incomplete cryoablation on the biological behavior of prostatic cancer RM-1 cells and its mechanism.Methods RM-1 cells of prostatic cancer were placed in -20℃ icebox to be frozen for 5 min.After the recovery of the cell state,the RM-1 cells were frozen again for 10 min and 15 min successively.After culture for one day,the cellular morphology was microscopically examined.A total of 20 C57/BL mice were used to establish the tumor-bearing models,which were randomly and equally divided into the control group and the incomplete cryoablation group with 10 mice in each group.At scheduled time points the tumor lesion size was measured for all mice.The mice were sacrificed at 14 days,the lung tissues were collected and were stained with lE;the numbers of metastatic lesions in the lung were calculated.Transwell assay was used to test the cell migration and invasion,immuno-blotting method was adopted to determine the epithelial-mesenchymal transition-related (EMT-related) protein expression level,and the enzyme-linked immunosorbent assay (ELISA) was employed to check the secretion volume of transforming growth factor-beta (TGF-β).Results After incomplete cryoablation,RM-1 cells became disorderly arranged,their morphology was changed,and antenna structure might be formed.At 3 and 7 days after cryoablation,the tumor size in the incomplete cryoablation group was slightly smaller than that in the control group,but only the difference at 7 days after cryoablation was statistically significant between the two groups (P=0.019).At 10 and 14 days after cryoablation,the tumor volume of the two groups was almost equal.The pulmonary metastatic lesions in the incomplete cryoablation group were obviously much more than those in the control group (P＜0.001).Transwell assay indicated that the cell migration and invasion ability in the incomplete cryoablation group was stronger than that in the control group (P＜0.05).Immuno-blotting test revealed that,when compared with the control group,in the incomplete cryoablation group the expressions of N-cadherin,MMP-9 and Vimentin were up-regulated,while the expression of E-cadherin was downregulated.ELISA test showed that increased secretion of TGF-β was observed in the incomplete cryoablation group.Conclusion Incomplete cryoablation can enhance the migration and invasion ability of RM-1 cells,increase the number of pulmonary metastatic lesions in tumor-bearing mice,and affect the EMT-related protein expression level.

A case study of cancer-associated VTE:diagnosis and treatment strategies / 中国肿瘤临床

Symptomatic venous thromboembolism (VTE) has a six-to seven-fold risk of occurring in cancer patients compared with non-cancer patients. VTE is the second most common cause of death among patients with cancer, and cancer-associated VTE is be-coming increasingly prevalent. Therefore, early diagnosis and treatment of cancer-associated VTE is particularly important. This study presents a pancreatic cancer-associated deep vein thrombosis (DVT) patient who engaged in a multidisciplinary comprehensive discus-sion in the Interventional Therapy Department, Tianjin Medical University Cancer Hospital to enhance concern, interdisciplinary com-munication, and cooperation in terms of cancer-associated VTE diagnosis and treatment strategies.

Therapeutic progress of locally advanced prostate cancer / 国际肿瘤学杂志

The standard treatment mode of locally advanced prostate cancer is still controversial.With the progress of medical technology,treatments of prostate cancer achieve different progresses in surgical treatment,radiotherapy and endocrine therapy.The three treatment modes have diverse tumor growth control rate and survival period,which have different complications and different influences on the quality of life.

Discrimination of axillary metastatic from nonmetastatic lymph nodes with PROPELLER diffusion-weighted MR imaging in a metastatic breast cancer model and its correlation with cellularity.

PURPOSE: To assess the accuracy of apparent diffusion coefficient (ADC) in the differentiation of axillary metastatic from nonmetastatic lymph nodes in rabbits with metastatic breast cancer and to determine the relationship between the ADC and the cellularity of axillary lymph nodes of two different types. MATERIALS AND METHODS: The axillary lymph node models were created by inoculating VX2 cell suspensions in the mammary glands of 30 female rabbits. Conventional MR imaging and multi-shot fast-spin-echo PROPELLER DW imaging were performed approximately 4 weeks after successful inoculation. Images of axillary lymph nodes were analyzed with regard to size and ADC. Differences in the forementioned criteria between the two types of lymph nodes were assessed with reference to histopathologic findings. Cellularity was correlated with the ADC in all selected axillary lymph nodes. RESULTS: A total of 41 axillary metastatic and 29 inflammatory lymph nodes were successfully isolated. The size-based criteria showed no significant difference between the malignant and inflammatory lymph nodes (Ps > 0.05); however, the ADC of metastatic nodes was significantly lower than that of inflammatory nodes (P < 0.001). There was a significant inverse correlation between the ADC and cellularity (r = -0.674; P < 0.001) regardless of their different tissue types. CONCLUSION: DW imaging is a new promising functional technique for differentiating metastatic from inflammatory lymph nodes. Furthermore, cellularity has a significant influence on the ADC in both malignant and benign lymph nodes.

MR spectroscopy in diagnosis of local recurrence of T3N0M0 of prostate cancer after cryotherapy / 中华放射学杂志

Objective To evaluate the usefulness of magnetic resonance spectroscopic imaging in detecting local recurrence in patients with T3N0M0 prostate cancer after cryotherapy.Methods Sixty-five patients with T3N0M0 prostate cancer underwent cryotherapy.The preoperative data of conventional MRI,MRS,transrectal ultrasound (TRUS)-guided prostate biopsy were collected.After cryotherapy,the prostate specific antigen (PSA) of all patients was detected monthly.If PSA ＞5 μg/L,MRI,MRS,and TRUS-guided prostate biopsy were planned within a week.If PSA was unremarkable,MRI,MRS,and TRUS-guided prostate biopsy were planned 12 months after cryotherapy.The prostate was divided 6 regions and the cancerous and noncancerous were marked.The signal-to-noise ratio(S/N) of choline (Cho),citrate (Cit)and the ratios of Cho + creatine ( Cre)/Cit of each regions were measured in pre-operation and postoperation.The patients were divided into non-recurrence and recurrence group according to TRUS-guided biopsy.The S/N of Cho,Cit,and the ratio of Cho + Cre/Cit were compared between the groups before and after cryotherapy by using independent samples t-test.Results ( 1) Fifteen patients were confirmed local recurrence 12 months after cryotherapy,including 11patients with an evaluate PSA level and 4 patients with PSA umemarkable.(2) The S/N of Cho,Cit and the ratios of Cho + Cre/Cit in the cancerous and noncancerous regions before cryotherapy in the sixty-five patients were 25 + 9,11+ 5,and 18 + 5,and 39 ±12,2.33 +0.60,and 0.53 ± 0.19.There had significant difference between that of two groups ( t values were 11.36,9.81,and 13.39,respectively,P =0.00).(3) In the patients with non-recurrence,The S/N of Cho,Cit in the cancerous and noncancerous regions were 4 ± 2 and 3 ± 2 ( t =1.024,P =0.305 ),and 2 +2 and 4 ±3 (t =1.147,P =0.178) and no difference was found.In necrotic area,the ratios of Cho + Cre/Cit could not be calculated because of low level of the S/N of Cho and Cit.(4)In the patients with local recurrence after cryotherapy,the S/N of Cho and Cit in the cancerous and noncancerous regions were 17 ±3 and 3 ± 2 ( t =17.24,p =0.00 ),9 ± 2 and 3 ± 3 ( t =23.66,P =0.00 ) and a significant difference was found.The ratio of Cho + Cre/Cit in the recurrent area was no significant different compared with that of preoperation(t =1.214,P =0.256 ).In necrotic area,the ratios of Cho + Cre/Cit could not be calculated because of low level of the S/N of Cho and Cit.Conclusions MRS is a useful tool to evaluate the changes of the S/N of Cho and Cit,the ratios of the Cho + Cre/Cit and help diagnosis of local recurrence.

Effect of Argon-Helium Cryosurgery on Regulatory T Lymphocytes in the Peripheral Blood of Patients with Advanced Renal Carcinoma / 中国肿瘤临床

Objective: To analyze the effect of Argon-Helium cryosurgery (AHCS) on CD4+ CD25+ regulatory T cells (Treg) and its implication in patients with advanced renal carcinoma.Methods:,Peripheral venous blood samples were ob-tained from 32 patients with advanced renal cell carcinoma before and after AHCS.The proportions of Treg cells and T lym-phocyte subsets (CD3+ T, CD4+ T, CD8+ T, CD4+ T/CD8+ T, and NK cells) in the peripheral blood were measured by flow cytometry.Enhanced CT or enhanced MRI was used to observe the necrosis of tumor at 1 month after AHCS.The areas with no imaging enhancement in tumor were regarded as tumor necrosis.The necrosis rate was measured by Cavalieri method and the tumor burden was evaluated.Results: At 3 months after AHCS, the percentages of Treg cells were gradual-ly decreased from 4.18%±1.58% to 1.96%±0.54%, with a significant difference (P=0.001).At 3 months after AHCS, the pro-portions of CD3+ T, CD4+ T, NK and CD4+ T/CD8+ T were gradually increased from 19.26%±7.52%, 43.54%±12.99%, 1.15%±0.57%, and 17.49%±8.36% to 30.83%±5.69%, 49.58±10.76%, 1.84%±0.12%, and 27.63%±8.20%, with a statistical significance (P=0.000, P=0.003, P=0.02, and P=0.001).The proportion of CD8 + T was decreased from 40.86%±8.89% to the lowest ratio (26.74%±4.29%) at 3 months after AHCS, with a significant difference (P=0.000).At 3～6 months after cryo-therapy, there was only a slight change in the proportions of CD3 + T, CD4 + T, CD4 + T/CD8 + T, NK, CD8 + T, and Treg cells, with no significant difference (P>0.05).Correlation analysis showed that the decrease in tumor burden was positively correlated with the decrease of the proportion of Treg cells (r=0.793, P<0.01).Conclusion: After AHCS, the distribution of T-lymphocyte subsets can be improved and the anti-tumor immune response was strengthened.The percentage of Treg cells is correlated with tumor burden.

Analysis of factors influencing recurrent occlusion of metallic stents in malignant biliary obstruction / 介入放射学杂志

Objective To analyze the clinical and pathological factors which can influence the occurrence of the recurrent occlusion of metallic stents in patients with malignant biliary obstruction. Methods The clinical data of 50 patients with malignant biliary obstruction, who suffered repeated metallic stents obstruction and were admitted to authors" hospital during the period of March 2006-September 2008, were retrospectively analyzed. Of 50 patients, liver carcinoma was diagnosed in 12, pancreatic carcinoma in 17 and carcinoma of bile duct in 21. The relevant factors which might bear a relation to the occurrence of repeated metallic stents obstruction were evaluated. Results Single factor analysis of variance indicated that the denomination of carcinoma, clinical stage of carcinoma, location of obstruction, whether infection being accompanied or not, and the anti-tumor therapy after biliary stenting treatment were the significant factors closely linked to the occurrence of repeated metallic stents obstruction in patients with malignant biliary obstruction, Logistic regression analysis demonstrated that clinical stage of carcinoma, location of obstruction and whether infection being accompanied or not were the important factors that determined the occurrence of repeated metallic stents obstruction. Conclusion Clinical stage of carcinoma, location of obstruction and whether infection being accompanied or not are important reference factors for judging the occurrence of occlusion of metallic stents in malignant biliary obstruction.

Relationship between Treg Cell and cancer immunity / 国际肿瘤学杂志

Many studies demonstrate the existence of regulatory T(Treg)cell at tumot sites,implying that these Treg cells may induce local immune tolerance.Deep studies on the role of Treg cells in cancer patients will offer new approaches for tumor immunotherapy.

Effect of castration on restenosis after precutaneous transluminal angioplasty in male rats / 中华男科学杂志

<p><b>OBJECTIVE</b>To observe the developing changes of adventitia in restenosis after precutaneous transluminal angioplasty(PTA), and investigate the effect of androgen on restenosis through contrasting the castrated male rat models and its mechanism.</p><p><b>METHODS</b>Models were constructed of castrated male rats and restenosis of the common carotid artery, and specimens were collected at the 3rd, 7th, 14th and 28th day respectively after modeling. Hematoxylin and eosin staining, immunohistochemical staining, and electronic microscopy were performed to observe the condition of restenosis.</p><p><b>RESULTS</b>Proliferating cells occurred in adventitia first and phenotype of adventitial cells was changed at the 3rd day after PTA. The adventitial proliferating index was the highest at the 7th day after PTA, and proliferating migration towards intimal was observed. The proliferating cells mostly occurred in the middle layer and neointima at the 14th day after PTA. The areas of adventitia and neointima were larger and the degrees of restenosis were higher in the castrated rats than in the non-castrated ones at different time points. Take the 14 d group, the adventitial area was[(3,566 +/- 337) micron2 vs (2,751 +/- 401) micron2, P = 0.008], the neointimal area[(3,553 +/- 477) micron2 vs (2,757 +/- 435) micron2, P = 0.025], the restenosis rate[(76 +/- 2)% vs (60 +/- 8)%, P = 0.005], and the proliferating index [(29 +/- 2)% vs (13 +/- 1)%, P < 0.001].</p><p><b>CONCLUSION</b>Adventitial proliferation and migration contribute to restenosis after PTA; Androgen in rats can physiologically relieve restenosis, probably through intervening in the activation of adventitia.</p>

Thrombolysis for acute lower limb arterial embolism in patients with recent cerebral embolism / 介入放射学杂志

Objective To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator(rt-PA)for acute limb embolism in patients with recent cerebral embolism.Methods Eight patients with atrial fibrillation history happened to suffer acute limb embolism after recent cerebral embolism.The affected arteries included 2 left common iliac arteries,4 femoral arteries(3 left,1 right),2 right popliteal arteries.Catheter-directed thrombolysis with rt-PA was applied with bolus administration plus continuous perfusion.Percutanous transluminal angioplasty with balloon dilatation was applied in 3 patients,and one stent placement in one patient.Results The mean duration of continous perfusion was 3.6 hours and the mean dose of rt-PA administered was 23.6 mg(range,20 ～ 28 mg)with complete recanalization rate of 100%.Clinical complete relief rate was 7/8 with one patient suffering from rest pain due to distal occlusion of anterior/posterior tibial artery.The complications included hematoma at puncture site(6/8),bleeding around the vascular sheath(2/8)and hematuria(1/8).No intracerebral hemorrhage was found on CT scans after the thrombolysis.During follow up of 3-6 months,no recurrent embolism or thrombosis occurred in the limbs except one patient with recurrent cerebral embolism and died.Conclusions Catheter-directed thrombolysis with rt-PA is probably to be a safe and effective method for acute limb embolism in patients with recent cerebral embolism and atrial fibrillation history.