Bimetallic nanoplatform for synergistic sonodynamic-calcium overload therapy utilizing self-supplied hydrogen peroxide and relieved hypoxia.

Sonodynamic therapy (SDT) has emerged as a potential alternative to traditional cancer treatments as it offers deep cellular penetration and reduced invasivity. Sonosensitizers generate reactive oxygen species (ROS) under ultrasound activation, focusing the ultrasound energy on malignant sites located deep in tissues and causing cell apoptosis and necrosis. However, due to tumor hypoxia and the limited levels of intracellular endogenous hydrogen peroxide (H2O2 is a fundamental species for supplying oxygen via catalase activity), SDT efficacy is still insufficient. In this study, a bimetallic and multifunctional system (Fe3O4-TAPP@PVP-CaO2) was prepared by using ferrosoferric oxide (Fe3O4) as a carrier loaded with 5,10,15,20-tetrakis(4-aminophenyl), porphyrin (TAPP), that was then coated with polyvinyl pyrrolidone (PVP) and calcium peroxide (CaO2). The CaO2 layer elevated the levels of H2O2 and Ca2+ in the tumor microenvironment when exposed to intracellular acidity, providing essential elements for oxygen generation. Intracellular hypoxia was alleviated via the catalase-like activity of Fe3O4 inducing calcium overload. Under ultrasonic irradiation, SDT generated toxic reactive oxygen species (ROS, singlet oxygen) and activated calcium influx through acoustic cavitation. Meanwhile, calcium overload therapy efficiently induced cell apoptosis at the moment of uncontrollable cellular accumulation of Ca2+. In addition, we modified the PVP on the surface to make it more stable. This study presents a bimetallic nanoplatform that can efficiently induce cancer cell death by synergistic sonodynamic-calcium overload therapy via modulation of O2/ROS/Ca2+ species, indicating its potential for multi-modality cancer therapy.

Study of the Associations between Color Doppler Ultrasound Grading of Hyperthyroidism and Biochemical Data on Thyroid Function.

Objective: The main study objective was to investigate the correlation between the color Doppler ultrasound grading of hyperthyroidism and the biochemical data of thyroid function. Methods: Seventy-six patients were diagnosed with hyperthyroidism based on clinical and laboratory data at our hospital. The patients were examined using color Doppler ultrasound and laboratory investigations before starting 131I treatment. First, patients were divided into two groups based on the blood flow distribution determined by ultrasound. If the blood flow signal in the parenchyma was scattered and thinned, with dispersive points and discontinuous streaky distribution, the blood flow distribution area in the sample frame was less than or equal to 1/2 of the sample frame area and was judged to be level 1. If the parenchyma was filled with diffuse blood flow signals or if most areas had depicted rich blood flow distribution when the area of blood flow distribution in the sampling frame was greater than 1/2 of the sampling frame area, it was judged to be level 2. Then, the correlations between color Doppler ultrasound grading and biochemical data of thyroid function were analyzed. The indices included FT3, FT4, TSH, anti-TG, anti-TPO, and TRAb. Parameters of thyroid homeostasis, including thyroid's secretory capacity (SPINA-GT), the total deiodinase activity (SPINA-GD), Jostel's TSH index, and the thyrotroph thyroid hormone sensitivity index (TTSI), were calculated and compared. Results: Correlations were noted between color Doppler ultrasound grading and FT3, FT4, TRAb, SPINA-GT, TSHI, and TTSI. Moreover, FT3, FT4, TRAb, SPINA-GT, TSHI, and TTSI were higher in level 2 patients compared with level 1 patients. Conclusion: Correlations were noted between color Doppler ultrasound grading and biochemical data of thyroid function.

Ultrasonic evaluation of congenital vaginal oblique septum syndrome: A study of 21 cases.

The aim of the present study was to investigate the ultrasound features and classify the lesion types of congenital vaginal oblique septum syndrome (CVOS) in 21 patients prior to surgery. Grey-scale pelvic ultrasound was performed to evaluate the uterus, vagina and kidneys in 21 patients with suspected CVOS. Ultrasound features, including the presence of a double uterus, hematocolpos masses and renal absence, in CVOS types I, II and III were studied and compared with intra-operative results and the results of surgery. Ultrasound identified the presence of double uteruses and cervices with ipsilateral renal agenesis on the oblique septum side in all 21 patients. There were 14 hematocolpos lesions on the right and 7 on the left of the vagina. Type I CVOS was diagnosed in 15 patients with a large hematocolpos mass (volume, 64-268 ml) and these diagnoses were confirmed by surgery. Furthermore, there were 4 patients with type II and 2 patients with type III CVOS exhibiting small hematocolpos lesions (volume, 5-36 ml) identified by ultrasound, which were all confirmed by surgery. Therefore, ultrasound imaging is useful tool to evaluate the abnormal features of CVOS and determine the type of CVOS in patients prior to surgical intervention.

Magnetic Resonance Venography Findings of Obstructed Hepatic Veins and the Inferior Vena Cava in Patients with Budd-Chiari Syndrome.

Objective: This study aimed to illustrate the magnetic resonance venography (MRV) manifestations of obstructed hepatic veins (HVs), the inferior vena cava (IVC), and accessory hepatic veins (AHVs) in patients with Budd-Chiari syndrome (BCS) and to evaluate the visualization capacity of MRV in the diagnosis of BCS. Materials and Methods: Fifty-two patients with chronic BCS were included in this study. All patients were examined via MRV performed with a 3T system following injections of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) or Gd-ethoxibenzyl-DTPA. HV and IVC lesions were classified, and their characteristics were described. HV cord-like occlusions detected via MRV were compared using ultrasonography (US). Digital subtraction angiography (DSA) was performed as a contrast in the MRV detection of IVC lesions. The HVs draining collaterals, mainly AHVs, were carefully observed. HV lesions were classified as segmental stenosis, segmental occlusion, membranous stenosis, membranous occlusion, cord-like occlusion, or non-visualized. Except for patent IVCs, IVC lesions were classified as segmental occlusion, segmental stenosis, membranous occlusion, membranous stenosis, and hepatomegaly-induced stenosis. Results: All patients (52/52, 100%) showed HV lesions of different degrees. MRV was inferior to US in detecting cord-like occlusions (6 vs. 19, χ2 = 11.077, p < 0.001). Dilated AHVs, including 50 (50/52, 96.2%) caudate lobe veins and 37 (37/52, 71.2%) inferior HV and AHV lesions, were well-detected. There were no significant differences in detecting segmental lesions and thrombosis between MRV and DSA (χ2 = 0.000, p1 = 1.000, p2 = 1.000). The capacity of MRV to detect membranous lesions was inferior to that of DSA (7 vs. 15, χ2 = 6.125, p = 0.013). Conclusion: In patients with BCS, MRV can clearly display the lesions in HVs and the IVC, as well as in AHVs, and it has diagnostic and therapeutic value.

Local Efficacy and Survival after Microwave Ablation of Lung Tumors: A Retrospective Study in 183 Patients.

PURPOSE: To retrospectively evaluate local efficacy and survival after microwave (MW) ablation of lung tumors and identify predictors of prognosis. MATERIALS AND METHODS: Data from 183 consecutive patients (67 women; mean age, 61.5 y ± 13.4) with lung tumors who had undergone 203 lung MW ablation sessions from January 2011 to May 2013 were assessed. The χ2 test, independent-samples t test, Kaplan-Meier analysis, and Cox regression model analysis were used to estimate survival rates and evaluate significance of factors affecting rates of incomplete ablation, local progression, remote progression-free survival (RPFS), and cancer-specific survival (CSS). RESULTS: Technical success rate was 100%. Incomplete ablation rate after 183 first MW ablations was 14.2% (26 of 183); maximum diameter of target tumors (P = .00001) was associated with incomplete ablation on univariate analysis. The local progression rate was 19.1% (35 of 183); emphysema (P = .020) and maximum diameter of target tumor (P = .000003) were associated with local progression. Median and 4-year RPFS were 15.0 months (95% confidence interval [CI], 11.1-18.9 mo) and 23.8%, respectively. Tumor stage (P < .01) and incomplete ablation (P = .002) were independent predictors of RPFS. Median and 4-year CSS were 24.9 months (95% CI, 19.9-29.9 mo) and 31.1%, respectively. Median and 4-year overall survival were 23.7 months (95% CI, 20.6-26.8 mo) and 29.6%, respectively. Tumor stage (P < .01) and maximum diameter (P = .009) were independent risk factors for CSS. CONCLUSIONS: MW ablation is effective for lung tumors, especially small lesions of early-stage primary lung cancer and solitary lung metastasis.

An innovative procedure of laparoscope combined with endoscopy for gastrointestinal stromal tumor resection and cholecystectomy: A case report and literature review.

The present study reports a novel approach to laparoscopic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumor (GIST) resection and cholecystectomy, and conducts a review of the associated literature. The novel surgical procedure was performed on one patient who was diagnosed with a GIST and cholecystic polypus. The GIST was resected using an insulation-tipped diathermic electrosurgical knife under the guide of an endoscope. Subsequently, a cholecystectomy was performed by inserting two more 5-mm trocars and instruments transumbilically, guided using an endoscope. The tumor and the gallbladder were exteriorized using a peroral approach and the incision lining of the stomach was sutured laparoscopically. The procedure was successfully performed and the patient experienced no discomfort during the 5-year follow-up. In conclusion, the present study demonstrates that laparoscopic and endoscopic cooperative surgery is feasible and would be an ideal choice for invisible abdominal scar surgery, in particular for multi-visceral resection.

Ultrasonographic Visualization of Accessory Hepatic Veins and Their Lesions in Budd-Chiari Syndrome.

The aim of this study was to investigate the ultrasonographic features of accessory hepatic veins (AHVs) and their lesions in Budd-Chiari syndrome (BCS). Three hundred patients with BCS were examined by ultrasonography with multifrequency (3-6 MHz) convex transducers. Sonography was performed 1 to 2 wk before digital subtraction angiography and computed tomography angiography or magnetic resonance imaging. Using sonograms, we evaluated the number, course, diameter, orifice, lesions and hemodynamics of patent and obstructed AHVs. Ultrasonography was superior to digital subtraction angiography, computed tomography angiography and magnetic resonance imaging in revealing AHV lesions and hemodynamics. Dilated AHVs were detected in 227 patients. There were 239 caudate lobe veins in 167 patients and 168 inferior right hepatic veins in 151 patients. Both caudate lobe veins and inferior right hepatic veins were found in 91 of the 227 patients. The inlets to AHVs were located mainly on the right lateral or right anterior wall of the inferior vena cava, and the remnant, on the left lateral wall. AHV lesions comprised mainly septal obstruction and segmental stenosis. The hemodynamics of AHVs varied with the condition of inferior vena cava and AHVs. Ultrasonic examination can reveal AHVs and their lesions in patients with BCS and is helpful in choosing and planning therapeutic approaches.

Computed tomography angiography manifestations of collateral circulations in Budd-Chiari syndrome.

The aim of this study was to assess the computed tomography angiography (CTA) manifestations of collateral circulations in patients with Budd-Chiari syndrome (BCS). Eighty patients with BCS were examined by CT scan. Using the CTA images of the relevant blood vessels, including the affected hepatic veins (HVs) and inferior venae cavae (IVCs), the collateral circulations were reconstructed. In addition to obstructed HVs and IVCs, collateral circulations were found in each of the patients. The collateral circulations were classified as intrahepatic, extrahepatic and portosystemic pathways. Intrahepatic collateral pathways were further classified as the following six types: HV-accessory HV (n=51, 63.8%), HV-HV (n=6, 7.5%), HV-accessory HV plus HV (n=6, 7.5%), IVC-HV/accessory HV-HV-right atrium (n=5, 6.3%), HV-umbilical vein (n=4, 5.0%) and HV-inferior phrenic vein (n=8, 10.0%). Extrahepatic collateral pathways included IVC-lumbar-ascending lumbar-hemiazygos/azygos vein (n=80, 100.0%), IVC-left renal-ascending lumbar-hemiazygos vein (n=75, 93.8%), IVC-left renal-inferior phrenic vein (n=49, 61.3%), IVC-renal -peri-renal -superficial epigastric vein (n=26, 32.5%) and superficial epigastric vein (n=12, 15.0%) types. The CTA characteristics of each type of collateral circulation were demonstrated. In conclusion, the present study revealed that CTA is able to show the intra- and extrahepatic collateral circulations of patients with BCS, which may be useful for therapeutic planning.

Diagnosis of the cavo-hepato-atrial pathway in Budd-Chiari syndrome by ultrasonography.

The aim of this study was to investigate the ultrasonic features of the cavo-hepato-atrial pathway in Budd-Chiari syndrome (BCS), by which blood is drained from the occluded inferior vena cava (IVC) to the right atrium via hepatic veins. Ultrasonograms from 11 patients with BCS with cavo-hepato-atrial pathways were retrospectively studied. Doppler ultrasound was used to observe the direction of the flow and measure the velocity of the blood-draining vessels. Blood flow in the draining vessels and the collaterals was shown as blue, red or bicolored depending on whether the flow direction was away from the transducer, towards the transducer or both. For measurement, the Doppler angle between the axis of the Doppler beam and that of the vein examined was always <60°. Ultrasonography was performed 1-2 weeks prior to digital subtraction angiography (DSA). All patients were confirmed by DSA. Membranous and segmental occlusions of IVCs were observed in seven and four cases, respectively. Blood flow from the IVC reversed to the hepatic/accessory hepatic vein, continued through the dilated intrahepatic collaterals, onward to the other hepatic vein and finally to the right atrium. The majority of the inlets (8/11) of hepatic veins above the occlusion were narrow compared with the dilated distant parts of the lumens. Accelerated blood flow in the inlets was detected in all patients regardless of the luminal diameter. In conclusion, the results from the present study suggest that the unusual cavo-hepato-atrial pathway can be diagnosed reliably by ultrasonography, which may be useful for clinical management.

Major complications after lung microwave ablation: a single-center experience on 204 sessions.

BACKGROUND: The purpose of this study is to retrospectively evaluate the incidence of and risk factors for major complications after microwave ablation (MWA) of lung tumors. METHODS: From January 2011 to May 2013 in 184 consecutive patients (67 women and 117 men; mean age, 61.5 years; range, 19 to 85 years), 204 sessions of MWA were performed on 253 lung tumor lesions. Records were reviewed to evaluate prevalence of major complications and risk factors, which were analyzed using univariate and multivariate analyses. RESULTS: Major complications developed after 42 sessions (20.6%), including 32 cases (15.7%) of pneumothorax requiring chest tube placement which that were associated with emphysema (p=0.001); 6 cases (2.9%) of pleural effusions requiring chest tube placement, which were associated with a distance of less than 1 cm from chest wall to target tumor (p=0.014); 6 cases (2.9%) of pneumonia which that were associated with target tumor maximal diameter (p=0.040); number of pleural punctures (p=0.001) and ablation time (p=0.006); and 1 case (0.5%) of pulmonary abscess. Two cases (1.0%) of the large pneumothorax occurred at the same time with extensive subcutaneous emphysema, including 1 case (0.5%) caused by bronchopleural fistula. Death related to the procedures occurred after 1 session (0.5%). CONCLUSIONS: As a relatively practical and safe modality, lung tumor MWA can induce serious complications. Enough attention should be paid to patients with emphysema, subpleural, or large target tumor, but the indications for lung MWA need not be limited as most major complications were easily managed.

Sonographic classification of draining pathways of obstructed hepatic veins in Budd-Chiari syndrome.

PURPOSE: To describe and propose a sonographic classification of the blood-draining pathways of obstructed hepatic veins in Budd-Chiari syndrome. METHODS: This retrospective study included 206 patients with hepatic vein obstructions who underwent sonographic examination. We evaluated the afflicted hepatic veins, as well as the course, orifice, blood flow direction of draining veins, and communicating branches. Results were classified and compared with digital subtraction angiography and computed tomography angiography. RESULTS: Of 618 hepatic veins in 206 patients, 542 were obstructed. The blood-draining pathways were classified as hepatic vein-accessory hepatic vein (131/206), hepatic vein-hepatic vein/accessory hepatic+hepatic vein (49/206), and, less frequently, collateral pathways (26/206). Blood was drained from obstructed hepatic veins to the inferior vena cava, right atrium, para-umbilical veins, or hepatic subcapsular veins through communicating branches of various number and diameters. Doppler signals were obtained from the draining veins. CONCLUSIONS: Sonography provides accurate information regarding the blood-draining pathways of obstructed hepatic veins in Budd-Chiari syndrome, which may be helpful for treatment and follow-up.