Changes in immunological function after treatment with transarterial chemoembolization plus radiofrequency ablation in hepatocellular carcinoma patients.

BACKGROUND: Different strategies for hepatocellular carcinoma (HCC) may have distinct effects on the immune system. The aim of this research was to investigate changes in the immunological function after transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) in HCC patients. METHODS: A total of 51 consecutive HCC treatment-naïe patients was enrolled in this study and 20 healthy subjects served as controls. The therapeutic strategy was selected according to the tumor stage and general conditions. TACE was performed in 25 cases, TACE plus RFA in 17 and RFA in nine. All the patients underwent routine examinations and peripheral blood was harvested for the detection of lymphocyte subset by flow cytometry 1 day before, and 2 and 4 weeks after the treatment. The serum levels of alpha-fetoprotein (AFP), ALT and AST were also measured before and 4 weeks after treatment for the evaluation of therapeutic efficacy and liver function impairment. RESULTS: When compared with healthy controls, the CD4/CD8 ratio and the number of B cells and natural killer (NK) cells were significantly decreased in HCC patients before treatment (P < 0.05). When compared with before treatment, the CD4+ cells and CD4/CD8 ratio decreased but CD8+ cells increased in the TACE group (P < 0.05); the CD4/CD8 ratio and NK cells decreased but CD8+ cells increased in the TACE-RFA group (P < 0.05); the CD3+ cells, CD4+ cells, CD4/CD8 ratio and NK cells increased in the RFA group (P < 0.05). Significant differences in the CD3+ cells, CD8+ cells, CD4/CD8 ratio and NK cells were observed among groups (P < 0.05). Moreover, the AFP level decreased and transaminase level increased in all groups (P < 0.05). Differences of pre and post treatment between groups were statistically significant (P = 0.016, 0.025, 0.018 respectively). CONCLUSIONS: Immunity was compromised in HCC patients; TACE and TACE plus RFA lowered immunologic function to a certain extent. RFA improved it accompanied by a protective effect on liver function.

[Pharmaceutical therapy for the severe hemodynamic depression with carotid artery stenting].

OBJECTIVE: To evaluate the efficacy of pharmaceutical therapy for the severe hemodynamic depression with carotid artery stenting(CAS). METHODS: Clinical data were retrospectively analyzed on CAS over the last 5 years. Severe hemodynamic depression was defined as periprocedural hypotension (blood pressure <90/60 mmHg) or bradycardia (heart rate <50 beats/min) persisting for at least 1 hour. 13 patients were included in the research. RESULTS: Dopamine was pumped intravenously in all the 13 patients .The dose was from 2 microg/min/kg to 10 microg/min/kg, the duration was from 4 to 48 hours. Dobutamine was used in 2 patients and dose from 5 microg/min/kg to 7 microg/min/kg, duration was from 24 to 36 hours. None of the patients developed any permanent neurological complications. One acute coronary syndrome occured during the postprocedure period. CONCLUSION: Severe hemodynamic depression can be controlled with vasopressors (dopamine or dobutamine) and the associated complications can be prevented.

[In vivo fluorescent microscopy of the liver microcirculation after embolization with a newly developed trans-proper hepatic arterial infusion animal model].

OBJECTIVE: To evaluate the value of the in vivo fluorescent microscopy in studying the changes of liver microcirculation after embolization with a newly developed animal model for tans-proper hepatic arterial infusion, and to summarize the method of making this animal model. METHODS: Ten Sprague-Dawley rats were used in this study. After a midline abdominal incision, microcatheter was placed into the gastroduodenal artery (GDA). The tip of the catheter was placed facing the orifice of proper hepatic artery. After infusions of 0.02%, 0.1%, 0.5%, 1% fluorescent sodium, fluorescent microscopy was used to evaluate the liver microcirculation. The image quality was then accessed. Embolization was obtained by injections of Lipiodol and Degradable Starch Microspheres (DSM) from the microcatheter. Corresponding changes of the liver microcirculation was evaluated by fluorescent microscopy. RESULTS: From the 10 rats, 8 animal models were successfully established. The microcirculation of the liver could be clearly visualized by the fluorescent microscopy. The optimal concentration of fluorescent sodium was 0.1%. The direct and indirect phenomena caused by embolic material could be evaluated by fluorescent microscopy. CONCLUSION: Fluorescent microscopy with the corresponding Trans-hepatic arterial infusion animal model is a valuable method to evaluate the microcirculation of the liver and can be used for the evaluation of changes of liver microcirculation caused by embolization material.