Objective:To improve the visibility of some nerve interventional devices in X-ray fluoroscopy, and to provide convenience for neurointerventional surgeries.Methods:The Enterprise stent was placed into a body phantom, and dynamic imaging was performed using digital radiography (DR) mode, with simultaneous adjustment of parameter values to achieve the clearest image. A specialized fluoroscopy protocol was created to observe specific stent structural details. Subsequently, this protocol was applied to 96 patients who underwent general fluoroscopy at Nanjing First Hospital from May 2020 to July 2021, but had their intracranial stents for neurointerventional treatment not clearly display. The clarity, detail observation time, average radiation dose rate and visual comfort of the operator were compared between the two types of fluoroscopy.Results:The exclusive perspective mode was constructed. In all 96 cases, the use of specialized fluoroscopy for intracranial stent visualization during the intervention procedure was superior to general fluoroscopy. The average dose rate of exclusive fluoroscopy was higher than that of general fluoroscopy and the mean ± sd difference was 43.27 ± 36.29 μSv/h, and the average observation time of exclusive fluoroscopy was shorter than that of general fluoroscopy and the mean ± sd difference was 6.35 ± 3.96 sand the accumulate dose of exclusive fluoroscopy was decreased 1.1 ± 1.71 μSv. The observation comfort of operators under exclusive fluoroscopy was all better than that of general fluoroscopy.Conclusion:It is feasible to create a specialized fluoroscopy program, which is an effective means to observe specific structural details in neurointerventional surgery and can be used as a complement to general fluoroscopy.
Objective:To construct hepatocellular carcinoma (HCC) cells lines that can mimic sub-lethal heat shock (HS) in vitro and orthotopic HCC mouse model that received incomplete thermal ablation.Methods:The suspension H22 cells were grown in 6-well plates, and the medium was replaced with fresh complete medium 8 hours before heat treatment. Then, the cells were divided into 4 groups for constant temperature water bath at 37°C, 42°C, 47°C, 50°C for 15 min, respectively. After the heat treatment was completed, the cells were maintained in a 37℃ incubator until detection. The phenotype of epithelial-mesenchymal transition (EMT) was detected by Western blot 48 hours later, and the cell viability was detected by Cell Counting Kit-8 (CCK-8) kit. The liver of mice was exposed by laparotomy along the abdomen midline and H22 cells (5×106) were injected through the hepatic capsule to conduct orthotopic HCC model. When the longest diameter of the tumor reached approximately 8 mm, the mice were randomly divided into complete ablation group (cMWA), incomplete ablation group (iMWA) and Control group treated with sham operation. Microwave ablation along the long axis of tumor was performed to establish the incomplete thermal ablation model of orthotopic HCC. MRI was performed for tumor measurement and liver specimens were collected for histopathological assessment at day 14 after microwave ablation.Results:14 daysafter inoculation of H22 cells, the tumors reached average tumor diameter of 9.32 ± 0.83 mm which was predetermined to be suitable for microwave ablation. 14 days after microwave ablation, the average tumor diameter reached 12.93 ± 1.51mm in iMWA group, which were significantly bigger than preoperative period. In addition, immunofluorescence staining showed a large number of infiltrated neutrophils in the residual tumor of iMWA group. Western blot was used to observe the change in EMT-phenotype, results showed that the expressions of Vimentin and α-SMA were up-regulated and the expressions of E-cadherin were down-regulated.Conclusions:HCC cells lines that can mimic Sub-lethal heat shock (HS) in vitro and orthotopic HCC mouse model that received incomplete thermal ablation were successfully constructed. There was substantial staining for neutrophils infiltration after incomplete ablation. Incomplete ablation may allow HCC cells to become more prone to migrate and to become more invasive.
Objective:To investigate the influence of abducting upper limb posture on DSA image display of upper limb veins, and summarize the reasonable posture of upper limb phlebography.Methods:According to the different positions of the upper limbs, 93 patients with upper limb phlebography were divided into two groups: the control group in the conventional anatomical position and the experimental group in the abduction position. The difference of DSA imaging between the two positions was compared from various aspects, including artifacts, vascular filling status and position standardization.Results:The standard rate of forearm DSA in the experimental group was 60.00% higher than that in the control group, the incidence of artifacts in the experimental group was 67.67% lower than that in the control group, and the DSA complete filling rate of upper arm veins was 45.95% higher than that in the control group.Conclusions:Venography of upper limb in abducting position can fully show the true state of upper arm veins, reduce artifacts, and can replace the traditional anatomy position angiography.
Objective:To explore the clinical characteristics, interventional diagnostic and therapeutic value of iatrogenic biliary hemorrhage.Methods:The clinical characteristics of 16 patients with iatrogenic massive biliary bleeding who received interventional treatment between July 2018 and June 2022 were reviewed. The clinical manifestations, laboratory examinations and digital subtraction angiography (DSA) findings of all patients were analyzed. The efficacy and safety were evaluated, using interventional therapy including replacement and adjustment of drainage tube, arterial embolization and stent-graft implantation for hemostasis.Results:Eleven of 16 patients had bleeding after PTBD, accounting for 68.8%. 4 hemorrhage cases had histories of biliary-related surgery (25.0%), including 1 case of hepatopancreatic trauma repair, 1 case of liver transplantation, 1 case of bile duct exploration and T-tube drainage, and 1 case of pancreatic necrotic tissue removal, and 1 hemorrhage case occurred after ERCP therapy (6.2%). The bleeding sites origin from portal vein bleeding in 7 cases, hepatic artery in 7 cases, and chronic bleeding of malignant tumor in 2 cases. Of the 7 hepatic artery bleeding cases, stent-graft implantation of hepatic artery was performed in 1 case, and hepatic artery embolization was performed in the other 6 cases. Of the 7 portal vein bleeding cases, the position of the drainage tube was adjusted in 5 cases, replacement of the drainage tube for the other 2 cases for compression hemostasis. At last, 2 cases with chronic tumor bleeding who were underwent empirical embolization. The technique success rate was 14/16 (87.5%), and the survival rate of 90 days was 13/16 (81.3%).Conclusions:Iatrogenic biliary hemorrhage usually is sudden onset and fatal. Interventional therapy was proved as a quickly diagnosis and serves as safely and efficiency methods for hemostasis.
Superselective arterial intubation technique used in superselective arteriography and embolization can significantly reduce the damage of target organs and improve the therapeutic effect. In clinic, it has been used in the fields of hepatic segment and sub hepatic segment embolization, bronchial artery embolization, prostate artery embolization and other peripheral artery embolization. However, it is still impossible to completely avoid the non-target vascular injury caused by the reflux of embolic substances. With the strong clinical demand, occlusion balloon microcatheter has become an important interventional device to solve such problems. It can significantly reduce the reflux of embolic agents. At present, it has been used in clinical hepatic artery embolization, bronchial artery embolization, prostate artery embolization and other fields. It can make the lesion achieve complete embolization, has high application value, and the incidence of adverse reactions after embolization is very low.
This paper reviews the literatures on cryoablation for peripheral lung cancer from PubMed, Scopus, SinoMed, Chinese Medical Ace Base. This review focuses on the mechanism of cryoablation for lung cancer, the current status and progress of cryoablation in peripheral lung cancer, as well as its advantages and disadvantages, in order to provide more evidence for the application of cryoablation in peripheral lung cancer.
Objective:This study aimed to investigate the crucial mutant gene of Chinese patients with retinoblastoma (Rb) by whole-exome sequencing (WES), and explore the functional role of this genetic variant in the development of Rb using biological experiments.Methods:Blood samples of 82 Rb patients with negative RB1 gene mutation (RB1-/-) in China were screened for rare variations via WES analysis. Moreover, the expression of protein encoded by selected rare variants was detected by Western blot. We further observed the effect of selected gene knockdown or overexpression on the proliferation, migration of Rb cells and xenograft tumor size in vitro and in vivo.Results:We identified a rare variation Y318H of PLK3 gene in RB1-/- patients by WES and SKAT analysis, and Y318H substitution was a pathogenic mutation. The PLK3 protein of Rb cell lines transfected with Y318H mutation plasmids was reduced compared to the control. PLK3 knockdown promoted the proliferation and migration potentials of Rb cells, while PLK3 overexpression inhibited the proliferation and migration potentials of Rb cells. Additionally, the transition of PLK3 expression regulated Rb growth of mouse subcutaneous xenograft model in vivo.Conclusions:Our findings provide evidence that the rare variation Y318H of PLK3 gene is an significant pathogenic factor for Rb progression in Chinese patients. The mutation of Y318H can reduce PLK3 protein expression. PLK3 knockdown promoted the proliferation and migration of Rb cells, thereby resulting in the growth of Rb. The study suggests that PLK3 rare variation Y318H can be used as a new molecular marker for the early genetic screening of Rb, and may provide a novel target for diagnosis and treatment of the disease.
Objective:To explore the seasonal variation characteristics of the procedural volume in the interventional operation room, so as to provide scientific basis for strengthening the management of interventional operation room and rational allocation of interventional medical resources.Methods:The procedural volume of interventional operation room in our hospital from 2004 to 2018 was analyzed by seasonal index analysis of time series data, and the changing trend of the operative volume with time was investigated.Results:The procedural volume in the past 15 years showed an increasing trend year by year and changed regularly with seasonal changes. The seasonal index showed the peak in July and September, the trough in January and February, the highest in the third quarter and the lowest in the first quarter.Conclusions:According to the seasonal variation of procedural volume in the interventional operation room of our hospital, targeted measures should be taken to scientifically organize and manage the interventional surgical treatment, rationally allocate interventional medical resources, and strive to achieve the optimal allocation of medical resources and maximize the effectiveness of serving patients.
Objective:To explore the influencing factors of puncture site bleeding in patients with liver cancer treated by femoral artery intervention.Methods:From July 2021 to January 2023, the clinical data of patients with liver cancer treated with percutaneous femoral artery intervention in our center were prospectively collected. Univariate and multivariate logistic regression analysis was used to determine the independent risk factors for bleeding at the puncture site in patients with liver cancer.Results:A total of936 patients with liver cancer were included for analysis, of which 109 (11.6%) had bleeding at the puncture site. Univariate analysis showed that gender, BMI, type of surgery, liver function, portal hypertension, platelets, prothrom-bin time, fibrinogen, sheath retention time, and number of vascular punctures were associated with bleeding at the puncture site (P < 0.1). Multivariate logistic regression analysis showed that female (OR = 16.421, 95%CI: 8.299~32.492), BMI≥28 kg/m2 (OR = 3.898, 95%CI: 1.489~10.202), liver cirrhosis Child-Pugh score 5~6 points (OR = 3.179, 95%CI: 1.754~5.761), liver cirrhosis Child-Pugh score≥7 points (OR = 8.171, 95%CI: 3.656~18.264), platelet count 50~100 × 109/L (OR = 6.228, 95%CI: 3.470~11.176), platelet count < 50 × 109/L (OR = 77.491, 95%CI: 16.321~367.917), sheath retention time > 240 min (OR = 4.060, 95%CI: 0.012~8.193), number of vascular punctures = 2 (OR = 9.422, 95%CI: 4.786~18.549), and number of vascular punctures > 2 (OR = 28.347, 95%CI: 12.217~65.773) were risk factors for bleeding at the puncture site. The use of hemostatic drugs (OR = 0.048, 95%CI: 0.015~0.151) one week before surgery was a protective factor.Conclusions:Female, obesity, liver cirrhosis, thrombocytopenia, sheath retention time > 240 min, and repeated vascular puncture are independent risk factors for bleeding at the puncture site. The higher the Child-Pugh score in cirrhosis, the more severe the thrombocytopenia, and the greater the risk of bleeding at the puncture site.
Objective:To evaluate the efficacy and safety of percutaneous multi-metal stent insertion in the treatment of hilar cholangiocarcinoma with Bismuth-Corlette typeⅡor above, and analyze the stent patency and overall survival.Methods:During the period from January 2019 to September 2021, the clinical data of patients with Bismuth Ⅱ or above hilar cholangiocarcinoma who treated with multi-metal stent insertion in Department of Vascular Surgery, Suzhou Municipal Hospital Affiliated to Nanjing Medical University were analyzed retrospectively. The technical success, clinical success, complications, stent patency, and overall survival were evaluated.Results:108 patients were enrolled, aged from 38 to 92, and the average was (66.8 ± 10.6) years old. Technical success was 100%, and successful drainage was achieved in 91 of 108(84.3%) patients. After the procedure, the total bilirubin level decreased from (266.23 ± 108.87) μmol/L to (153.08 ± 98.63) μmol/L. Besides, the level of direct bilirubin, alanine transferase, aspartate aminotransferase and alkaline phosphatase were significantly decreased (P < 0.01), however there was no significant change in albumin level (P = 0.252). Incidence of complications was 12.0%, and no major complications occurred. The median stent patency was 122 days (range, 17~833 days), and the median survival time was 151 days (range, 17~915 days).Conclusions:Percutaneous multi-metal stent insertion may offer a safe and effective way for patients with BismuthⅡor above hilar cholangiocarcinoma to solve jaundice and recover liver function in a certion extent.
Objective:To investigate the value of CT perfusion imaging combined with CT angiography in predicting the progression of transient ischemic attack (TIA) to acute cerebral infarction (ACI).Methods:150 patients with TIA admitted to our hospital from March 2019 to August 2022 were selected. All patients underwent CT perfusion imaging and CT angiography within 24 hours after admission. They were divided into ACI group and non-ACI group according to whether ACI occurred within 7 days after the onset of the disease. CT perfusion imaging parameters [cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), time to peak (TTP)] and angiographic characteristics were compared between ACI group and non-ACI group. Draw receiver operating characteristic (ROC) curve to analyze the predictive value of CT perfusion imaging combined with CT angiography for TIA patients' progression to ACI.Results:The incidence of ACI in TIA patients was 18.67% (28/150). CBV and CBF in ACI group were lower than those in non ACI group (P < 0.05), and MTT and TTP were higher than those in non ACI group (P < 0.05). The degree of vascular stenosis in ACI group was higher than that in non ACI group (P < 0.05). The sensitivity, specificity and area under the curve (AUC) of CBV, CBF, MTT and TTP in predicting the progression of TIA patients to ACI were 78.57%, 88.52% and 0.824 respectively, and the AUC predicted by CBV, CBF, MTT and TTP was higher than that predicted alone. The AUC and sensitivity of CT perfusion imaging combined with CT angiography in predicting the progression of TIA to ACI were higher than those predicted alone (P < 0.05), but there was not statistically significant compared with that predicted alone (P > 0.05).Conclusions:CT perfusion imaging and CT angiography have a certain predictive value for the progression of TIA patients to ACI, but the combined predictive value is higher.
胸腔穿刺术主要用于胸腔积液诊断和气胸、胸腔积液的治疗，该手术操作的典型并发症包括气胸、出血（包括血胸）和复张性肺水肿[1]。胸腔穿刺引起肋间动脉损伤造成大出血为罕见的并发症；文献中报道的医源性损伤病例相对较少，既往的报道主要为外科手术的并发症[2]。对肋间动脉大出血的及时处理很重要，我们将2例胸腔穿刺术致肋间动脉大出血成功行介入止血（1例明胶海绵栓塞及1例弹簧圈栓塞）的病例报道如下。
Silent pulmonary embolism (SPE) is a common complication in deep vein thrombosis (DVT). Although the consequences of SPE are less severe than symptomatic PE, the treatment regimen for venous thromboembolism (VTE) may be influenced by concomitant SPE. Moreover, SPE may be associated with an increased risk of VTE recurrence and long-term pulmonary hypertension. Most previous studies and guidelines focused on the diagnosis and treatment for symptomatic PE, whereas the concerns regarding SPE were limited. In order to have a better understanding of SPE, the present review focused on the incidence, screening, risk factors and treatment for SPE.
Objective:To compare the safety and efficacy of anticoagulant therapy of rivaroxaban and warfarin in patients with post-thrombotic syndrome (PTS) after iliac vein stent implantation.Methods:A total of 132 PTS patients who underwent iliac vein stent implantation were selected from the 970th Hospital of PLA from January 2017 to December 2020 and were given anticoagulant therapy for 1 year after surgery. They were randomly divided into 59 cases in the rivaroxaban group and 73 cases in the warfarin group. The primary safe outcome was the incidence of hemorrhage within 1 year, the primary effective outcome was the rate of primary stent patency, and the secondary outcome included Villalta score, symptom recurrence rate, and ulcer healing rate.Results:There was no significant difference in baseline data between the two groups. The mean follow-up time was (38.00 ± 5.69) months. There was no significant difference in the incidence of major bleeding events (0% vs 1.4%, P = 0.367) and minor bleeding events (6.8% vs 9.6%, P = 0.561) between the Rivaroxaban and warfarin groups within 1 year. The 1-year patency rate (88.1% vs 72.6%, P = 0.028) and 2-year patency rate (81.3% vs 61.7%, P = 0.014) in rivaroxaban group were higher than those in warfarin group. The Villalta score (4.67 ± 1.43 vs 7.86 ± 2.51, P = 0.001), symptom recurrence rate (15.3% vs 38.3%, P = 0.003) and ulcer healing rate (89.5% vs 61.5%, P = 0.036) in rivaroxaban group were all better than those in warfarin group.Conclusions:For PTS patients undergone iliac vein stenting, rivaroxaban was similar to warfarin in safety and superior to warfarin in efficacy, showing higher primary patency rate and better clinical symptom improvement rate.
Objective:To explore a novel technique for stone extraction of bile duct stones after choledochoenterostomy.Methods:Using PTCD to control the biliary infection. The site of percutaneous jejunum puncture was determined by CT. The jejunum was punctured in the dilated state, and 8.5F catheter was placed and fixed. After 1 month, take out the bile duct stones with the stone basket through this sinus under fluoroscopy. After removing the bile duct stones, give 14F drainage tube to support the choledochojejunostomy for 1 year.Results:Removal of bile duct stones were performed in 18 cases by the way of percutaneous jejunal puncture. 17 cases were removed completely by one or more fluoroscopy, and 1 case was transferred to the jejunal sinus choledochoscopy after three times of incomplete stone extraction, without obvious complications such as hemorrhage, intestinal fistula, biliary fistula and abdominal infection. During the follow-up period, no stone was found, and the biliary and intestinal anastomosis was unobstructed..Conclusions:Percutaneous jejunal puncture for removal of bile duct stones is a feasible,safe and effective method for the treatment of bile duct stones after choledochoenterostomy.
脾错构瘤（splenic hamartoma，SH）是脾正常成分的比例发生混乱的良性肿瘤样病变。临床表现无特异性，多在体检或手术中偶然发现。尸检回顾显示其发生率为0.024%~0.13%[1]。脾错构瘤可发生于任何年龄，无性别差异[2]。瘤体增殖常小于3 cm，偶可见巨大病灶压迫临近器官引起腹部隐痛或不适症状，但一般不合并脾功能亢进和继发贫血[3]。由于临床表现及影像学缺乏特异性，脾错构瘤常容易误诊为脾血管瘤或其他良性肿瘤，病理学诊断脾脏错构瘤没有困难。脾脏恶性肿瘤及症状性良性肿瘤主流治疗方式为传统外科手术行脾完全切除[4]。存在创伤大、手术风险高、术后门静脉系统血栓发生率高等缺点[5]。目前国内外尚未见脾错构瘤经动脉途径栓塞治疗的公开报道。本病例采取超声引导下穿刺活检的方式获取病理标本，损伤小，穿刺术后行经动脉途径栓塞治疗，可降低活检术后的出血风险，同时达到阻断瘤体血供及局部药物治疗的目的。相对传统外科手术更安全，为年轻患者的治疗提供了新的思路。
Aortic dissection is one of the life-threatening cardiovascular emergencies, and its complex hemodynamic features have important implications for disease initiation and progression. After the computational fluid dynamics (CFD) was came out, it has been widely used to analyze human vascular hemodynamics. The inadequacy of existing TBAD studies based on CFD lie in the fact that the accuracy of results and the interpretation of clinical significance need to be improved. The combination of 4D flow MRI and CFD to solve these problems provides new thoughts. We provide a review on the progress of 4D flow MRI in CFD studies on the hemodynamic applications of TBAD.
Objective:This study uses Ti3C2 nanosheets loading doxorubicin (DOX) and CaCO3 to prepare a novel nano-composite Ti3C2/DOX@CaCO3 for drug delivery, aiming to increase the accumulation of drugs at the site of tumors, enhance the therapeutic effect of breast cancer combined with photothermal therapy, and reduce the toxicity of DOX.Methods:Ti3C2/DOX@CaCO3 was prepared from Ti3C2, cyclohexane, Triton X-100, 1-hexanol, calcium chloride solution and sodium carbonate solution. CCK8 assay was used to detect the effect of Ti3C2/DOX@CaCO3 combined with photothermal therapy on the proliferative ability of MDA-MB-231 cells. Subsequently, we established MDA-MB-231 tumor burden animal model. The toxicity of Ti3C2/DOX@CaCO3 combined with photothermal therapy and the inhibitory effect of tumor growth in MDA-MB-231 breast cancer were evaluated by animal experiments.Results:Zeta potential showed Ti3C2 loading DOX successfully.The CCK8 experiment confirmed that Ti3C2/DOX@CaCO3 combined with photothermal therapy could better inhibit the proliferation of MDA-MB-231 cells compared with the DOX group. In vivo experiments, the results confirmed that Ti3C2/DOX@CaCO3 nanocomposites combined with photothermal therapy could more effectively inhibit the growth of subcutaneous tumors in mice. Moreover, there were no other obvious morphological changes or pathological damage in other organs.Conclusions:This study has confirmed that the Ti3C2 two-dimensional nanosheets loading chemotherapeutic drugs DOX and Ca2+, combined with photothermal therapy can effectively inhibit the growth of breast cancer cells, and reduce the toxicity of DOX. This also provides a new synergistic strategy for breast cancer treatment, which has a promising clinical application prospects.
完全植入式静脉输液港（totally implantable venous access ports，TIVAP）是临床常用的用于化疗的深静脉置管装置，具有留置时间长、感染机率低、美观度高、维护周期间隔长、并发症少等优点。TIVAP植入过程中要求导管尖端位于上腔静脉下1/3与右心房交界处。永存左上腔静脉（persistent left superior vena cava，PLSVC）是最为常见的一种体静脉回流畸形，发生率占所有先天性心脏病患者的3.0%~10.0%[1]。本科室自2018年9月至2021年12月共行TIVAP植入术1 037例，仅出现1例PLSVC，术后静脉港正常使用，现将病例要点报告如下。
Interventional medicine is the third clinical discipline after internal medicine and surgery, and is one of the core supporting technologies for China's implementation of the "Healthy China 2030 Plan" and the "Establishing Five Medical Centers in Secondary or Higher Hospitals" by the National Health Commission. However, most medical staff and social groups in China have poor understanding of interventional medicine. The article is based on national strategic policies, combined with the disciplinary characteristics of interventional medicine, summarizes the experience of over 20 years of interventional medicine science popularization in our undergraduate department, and proposes for the first time the "New Era Interventional Medicine Science Popularization System", which includes one center, two categories, three populations, four fields, five levels, and six means, in order to further promote the development of interventional medicine science popularization in China.
