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.
