Reduced myocardial strain of interventricular septum among male amateur marathon runners: a cardiac magnetic resonance study

OBJECTIVES

To analyze the long-term effect of multiple marathons on cardiac structure and function in amateur marathon runners compared with healthy controls.

DESIGN

Cross-sectional study using male amateur marathon runners (n = 32) and age-matched cohort of male healthy controls (n = 12).

METHODS

A total of 32 male amateur marathon runners (age 44 ± 7 years) and 12 male healthy controls (age 42 ± 8 years) underwent cardiac magnetic resonance (CMR). The relevant parameters of cardiac structure and function were studied employing feature-tracking strain analysis.

RESULTS

Amateur marathon runners showed lower heart rates, body mass index and body surface area. The left ventricular (LV) mass index, LV end-diastolic volume index and right ventricular end-systolic volume index were significantly higher in amateur marathon runners compared with healthy controls. Furthermore, walls of interventricular septum (IVS) in amateur marathon runners were thicker than healthy controls. There was no significant difference between two groups in the global myocardial strain (MS) in LV. However, the segmental radial and circumferential strains of the LV were lower in amateur marathon runners compared to healthy controls, specifically in the 8th and 9th segments. Finally, we also found as the total running intensity increased, so did global longitudinal strain.

CONCLUSIONS

We reported higher wall thickness and lower regional radial and circumferential strain in the IVS region in amateur marathon runners, suggesting that prolonged and high-intensity exercise may cause cardiac remodeling. Further studies are needed to investigate whether this is an adaptive or maladaptive change in amateur marathon runners.

[One case of severe exogenous lipoid pneumonia complicated with lung abscess caused by diesel inhalation]

Exogenous lipoid pneumonia is an inflammatory response to the lungs caused by inhaled lipid substances, which is prone to secondary bacterial infection, resulting in the formation of local abscesses, which can be life-threatening in severe cases. This paper reports a case of a 55-year-old patient with diesel aspiration, secondary to Klebsiella pneumoniae (ESBL positive) and Candida glabrata infection resulting in lung abscess formation. He was treated with a variety of antibacterial drugs for anti-infection, non-invasive ventilator ventilation, bronchoalveolar lavage, glucocorticoids, phlegm and other medical treatments. Finally, he underwent middle lobectomy for improvement and was discharged from the hospital, and he recovered well with regular follow-up.

[A case of corrosive digestive tract and lung injury caused by ingestion of pipeline dredging agent]

Ingestion of corrosive substances can severely burn the upper digestive tract leading to bleeding or perforation, and may even be life-threatening. Less commonly, damage to the trachea and bronchi is involved. In this paper, a case of corrosive digestive tract injury and lung injury after oral administration of pipeline dredging agent (the main components are hydroxide, sodium carbonate, sodium hypochlorite, etc.) was analyzed. After active rescue treatment, the patient died of massive hemoptysis. It is suggested that serious complications may occur after ingestion of corrosive substances. Timely diagnosis and reasonable medical management are needed to improve the level of recognition and treatment of such diseases.

Temperature-perturbed two-dimensional generalized correlation characteristic slice spectra combined with multivariate method to identify adulterated milk

In order to improve the discrimination accuracy of adulterated milk, a detection method was proposed based on temperature-perturbed generalized two-dimensional (2D) correlation characteristic slice spectra. A total of 240 samples were prepared including three brands of 40 pure milk and 40 urea-tainted milk, respectively. The infrared attenuated total reflection spectra of each sample were collected at different temperatures. Synchronous 2D infrared correlation spectrum of each sample was calculated under the external perturbation of temperature. The characteristic slice spectra of each sample were extracted from synchronous 2D correlation spectrum at characteristic peaks of milk and adulterants. N-way partial least squares discriminant analysis (NPLS-DA) models of single brand and the fusion of three brands of adulterated milk were established based on 2D correlation characteristics slice spectra. For comparison, the discrimination models were established using synchronous 2D correlation spectra and one-dimensional (1D) infrared spectra at room temperature, respectively. For the three brand fusion models, the discrimination accuracies of unknown samples were 100%, 98.8% and 82.7% using 2D correlation characteristic slice spectra, 2D correlation spectra, and 1D spectra, respectively. The results showed that the proposed method not only compressed the data, but also effectively extracted the characteristic information, and improved the accuracy of discrimination.

Identification of adulterated milk based on auto-correlation spectra

A qualitative analysis of melamine-adulterated milk was proposed based on two-trace two-dimensional (2T2D) auto-correlation spectra. The concentration of melamine was used as external perturbation, and 40 adulterated samples of each brand with different concentrations of melamine (0.01 g/L to 1 g/L) were configured. Four brands of milk were used to configure experimental samples, including Guangming brand, Mengniu brand, Sanyuan brand and Wandashan brand. Spectroscopic data of pure milk and melamine-adulterated milk were measured by infrared (IR) (80-4000 cm^-1) spectrophotometer. 2T2D auto-correlation spectral technology combined with least squares support vector machine (LS-SVM) method was used for qualitative analysis. The two strongest auto-correlation peaks in the auto-correlation spectra were selected for modeling. For Guangming brand, the intensities of auto-correlation at two wave numbers 2898 cm^-1 and 2972 cm^-1 were selected as independent variables. For Mengniu brand, the intensities of auto-correlation at two wave numbers 2852 cm^-1 and 2920 cm^-1 were selected. For Sanyuan brand, the intensities of auto-correlation at two wave numbers 2900 cm^-1 and 2974 cm^-1 were selected. For Wandashan brand, the intensities of auto-correlation at two wave numbers 2900 cm^-1 and 2974 cm^-1 were selected. For four brands fused together, the intensities of auto-correlation at two wave numbers 2900 cm^-1 and 2974 cm^-1 were selected. For each brand, the accuracy of qualitative analysis was 100 %. For four brands fused together, the accuracy of qualitative analysis was 99.05 %. In this way, it greatly reduced the amount of data to be processed. This study showed that 2T2D auto-correlation spectral technology combined with LS-SVM method was perfect for the discrimination of melamine-adulterated milk.

Discrimination of adulterated milk using temperature-perturbed two-dimensional infrared correlation spectroscopy and multivariate analysis

The discrimination method for adulterated milk is proposed based on temperature-perturbed two-dimensional (2D) infrared correlation spectroscopy and N-way partial least squares discriminant analysis (NPLS-DA). Two brands of pure and adulterated milk samples were prepared. The mid-infrared spectra of all samples were obtained from 30 ℃ to 55 ℃ with an interval of 5 ℃. Under the perturbation of temperature, synchronous 2D correlation spectra were calculated to build discrimination models of pure milk and adulterated milk. In comparison, the NPLS-DA models were built based on three-dimensional (3D) stacked map (sample × temperature × wavenumber variable). For the NPLS-DA models of two brands of milk, the discrimination accuracy of unknown samples in the prediction set is 100% using temperature-perturbed 2D infrared correlation spectra, versus 77.8% using conventional 3D stacked map. The proposed method can be used as an alternative way for classifying pure and adulterated milk.

Real-world study of hepatic artery infusion chemotherapy combined with anti-PD-1 immunotherapy and tyrosine kinase inhibitors for advanced hepatocellular carcinoma

Aim: We investigated the efficacy and safety of hepatic artery infusion chemotherapy (HAIC) combined with anti-PD-1 immunotherapy and tyrosine kinase inhibitors (TKIs) for advanced hepatocellular carcinoma (HCC). Method: This retrospective study included HCC patients treated with HAIC, TKIs and anti-PD-1 antibodies between May 2019 and November 2020 in our hospital. Primary end points were progression-free survival and safety. Results: Twenty-seven advanced HCC patients were analyzed. The median follow-up was 12.9 months (range: 4.0-24.0 months) and the median progression-free survival was 10.6 months. The objective response rate and disease control rate were 63.0 and 92.6%, respectively. No treatment-related deaths occurred. Conclusion: In patients with advanced HCC, treatment with HAIC, anti-PD-1 antibodies and oral TKIs was effective and safe.

Hepatic artery injection of 131I-metuximab combined with transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: a prospective non-randomized, multicenter clinical trial

This prospective non-randomized, multicenter clinical trial was performed to investigate efficacy and safety of ¹³¹I-labeled metuximab in adjuvant treatment of unresectable hepatocellular carcinoma. Methods: Patients were assigned to treatment with transcatheter arterial chemoembolization (TACE) combined with ¹³¹I-metuximab or TACE alone. The primary outcome was overall tumor recurrence. The secondary outcomes were safety and overall survival. Results: The median time to tumor recurrence was 6 months in the TACE+¹³¹I-metuximab group (n = 160) and 3 months in the TACE group (n = 160) (hazard ratio, 0.55; 95% confidence interval, 0.43 to 0.70; P < 0.001). The median overall survival was 28 months in the TACE+¹³¹I-metuximab group and 19 months in the TACE group (hazard ratio, 0.62; 95% confidence interval, 0.47 to 0.82; P = 0.001). Conclusion: TACE+¹³¹I-metuximab showed a greater anti-recurrence benefit, significantly improved the 5-year survival of patients with advanced hepatocellular carcinoma, and was well tolerated by patients.

[Assessment of setup errors of IGRT combined with a six degrees of freedom bed for patients with primary rectal cancer]

Objective: To investigate the effect of six degree of freedom (6-DOF) bed combined with cone beam computed tomography (CBCT) in the on-line correction of setup errors in patients with primary rectal cancer. Methods: The clinicopathological data of 17 patients with primary rectal cancer in Department of Radiotherapy, Third Hospital of Peking University from July 2013 to January 2014 were collected. There were 14 males and 3 females, a median age of 65 years. The difference of CBCT and 6-DOF bed combined with CBCT online correction of patients with positioning error were retrospectively analyzed. Results: Before position correction, the first CBCT verification of setup errors in the three translation directions including X (left and right), Y (in and out) and Z (up and down) directions were (0.06±0.25) cm, (0.13±0.40) cm and (-0.28±0.31) cm, respectively. The setup errors of RX (rotation pitch), RY(rolling) and RZ (left and right rotation) directions were (0.62±1.15)°, (-0.19±0.99)°, and (-0.34 ± 0.84)°, respectively . After correction of IGRT combined with six freedom of bed, the setup errors of translation X, Y and Z were (0.01±0.09) cm, (-0.01±0.05) cm and (-0.03±0.08) cm, respectively, and the setup errors of rotation RX, RY and RZ directions were (-0.16±0.40)°, (0.36±0.31)°and (-0.01±0.25)°, respectively. There were significant differences in translation direction (X, Y and Z direction) and rotation direction (Rx, RY and RZ) before and after 6-DOF bed combined with CBCT correction (all P<0.05). In the translation direction, the higher frequency range of Z-direction error value was 0.20-0.79 cm. In the rotation direction, the frequency range of error in Rx direction was 0.20°-2.99°. There was no significant difference between bone mode and gray scale model registration (P>0.05). With the progress of radiotherapy, the setup errors of X, Z, Rx, RY and RZ directions increased except Y direction. Conclusions: In radiotherapy, six freedom bed combined with CBCT is helpful to correct the setup errors of patients with primary rectal cancer. Six freedom bed may be used to correct the setup errors of patients with primary rectal cancer online. Image-guided radiation therapy (IGRT) is recommended for bone pattern registration in patients with rectal cancer.

[Analysis of EGFR mutation and clinical features of lung cancer in Yunnan]

Objective: To analyze the EGFR mutation profile of lung cancer patients in Yunnan, and to provide evidence for clinical personalized treatment. Methods: Demographic and clinical data of 2 967 lung cancer patients undergoing EGFR identification were collected and analyzed from January 2014 to August 2019 in Yunnan Cancer Hospital. Results: The proportion of EGFR mutation in 2 967 patients with lung cancer was 46.2%. Univariate analysis showed that the proportion of EGFR mutation in women was higher than that in men (P<0.001) and displayed a downward trend with age (P=0.03). The mutation rate of ethnic minorities was higher than Han (P=0.012). Mutation rate in patients without smoking history was higher than those with smoking history (P<0.001), and patients without drinking history was higher than patients with drinking history (P<0.001). Mutation rate in patients without family history of lung cancer was higher than those with family history (P=0.008). The mutation rate of adenocarcinoma was higher than other pathological types (P<0.001). The mutation rate was different among stages, and it was higher in early patients than that in advanced patients (P<0.001). The mutation rate of tissue specimens was higher than those of cytology and peripheral blood samples (P<0.001). The mutation rate of Xuanwei area was lower than that in non-Xuanwei area (P<0.001). Multivariate analysis showed that gender (P<0.001), age (P=0.036), smoking history (P<0.001), pathological type (P<0.001), specimen type (P<0.001), and whether or not Xuanwei area (P<0.001) were the independent factors of EGFR mutation.The EGFR mutation was more common in female, non-smokers, adenocarcinoma, non-Xuanwei area, tissue specimen and young lung cancer patients.The mutation types of EGFR in 1 370 cases mainly included 19-Del and L858R. The predominant mutation of EGFR in Xuanwei area was L858R, while in non-Xuanwei area was 19-Del.The mutation rates of G719X, G719X+ L861Q, G719X+ S768I, and S768I in Xuanwei were higher while the mutation rates of 19-Del, L858R, and 20-ins were lower than non-Xuanwei area (P<0.05). The 19-Del mutation rate of ethnic minorities is higher than that of Han (P<0.001). The combined mutation rate of G719X, L861Q in Han was higher than that of ethnic minorities (P=0.005). Conclusions: The EGFR mutation rate in lung cancer patients in Yunnan is similar to Asian and Chinese, and higher in female, non-smokers, adenocarcinomas, young and non-Xuanwei area patients. The most common types of EGFR mutation in Yunnan are 19-Del and L858R. The predominant mutation of EGFR in Xuanwei area is L858R, while in non-Xuanwei area is 19-Del. The mutation rates of G719X, G719X+ L861Q, G719X+ S768I and S768I are higher in Xuanwei patients than those in non-Xuanwei patients. The combined mutation rate of G719X and L861Q in Han nationality is higher than that of ethnic minorities.

Transarterial chemoembolization with hepatic arterial infusion chemotherapy plus S-1 for hepatocellular carcinoma

BACKGROUND

Transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) have shown promising local benefits for advanced hepatocellular carcinoma (HCC). S-1, a composite preparation of a 5-fluorouracil prodrug, has proven to be a convenient oral chemotherapeutic agent with definite efficacy against advanced HCC.

AIM

To evaluate the efficacy and safety of TACE followed by HAIC with or without oral S-1 for treating advanced HCC.

METHODS

In this single-center, open-label, prospective, randomized controlled trial, 117 participants with advanced HCC were randomized to receive TACE followed by oxaliplatin-based HAIC either with (TACE/HAIC + S-1, n = 56) or without (TACE/HAIC, n = 61) oral S-1 between December 2013 and September 2017. Two participants were excluded from final analysis for withdrawing consent. The primary endpoint was progression-free survival (PFS) and secondary endpoints included overall survival (OS), objective response rate, disease control rate and safety.

RESULTS

In total, 115 participants (100 males and 15 females; mean age, 57.7 years ± 11.9) were analyzed. The median PFS and OS were 5.0 mo (0.4–58.6 mo) (95% confidence interval (CI): 3.82 to 6.18) vs 4.4 mo (1.1–54.4 mo) (95%CI: 2.54 to 6.26; P = 0.585) and 8.4 mo (0.4–58.6 mo) (95%CI: 6.88 to 9.92) vs 8.3 mo (1.4–54.4 m) (95%CI: 5.71 to 10.96; P = 0.985) in the TACE/HAIC + S-1 and TACE/HAIC groups, respectively. The objective response rate and disease control rate were 30.9% vs 18.4% and 72.7% vs 56.7% in the TACE/HAIC + S-1 and TACE/HAIC groups, respectively. Grade 3/4 adverse events had a similar frequency in both treatment groups.

CONCLUSION

No improvements in tumor response rates, PFS or OS were observed with the addition of S-1 to TACE/HAIC in advanced HCC. Both treatment regimens had a similar safety profile.

Sorafenib combined with embolization plus hepatic arterial infusion chemotherapy for inoperable hepatocellular carcinoma

BACKGROUND

There is little evidence of combining sorafenib with hepatic arterial infusion chemotherapy (HAIC) after transarterial chemoembolization (TACE) for intermediate and advanced hepatocellular carcinoma (HCC). It is important to identify that patients with intermediate and advanced HCC are most likely to benefit from this combination therapy.

AIM

To investigate the safety and clinical outcomes of sorafenib combined with HAIC with folinic acid, 5-fluorouracil (5-FU), and oxaliplatin (FOLFOX) after TACE for intermediate and advanced HCC.

METHODS

This prospective phase II study enrolled patients with intermediate and advanced HCC who underwent treatment with sorafenib combined with TACE-HAIC. All patients initially received the standard 400 mg dose of sorafenib twice daily before TACE-HAIC. Participants at our institute with intermediate and advanced HCC underwent routine TACE. Then, the catheter used for embolization was kept in place in the hepatic artery, and oxaliplatin was intra-arterially administered for 6 h, followed by 5-FU for 18 h, and folinic acid was intravenously administered for 2 h. The primary endpoints were safety, as evaluated by the Common Terminology and Criteria for Adverse Events version 4.0, and 12-mo progression-free survival (PFS), as analyzed by the Kaplan-Meier method. As secondary endpoints, the objective response rate (ORR) was evaluated by the modified Response Evaluation Criteria for Solid Tumors, and survival time [overall survival (OS)] was analyzed by the Kaplan-Meier method.

RESULTS

Sixty-six participants at our institute with intermediate and advanced HCC were enrolled in this prospective study (mean age, 53.3 ± 11.7 years). Approximately 56.1% of participants had Barcelona Clinic Liver Cancer (BCLC) stage C disease, and 43.9% had BCLC stage B disease. The ORR was 42.4%. The disease control rate was 87.9%. The grade 3-4 toxicities consisted of thrombocytopenia (4.5%), neutropenia (3.0%), and elevated aspartate aminotransferase (12.2%). Hand-foot skin reaction was also observed (40.9%). The median PFS was 13.1 mo (13.5 mo in the BCLC stage B participants and 9.4 mo in the BCLC stage C participants). The 6-mo, 12-mo, and 24-mo PFS rates were 75.0%, 54.7%, and 30.0%, respectively. The median OS was 21.8 mo.

CONCLUSION

Sorafenib combined with HAIC (FOLFOX) after TACE may be a feasible treatment choice for intermediate and advanced HCC because this treatment met the prespecified endpoint of a 6-mo PFS rate exceeding 50% and had good patient tolerance. Prospective randomized controlled trials are needed to confirm the effect of this combination therapy.

Effect of primary tumor side on survival outcomes in metastatic colorectal cancer patients after hepatic arterial infusion chemotherapy

AIM

To analyze the survival data between patients diagnosed with right-sided primary (RSP) tumors and patients diagnosed with left-sided primary (LSP) tumors after hepatic arterial infusion chemotherapy (HAIC) at our center.

METHODS

A retrospective analysis of pretreated metastatic colorectal cancer patients who received HAIC from May 2006 to August 2015 was conducted. A Cox proportional hazard regression analysis was used to assess the long-term survival outcomes. The mean and median age of patients was 61 years (range 27-85 years). There were 115 males and 53 females in our study.

RESULTS

One hundred sixty-eight patients were enrolled in this study. The overall response rate was 28.9% in LSP patients and 27.3% in RSP patients. The disease control rate was 76.3% in LSP patients and 69.7% in RSP patients. The median overall survival in response to HAIC was 16.3 mo in the LSP arm and 9.3 mo in the RSP arm (P = 0.164). The median progression-free survival was 5.7 mo in the LSP arm and 4.2 mo in the RSP arm (P = 0.851).

CONCLUSION

There was no significant difference in survival between LSP patients and RSP patients after HAIC. Further prospective studies are needed to confirm these findings.

[Dosimetric analysis of volumetric modulated arc therapy and intensity modulated radiotherapy for patients undergone breast-conserving operation]

OBJECTIVE

To compare the dosimetric differences between volumetric modulated arc therapy and intensity modulated radiotherapy for breast cancer patients after breast-conserving surgery.

METHODS

Ten patients who received radiotherapy after breast-conserving surgery were selected. Eclipse planning system was used to design volumetric rotating intensity-modulated (2F-RapidArc) and two field intensity-modulated radiation therapy (2F-IMRT) planning for each patient. 2F-RapidArc plans were made using two partial arcs with gantry rotation from 287°-293° to 152°-162°, and 0° to 90 ° was avoidance sector. The gantry angle of 2F-IMRT were 301°-311° and 125°-135°. The prescription dose was 46 Gy/23 fractions. All plans required 95% of the target volume receiving the prescription dose. The dose distribution of the target, organs at risk, machine unit (MU) and treatment time were compared.

RESULTS

2F-RapidArc and 2F-IMRT plans' uniformity index was 1.12±0.02 and 1.11±0.03 (P=0.282), respectively; conformal index was 0.80±0.03 and 0.65±0.04 (P<0.001), respectively. V110 of plan target volume was 20.98%±14.47% and 10.43%±10.49% (P=0.030), respectively. Compared with the 2F-IMRT, 2F-RapidArc plans had a higher dosimetric parameters for left lung: V5 (48.06%±17.32% vs. 24.23%±6.56%,P=0.001), V10 (28.89±9.28 vs.17.07±4.78%,P=0.004), Dmean [(9.70±2.14) Gy vs. (6.86±1.77) Gy, P=0.002], increased the double lung: V5 (22.85%±7.55% vs. 11.01%± 2.95%,P=0.001), V10 (13.16%±4.33% vs. 7.76%± 2.16%, P=0.006), Dmean [(4.66±0.95) Gy vs. (3.17±0.82) Gy, P=0.001], reduced the left lung: V40 (3.58%±1.46% vs. 6.19%±3.04%, P=0.006), reduced the double lung: V40 (1.61%±0.64% vs. 2.81%± 1.39%,P=0.005), increased cardiac: V5 (39.3%±17.19% vs. 8.79%±4.24%, P<0.001), V10 (21.31%±13.8% vs. 5.73%±3.42%, P=0.002), V20 (7.80%±6.08% vs. 4.05%±2.85%,P=0.018), Dmean [(0.64±0.25) Gy vs. (0.29±1.39) Gy,P<0.001],reduced the heart: V40(0.50%±0.40% vs. 1.86%±1.94%,P=0.037),increased the contralateral breast Dmean [(1.63±1.26) Gy vs. (0.09±0.05) Gy, P=0.004]. Compared with 2F-IMRTplan, 2F-RapidArc increased the treatment time [(132.9±7.2) s vs. (140.3±11.6) s, P=0.030]. Both the machine units were almost the same [(467.0±30.4) MU vs. (494.7±44.9) MU, P=0.094].

CONCLUSION

Both 2F-RapidArc and 2F-IMRT plans could reach the clinical requirements. 2F-RapidArc had a better conformal index, reduced the high dose area, but increased the low dose regions of the lung, heart, body area, and increased the average dose of the contralateral breast. The treatment time of 2F-RapidArc was longer than that of 2F-IMRT, and the MU of 2F-RapidArc and 2F-IMRT plans were almost the same.

Exogenous NO depletes Cd-induced toxicity by eliminating oxidative damage, re-establishing ATPase activity, and maintaining stress-related hormone equilibrium in white clover plants

Various nitric oxide (NO) regulators [including the NO donor sodium nitroprusside (SNP), the NO scavenger 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (cPTIO), the NO-synthase inhibitor N (G)-nitro-L-Arg-methyl ester (L-NAME), and the SNP analogues sodium nitrite/nitrate and sodium ferrocyanide] were investigated to elucidate the role of NO in white clover (Trifolium repens L.) plants after long-term (5 days) exposure to cadmium (Cd). A dose of 100 μM Cd stress significantly restrained plant growth and decreased the concentrations of chlorophyll and NO in vivo, whereas it disrupted the balance of stress-related hormones and enhanced the accumulation of Cd, thereby inducing reactive oxygen species (ROS) burst. However, the inhibition of plant growth was relieved by 50 μM SNP through its stimulation of ROS-scavenging compounds (ascorbic acid, ascorbate peroxidase, catalase, glutathione reductase, non-protein thiol, superoxide dismutase, and total glutathione), regulation of H(+)-ATPase activity of proton pumps, and increasing jasmonic acid and proline but decreasing ethylene in plant tissues. Even so, the alleviating effect of SNP on plant growth was counteracted by cPTIO and L-NAME and was not observed with SNP analogues, suggesting that the protective roles of SNP are related to the induction of NO. These results suggest that NO may improve the Cd tolerance of white clover plants by eliminating oxidative damage, re-establishing ATPase activity, and maintaining hormone equilibrium. Improving our understanding of the role of NO in white clover plants is key to expanding the plantations to various regions and the recovery of pasture species in the future.

Chemoembolization alone vs combined chemoembolization and hepatic arterial infusion chemotherapy in inoperable hepatocellular carcinoma patients

AIM: To compare the efficacy and safety of chemoembolization alone or chemoembolization combined with hepatic arterial infusion chemotherapy (HAIC), including oxaliplatin (OXA), 5-fluorouracil (5-FU) and folinic acid (CF), in inoperable hepatocellular carcinoma (HCC) without distant metastasis.

METHODS: Eighty-four inoperable HCC patients were enrolled. Thirty-nine patients underwent chemoembolization alone, and the other 45 patients underwent chemoembolization + HAIC (OXA/5-FU/CF) treatment non-randomly. The progression free survival (PFS), objective response rate (ORR), disease control rate (DCR) and adverse reactions were compared between the two groups.

RESULTS: A significant difference in the ORR was observed between the chemoembolization alone and chemoembolization + HAIC groups. There was no statistically significant difference in DCR between the two groups. The median PFS (mPFS) showed a significant difference between the two groups. For patients with BCLC stage A/B disease, with or without vessel invasion, the chemoembolization + HAIC group showed better mPFS when compared to chemoembolization alone, but no significant difference was found in patients with BCLC stage C disease. The parameter of pain (grade III-IV) in the chemoembolization + HAIC group was increased statistically.

CONCLUSION: Chemoembolization combined with HAIC with OXA/5-FU/CF may be safe and more effective than chemoembolization alone for inoperable HCC patients without distant metastasis.

Clinical value of ultrasound-guided percutaneous biopsy of pulmonary lesions

The purpose of this study was to evaluate the applica-bility of ultrasound-guided percutaneous biopsy for the diagnosis and differentiation of various pulmonary lesions in a Chinese population. A total of 338 pulmonary lesions were biopsied with 18-gauge cutting needles, guided by ultrasound, and sent for histopathological analy-sis. The ultrasonographic characteristics of these lesions, procedure complications, and histopathological diagnoses were analyzed. Suffi-cient specimen for histopathologic analysis was obtained in 95.64% (351/367), and mild complications occurred in 2.72% (10/367) of the patients. Accurate diagnosis was obtained in 94.03% (315/335) of the patients; 16 were lost to follow-up. Using the combination of shape and echogenicity to distinguish benign vs malignant lesions, diagnos-tic sensitivity and specificity were 57.39 and 95.65%, respectively. No significant difference was found between malignant and benign lesions in blood flow signals. Ultrasound-guided core biopsy is valuable for the diagnosis, management, and prognosis of unknown pulmonary lesions. Shape and echogenicity on ultrasonography correlate well with histo-pathology and provide useful information for distinguishing between benign and malignant lesions. On the contrary, color Doppler is of little value for this purpose.

FAM83D activates the MEK/ERK signaling pathway and promotes cell proliferation in hepatocellular carcinoma

Publicly available microarray data suggests that the expression of FAM83D (Family with sequence similarity 83, member D) is elevated in a wide variety of tumor types, including hepatocellular carcinoma (HCC). However, its role in the pathogenesis of HCC has not been elucidated. Here, we showed that FAM83D was frequently up-regulated in HCC samples. Forced FAM83D expression in HCC cell lines significantly promoted their proliferation and colony formation while FAM83D knockdown resulted in the opposite effects. Mechanistic analyses indicated that FAM83D was able to activate the MEK/ERK signaling pathway and promote the entry into S phase of cell cycle progression. Taken together, these results demonstrate that FAM83D is a novel oncogene in HCC development and may constitute a potential therapeutic target in HCC.

Technical note: Selection of suitable reference genes for studying gene expression in milk somatic cell of yak (Bos grunniens) during the lactation cycle

Quantitative real-time PCR is the most sensitive technique for gene expression analysis. Data normalization is essential to correct for potential errors incurred in all steps from RNA isolation to PCR amplification. The commonly accepted approach for normalization is the use of reference gene. Until now, no suitable reference genes have been available for data normalization of gene expression in milk somatic cells of lactating yaks across lactation. In the present study, we evaluated the transcriptional stability of 10 candidate reference genes in milk somatic cells of lactating yak, including ACTB, B2M, GAPDH, GTP, MRPL39, PPP1R11, RPS9, RPS15, UXT, and RN18S1. Four genes, RPS9, PPP1R11, UXT, and MRPL39, were identified as being the most stable genes in milk somatic cells of lactating yak. Using the combination of RPS9, PPP1R11, UXT, and MRPL39 as reference genes, we further assessed the relative expression of 4 genes of interest in milk somatic cells of yak across lactation, including ELF5, ABCG2, SREBF2, and DGAT1. Compared with expression in colostrum, the overall transcription levels of ELF5, ABCG2, and SREBF2 in milk were found to be significantly upregulated in early, peak, and late lactation, and significantly downregulated thereafter, before the dry period. A similar pattern was observed in the relative expression of DGAT1, but no significant difference was revealed in its expression in milk from late lactation compared with colostrum. Based on these results, we suggest that the geometric mean of RPS9, PPP1R11, UXT, and MRPL39 can be used for normalization of real-time PCR data in milk somatic cells of lactating yak, if similar experiments are performed.

[Identification of adulterated milk based on two-dimensional correlation near-infrared spectra parameterization and BP neural network]

Discriminant models of adulterated milk and pure milk were established using BP neural network combined with two-dimensional (2D) correlation near-infrared spectra parameterization. Forty pure milk samples, 40 adulterated milk samples with urea (1-20 g x L(-1)) and 40 adulterated milk samples with melamine (0.01-3 g x L(-1)) were prepared respectively. Based on the characteristics of 2D correlation near-infrared spectra of pure milk and adulterated milk, 5 apparent statistic parameters were calculated based on the parameterization theory. Using 5 characteristic parameters, discriminant models of urea adulterated milk, melamine adulterated milk and two types of adulterated milk were built by BP neural network The prediction rate of unknown samples were 95%, 100% and 96.7%, respectively. The results show that this method can extract effectively feature information of adulterant, reduce the input dimensions of BP neural network, and better realize qualitative analysis of adulterant in milk.

Efficacy and safety of percutaneous microwave coagulation therapy followed by 125I seed brachytherapy for VX2 hepatic tumors in a rabbit model

The aim of this study was to evaluate the efficacy and safety of percutaneous microwave coagulation therapy (PMCT) followed by ¹²⁵I seed brachytherapy for VX2 liver cancer in rabbits. Eighty New Zealand rabbits were injected with suspensions of VX2 tumor cells to create an animal model. The rabbits were randomly divided into 4 groups (n=20); the control, PMCT, ¹²⁵I seed brachytherapy and combination groups. Group A was treated with PMCT at 40 W for 120 sec, group B was treated with ¹²⁵I seed brachytherapy and group C was treated with PMCT followed by ¹²⁵I seed brachytherapy. Group D were not treated and served as the control group. At 21 days after treatment, the rabbits were sacrificed for pathological assessment. The complete tumor necrosis rate was 19 out of 20 tumors (95%) in group C, 6 (30%) in group A, 0 (0%) in group B and 0 (0%) in the control group. The complete tumor necrosis rate was observed to be significantly different between groups C and A, and between groups C and B (P<0.01). No intraheptic metastasis occurred in group C, compared with an incidence of 7 (35%) in group A, 2 (10%) in group B and 20 (100%) in the control group. Between groups C and A, and between groups C and D, the intraheptic metastasis rate was statistically significant (P<0.01). PMCT followed by ¹²⁵I seed brachytherapy increased the rate of carcinoma necrosis and decreased carcinoma metastasis in the VX2 rabbit model. This combined treatment is a safe, effective and minimally invasive therapeutic option for liver cancer.

[Application of kernel orthogonal projection to latent structure discriminant analysis in the discrimination of adulterated milk]

Based on the method of kernet Orthogonal Projection to Latent Structure Discriminant Analysis, discrimination models for adulterated milk were established in the present paper. Forty adulterated milk samples with melamine (0.01-3 g x L(-1)) and 40 adulterated milk samples with urea (1-20 g x L(-1)) were prepared, respectively. Then the near-infrared absorption spectra of all samples were measured. The spectra in the range of 4 200-4 800 cm(-1) were selected to construct the KOPLS-DA models for milk adulterated with melamine, milk adulterated with urea and milk adulterated with both melamine and urea. The results showed that, compared with PLS-DA and OPLS-DA models, KOPLS-DA model had better discriminant ability for the adulterated milk, and its classification accuracy rate (CAR) for milk adulterated with melamine, milk adulterated with urea and milk adulterated with both melamine and urea were 95%, 100% and 97.5%, respectively.

Technical note: identification of suitable normalizers for microRNA expression analysis in milk somatic cells of the yak (Bos grunniens)

MicroRNA are approximately 18- to 22-nucleotide nonprotein coding molecules that play important roles in the regulation of gene expression at the posttranscriptional level. In the present study, we assessed the suitability of 8 noncoding small RNA as normalizers for microRNA (miR) quantitative analysis in milk somatic cells of lactating yaks, including 3 small nuclear RNA (snRNA; RNU1A, RNU5A, and RNU6B), 3 small nucleolar RNA (snoRNA; SNORA73A, Z30, and SNORA74A), 1 rRNA (5S), and 1 transfer RNA (Met-tRNA). The snRNA RNU1A, RNU5A, and SNORA73A were identified as the most stable references in milk somatic cells of lactating yaks. Also, a minimum of 3 reference RNA (RNU1A, RNU5A, and SNORA73A) were required for the normalization of microRNA expression data in milk somatic cells of the lactating yak. We further evaluated the suitability of the combination of RNU1A, RNU5A, and SNORA73A as reference RNA in milk somatic cells of lactating yaks via detecting the relative expression of miR 16b, miR 21-5p, miR 145, and miR 155 as microRNA of putative interest. In comparison to the colostrum period, on the whole, the expressions of the 4 microRNA were found to be upregulated at an early period and, thereafter, a declining pattern was exhibited from early to final periods in all microRNA investigated. Based on the results from this study, we recommend that the combination of RNU1A, RNU5A, and SNORA73A can be used as normalizers for microRNA quantitative analysis in future longitudinal studies on milk somatic cells of lactating yaks in relation to lactation.

Hepatocellular carcinoma with blood supply from parasitized omental artery: angiographic appearance and chemoembolization

OBJECTIVE

To analyze angiographic appearance of hepatocellular carcinoma (HCC) with blood supply from parasitized omental artery (POA), and evaluate the technical feasibility, safety and therapeutic efficacy of chemo-embolization via the POAs.

METHODS

A total of 1,221 HCC patients who had undergone chemoembolization procedures were evaluated retrospectively. The evaluated indexes included the incidence rate of POAs, success rate of superselective catheterization, post-reaction after chemoembolization, and the cumulative survival rates.

RESULTS

Totally 1,221 HCC patients had undergone 3,639 chemoembolization procedures, and 32 patients with POAs were enrolled, with 97 POAs found in 76 angiography procedures, giving an incidence rate of 2.09%. POA was observed mostly at the right lobe and left medial lobe except the segment II, and 62 POAs underwent superselective catheterization with microcatheter, giving a success rate of 63.9%. The angiographic appearance was: (1) hypertrophic POAs participating in tumor staining (n=28); (2) stiff and distorted POA (n=11), displaced due to tumor's oppression (n=8); and (3) defective tumor staining close to either gastrocolic omentum distribution or liver capsule (n=7). In 19 patients, chemoembolization via POAs was performed successfully (A group), while the remaining 13 patients failed (B group). Except 1 acute edema pancreatitis case, no serious complication was recorded. The cumulative survival rates of 6-, 12-, 18- and 24-month were 78.9%, 47.4%, 31.6% and 21.1% respectively for A group; correspondingly, 61.5%, 30.8%, 15.4% and 7.7%% for B group, in which 2 patients died of ruptured HCC.

CONCLUSION

Chemoembolization with microcatheter via POAs is a relatively safe, feasible and valuable method.

Impact of serum vascular endothelial growth factor on prognosis in patients with unresectable hepatocellular carcinoma after transarterial chemoembolization

OBJECTIVE

To investigate the expression level of serum vascular endothelial growth factor (VEGF) in patients with unresectable hepatocellular carcinoma (HCC) and its relationship with the clinicopathological characteristics, and to assess the impact of serum VEGF as a predictive factor for HCC prognosis during transarterial chemoembolization (TACE) treatments.

METHODS

Serum VEGF levels were measured using enzyme-linked immunosorbent assay (ELISA) in 60 random patients who underwent TACE or transarterial infusion (TAI) for unresectable HCC between May and September 2008 and 12 healthy volunteers were also involved in this study to serve as control. All patients' clinicopathological features were retrospectively analyzed. Serum VEGF levels were correlated with clinicopathological features of the HCC patients. The patients' survival rates were analyzed with Kaplan-Meier survival curves and compared by the log-rank test. The prognostic significance of serum VEGF levels and factors related to survival rate were evaluated by univariate and multivariate analysis.

RESULTS

The median serum VEGF level in the HCC patients was 285 pg/ml (range 14-1,207 pg/ml), significantly higher than that of healthy controls (P=0.021). The serum VEGF levels were significantly correlated with platelet counts (r=0.396, P=0.002) but not other clinicopathological features. Patients with serum VEGF level >285 pg/ml had worse overall survival compared with those with serum VEGF level <285 pg/ml (P=0.002). By multivariate analysis, the serum VEGF level was a significant prognostic factor.

CONCLUSION

High serum VEGF levels may predict poor prognosis of HCC after TACE. This study highlights the importance of tumor biomarker as a prognostic predictor in TACE therapy for HCC, which has an intrinsic problem of unavailability of histopathological prognostic features.

[Adulteration detection of urea in milk by mid-infrared spectroscopy]

In the present study, a technique of mid-infrared spectroscopy for detection of urea in milk was put forward. Eighteen adulterated milk samples with added different content of urea (1-18 g x L(-1)) were prepared. The mid-infrared spectra of these milk samples were measured. The infrared characteristics of pure milk and adulterated milk were studied, and analysis and comparisons of the differences were carried out. The absorption peak area (A1 562) of 1 562 cm(-1), which was assigned to the C-N stretching vibration for urea, and the absorption peak area (A1 464) of 1 464 cm(-1), which was assigned to the C=O stretching vibration for amide III', were calculated by origin. Linear fitting of relation was made between A1 562/A1 464 and urea concentration in milk. The results show that the A1 562/A1 464 is linear with urea concentration in milk, with a regression coefficient of 0.96. The study is important to improving quality of dairy products and protecting the benefit of consumers, and takes on crucial social significance and application prospect.

[Feasibility of using laser-induced fluorescence to detect directly polycyclic aromatic hydrocarbons in soil]

Abstract In the present paper, a technique of laser-induced fluorescence(LIF)for direct assay of polycyclic aromatic hydrocarbons(PAH) in soil was put forward. The research objective of this article is anthracene. The possibility of using LIF spectra to detect directly anthracene in soil was studied. Anthracene was detected in soil by AvaSpec-3648 Fiber Optic Spectrometer of thermoelectric refrigeration. The authors drew a conclusion that in the range of certain anthracene concentration(0.000 005-0.001 g x g(-1)), the intensity of LIF fluorescence is linear with anthracene concentration in soil, with a regression coefficient of 0. 929. This showed that direct assay of anthracene in soil was feasible by laser-induced fluorescence. The study is important to developing a new analytical technique of quantitative fluorescence detector which can be applied to the analysis of PAH in soil without pretreatment, and is significant to realization of real-time, in-line, in-situ measurement of PAH in soil.

Molecular characterization and expression analysis of osteopontin cDNA from lactating mammary gland in yak (Bos grunniens)

Osteopontin (OPN) is a secreted phosphorylated glycoprotein. It has an important role in mammary gland development and lactation, as well as, is thought to be a potential candidate gene for lactation traits. In the present work, we isolated and characterized a full-length open reading frame (ORF) of yak OPN cDNA from lactating mammary tissue, and examined its expression pattern in mammary gland during different stages of lactation, as well as, the recombinant OPN protein of yak was expressed successfully in E. coli. The sequencing results indicated that the isolated cDNA was 1132-bp in length containing a complete ORF of 837-bp. It encoded a precursor protein of yak OPN consisting of 278 amino acid with a signal peptide of 16 amino acids. Yak OPN has a predicted molecular mass of 29285.975 Da and an isoelectric point of 4.245. It had an identity of 65.50-99.16% in cDNA, identity of 52.06-98.56% and similarity of 65.40-98.56% in deduced amino acids with the corresponding sequences of cattle, buffalo, sheep, goat, pig, human, and rabbit. The phylogenetic analysis indicated that yak OPN had the closest evolutionary relationship with that of cattle, and next buffalo. In mammary gland, yak OPN was generally transcribed in a declining pattern from colostrum period to dry period with an apparent increase of OPN expression being present in the late period of lactation compared with peak period of lactation. Western blot analysis indicated that His-tagged yak OPN protein expressed in E. coli could be recognized not only by an anti-His-tag antibody but also by an anti-human OPN antibody. These results from the present work provided a foundation for further insight into the role of OPN gene in yak lactation.

Dose delivery estimated by bremsstrahlung imaging and partition model correlated with response following intra-arterial radioembolization with 32P-glass microspheres for the treatment of hepatocellular carcinoma

RATIONALE

The objective of this study was to retrospectively evaluate the efficacy of a combination of (32)P-glass microsphere-mediated intra-arterial internal radiation and chemoembolization for the treatment of hepatocellular carcinoma.

METHODS

Twenty-five consecutive patients with primary hepatocellular carcinoma referred for radiation therapy were treated with intra-arterial infusion of (32)P-glass microspheres followed by chemoembolization. beta-bremsstrahlung imaging was performed to monitor microsphere distribution. A partition model and a radiation dose equation were used for determination of radiation exposure in various tissues. Clinical response was evaluated using computed axial tomography scans.

RESULTS

The mean estimated absorption dose in tumor tissue was 137.42 +/- 56.69 Gy. A receiver operating characteristic curve was used to establish 90.65 Gy as the cutoff absorption dose with the best sensitivity and specificity for predicting response. The overall tumor response rate was 92%, while response in patients with radiation doses >90.65 Gy was 100%. Overall median patient survival was 15 months.

CONCLUSION

beta-bremsstrahlung imaging following intra-arterial infusion of (32)P-glass microspheres and chemoembolization incorporates effective treatment with convenient dosimetry monitoring and manageable adverse events using a single surgical procedure. This approach is a safe and effective method for ameliorating hepatocellular carcinoma.

[Immunotherapy against tumor with dendritic cell sensitized by necrotic tumor tissue after microwave coagulation therapy]

OBJECTIVE

To evaluate if the necrotic tumor tissue treated with microwave coagulation therapy (MCT) can sensitize dendritic cell (DCs), and if the sensitized DCs have the specific inhibit effect on tumor cell.

METHODS

CT-26 tumor nodules planted percutaneously in BALB/c mice were treated with MCT. The treated tumor tissue was levigated and filtrates and the filtrate obtained was incubated with the DCs from marrow of the BALB/c mice to get sensitized DCs. The shape of the DCs was observed by the microscopy and the electron microscopy respectively and the immune phenotype was detected by flow cytometer. The ability of the DCs to induce proliferation of T cells was measured by (3)H-TdR incorporation assay. The cytotoxicity of CTL activated by the DCs was measured by (51)Cr release assay. The inhibition of the DCs on the growth of CT-26 tumor in the mice was observed.

RESULTS

The DCs cultured with the filter from necrotic tissue of CT-26 tumor had the typical shape and immune phenotype of the sensitized DCs. The intensity of the sensitized DCs and the naive DC to stimulate T lymphocyte proliferation at the DC/T of 1:10 was 80 +/- 10 vs 10 +/- 5 (P < 0.01); and at the DC/T of 1:20 was 58 +/- 7 vs 9 +/- 3 (P < 0.01). The killing effect of specific CTLs on CT-26 cancer cells in the sensitized DCs and the naive DCs group were 13.6 +/- 2.5 vs 1.1 +/- 0.4 (P < 0.01) at the E/T of 10:1, 27.5 +/- 4.4 vs 1.4 +/- 0.4 (P < 0.01) at E/T 20:1, and 51.2 +/- 8.1 vs 1.4 +/- 0.5 (P < 0.01) at the E/T of 50:1 respectively. The specific CTL's killing effect on MIP/ND4 lymphoma cells in the sensitized DCs and the naive DCs group were 2.61 +/- 0.64 vs 0.87 +/- 0.15 (P > 0.01) at the E/T of 10:1, 5.22 +/- 0.65 vs 2.18 +/- 0.41 (P > 0.01)at the E/T of 20:1, and 6.09 +/- 0.83 vs 3.91 +/- 0.51 (P > 0.01) at the E/T of 50:1 respectively. The difference of the volumes of the tumor implanted percutaneously in the BALB/c mice became more and more obviously with the prolongation of mice survival times in the sensitized DC group, the naive DC group and the control group. The weight of the tumor at the fortieth day were 4.5 g +/- 1.1 g, 6.9 g +/- 1.6 g, 9.0 g +/- 1.5 g in the three groups respectively (P < 0.01). Finally the special killing effect of the T cells which extracted from the spleen of the mice whose tumor had been treated by the sensitized DCs in vivo and in vitro were observed.

CONCLUSION

As an whole cell antigen, the necrotic CT-26 tumor tissue treated with MCT can sensitize DCs, and the sensitized DCs have the specific inhibitory effect on CT-26 tumor cells both in vivo and in vitro.

Virus diffusion in isolation rooms

In hospitals, the ventilation of isolation rooms operating under closed-door conditions is vital if the spread of viruses and infection is to be contained. Engineering simulation, which employs computational fluid dynamics, provides a convenient means of investigating airflow behaviour in isolation rooms for various ventilation arrangements. A cough model was constructed to permit the numerical simulation of virus diffusion inside an isolation room for different ventilation system configurations. An analysis of the region of droplet fallout and the dilution time of virus diffusion of coughed gas in the isolation room was also performed for each ventilation arrangement. The numerical results presented in this paper indicate that the parallel-directional airflow pattern is the most effective means of controlling flows containing virus droplets. Additionally, staggering the positions of the supply vents at the door end of the room relative to the exhaust vents on the wall behind the bed head provides effective infection control and containment. These results suggest that this particular ventilation arrangement enhances the safety of staff when performing medical treatments within isolation rooms.

[Application of cross-correlation analysis to model transfer of near infrared spectrum]

Model transfer was studied by cross-correlation in near infrared spectrum. The hypothesis is that there exists an inherent proportional constant between the two spectra for model building measured by two different spectrometers after cross-correlation analysis is put forward and approved. The compatibility of the two models is enhanced after using the proportional constant. So the good results were obtained.

[Detection rate of human papillomavirus-16 in esophageal squamous cell carcinoma from different Chinese populations]

BACKGROUND & OBJECTIVE

Anyang in Henan Province of China is a hyperendemic area of esophageal cancer. The infection of human papillomavirus (HPV) is thought as an important pathogenesis of esophageal cancer in Anyang. This study was to detect infection rate and level of HPV-16 in esophageal squamous cell carcinoma (ESCC) patients from 3 different Chinese areas, and investigate its relationship with the pathogenesis of ESCC.

METHODS

Infection status of HPV-16 in 119 ESCC specimens (43 collected from Anyang, 43 from Beijing, and the rest 33 from Mongolia nationality of Inner Mongolia) was detected by in situ hybridization (ISH) technique with digoxin-labeled HPV-16 E6 probe.

RESULTS

HPV16 infection rates were 81.4%, 69.8%, and 63.6% in the specimens from Anyang, Beijing, and Inner Mongolia, respectively. Infection level of HPV-16 was significantly higher in Anyang group than in Beijing group (H=3.91, P<0.05) and Inner Mongolia group(H=4.22,P<0.05). There was no significant difference between the latter 2 groups. Furthermore, the proportion of strong expression of HPV16 (++ and +++) was significantly higher in Anyang group than in the other 2 groups(H=3.95, P<0.05).

CONCLUSIONS

HPV-16 infection rate is high in the esophageal specimens from the 3 different areas. Infection status of HPV16 is serious in Anyang.

[Adopting the method of correlation coefficient to improve the accuracy of the xylene isomer's prediction model]

This paper focuses on the detailed researches on the correlation coefficient in near infrared spectrum and points out its characteristics in multi-component solution; the paper also proves the principle of obtaining more accurate results when using high correlation coefficient for model building, and presents a practical experiment to test the conclusions by using para-xylene, meta-xylene, and orthoxylene's mixture.

Restenosis following balloon dilation of benign esophageal stenosis

AIM: To elucidate the mechanism of restenosis following balloon dilation of benign esophageal stenosis.

METHODS: A total of 49 rats with esophageal stenosis were induced in 70 rats using 5 mL of 50% sodium hydroxide solution and the double-balloon method, and an esophageal restenosis (RS) model was developed by esophageal stenosis using dilation of a percutaneous transluminal coronary angioplasty (PTCA) balloon catheter. These 49 rats were divided into two groups: rats with benign esophageal stricture caused by chemical burn only (control group, n = 21) and rats with their esophageal stricture treated with balloon catheter dilation (experimental group, n = 28). Imaging analysis and immunohistochemistry were used for both quantitative and qualitative analyses of esophageal stenosis and RS formation in the rats, respectively.

RESULTS: Cross-sectional areas and perimeters of the esophageal mucosa layer, muscle layer, and the entire esophageal layers increased significantly in the experimental group compared with the control group. Proliferating cell nuclear antigen (PCNA) was expressed on the 5th day after dilation, and was still present at 1 mo. Fibronectin (FN) was expressed on the 1st day after dilation, and was still present at 1 month.

CONCLUSION: Expression of PCNA and FN plays an important role in RS after balloon dilation of benign esophageal stenosis.

Electrokinetic injection techniques in microfluidic chips

The separation efficiency of a microfluidic chip is influenced to a significant degree by the flow field conditions within the injection microchannel. Therefore, an understanding of the physics of the flow within this channel is beneficial in the design and operation of such a system. The configuration of an injection system is determined by the volume of the sample plug that is to be delivered to the separation process. Accordingly, this paper addresses the design and testing of injection systems with a variety of configurations, including a simple cross, a double-T, and a triple-T configuration. This paper also presents the design of a unique multi-T injection configuration. Each injection system cycles through a predetermined series of steps, in which the electric field magnitude and distribution within the various channels is strictly manipulated, to effectuate a virtual valve. The uniquemulti-T configuration injection system presented within this paper has the ability to simulate the functions of the cross, double-T, and triple-T systems through appropriate manipulations of the electric field within its various channels. In other words, the proposed design successfully combines several conventional injection systems within a single microfluidic chip.

Treatment of malignant digestive tract obstruction by combined intraluminal stent installation and intra-arterial drug infusion

AIM: To study the palliative treatment of malignant obstrution of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs.

METHODS: A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus, stomach, duodenum and jejunum), per anal (colon and rectum) and percutaneous transhepatic (biliary) installation of metallic stent. Among them, 203 cases received drug infusion by cannulation of tumor supplying artery with Seldinger’s technique.

RESULTS: Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8-43 weeks among those with intra-arterial drug infusion, which was later than 4-26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3-105) weeks, which was significantly longer than 13 (3-24) weeks of the latter group.

CONCLUSION: Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.

Dependency of tissue necrosis on gelatin sponge particle size after canine hepatic artery embolization

PURPOSE

To determine the optimal size of gelatin sponge particles (GSPs) to produce maximum tumor necrosis with minimum side effects after canine hepatic artery embolization (HAE).

METHODS

GSPs were separated into four size ranges: A, up to 200 microns (mean 152) as Gelfoam powder; B, 200-500 microns (mean 336) as Gelfoam powder; C, 500-1000 microns (mean 649) as Spongel; and D, 1000-2000 microns (mean 1382) as Spongel. Three mongrel dogs were assigned randomly to HAE with each particle size. On day 7 after HAE, the livers were removed and subjected to pathological examination.

RESULTS

The mean volume of liver necrosis was 11% after embolization, with particle size A, 36.3% with B, 0% with C, and 1% with D. Coagulation necrosis was found in all livers with particles of sizes A and B, and in 1 of 6 with sizes C and D. Bile duct injury was found in five of six dogs with sizes A and B and in none with sizes C and D. Gallbladder necrosis was found in one dog with size B and pancreas necrosis in one with size A.

CONCLUSION

GSPs of 500 microns are considered optimally effective for tissue necrosis according to this model.

Self-expandable metallic stent therapy for superior vena cava syndrome: clinical observations

PURPOSE

To study clinical and physiologic aspects of Z-stent therapy for superior vena cava (SVC) syndrome secondary to malignant disease.

MATERIALS AND METHODS

Signs and symptoms of SVC syndrome were classified, graded, and scored in 11 cases. Six patients with caval pressure higher than 22 mm Hg peripheral to the stenosis underwent stent therapy.

RESULTS

Immediately after Z-stent implantation into the stenotic lesion, the diameter of the constriction increased from 3.3 mm +/- 2.0 (mean +/- standard deviation) to 14.0 mm +/- 3.2, the mean caval pressure peripheral to the stenosis decreased from 26.6 mm Hg +/- 2.5 to 8.9 mm Hg +/- 0.7, and the symptom score decreased from 6.7 +/- 1.8 to 1.3 +/- 1.4. The caval pressure, lesion diameter, and symptom score correlated highly with each other. One complication--transient pulmonary edema attributable to volume overload caused by reperfusion--was observed. Mean survival exceeded 7.1 months.

CONCLUSION

Stent placement could be a useful treatment for refractory SVC syndrome.

[Expandable metallic stent therapy for SVC syndrome--effects on local venous pressure, vascular diameter, symptoms, and these correlations]

To evaluate the efficacy of Z-stent therapy for SVC syndrome, we studied changes in the pressure, the diameter of stenotic lumen and the symptoms in the cases of SVC syndrome with higher pressure than 30 cmH2O at distal to the stenosis. The symptoms were classified and graded to be scored up. Immediately after the Z-stent placement into the stenotic lesions, the venous pressure distal to the stenosis decreased from 36.0 +/- 3.4 cmH2O to 12.0 +/- 12.0 cmH2O (p < 0.001), the diameter of stenotic lumen increased from 3.3 +/- 3.4 mm to 14.0 +/- 3.4 mm (p < 0.01). According to the remarkable symptomatic improvements the averaged score decreased from 6.7 to 1.3 (p < 0.01). The pressure, the diameter and the symptom scores were highly correlated each other (magnitude of gamma not equal to 0.9). Among two cases with the right atrial pressure increase by 2 cmH2O after the placement one suffered transient cardiac in compensation due to overload by reperfusion. Conclusively, the Z-stent therapy was very effective on the SVC syndrome in reducing abnormally elevated venous pressure due to the stenosis, and relieving the symptoms, while the pressure monitor was necessary.

[A stent therapy for portal tumor thrombi. Use of Dacron sheet covered self expandable metallic stent]

We developed a method of intraportal placement of a covered stent against portal tumor thrombi. Half around a z-stent was covered with a Dacron mesh sheet. In one case with portal tumor thrombi protruding into the main portal branch, the stent was placed percutaneously-transhepatically, through a coaxial introducer. Immediately after the placement, portal vein was dilated and, which was still patent after six months. No complication has been observed.

[Direct injection chemotherapy combined with arterial embolization in the treatment of liver cancers]

Direct injection chemotherapy in combination with transcatheter arterial embolization (TAE) was carried out in primary and secondary liver cancers. In this treatment, the anticancer agents dissolved in contrast media were directly injected into the tumor tissue with the echo-guided puncture needle after TAE. The dynamics of the injected drugs marked with non-ionic and water-soluble contrast media was followed up by the sequential CT studies, on which the contrast media was observed only in the tumor area in 18 out of 30 nodules from 2 to 8 weeks after the injection. The procedure is considered an effective drug delivery system to achieve a targeting chemotherapy in the liver cancers.

[A study of new retrievable expandable metallic stent]

The authors improved retrievable expandable metallic stent (REMS), instead of the nylon suture, the REMS was connected with the stainless steel thread. Under fluoroscopy the stainless steel thread of the shrinking body could be observed and was strong enough to retract the placed stent, then the stent could be removed by the stainless steel hook. We placed the REMS in the I.V.C. of canine, and removed them after one week placement, we could not remove them after two weeks placement. This study suggested that the REMS was considered to be useful and safe for clinical application.