Objective To evaluate the efficacy of interventional catheter drainage combined with ozone therapy for the management of postoperative enterocutaneous fistula. Method A total of 70 patients with postoperative enterocutaneous fistula were enrolled and divided into group A (35, conventional surgical treatment) and group B (35, interventional catheter drainage and ozone therapy). Clinical efficiency, hospital stays, hospital expenses and complications were compared. Follow-up observations of the infection score in 2 groups before and after treatment (3 days, 1 week, 2 weeks and 1 month) were also compared. Results 30 cases in group A recovered (85.7%), and 28 cases in group B recovered (80.0%), the result of which shows no statistic significance. The hospital stays and expense in group B were significantly lower than those in group A. 4 cases of group A suffered from incision complications , 2 intra-abdominal hemorrhage , 1 severe pneumonia and 1 septic shock. 2 cases in group B suffered from stomachache. The differences can be shown significantly. The infection score between the two groups shows no significant difference, but the score was found to be obviously lower after treatment than before. The infection score decreased by an average of 19.9 in group A and 23.5 in group B,indicating a better anti-infective effect in group B. Conclusion Interventional catheter drainage combined with ozone therapy for the management of postoperative enterocutaneous fistula is safe and effective, with lower hospital stays and expense.

Objective To investigate the success rate of fluoroscopy-guided subclavian vein catheter implantation (SVCI) in children with hematologic diseases,to improve the visualization of the position of the catheter head,and to reduce the incidence of procedure-related complications.Methods Fluoroscopyguided SVCI was performed in 183 sick children (aged 1-16 years) with confirmed hematologic disease.The success rate of the catheter implantation,the number of needle puncturing,the operation time,the fluoroscopy time and the occurrence of procedure-related complications were recorded.Results Successful fluoroscopy-guided SVCI was accomplished in all 183 sick children,with a success rate being 100％.Successful SVCI was obtained with ＜3 times of puncturing in 151 sick children (82.5％),with 4-6 times of puncturing in 25 sick children,and with 7-10 times of puncturing in 7 sick children.The catheter tip was successfully positioned at the junction of the superior vena cava with the right atrium in all sick children.The operation time ranged from 5 min to 25 min with a mean of (10.38±4.04) min.The fluoroscopy time varied from 16 seconds to 607 seconds with a mean of (65.46±55.86) seconds.During the procedure,artery was wrongly punctured two times in two sick children.The mean follow-up time was 35 days.Cather-related infection occurred in 2 sick children.No local hematoma at puncture point,nor hemopneumothorax or catheter-related thrombosis occurred.Conclusion Fluoroscopy-guided SVCI has high technical success rate in children with hematologic diseases.For a successful procedure of SVCI,less number of needle puncturing is needed by using this technique.The satisfaction rate for the placement of catheter tip is high and the incidence of complications is low.Therefore,fluoroscopy-guided SVCI is a safe and effective method.

Objective To investigate the effects of transcatheter arterial chemoembolization(TACE) on the expression of nm23, tissue inhibitor of metalloproteinase-2 (TIMP-2) and extrahepatic metastasis in hepatocellular carcinoma (HCC). Methods The specimens were collected from resectable HCC in 72 patients. Patients were divided into two groups. In one group, TACE was performed before tumor resection (Group A, n=36). In another group, the tumors were resected directly without preoperative TACE (Group B, n=36). The expression and distribution of nm23, TIMP-2 in the tumor tissue and liver parenchyma in the two groups were compared. All patients were followed up for 24 months,and the incidence of extrahepatic metastasis was compared between the two groups. Chi-square test was applied to compare the expression levels of nm23-H1 and TIMP-2. Results The number of cases of strong, moderate and no expression of nm23 were 24, 6 and 6 cases in group A respectively, and were 9, 6 and 21 cases in group B. Statistical differences were found between the two groups(X~2=15.52, P<0.01). The number of cases of strong, moderate and no expression of TIMP-2 were 21,3 and 12 cases in group A respectively, and were 9, 9 and 18 cases in group B. Statistical differences were demonstrated between them (X~2=9.00, P<0.05). There were 13 cases in group A and 15 cases in group B being diagnosed to have extrahepatic metastasis within 24- month period of follow up, but there was no significant difference between the two groups(X~2= 0.23, P>0.05). Conclusions TACE could enhance the expression of nm23-H1 and TIMP-2 in tumor tissues. Therefore, the potential of metastasis of tumor cells might be prohibited by TACE.

Objective To discuss the safety and efficacy of using ExoSealTM vascular closure device to obtain rapid hemostasis of puncture site in interventional procedure via retrograde femoral artery access.Methods The clinical data of 124 patients,who were admitted to authors' hospital during the period from March 2016 to April 2016 to receive interventional procedure via retrograde femoral artery access,were retrospectively analyzed.During the performance of intervention,ExoSealTM vascular closure device (ExoSealTM group,n=52) or manual compression (MC group,n=72) was employed to make femoral artery puncture point hemostasis.The time spent for hemostasis,the manual compression time,the limb immobilization time,the amount of blood loss during compression process,and the procedure-related complications were recorded and the results were compared between the two groups.Results Technical success rate in ExoSealTM group was 98.1％(51/52).In ExoSealTM group and MC group,the time spent for hemostasis was (0.28±0.08) min and (5.83±1.46) min respectively,the manual compression time was (2.65 ±0.57) min and (7.70± 1.88) min respectively,the limb immobilization time was (2.72±0.43) h and (6.15±0.69) h respectively;all the differences between the two groups were statistically significant (P＜0.01).In ExoSealTM group subcutaneous hemotoma occurred in one patient,while in MC group subcutaneous hemotoma occurred in 3 patients and pseudoaneurysm in one patient;the complication rates were 1.92％ (1/52) and 5.56％ (4/72) respectively,but the difference was not statistically significant (P＞0.05).In MC group the amount of blood loss during compression process was (1.11±0.86) ml,which was remarkably less than (7.83±2.08) ml in ExoSealTM group,the difference between the two groups was statistically significant (P＜0.01).Conclusion For hemostasis of puncture site in interventional management via retrograde femoral artery access,the use of ExoSealTM vascular closure device is safe and effective.

Objective To compare the therapeutic efficacy of preventive transcatheter arterial chemoembolization (TACE) with that of preventive transhepatic arterial infusion (TAI) for patients with primary hepatocellular carcinoma (HCC) after hepatectomy. Methods During the period from June 2011 to June 2012 at authors’ hospital, preventive transhepatic interventional therapy was employed in 79 HCC patients within three months after hepatectomy. The followed-up endpoint was in June 2013. The clinical data were retrospectively analyzed. The patients were divided into TACE group (n=41) and TAI group (n=38). No significant differences in age, sex, preoperative liver function, Child-Pugh scores, tumor size and AFP level existed between the two groups. During interventional procedure , catheterization of proper hepatic artery was performed first, which was followed by angiography in order to clarify that there were no newly-developed tumor vessels or tumor lesions in the residual liver, then the chemotherapeutic agents were infused through the catheter. The emulsion of iodized oil with chemotherapeutic agent was used in the patients of TACE group, while only chemotherapeutic agent was adopted in the patients of TAI group. By using Chi-square test the one-year recurrence rate was determined. Kaplan-Meier estimation method was used to calculate the disease-free survival time, and t test was adopted to estimate the mean hospitalization days. The results were compared between the two groups. Results Of the 79 patients, postoperative recurrence was confirmed in 11, and the overall one-year recurrence rate was 13.9%. The one-year recurrence rate of TACE group and TAI group was 12.20% and 15.79% respectively , and no significant difference in one- year recurrence rate existed between TACE group and TAI group (χ2= 0.213, P = 0.645). The average disease-free survival time of TACE group and TAI group was (21.60 ± 1.52) months and (17.38 ± 3.01) months respectively, the difference between the two groups was of statistical significance (P = 0.038). The mean hospitalization days of TACE group and TAI group were (6.30 ± 1.84) days and (5.89 ± 2.08) days respectively, and the difference between the two groups was not statistically significant (P = 0.522). Conclusion No significant difference in one-year recurrence rate exists between the patients receiving preventive TACE and the patients receiving preventive TAI after hepatectomy for HCC. Nevertheless , preventive TACE can probably improve the disease-free survival time after hepatectomy.

OBJECTIVETo explore the role of transforming growth factor-β1 (TGF-β1) in intervertebral disc degeneration and its association with the pathological grading of disc degeneration.

METHODSNormal and degenerative intervertebral disc tissues were collected were classified into 5 grades of increasing degenerative changes. HE staining, immunohistochemistry, TUNEL staining and RT-PCR were used to detect the expression of TGF-β1 in the disc tissues.

RESULTSImmunohistochemistry and RT-PCR showed positive expressions of TGF-β1 and Bcl-2 in normal disc tissues, where Bax was expressed at have a trace level. In the degenerative disc tissues, TGF-β1 expression increased with the pathological grades; the expression levels of TGF-β1 showed significant differences between degenerative and normal tissues and between grade IV and grade I disc tissues (P<0.01).

CONCLUSIONTGF-β1 is an important factor participating in the disc degeneration and its expression level is closely related to the pathological grade of degenerative discs.

Adult ; Aged ; Female ; Humans ; Intervertebral Disc ; pathology ; Intervertebral Disc Degeneration ; classification ; metabolism ; pathology ; Male ; Middle Aged ; Transforming Growth Factor beta1 ; metabolism

Objective:To investigate the efficacy and safety of different transcatheter arterial chemoembolization(TACE)-based regimens in patients with unresectable hepatocellular carcinoma(uHCC)and explore the optimal timing for combining TACE with tyrosine kinase inhibit-ors(TKIs)and immune checkpoint inhibitors(ICIs).Methods:A retrospective analysis was conducted on data from 555 patients with uHCC who underwent TACE-based treatment between April 2016 and December 2021 in Nanfang Hospital,Southern Medical University.The pa-tients were assigned into the following four groups according to different treatment regimens:TACE group(n=317),TACE combined with TKIs group(TACE+TKIs,n=66),TACE combined with ICIs group(TACE+ICIs,n=33),and TACE combined with TKIs+ICIs group(TACE+TKIs+ICIs,n=139).Subgroup analysis was performed within the TACE+TKIs+ICIs group,with patients being assigned into"pre-TACE"and"post-TACE"groups based on the timing of the combination therapy.Univariate and multivariate Cox regression analyses were conducted to identify pro-gnostic factors influencing overall survival(OS).Results:The TACE+TKIs+ICIs group showed the longest OS(21.9 months,95%confidence in-terval[CI]:17.2-26.6,P=0.030)and progression-free survival(PFS)(8.3 months,95%CI:7.3-9.3,P=0.004)compared to those in the other three groups.In the subgroup analysis,the"post-TACE"group had longer OS than the"pre-TACE"group(26.8 months vs.19.2 months,P = 0.011).The objective response rate(ORR)was 32.8%,41.1%,42.4%,and 52.5%(P=0.001)and the disease control rate(DCR)was 59.6%,71.2%,69.7%,and 82.7%(P<0.001)in the TACE,TACE+TKIs,TACE+ICIs,and TACE+TKIs+ICIs groups,respectively.The adverse events were similar to those reported in previous studies.Cox regression analysis revealed that tumor number,extrahepatic metastasis,and treatment regimen were independent factors influencing OS in patients(all P<0.05).Conclusions:TKIs or ICIs can improve OS and PFS in patients with uHCC receiving TACE,and the combination of TKIs+ICIs with TACE achieves better beneficial outcomes.The greatest OS was observed when the combination therapy TKIs+ICIs was initiated within 3 months after the first TACE procedure.