Objective To assess the clinical value of transcatheter arterial chemoembolization (TACE) together with radiofrequency ablation (RFA) and sorafenib in treating recurrent hepatocellular carcinoma (HCC) after surgery.Methods A total of 40 patients with recurrent HCC after surgery, who were encountered at authors' hospital during the period from December 2009 to May 2014, were collected. The patients were divided into the study group (n=20) receiving TACE combined with RFA and sorafenib and the control group (n=20) receiving TACE plus RFA. Within 7-10 days after TACE, RFA was carried out. In the study group, oral sorafenib therapy (400 mg, two times everyday) started at 4 days after TACE. Withdrawal of sorafenib would be ordered if drug resistance occurred. Each patient underwent TACE combined with RFA not less than two times. Results The median survival time of the study group and the control group was 31.0 months and 24.8 months respectively, and statistically significant difference existed between the two groups (P<0.05). The one-year, 2-year and 3-year survival rates of the study group were 85%, 70% and 50%respectively, while the one-year, 2-year and 3-year survival rates of the control group were 80%, 55% and 30% respectively; the differences between the two groups were not statistically significant (P>0.05). The progression free survival (PFS) time of the study group and the control group was 6.8 months and 5.7 months respectively, the difference between the two groups was statistically significant (P<0.05). Conclusion TACE combined with RFA and sorafenib can prolong the overall survival time and the progression free survival time of patients with recurrent HCC after surgery.

Objective To assess the condition of left ventricular outflow tract obstruction (LVOTO) under resting conditions and physiological exercise in hypertrophic cardiomyopathy (HCM) patients.Methods A total of 60 patients with HCM and left ventri cular outflow tract gradient (LVOTG) ＜ 50 mm Hg (1 mm Hg =0.133 kPa) at rest were enrolled consecutively,and LVOTG at rest and exercise were measured by echocardiography.Of 51 patients with gradients ＜ 30 mm Hg at rest,26 were latent LVOTO with exercise peak value LVOTG ≥ 30 mm Hg,25 were non LVOTO with exercise peak value LVOTG ＜ 30 mm Hg,and 9 were resting obstruction with LVOTG 30-49 mm Hg.The morphological characteristics of different types of obstruction were analyzed.Results Patients with latent LVOTO were more likely to have SAM(73.1％ vs 8.0％),narrow of LVOT(46.2％ vs 4.0％),higher resting gradients [(16.9 ±7.2) mm Hg vs (7.1 ± 4.3) mm Hg] and mitral regurgitation grade at rest than patients with non-obstructive (all P values ＜ 0.05).The distribution of septal hypertrophy were different in the two groups (P ＜ 0.05).Multivariate logistic regression analysis showed independent predictors of latent LVOTO were SAM (OR 6.431,95 ％ CI 2.323-291.112,P =0.002) at rest and distribution of septal hypertrophy (OR 0.011,95％ CI 0.001-0.179,P =0.008).Conclusions Approximately half of patients with nonobstructive HCM at rest have latent LVOTO.SAM and distribution of septal hypertrophy may be useful to identify patients with latent obstruction.

Objective To investigate the diagnosis and treatment methods of traumatic renal infarction.Methods A retrospective analysis was performed on 6 cases of traumatic renal infarction treated between September 2008 and February 2013.There were 5 males and 1 female,at age of 5-65 years (average,36.2 years).Causes of injury included vehicle collisions in 4 cases and high falls in 2.Out of 6 cases,segmental renal infarction was identified in 2 and total infarction in 4.According to American Association for the surgery of trauma renal trauma grading system,2 cases were classified to grade Ⅳ and 4 to grade Ⅴ.Results Three cases were managed conservatively,which showed segmental infarction in 1 case and total infarction in 2.Three cases underwent surgical exploration,followed by partial nephrectomy in 1 case,left kidney removal plus partial pancreectomy in 1 and right kidney removal in 1.There were no major complications intraoperatively or postoperatively and no cases received blood transfusion.Period of follow-up was 3-34 months.In conservative management,there were no renal atrophies in segmental renal infarction cases and some degree of atrophies in total renal infarction cases,but none presented with arterial hypertension.Conclusions Enhanced CT is the preferred diagnostic tool for evaluation of traumatic renal infarction.Conservative therapy is the optimal option for most cases,but nephrectomy is reserved for cases of infection or renal hypertension.

Objective To evaluate the clinical application of selective renal artery embolization (SRAE) for the treatment of kidney diseases. Methods Seventy-four cases of renal carcinomas, 11 cases of renal angiomyolipomas (RAML) and 72 cases of traumatic renal haemorrhages were first demonstrated by renal arteriography under Seldinger technique to ensure a site, range and neighbouring relation of lesions and then followed by percutaneous catheterized selective renal arterial embolization with embolic agents. Results The edema around the carcinomas and abscesses became obvious, and bleeding were reduced, which were convenient for operation after SRAE for the preoperative adjuvant treatment of renal carcinomas. The clinical symptoms were improved obviously in 9 eases with advanced renal carcinoma after palliative treatment. The tumour volumes of 11 RAML were decreased evidently by 15 %-65 % with the average of 42 %. The bleeding in 68 cases of traumatic renal haemorrhage were ceased completely in 1-4 days after embolism, 2 cases with serious renal fragmented injury and huge perirenal hematoma combined with shock received successful operation after SRAE, 2 cases bleeding again after SRAE were cured by the second SRAE. No severe complications occurred after embolization in all the patients. Conclusions As a minimal invasive technique,selective renal artery embolization is a safe, effective method with less complications and an adjuvant pre-op-erative therapy for renal carcinoma or a palliative treatment for advanced carcinoma and an effective treatment for RAML and traumatic renal haemorrhage.

Preoperative serum specimens were collected from 249 endometrial cancers and 99 uterine leiomyomas and their concentrations of human epididymis protein 4 (HE4),CA 125 and CA 19-9 were detected.The indices of diagnostic evaluation were calculated.Preoperative serum concentrations of HE4,CA125 and CA19-9 in endometrial carcinoma group were significantly higher than those of control group.The areas under curve of HE4,CA125 and CA19-9 were 0.736,0.615 and 0.661 respectively and that of combiued markers was 0.774.At a 90％ specificity,the sensitivities for HE4,CA125,CA19-9 were 55.0％,26.9％ and 30.1％ while that of combined markers was 56.2％.HE4 is an ideal tumor marker for endometrial cancer and combined detection improves diagnostic rate.

Objective: To assess the effect of percutaneous transluminal septal myocardial ablation (PTSMA) on mid- to long-term left ventricular diastolic function in patients with hypertrophic obstructive cardiomyopathy (HOCM) by real-time three-dimensional echocardiography (RT-3DE). Methods: A total of 46 HOCM patients who received 2DE and RT-3DE examination before and after (with the mean of 18.8 months) PTSMA were studied. The ratios of E/A and E/Ea were analyzed, RT-3DE was conducted to collect the images, to obtain 17-segmant volume-time curve and to calculate the parameters of rEDV, rESV, rSV and rPFR respectively. Results: The follow-up echocardiography in all 46 patients indicated that the ratio of E/Ea decreased after the operation (12.04 ± 3.29) vs (15.70 ± 5.68),P<0.001, the rSV of left ventricular anterior wall middle segment and anterior septal middle segment decreased after the operation,P<0.05, while the rPFR of anterior septal middle segment, rear septal middle segment and apical segment increased,P<0.05. Conclusion: PTSMA may improve local left ventricular diastolic function in HOCM patients, RT-3DE provides a new method and viewing angle for HOCM evaluation.

Objective: To explore the changing features of plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) level in patients with hypertrophic obstructive cardiomyopathy (HCM) after alcohol septal ablation (ASA). Methods: A total of 82 HCM patients treated by ASA in our hospital were studied. According to plasmalevel of NT-proBNP, the patients were divided into 2 groups: High NT-proBNP group and Low NT-proBNP group,n=41 in each group. Plasma NT-proBNP was examined by ELISA; ventricular septal thickness (VST), left ventricular posterior wall thickness (LVPWT), maximal ventricular wall thickness (MLVWT) and left atrial diameter (LAD) were measured by echocardiography. There were 50 patients ifnished 1 year clinical or in-hospital follow-up, their NT-proBNP level and echocardiography were detected at 2 days and 1 year post-operation.The relationship between echocardiography parameter and NT-proBNP level was assessed; NT-proBNP was compared between pre- and 2 days, 1 year post-operation. Results:①In all 82 patients: compared with Low NT-proBNP group, High NT-proBNP group had increased VST (23.66±6.46) mm vs (20.79±4.56) mm,P=0.035, LVPWT (12.79±2.99) mm vs (11.50±2.35) mm,P=0.048, MLVWT (28.03±5.66) mm vs (25.18±4.81) mm,P=0.027 and LAD (40.73±4.86) mm vs (38.08±6.17) mm,P=0.049.②In 50 patients who ifnished 1 year follow-up study: compared with pre-operation, NT-proBNP level was slightly increased at 2 days post-operation (1841.79±1310.88) fmol/ml vs (1552.15±951.57) fmol/ml,P=0.066, while decreased at 1 year post-operation (1038.46±714.03) fmol/ml vs (1552.15±951.57) fmol/ml,P=0.000. Conclusion: Plasma NT-proBNP level was affected by atrial size and ventricular thickness in HCM patients, it may obviously decrease during long-term follow-up period.

Objective To analyze the correlation between septal branch characteristics and the prognosis of alcohol septal ablation ( ASA ) in patients with hypertrophic obstructive cardiomyopathy . Methods The clinical , echocardiographic , angiographic and procedural characteristics were analyzed retrospectively in 55 patients.Good prognosis was defined as left ventricular outflow tract gradient decreased by 50%at long term follow-up.The characteristics of septal branch were analyzed in terms of QCA .Results There were no differences in the length of the ablated septal branch , sizes of the adjacent branches , distances between the septal branch and the ostia of the coronary arteries and the volume of alcoholo consumed ( all P>0.05).Compared with poor prognosis group (n =27), the diameter of the ablated septal branches were significantly larger in the good prognosis group ( n=28 ) [ ( 1.75 ±0.36 ) mm vs.( 1.48 ±0.41 ) mm, P=0.012].The distance between the ablated branch and its adjacent branch was farer in the good prognosis group [(18.80 ±10.20)mm vs.(13.04 ±6.65)mm, P=0.020].In multivariate analysis, the diameter of the ablated branch (OR 9.258,95%CI 1.427-60.069, P=0.020)and the distance between the ablated septal branch and its adjacent septal branch (OR 1.102,95% CI 1.002-1.213, P =0.046) were found to be independent risk factors for good prognosis of ASA .Conclusions The diameter of the ablated septal branch and the distance between its adjacent septal branch are associated with better prognosis of ASA .

Objective To evaluate the effect of the percutaneous transluminal septal myocardial ablation(PTSMA)on the left ventricular function in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods All HOCM patients underwent echocardiogram measurements before and after the PTSMA procedure.The peak velocity of mitral annulus was measured at Doppler tissue pulsed wave mode.Doppler tissue imaging(DTI)was obtained at the 4- and 2-chamber apical view,and the peak systolic(Sa),early diastolic(Ea),and late diastolic(Aa)myocardial velocities of mitral annulus was measured at the long apical view.Results Compared with the velocity parameters before the PTSMA procedure,the peak Sa and Ea after the PTSMA were significantly lower while Aa was un-significantly lower.Conclusions In patients with HOCM,the diastolic and systolic function of the left ventricle decreased after the PTSMA procedure.

Objective:To explore the relationship between big endothelin-1 (big ET-1) and cardiac remodeling in patients with hypertrophic obstructive cardiomyopathy (HOCM).
Methods:A total of 167 consecutive HOCM patients admitted in our hospital from 2015-01 to 2016-05 were enrolled. Blood levels of big ET-1 and NT-proBNP were measured;electrocardiogram(ECG), dynamicECG,echocardiography (UCG) and cardiovascular magnetic resonance (CMR) were examined for relevant statistical analysis.
Results:In all 167 HOCM patients, blood level of Big ET-1 was positively related to NT pro-BNP (r=0.35, P=0.000), left atrial (LA) diameter (r=0.169, P=0.019) and heart rate (r=0.141, P=0.037);negatively related to hemoglobin (r=-0.173, P=0.013) and the ratio of interventricular septum (IVS)/posterior wall of left ventricle (r=-0.165, P=0.017). Based on the finding of positive correlation between Big ET-1 and LA diameter, the patients were divided into 2 groups:Normal LA group, n=74 and Enlarged LA group, n=93. Compared with Normal LA group,Enlarged LA group had the higher blood level of Big ET-1 (P=0.001);increased left ventricular end-diastolic diameter (LVEDD) (P=0.024), thicker IVS (P=0.003), lower LVEF (P=0.001);enlarged LVED volume (P=0.002) and IVS (P=0.002);elevated ratio of atrial fibrillation(AF);more patients with moderate to severe mitral regurgitation (MR) and NYHA functional classIII/IV.
Conclusion: Blood level of Big ET-1 was positively related to NT pro-BNP and LA diameter in HOCM patients;the patients with enlarged LA had increased Big ET-1, more obvious cardiac remodeling and the higher incidence of AF occurrence which implied that Big ET-1 might play the role in cardiac remodeling in HOCM patients.