Objective To investigate the diagnosis and treatment value of digital subtraction angiography (DSA) and transcatheter arterial embolization (TAE) for post pancreatectomy hemorrhage (PPH),and influencing factors of severity of PPH.Methods The retrospective case-control study was conducted.The clinicopathological data of 20 patients with PPH who were admitted to the Zhongshan Hospital of Fudan University from August 2009 to November 2016 were collected.Patients with PPH in the early stage underwent reoperations for hemostasis;patients with PPH in the later stage received conservative treatment,and then DSA and TAE were considered when patients had the stable vital signs.Observation indicators:(1) DSA situations:overall times,positive rate and bleeding sites;(2) TAE situations:successful rate of hemostasis,operating time and postoperative complications;(3) follow-up situations;(4) influencing factors analysis of severity of PPH.Follow-up using outpatient examination and telephone interview was performed to detect occurrence of complications after discharging from hospital up to April 2017.Measurement data with skewed distribution were described as M (range).Count data were evaluated by the ratio and proportion.The univariate analysis was done using the Fisher exact probability.Results (1) DSA situations:all the 20 patients underwent DSA,with overall times of 27.The direct sign was 18 times extravasation of the contrast medium,with a positive rate of 66.7％ (18/27).Of 18 times positive DSA,clear bleeding sites were located in 5 times gastroduodenal artery (3 times with pseudoaneurysm of gastroduodenal artery stump),in 4 times common hepatic artery (3 times with pseudoaneurysm of common hepatic artery),in 3 times superior mesenteric artery,in 2 times splenic artery,in 1 time left gastric artery,in 1 time right gastric artery,in 1 time left hepatic artery (pseudoaneurysm of left hepatic artery) and in 1 time inferior mesenteric artery.(2) TAE situations:of patients with 18 times positive DSA,patients with 15 times positive DSA received TAE,with a successful rate of hemostasis of 13/15,and patients with 5 times positive DSA received successful hemostasis by reoperation.A median operating time of TAE for patients with 15 times positive DSA was 30 minutes.There was no occurrence of adverse reaction,including fever,abdominal pain,melena,elevated aminotransferase and liver abscess.One patient complicated with splenic abscess after transcatheter splenic arterial embolization underwent puncture drainage and then had a good recovery.Of patients with 9 times negative DSA,patients with 8 times negative DSA were cured by conservative treatment and patient with 1 time negative DSA received successful hemostasis by operation.All the 20 patients were cured and then discharged from hospital.(3) Follow-up situations:20 patients were followed up for 4-92 months,with a median time of 24 months.During the follow-up,20 patients recovered well,without long-term complications.(4) Influencing factors analysis of severity of PPH:the results of univariate analysis showed that gender,age,preoperative blood sugar,preoperative combined jaundice,preoperative albumin (Alb),preoperative prothrombin time (PT) extended,preserving pylorus,pancreatic duct stent placement,pancreatic operation time,volume of intraoperative blood loss,intraoperative blood transfusion,property of tumor,postoperative pancreatic fistula and time of PPH were not factors affecting the severity of PPH (P＞0.05).Conclusion DSA is minimal-invasive in the diagnosis for PPH,and TAE is safe and effective for patients with positive DSA.

Percutaneous transhepatic biliary drainage(PTBD) is an effective therapeutic option for obstructive jaundice.With various novel puncture instruments being created,the manipulating technique being improved and medical idea being updated,PTBD has been widely employed in clinical practice for alleviating the biliary tract obstruction.In order to standardize this technique this paper aims to make some suggestions for the PTBD guidelines concerning the indications,contraindications,operative skill,postoperative management,complications and their preventions,points for attention,etc.

Reference materials are one of the major approaches to achieve measurement accuracy and metrological comparability. Different functions of reference materials should also be distinguished when applied to mass spectrometry as an emerging technology in clinical laboratory. Proper reference materials for validation, calibration and quality control of measurement method can ensure the accuracy and comparability of test results. Based on the problems of reference materials in clinical mass spectrometry, the precautions for the use of reference materials are summarized in the aspects of measurement method validation, calibrator usage and quality control.

Objective To evaluate the value of MRI in diagnosis of giant cell tumor of bone.Methods Nine cases with giant cell tumor of bone proved by pathology were examined preoperation with MRI and X-ray film.CT was processed in 7 caaes.There were 4 males and 5 females,with a mean age of 32(range 14~62 years).The location of the tumor was in the proximal tibia(5 cases),the distal femur(2 cases),the distal radius(1 case)and the scapula(1 case).Results In all cases,the signal intensity of the tumor was low to intermediate on T 1WI,high homogeneous signal intensity in 5 cases on T 2WI,heterogeneous signal intensity in 4 cases.There was destruction of cortical bone in 5 cases.There wasn't osteoplaque in 3 cases.In 2 cases,the soft tissues and the joint were involved.The pathological macrosection tumor was crimson or brown in 3 cases with heterogeneous signal intensity on MRI.In another 5 cases with homogeneous signal intensity on MRI was brownish yellow or yellow.Conclusion Comparing the MRI,CT and X-ray film,diagnostic value of the giant cell tumor of bone,we believe:(1)CT scan is considered superior to MRI in showing the cortical bone destruction or in showing the osteoplaque.(2)MRI is considered superior to CT scan and X-ray film in showing the soft tissues the joint involvement.(3)MRI is fair super to evaluating the extension of the giant cell tumor of bone,but not super to quality diagnosis in the bone tumor.

Objective To compare the short-term safety and efficacy of radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of large benign thyroid nodules.Methods A total of 34 patients with large benign thyroid nodules were studied retrospectively,including 13 patients treated with ultrasound-guided RFA and 21 patients treated with MWA between Jun.,2016 and Feb.,2017 in Zhongshan Hospital.The thyroid function parameters,serum antibodies,complications and thyroid nodules volume reduction rate(VRR) were compared between the two groups during the follow-up.Results There were no statistically significant differences(P＞0.05)among those patients before and after treatment in serum free triiodothyronine (fT3),free thyroxine (fT4),thyroid stimulating hormone (TSH),anti-thyroglobulin antibodies (TG-Ab) levels,and thyroid peroxidase antibodies (TPO-Ab).One patient in the MWA group had mild hoarseness after ablation and another patient in the RFA group had intraoperative hemorrhage for about 10 mL.There were no other complications such as neck scar,postoperative infection,skin burns,tracheal and esophageal injury.One day after the ablation,all nodules were showed hypoecho and contrast-enhanced ultrasound proved there was no blood supply.One month after treatment,no statistically significant difference was found in VRR between two groups (23.8％ vs.22.6％,P =0.127).Conclusions RFA and MWA are safe and effective treatments for large benign thyroid nodules,and no significant difference was observed in short-term follow-up.

Background and purpose:The evaluation of treatment response is one of the most important building blocks in determining the best strategy for the management of malignant tumors. In lymphoma and several solid cancer types, PET/CT-based response evaluation has been shown to be valuable, especially in visualizing the effect of the targeted treatment, which induces tumor activity changes not necessarily followed by tumor shrinkage. This study aimed to evaluate the role of18F-FDG PET/CT in the monitoring of response to sorafenib treatment in radioiodine-refractory differentiated thyroid cancer (RR-DTC) patients; and to compare the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) with the European Organization for Research and Treatment of Cancer (EORTC) criteria.Methods:This was a single-center retrospective analysis of 14 patients with RR-DTC treated with sorafenib in the period from Dec. 2011 to Dec. 2014. A Wilcoxon signed-rank sum test was used to assess the differences in percentage changes between the sum of diameter and ∑SUVmax. These values of responses were statistically compared using the chi-square test (Fisher’s exact test). The differences in PFS between response categories according to either RECIST 1.1 or the EORTC criteria were evaluated using the Wilcoxon signed-rank sum test. The Spearman rank correlation coefficient was estimated between PFS and either morphologic (RECIST 1.1) or metabolic response (EORTC criteria) categories.Results:There was an agreement between the RECIST 1.1 and EORTC criteria in 10 of the 14 patients (χ2=2.345,P=0.424). The remaining 4 patients with SD in-cluded 2 patients with PMR and 2 patients with PMD. Differences in PFS among different response categories according to either RECIST 1.1 (χ2=8.571,P=0.003) or EORTC criteria (χ2=8.781,P=0.003) were statistically significant. Correlations were found between PFS and either morphologic (r=0.741,P=0.002) or metabolic (r=0.816,P=0.0004) response criteria. Conclusion:18F-FDG PET/CT imaging is of value in the monitoring of response to sorafenib in patients with RR-DTC. Although RECIST 1.1 and EORTC criteria agree in 71.4% patients, PET-based metabolic response criteria seems to be more accurate in predicting therapeutic outcome and may be more suitable than morphologic response criteria for the eval-uation of response to targeted therapy.

Objective To detect the expression of human endogeneous retrovirus family W env1 (HERVWE1) in placentas of normal pregnant women and patients with preeclampsia and explore its role in the pathogenesis of preeclampsia.Methods Fifty-two cases of placental tissues provided by Shandong Maternity Hospital were from iodine deficiency areas (county or city:.Zhangqu, Changqing, Pingyin) of Shandong Province, including 30 cases of preeclampsia placentas as case group, 22 cases of normal term pregnancy placentas as control group.The mRNA expression of HERVWE1, human chorionic somator mammotropin (HCS), chorionic specific transcription factor (GCMa) and amino acyl carrier 2 (ASCT-2) in placentas of the two groups were determined by real-time PCR, and the protein expression of HERVWE1 was determined by Western blotting.Results The mRNA expression levels of HERVWE1 (0.149 ± 0.045 vs.0.409 ± 0.028) and HCS (336.600 ± 50.100 vs.815.600 ± 101.300) in placentas of patients with preeclampsia were significantly lower than those in the control group (t =25.60, 20.40,all P ＜ 0.05).There were no significant difference in GCMa (0.022 ± 0.007 vs.0.024 ± 0.009) and ASCT-2 (0.423 ± 0.050 vs.0.438 ± 0.060) between the two groups (t =0.87, 0.95, all P ＞ 0.05);Western blotting analysis showed that expression of HERVWE1 protein (0.340 ± 0.010 vs.0.580 ± 0.010) in placentas of the case group was lower than that in normal pregnant women (t =85.50, P ＜ 0.05).Conclusion The expression of HERVWE1 is significantly decreased in placentas of the case group and is associated with pathogenesis of preeclampsia.

Objective To analyze the results and prognosis for patients with inoperable pancreatic carcinoma treated by interventional chemotherapy (IC) ,three-dimensional radiotherapy (RT), or IC + RT.Methods From 2003 to 2008,139 patients with locally advanced (82 patients, stage Ⅲ) or metastatic (57 patients, stage Ⅳ) pancreatic cancer were retrospectively analyzed, including 74 with pancreatic head carcinoma (53.2%).Three patients with ductal adenocarcinoma were diagnosed with fine-needle aspiration, all other patients were clinically diagnosed with imagings (CT, MRI and/or ultrasonosraphy),clinical symptoms and tumor markers, There were 71,34 and 34 patients receiving IC alone, 3DCRT alone and 3DCRT plus IC, respectively.Log-rank univariate and Cox model multivariate analyses were used to determine prognostic factors.Results The follow-up rate was 92.1%.115 and 98 patients were followedup longer than 1 and 2 years, respectively.The 1-and 2-year overall survival rates were 37.1% and 16.3%for all patients, 44% and 20% for patients with locally advanced disease.The corresponding rates were 18% and 5%, 61% and 29% ,48% and 25% (χ2= 14.65,P=0.001) for patients receiving IC alone, RT alone, and IC + RT, respectively.In univariate analysis, staging (χ2= 44.49, P = 0.035), radiotherapy (χ2= 15.32, P = 0.000) and tumor location (χ2= 10.741, P = 0.002) were prognostic factors.In multivariate analysis, tumor location (χ2= 5.00, P = 0.025) and radiotherapy (χ2= 7.93, P = 0.005) were prognostic factors.Conclusions Radiotherapy can improve overall survival among patients with inoperable pancreatic cancer.The effect of RT + IC should be further investigated.

Objective To investigate the safety and efficacy of transarterial chemoembolization (TACE) combined with implantation of irradiation IVC stent in treating hepatocellular carcinoma (HCC)complicated by inferior vena cava tumor thrombosis (IVCTT).Methods The clinical data of 61 consecutive patients with HCC complicated by IVCTT were retrospectively analyzed.Irradiation IVC stent was prepared by strapping 125I particles on the bare stent,and it was employed in 33 patients (group A).Bare stent was adopted in 28 patients (group B).Propensity score matching method was used to conduct randomized analysis of the original data in order to reduce the selection bias.The survival time,remission rate of symptom and procedure-related adverse events of both groups were calculated and the results were compared between the two groups.Results The incidence of adverse reactions was similar in the two groups,and symptomatic treatment with internal medicine was adopted.The survival time in group A was superior to that in group B.The median survival time in group A was (203.0±28.1) days,which was (93.0±24.3) days in group B (P=0.006).Propensity score matching (24 pairs in total) cohort analysis showed that the median survival time was (200±31) days in group A and (66±23) days in group B (P=0.019).The edema remission rates in group A and in group B were 97.0％ and 96.4％ respectively.Multiple factor analysis revealed that irradiation stent implantation and objective tumor response were independent factors predicting a good prognosis.Conclusion For the treatment of HCC associated with IVCTT,TACE combined with irradiation stent implantation is safe and effective,this therapy can prolong the patient's survival time

Objective To investigate the curative effect of transcatheter arterial chemoembolization (TACE) combined with endovascular 125I seed strip implantation for the treatment of primary hepatocellular carcinoma (PHC) complicated by extensive portal vein tumor thrombus. Methods The clinical data of 72 patients with PHC complicated by extensive portal vein tumor thrombus were retrospectively analyzed. The patients were divided into group A (n=32) and group B (n=40). TACE combined with endovascular 125I seed strip implantation was performed for the patients of group A, while only TACE was employed for the patients of group B. The changes of portal vein tumor thrombus, the survival time and procedure-related adverse events were recorded. The preoperative and postoperative measured values were compared using paired samples t test, the count data were evaluated by χ2 test, and the survival time was analyzed with Kaplan-Meier method. Results Technical success rate of portal vein 125I seed strip implantation was 100%. No serious procedure-related adverse events occurred. The median survival periods of group A and group B were 210 days and 141 days respectively, the difference between the two groups was statistically significant (P=0.012). Conclusion For the treatment of primary hepatocellular carcinoma complicated by extensive portal vein tumor thrombus, TACE combined with endovascular 125I seed strip implantation can significantly improve the patient’s survival time.