Objective To explore the relationship of MDR1 and its encoded product P-gp expressions with clinical efficacy of transcatheter arterial chemoembolization (TACE)in primary liver cancer and their clinical significance.Methods We selected 108 patients with primary liver cancer who came to our hospital between June 2010 and June 2013 as observation subjects.Meanwhile 50 healthy people in our hospital for liver biopsy were selected as controls.MDR1 mRNA level in observation group and control group was determined by real-time quantitative PCR.P-gp protein level was analyzed by immunohistochemistry.According to P-gp level,the 108 patients were divided into drug-resistance groups and non-resistance group;the relationship between P-gp expression level and clinical efficacy was analyzed.Results MDR1 mRNA level in liver tissues significantly enhanced in observation group compared with that in control group (P <0.05).In observation group 32 patients had the ratio of MDR1 mRNA level-normal level of more than 2 and 76 patients had the ratio of MDR1 mRNA level-normal level of less than 2. Immunohistochemistry revealed that MDR1 encoded product P-gp was brownish yellow, mainly expressed in the cell surface of liver cancer cells.There were 35 P-gp protein-negative patients (non-resistance group)and 73 positive patients (resistance group).Clinical efficacy was significantly higher in non-resistance group (74.28%)than in resistance group (43.28%)(P <0.05).The 1 year and 2-year cumulative survival rates were 54. 12% and 27.40% in resistance group and 77.14% and 42.86%% in non-resistance group.They were significantly higher in the latter group (P <0.05 ).Conclusion The overexpressed MDR1 encoded product P-gp in primary liver cancer is associated with multidrug resistance in tumor chemotherapy,suggesting that P-gp can be used as one of the guiding clinical markers of chemotherapy.

Objective To investigate the radiological features of granulomatous mastitis (GM) in dynamic contrast enhanced MRI (DCE-MRI) and DWI and to differentiate it from the breast cancer in diagnose.Methods Forty five cases of GM and 64 cases of breast cancer confirmed by surgical histopathology or biopsy were retrospectively analyzed in the study.All of the patients were examined preoperatively by DCE-MRI and DWI.Including lesion type,location,enhancement pattern,nipple retraction,supplying arteries,skin thickening and axillary adenopathy in the two groups were evaluated and analyzed by using x2 test.One-way ANOVA was employed to compare the ADC values between the abscess area of GM and non-abscess area,and the difference among the breast cancer lesion area.Dynamic enhancement MR pharmacokinetic parameters were used to measure including early-phase enhancement rate (EER),peak enhancement ratio(Emax),and time to peak ehhancement(Tmax).The statistical differences of EER,Emax and Tmax between the two groups were calculated by using Wilcoxon test.Results In 45 cases of GM,DCE MR images showed nonmass-like lesions (43 patients) and mass-like lesions (2 patients); the nipple involved(16 patients) and segment involved (29 patients);rim-like with heterogeneous enhancement (40 patients) and heterogeneous enhancement (5 patients); nipple retraction (24 patients) supplying arteries dilatation (42 patients),skin thickening (29 patients),and axillary adenopathy (17 patients).Corresponding to the radiological features above,in the 64 breast cancer cases,it showed 54,10,5,59,30,34,16,51,12 and 20,respectively.There were statistical significance between GM and breast cancer in lesion type,location,enhancement pattern,and nipple retraction (x2=67.574,13.075,20.297,20.398 and 23.510,respectively,all P＜0.01).But no differences were existed between 2 groups in supplying arteries and axillary adenopathy(x2=3.928 and 0.502,P＞0.05).EER,Emax and Tmaxin GM were 146.58％,191.13％,195.00 s in GM and 118.13％,159.43％,183.33 s in breast cancer,respectively.Significant statistic differences between GM and breast cancer were found in EER and Emax(Z values were-2.271 and-2.948,P＜0.01).But it did not show significant difference in Tmax (Z =-0.548,P＞0.05).The ADC values of GM on abscess area,non-abscess area,and breast cancer lesion area were (8.0±2.6) × 10-3,(11.3± 1.7) × 10-3 and (8.2± 1.1) × 10-3mm2/s,respectively.There were significant differences in the groups (F=52.167,P＜0.01).Conclusions The characteristic of radiological findings can be found in GM by using advanced MR imaging techniques.DCE-MRI combined with DWI is useful in the differential diagnosis between GM and breast cancer.

Objective Toinvestigatethemethod,safetyandefficacyoftranscatheterarterialchemoembolization(TACE)combined withargonheliumknifecryoablationintreatmentofadvancedprimaryhepaticcancer.Methods FiftyGfourpatientswithadvanced primaryhepaticcancerunderwentTACEfirstly,andfollowedbytheargonhelium knifecryoablationunderCT/ultrasoundguiding percutaneouspunctureafter1－2weeks.2－3cyclesofcryotherapywereperformedduringtheoperation.Afteroperation,enhanced CT/MRIwasperformedtofollowGup.Results Themediansurvivaltimewas17.6months.The6Gmonthsurvivalratewas100%,the 12Gmonthsurvivalratewas89.34%,thetumorprogressiontimewas9.3 months,andtheshortestsurvivalperiodwas8 months.Recent curativeeffectevaluationshowedCRin9patients,PRin34patients,SDin6patients,PDin5patients(RR＝79.62%,DCR＝90.74%). Conclusion TACEcombinedwithargonheliumknifecryoablationisasafeandeffectivetreatment,whichprovidesanewtreatment planforpatientswithprimaryhepaticcancer.

Objective ToexploretheeffectofTIPS+GCVEcombinedwithPSEonhemodynamicsinpatientswithlivercirrhosis,portal hypertensionandsplenomegaly.Methods 56patientswereincludedfromJanuary2015toDecember2016 whounderwentTIPS+GCVEcombinedwithPSE.Patientswerefollowed-upon1month,3months,6monthsand1yearaftersurgery,andstatisticanalysis weredoneonportalveinhemodynamicindex:portalveintrunkdiameter(PVD),portalveinvelocity(PVV),portalvenousbloodflow (PVF),splenicveintrunkdiameter(SVD)andvelocityofbloodflowinsplenicvein(SVV).Results Thereweresignificantdifferencesinportal veinpressurebeforeandafterthebypassinall56patients.PVDandPVV weresignificantlydifferentbetween3and6 monthsafter surgeryandpre-surgery.PVF wassignificantlydifferentcomparing6 monthsand1yearaftersurgery withpre-surgery.SVDand SVV weresignificantlydifferentbetween3 months,6 monthsand1yearaftersurgeryandpre-surgery.Conclusion TIPS+GCVE combinedwithPSEcouldeffectivelyreduceportalveinpressure,improveportalveinandspleenveinbloodflow,increaseportalvenousblood flow,andimprovepatients’liverfunction.

Background and purpose: The technique of dynamic contrast-enhanced MRI (DCE-MRI) is widely applied in differential diagnosis between benign and malignant tumor and therapeutic estimation of neoadjuvant chemotherapy in clinic. However, there is no standard quantitative measurement method. This study aimed to assess the variability of different region of interest (ROI) selections for tumor bed of breast cancer using DCE-MRI, and to ascertain the optimal ROI delineation. Methods: We retrospectively analyzed DCE-MRI of 30 patients diagnosed with breast cancer by pathology. The ROIs were delineated by 2 different observers using iCAD software with 4 methods, including whole tumor (Whole), the slice containing the most enhancing voxels (SliceMax), 3 slices centered in SliceMax (Partial) and the 5％ most enhancing contiguous voxels within SliceMax (5Max), to generate the volume transfer constant (Ktrans), the extracellular volume fraction (Ve) and rate constant (Kep). And the reproducibilities of the measurements were assessed using the Bland-Altman method. Results: In the analysis of ROIs delineation, the Ktrans, Ve and Kep reported by different observers were 1.26±0.54 vs 1.25±0.53, 0.75±0.23 vs 0.73±0.22 and 1.93±1.46 vs 1.95±1.51 (P＞0.05) using the method of Whole, and 1.28±0.43 vs 1.26±0.43, 0.74±0.21 vs 0.80±0.27, 1.95±1.53 vs 1.93±1.43 (P＞0.05) using the method of Partial, and 1.30±0.33 vs 1.32±0.33, 0.77±0.20 vs 0.73±0.24, 1.82±1.53 vs 1.87±1.45 (P＞0.05) using the method of SliceMax, and 1.31±0.35 vs 1.35±0.33, 0.77±0.20 vs 0.98±0.25, 1.97±1.36 vs 1.73±1.55 using the method of 5Max (P＜0.05). Using the methods of ROI delineation except 5Max, there was no significant difference between Ktrans, Ve and Kep reported by different observers. The bias vs limits of agreement were 0.002 vs-0.013 to 0.012,-0.003 vs-0.023 to 0.017, 0.006 vs-0.018 to 0.029,-0.035 vs-0.054 to 0.018 measured with Whole method, SliceMax, Partial and 5Max respectively using the Bland-Altman method. Conclusion: It may be reliable to measure functional parameters of primary tumors in breast cancer using DCE-MRI according to the methods of Whole, Partial and SliceMax.

Objective To observe the efficacy of hepatic artery infusion chemotherapy(HAIC)combined with lenvatinib for treating Barcelona clinic liver cancer(BCLC)stage B or C hepatocellular carcinoma(HCC),and to explore the impact factors of patients'survival time.Methods Data of 104 patients with BCLC stage B or C HCC were retrospectively analyzed.The patients were divided into observation group(n=46,underwent HAIC combined with lenvatinib)and control group(n=58,underwent HAIC alone).The clinical efficacy and adverse reactions of treatments,as well as patients'overall survival(OS)and progression free survival(PFS)were recorded and compared between groups.Cox regressions were used to explore the impact factors of patients'survival time.Results Three months and 6 months after HAIC,the results of modified response evaluation criteria in solid tumors(mRECIST)in observation group were both better than those in control group(both P＜0.05),while no significant difference was found between groups one year after HAIC(P＞0.05).The overall survival rate in observation group was higher than that in control group(P＜0.05),while there was no significant difference of progression free survival rate between groups(P＞0.05).The incidence of rash in observation group was higher than that in control group(P＜0.05).Multiple Cox regression showed prolonged OS in HCC patients in observation group(hazard ratio[HR]=0.425,95%CI[0.255,0.791])compared with that in control group.Compared with pre-treatment Eastern Cooperative Oncology Group(ECOG)score 1,AFP≥400 μg/ml,the number of tumor foci≥3 and BCLC stage C,pre-treatment ECOG score 0,AFP＜400 μg/ml,the number of tumor foci≤2 and BCLC stage B were all independent protective factors of OS in HCC patients(all P＜0.05).Conclusion HAIC combined with lenvatinib was safe and effective for treating BCLC stage B or C HCC.Pre-treatment ECOG score,serum AFP level,the number of tumor foci and BCLC stage were all independent impact factors of OS.