Objective To explore whether the PDA patients in the early stage of Eisenmenger syndrome can accept interventional surgery. Methods Three patients were choose from the “National Multicenter Prospective Registration Study on Pulmonary Artery Hypertension”, Clinical assessment, as well as examinations and registrations associated with PAH, was conducted in accordance with relevant provisions of the registration study within 1 wk prior to surgery. The way of the interventional treatment were right heart catheterization and pulmonary vasodilator testing (a capsule of iloprost solution for inhalation), and measurement of the pulmonary arterial pressure, descending aortic pressure, ratio of pulmonary to systemic blood flow, ratio of pulmonary to systemic blood pressure, pulmonary capillary wedge pressure [mean≤15 mmHg(1 mmHg=0.133 kPa)], before and after testing. After clear the results of pulmonary vasodilator test all patients underwent transcatheter closure testing, if it was positive,the amplatzer was released if her family members’ approved;Conversely, the amplatzer was quickly withdrawn with negative results, and symptomatic treatment was conducted based on the patient’s clinical symptoms. Results The first cases pulmonary vasodilator test was negative, but positive in transcatheter closure testing. Satisfaction immediate effect of surgery, and the occluder was released with her family members’ approval. patients of Example 2 and Example 3 were negative in pulmonary vasodilator testing and transcatheter closure testing, can not released the occluder. Conclusions Some Patents Ductus Arteriosus (PDA) patients in early stage of Eisenmenger syndrome is feasible to accept interventional therapy , try plugging test is may be an important indicator of prognostic assessment.

Objective To determine the brain natriuretic peptide(BNP) levels and the effects of endothelin receptor antagonist(ERA) on BNP levels in patients with tetralogy of Fallot(TOF) recently surgical repaired.Methods During January 2010 to January 2012,32 cases of TOF after surgical repaired in hospital were selected.There are 20 males and 12 females,Aged 4 years to 18 years [mean age (7.64 ± 3.75) years] in age.All patients underwent enhanced CT to evaluate the pulmonary vessels and left ventricular before surgery arrangements.As the surgeries done,the patients were grouped randomly as either A or B.All 14 patients in group A started to follow the recommended dosage of bosentan within 3 days after surgery.Meanwhile,all 18 in group B had not taken bosentan or any other ERAs since the surgeries.Both group was evaluated and examined with echocardiography and blood test at the 10th day after surgery.Results None of the patients died within 10 days after surgery.BNP levels of group A was significantly lower than of group B.Inotropic score of group A was markedly lower,too.However,although group A showed mildly advantages in tricuspid regurgitation,pulmonary regurgitation,ratio of RV/LV end-systolic dimension and liver functions,there was no statistically significant difference.Conclusion For patients with tetralogy of Fallot,early use of ERAs after surgical repaired could reduce the use of inotropic agents and significantly decrease the BNP levels when discharged.

Hilar cholangiocarcinoma is the most common malignant tumor of the biliary tract. Surgical resection is the only radical treatment method at present. However, due to its insidious onset and high degree of malignancy, it is usually in the middle or late stage when first diagnosed, most patients have lost the chance of radical surgery and have a very poor prognosis. In recent years, with the continuous progress of medical technology, the optimization and different combination of treatment methods such as chemotherapy, radiotherapy, biliary drainage, photodynamic therapy, nano-knife ablation, intraluminal radiofrequency ablation, liver transplantation, targeted therapy and immunotherapy has significantly improved the prognosis of patients with unresectable hilar cholangiocarcinoma. Chemotherapy, radiotherapy, photodynamic therapy and intraluminal radiofrequency ablation on the basis of biliary drainage can prolong the time of biliary patency. Nano-knife ablation can maximize the elimination of tumor cells on the premise of protecting the structure of the ducts. Liver transplantation offers a possibly curative opportunity for patients with unresectable hilar cholangiocarcinoma. Targeted therapy and immunotherapy provide a breakthrough point for precision therapy and individualized therapy. Based on the literature and the clinical experience of our team, this paper discussed the therapeutic approaches for unresectable hilar cholangiocarcinoma and encountered problems, so as to provide reference for clinical treatment and related research.

OBJECTIVE: To investigate the in vitro and in vivo anticancer efficacy of the immunotoxin DTATEGF against human NSCLC brain metastatic tumor PC9-BrM3 cell line. METHODS: The effect of the immunotoxin DTATEGF was tested for its ability to inhibit the proliferation of PC9-BrM3 cells in vitro by MTT assay. The cell cycle and the apoptosis of cells with 1 pmol/L DTATEGF were examined by flow cytometry. In vivo, 2 μg of DTATEGF or control Bickel3 was given intratumor to nude mice with established PC9-BrM3 xenografts on their hips, and tumor volumes were measured and tumor samples were investigated by immunchistochemistry SABC method. The microvessel density (MVD) was measured in each group. RESULTS: In vitro, DTATEGF killed PC9-BrM3 cells and showed an IC50 of 1 pmol/L. The apoptotic rate in the 1 pmol/L DTATEGF group was (64.0±0.5)% , significantly higher than that in the control group (1.5±0.4)% (P<0.01). The cell cycle was obviously inhibited by DTATEGF in a dose-dependent manner. The percentage of cells treated with 1 pmol/L DTATEGF in SubG0/G1 phase was (32.0±1.5)%, significantly higher than that in the control group (2.0±0.4)% (P<0.01). In vivo, DTATEGF significantly inhibited the growth of PC9-BrM3 hip tumors (P<0.05). The MVD of the DTATEGF group was (15.6±4.6)/mm2, significantly lower than that of the control group (31.2±5.4)/mm2 (P<0.01). CONCLUSION DTATEGF inhibits the growth of the PC9-BrM3 cell line and induces its apoptosis. It is highly efficacious against human metastatic NSCLC brain tumor and against neovascularization.
Animals ; Antibodies, Bispecific ; pharmacology ; Apoptosis ; Brain Neoplasms ; drug therapy ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; Cell Cycle ; Cell Line, Tumor ; Humans ; Immunotoxins ; pharmacology ; Mice ; Mice, Nude ; Neovascularization, Pathologic ; prevention & control ; Xenograft Model Antitumor Assays

OBJECTIVE: To investigate the in vitro and in vivo anticancer efficacy of the immunotoxin DTAT and DTATEGF against globlastoma multiforme. METHODS: The in vitro cytotoxicity of DTAT and DTATEGF was measured using MTT assay. In vivo studies were performed in which 18 nude mice were randomly divided into 3 groups and the glioma xenograft intracranial mouse model was constructed with U87-luc cell line of human glioma. Then 1 μg of DTAT, or DTATEGF, or a control protein Bickel3 was delivered intracranially by convection-enhanced delivery (CED) via an osmotic minipump. The brain tumor fluorescence signal intensity was investigated by bioluminescent imaging (BLI). Microvessel density (MVD) was measured by immunchistochemistry SABC method in each group. RESULTS: In vitro DTAT and DTATEGF were found highly potent against U87-luc cell line, with IC(50) <0.01 nmol/L and IC(50)<1 nmol/L, respectively. In vivo BLI monitoring of the control group showed progressively increasing luminescence, while in the two treatment groups, luminescence was reduced on day 8, and increased slowly (P<0.05). The MVD of DTAT (31.6±5.2)/mm(2) and DTATEGF (25.1±6.5)/mm(2) groups had significant difference with that of the control group (51.3±7.4) /mm(2) (P<0.01). CONCLUSION Both DTAT and DTATEGF have potential in clinical application against globlastoma multiforme because of their ability to target the tumor cells and neovasculature simultaneously.
Angiogenesis Inhibitors ; pharmacology ; Animals ; Brain Neoplasms ; drug therapy ; Cell Line, Tumor ; Glioblastoma ; drug therapy ; Glioma ; Humans ; Immunotoxins ; pharmacology ; Mice ; Mice, Nude ; Xenograft Model Antitumor Assays

Objective:To study the effect of sorafenib and prophylactic transarterial chemoembolization (TACE) for prevention of postoperative relapse in patients with liver cancer combined with microvascular invasion (MVI) after using radical hepatectomy.Methods:A retrospective analysis was performed on 137 cases that underwent radical hepatectomy at the First Affiliated Hospital of Zhengzhou University from August 2015 to January 2018. Clinical data of liver cancer patients with MVI were diagnosed by postoperative pathology. General data of the three groups were analyzed. Kaplan-Meier was used to calculate the tumor-free survival rate. COX proportional hazards-model was used to analyze the independent risk factors for postoperative recurrence of liver cancer with MVI recurrence. Counting data was compared by x 2 test between groups, and log-rank test was used to compare the tumor-free survival rates. Results:A, B, and C groups had 49, 36, and 52 cases, respectively. General clinicopathological data of the three groups were not statistically significant. The postoperative tumor-free survival rates at 1-, 2-, and 3-years were 71.4%, 51.0%, 38.8%, 86.1%, 75.0%, 66.7%, and 82.7%, 75.0%, and 59.6% respectively in A, B, and C groups. Multivariate Cox proportional-hazards regression model showed that patients' age ( HR = 0.622, P = 0.046), maximum tumor diameter ( HR = 1.661, P = 0.033), prophylactic TACE ( HR = 0.544, P = 0.019), and postoperative use of sorafenib ( HR = 0.419, 0.222, 0.791, P = 0.007) were independent risk factors for postoperative recurrence of liver cancer with MVI. Conclusion:Sorafenib or prophylactic TACE use can significantly reduce the recurrence rate within 3 years after radical surgery in patients with liver cancer who were confirmed to have MVI by postoperative pathology.

ObjectiveTo investigate the level of positive aspects and current status of their general self-efficacy among the family caregivers of disabled elderly,and to explore the correlation between them. MethodsBy convenience sampling, a cross-sectional survey was conducted among 120 family caregivers of disabled elderly in Fangzhuang Community, Heping Li Community, Tiancun Community and Peking Union Medical College Hospital from April to June 2018 by Self-designed General Questionnaire,Activities of Daily Living Scale(ADL), General Self-Efficacy Scale(GSES) and Positive Aspects of Caregiver(PAC) to investigate the current status of the caregivers' self-efficacy and positive aspects and analyze the correlation between them using statistical software. ResultsThe 120 caregivers of disabled elderly got (27.98±7.82)points from GSES, which is at a moderate level; the caregivers achieved (35.60±8.16)points from PAC among which the score of"self-affirmation"dimension was (19.93±4.51) points, and "life prospects" dimension was (15.68±4.24)points;the total score of GSES and PAC as well as all dimensions of the family caregivers of disabled elderly showed a moderate level of positive correlation (r=0.524, 0.435, 0.541;P＜0.01). ConclusionsThe family caregivers of the disabled elderly had positive aspects which correlated positively with their general self-efficacy. Medical staff can take corresponding measures to improve the family caregivers' self-efficacy and positive aspect so as to improve the quality of their care and as well as the life quality of the elderly.

Objective To investigate the detection rate and grading diagnostic value of ultra-wide field swept-source optical coherence tomography angiography(UWF SS-OCTA)combined with ultra-wide field scanning laser ophthalmoscopy(UWF SLO)in diabetic retinopathy(DR)lesions.Methods In this cross-sectional study,diabetic patients attending the Ophthalmology Department of Sichuan Provincial Peoples Hospital were recruited.All participants underwent UWF SS-OC-TA,UWF SLO and fundus fluorescein angiography to detect DR lesions,including microaneurysms(MA),intraretinal hem-orrhages(IRH),nonperfusion areas(NPAs),intraretinal microvascular abnormalities(IRMAs),venous beading(VB),neovascularization elsewhere(NVE),neovascularization of the optic disc(NVD),and vitreous hemorrhage(VH).The re-sults of the combination of three imaging examinations(triple imaging)were used as the standards,evaluating the detec-tion rate and severity grading consistency in DR lesions of pairwise combinations of different imaging modalities.Results A total of 101 patients(175 eyes)were included.Compared with the triple imaging results,the detection rates of UWF SS-OCTA combined with UWF SLO for MA,IRH,NPAs,IRMAs,NVE,NVD and VH were 91％,83％,77％,69％,27％,10％and 12％,respectively,with Kappa values of 0.812,1.000,1.000,1.000,0.986,0.970 and 1.000.Compared with the triple imaging results,the combination of UWF SS-OCTA and UWF SLO demonstrated excellent consistency in grading the severity of DR(Kappa=0.943).Conclusion UWF SS-OCTA combined with UWF SLO can accurately identify MA,IRH,NPAs,IRMAs,NVE,NVD and VH,demonstrating high accuracy in DR screening and grading diagnosis,making it suitable for large-scale screening and management of DR in clinical practice.

OBJECTIVETo investigate the indications of the pretemporal transcavernous approach for cavernous sinus tumors resection and design individually tailored surgery according to the extent of tumors and operation requirements.

METHODSA retrospective analysis of clinical data, surgical outcomes and complications in a series of 31 cases with cavernous sinus tumor operated via the individually tailored pretemporal transcavernous approach between May 2012 and September 2015 in Department of Neurosurgery, Xiangya Hospital, Central South University. There were 13 male and 18 female patients, aging from 17 to 67 years with a mean of (41±14) years. The patients included 18 cases of shwannomas, 4 cases of meningiomas, 3 cases of cavernous hemangiomas, 2 cases of invasive pituitary adenomas, 1 case of chordoma, 1 case of chondroma, 1 case of recurrent teratoma, 1 case of metastatic nasopharyngeal carcinoma. The first followed-up visit was on the 3(rd) month after surgery, and if tumor progression or recurrence was observed on MRI, the Gamma knife treatment was recommended, the patient was followed up every 6 months, otherwise the patient was followed up again 6 months later, then, every 12 months.

RESULTSGross total removal of tumors was achieved in 22 cases of 31 patients (71.0%), containing 17 cases of shwannomas, 3 cases of hemangiomas, 1 case of chondroma, 1 case of teratoma; subtotal removal in 6 cases (19.3%), including 3 cases of meningiomas, 1 case of pituitary adenoma, 1 case of chordoma, 1 case of metastatic carcinoma; partial removal in 3 cases (9.7%), comprising 1 case of meningioma, 1 case of recurrent shwannoma, 1 case of recurrent pituitary adenoma. The symptoms of cranial never aggravated in 5 cases, the new postoperative cranial never palsy was observed in 7 cases. There was no surgical mortality, intracranial hematoma, intracranial infection and cerebrospinal fluid leakage cases, ect. Twenty-eight cases were followed up for more than 3 months (3 to 40 months), 1 case of chordoma had tumor progression; the nerve function was restored in 5 cases, among the 12 cases with postoperatively new occurred or deteriorated cranial nerve paralysis.

CONCLUSIONSThe pretemporal transcavernous approach can be used to resect tumors limited in cavernous sinus or tumors simultaneously involving the cavernous sinus and its vicinity areas, it can be individually tailored based on the extent and exposure of the tumor. This approach can improve the surgical results in terms of high tumor resection rate, less complication, is an ideal approach for cavernous sinus tumor resection.

Adenoma ; surgery ; Adolescent ; Adult ; Aged ; Cavernous Sinus ; pathology ; surgery ; Chordoma ; surgery ; Female ; Hemangioma ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Meningioma ; surgery ; Middle Aged ; Neoplasm Recurrence, Local ; Pituitary Neoplasms ; surgery ; Postoperative Period ; Radiosurgery ; Retrospective Studies ; Young Adult

Objective:To discuss whether balloon atrial septostomy(BAS) can provide safe and effective left ventricular venting for venoarterial extracorporeal membrane oxygenation(V-A ECMO).Methods:From March 2017 to January 2019, 9 patients received BAS for left ventricular venting during V-A ECMO treatment in our hospital, including 5 males and 4 females, aged 12-72 years. There were 3 cases of severe myocarditis, 4 cases of low cardiac output after cardiac surgery, and 2 cases of acute myocardial infarction. Basic data, procedure data, outcome and follow-up were recorded.Results:BAS were successfully performed in 9 patients. Procedure time on average was 42.2 min. Anterior mediastinal hematoma occurred in 1 case. There were no other procedure-related complications in the rest cases. No pulmonary edema or thrombosis occurred in all 9 cases during ECMO. No closure procedure was performed.Conclusion:BAS is a safe and effective method for left ventricular venting. The procedure is conductive to the recovery of patients with severe left heart failure.