Venous thromboembolism (VTE) and pulmonary embolism(PE) contributes to morbidity and mortality in cancer patients and is a frequent complication of anticancer therapy. Precautions and managements are needed to decrease the morbidity due to VTE and PE. There is no standard procedure for the treatment of the complications. Interventional radiology has been shown to play an important role in the treatment of various diseases. Recently, interventional radiology has developed in the treatment of VTE and PE. This review is to summarize the status of VTE and PE in patients with malignant tumors and their treatment by interventional radiology therapy.

In China, medical system reforms have made an obvious achievement in recent years .However, lots of urgent problems still exist.Doctors are not satisfied with their working environment.The high-pressure job with low remuneration reduces doctors'enthusiasm for work.Meanwhile, both the threat to personal safety and disrespect from patients bring negative effects to doctor's physical and mental health .The main factors causing this situation include the leaky health care system , the incomplete health -care legislation, the misleading reports and the poor medical knowledge of patients .Therefore, some countermeasures should be taken to solve problems mentioned above and the construction of medical ethics should be strengthened at the same time .

The purpose of intra-arterial perfusion chemotherapy for locally advanced and recurrent breast cancer is to gain the chance of operative excision and to control the clinical symptoms.Intra-arterial perfusion chemotherapy has been widely employed in clinical practice and has already achieved satisfactory therapeutic results.Based on the medical documents concerning the interventional therapy of breast cancer,which have been published both at home and abroad,the authors attempt to make some suggestions in order to standardize the clinical application of this interventional technique.This paper will focus on the blood supply and imaging findings of the breast cancer,as well as on the preoperative preparation,indications and contraindications,medication,complications and therapeutic efficacy of intra-arterial perfusion chemotherapy.

OBJECTIVE:To summarize the types of esophageal stent implantation and explore the clinical application and complications following esophageal stent implantation.METHODS:A computer-based online search of VIP database (http://www.cqvip.com/) was performed for articles about clinical application of esophageal stent implantation,published between January 1998 and October 2009,with the key words "esophageal stent,indication,complication".The data were collected,and the references were reviewed.Inclusion criteria:Type of esophageal stent;clinical application and complications following esophageal stent implantation.Exclusion criteria:repetitive studies.A total of 22 articles were finally included.RESULTS:Esophageal stent implantation as a novel technique has become an important approach for innocent or malignant esophageal stenosis,as well as orificium fistulae.The metal stent with no cover,partially covered stent and fully-covered stent have effectively cure esophageal diseases.However,patients suffer from the complications,such as chest pain,bleeding and perforation,gastroesophageal reflux,stent dislocation or shedding,and restenosis.Reduction of complications can improve quality of life of the patients.CONCLUSION:There are various types of esophageal stents.Therefore,appropriate selection of type,size,and characteristics of stent according to different disease condition,and accurate operation may minimize incidence of complications.

Objective To study the cause of different prognosis in typical medullary carcinoma and atypical medullary carcinoma. Methods The immunohistochemical staining method was used to evaluate the positivity of E cadherin,? catenin, in 30 cases of atypical medullary carcinoma and 18 cases of typical medullary carcinoma and 10 cases of normal breast. Results The positive rate and staining intensity of E cadherin and ? catenin oncoprotein were significantly higher in typical medullary carcinoma than in atypical medullary carcinoma( P

Transcatheter arterial chemoembolization (TACE) is the main treatment method for advanced hepatocellular carcinoma (HCC). As a non-invasive functional MR imaging, diffusion weighted imaging (DWI) can relfect the functional changes in tumor before morphologic changes. In the follow-up of HCC after TACE, DWI can detect new lesions and distinguish necrotic neoplastic tissue and residual neoplastic tissue timely and accurately.

At present,peripherally inserted central catheter (PICC) and totally implantable access port (TIAP) are most commonly used for the medium-term and long-term ccntral vcnous infusion in China,which is mainly adopted for long-term repeated chemotherapy,nutritional support and other clinical treatments.As an advanced infusion route,this technique needs to be further popularized in clinical practice to benifit the majority of patients.However,in aspect of the implantation,use,maintenance,and the diagnosis and treatment of complications of long-term central venous access,there are still a lot of problems,to which sufficient attention should be paid.Standard implantation and maintenance are of great importance for the safe implantation of central venous access and long-term safe use.This paper aims to make a comprehensive review concerning the problems of long-term indwelling of central venous access,the basic solutions,and the whole course management of central venous access.In order to promote the technique of central venous access to continually develop,the multidisciplinary collaborative team with tacit cooperation,standardized system and regulatory process should be emphasized.

Background and purpose: With characteristic but non-specific features, subsolid pulmonary nodules (SSPN) is closely associated with early lung cancer. This study aimed to estimate the imaging value of SSPN in stageⅠA lung cancer, and summarized the radiological features of various SSPNs, retrospectively. Methods:The clinical data and imaging data of 405 patients with solitary pulmonary nodules (SPNs) from Apr. 2008 to Apr. 2014 at Fudan University Shanghai Cancer Center were collected. According to ground-glass opacity (GGO) proportion, SPNs were divided into 3 groups:pure ground-glass opacity (pGGO), mixed ground-glass opacity (mGGO) and solid nodule (SN). The malignant ratios were calculated based on the postoperatively pathological results. Besides, SSPNs were classiifed into stageⅠA lung cancer group and benign lesions group aiming at identifying the differentiating computed tomography (CT) features. Results:Of the enrolled 405 SPN patients, there were 367 SSPNs (including 124 pGGOs and 243 mGGOs) whose incidence in stageⅠA lung cancer group was signiifcantly higher than those in benign group [95.9%(257/268) vs 80.3%(110/137), P<0.001]. The total malignant ratio of SSPN was 70.0%(257/367), mGGO had a higher malignant ratio (72.0%) than those of pGGO (66.1%) and SN (28.9%). The malignant SSPNs were frequently detected in upper lobe of middle-aged women with a higher incidence of irregular edge, spiculation, lobulation and pleural retraction than benign group (P<0.05). Conclusion:SSPN is one of the signiifcantly malignant indicators, and mGGO has the highest malignant tendency. Senility, female, irregular edge, spiculation, lobulation, pleural retraction and pulmonary upper lobe distribution are demonstrated the signiifcant discriminators from benign lesions.

Objective To compare the accuracy of bispectral index (BIS),Narcotrend index (NI),index of consciousness (IoC) versus auditory evoked potential index (AAI) in monitoring the depth of sedation induced by propofol.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 41-64 yr,with body mass index 20-30 kg/m2,scheduled for elective surgeries under general anesthesia,were enrolled in the study.Propofol was given by target-controlled infusion (TCI) with the initial target effect-site concentration (Ce) of 0.8 μg/ml using Marsh pharmacokinetic model,and then the Ce of propofol was increased by 0.1 μg/ml,and OAA/S was performed.Before TCI of propofol,the values of BIS,NI,IoC and AAI were recorded,and at the same time the value of OAA/S score was 5.During TCI of propofol,when OAA/S score reached 4,3,2 and 1 in turn,the Ce of propofol was recorded,the sequence for determination of the values of BIS,NI,IoC and AAI was determined using a random number table,and the values were then recorded for 5 s after the values were stable and then averaged.The parameters for vital signs were maintained within the normal range.Pearson correlation of BIS,NI,IoC and AAI values with Ce of propofol was analyzed.Results The correlation coefficients of BIS,NI,IoC and AAI values with the Ce of propofol were rBIs-Ce =-0.829,rSI-Ce =-0.886,rloC-Ce =-0.881 and rAAI-Ce =-0.791,respectively.There was no significant difference between rBIS-Ce,rNI-Ce,rIoC-Ce and rAAI-Ce.Conclusion There are no significant differences in the accuracy of BIS,NI,IoC or AAI in monitoring the depth of sedation induced by propofol in middle-aged patients with non-noxious stimuli.

Objective:To explore the value of improved sequential organ failure assessment (ISOFA) in predicting the prognosis of Klebsiella pneumoniae sepsis. Methods:The clinical data of 379 patients with Klebsiella pneumoniae sepsis admitted to the First Hospital of Jilin University from January 1, 2018 to June 30, 2019 were retrospectively analyzed.They were divided into survival group and death group according to the 28-day prognosis, and the age, gender, C-reactive protein, procalcitonin, grade of bacterial resistance, and the occurrence of septic shock of the two groups were compared.Statistical analysis was conducted by using independent sample t test, Mann-Whitney U test and chi-square test. Risk factors for the prognosis of the disease was analyzed by logistic regression analysis.The correlation between ISOFA and other scoring system including Charlson′s weighted index of comorbidities (WIC), national early warning system (NEWS), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), simplified acute physiology scoreⅡ (SAPSⅡ), mortality in emergency department sepsis score (MEDS), sequential organ failure assessment (SOFA), acute gastrointestinal injury (AGI) was determined by Spearman correlation coefficient.The area under the receiver operating characteristic curve (AUROC) was used to compare the evaluation value of each scoring system for the prognosis of Klebsiella pneumoniae sepsis. The clinical significance of ISOFA risk stratification was evaluated by Kaplan-Meier survival curve. Results:Among the 379 patients with Klebsiella pneumoniae sepsis, 278 were in the survival group and 101 were in the death group.The differences of age, gender, the occurrence of septic shock, grade of bacterial resistance, C-reactive protein, procalcitonin, WIC, NEWS, APACHEⅡ, SAPSⅡ, MEDS, SOFA, AGI and ISOFA score between the two groups were all statistically significant ( t=-3.218; χ2=6.781, 24.374 and 27.208, respectively; Z=-3.689, -5.022, -4.396, -4.697, -7.438, -6.348, -6.358, -8.676, -6.680 and -11.658, respectively; all P<0.01). The calculation method of ISOFA was obtained by single factor analysis: ISOFA=SOFA+ 1.5×AGI.Multivariate logistic regression suggested that ISOFA, gender, SOFA, procalcitonin, C-reactive protein, and bacterial resistance were independent risk factors for the prognosis of the disease. The Spearman correlation coefficients of ISOFA and WIC, NEWS, APACHEⅡ, SAPSⅡ, MEDS and SOFA were 0.327, 0.371, 0.614, 0.564, 0.578 and 0.847, respectively. The AUROC and its 95% confidence interval for WIC, NEWS, MEDS, SAPSⅡ, APACHEⅡ, SOFA alone, SOFA plus AGI, and ISOFA to predict the prognosis of Klebsiella pneumoniae sepsis were 0.646 (0.584-0.708), 0.657 (0.597-0.716), 0.712 (0.654-0.771), 0.713 (0.653-0.773), 0.749 (0.693-0.806), 0.788 (0.737-0.838), 0.872 (0.826-0.917) and 0.891 (0.845-0.937), respectively.The results showed that ISOFA had the best predictive effect.The Kaplan-Meier survival curve suggested that there were statistical differences in survival rate among ISOFA low-risk level, medium-risk level, and high-risk level (all P<0.01). Conclusion:ISOFA has important clinical significance in predicting the prognosis of Klebsiella pneumoniae sepsis.