Objective To evaluate the effectiveness of combined treatment with thrombolysis,PTA,and endovascular stent placement for malignant obstruction of vena cava.Methods The study included 29 patients with malignant obstruction of vena cava(superior,8 patients;inferior,21 patients).The patients underwent treatment of PTA and endovascular stent placement(for patients with complete vena cava obstruction or patients with incompletely expanding stent),or endovascular stent placement(for patients with incomplete vena cava obstruction),or endovascular stenting combined with thrombolysis(for patients with thrombosis in vena cava),respectively.Results A total of 29 stents was implanted,with a success rate of stent placement of 100%.Symptoms of SVC obstruction completely disappeared in the 8 patients.Scores of patients' IVC syndrome were declined from 4～5(median,4.2) preoperatively to 0～2(median,0.3) postoperatively,with statistically significant difference(Z=-55.245,P=0.000).Follow-up checkups for 1～20 months(mean,6.2 months) in the 29 patients found patent vena cava.There were no serious complications except for vena cava laceration in 1 patient and stent displacing to the right atrium on the third day after therapy in 1 patient.Conclusions The combined treatment of thrombolysis,PTA,and endovascular stenting is safe and effective in the treatment of vena cava obstruction.

Objective To evaluate the effect of MRI in reflecting the pathological changes of VX2 carcinoma in rabbits after radiofrequency ablation (RFA) . Methods RFA was performed in the livers of 24 rabbits with planted VX2 carcinoma. The rabbits were divided into 4 groups. After RFA, the rabbits were killed after MR imaging on 0, 1, 2, and 4 weeks, respectively. The correlation between MRI and pathological findings was analyzed. Results In the acute phase, coagulative necrosis of the ablated tumors and inflammatory reaction with hyperemia around were detected at microscopic examination. The ablated tumor showed as hypointensity on T1WI and hyperintensity on T2WI, while rim of high signal intensity on T1WI and low signal intensity on T2WI was found. Gadolinium-enhanced MRI showed a thin high signal rim surrounding the central coagulative necrosis. In the subacute phase, extensive coagulative necrosis and marked infiltration by neutrophils, lymphocytes, macrophages and a peripheral fibrous generation rim were observed microscopically on the ablated tumor. The ablated tumor showed iso-or hyperintensity on T1WI and hypointensity on T2WI, while the periphery of ablated lesions was hypointensity on T1WI and hyperintensity on T2WI. There was prominent rim enhancement along the ablated margin. In the chronic phase, peripheral fibrous rim became obvious, more regular and thicker than at subacute phase as hypointensity on T1WI and T2WI, and unenhancement was observed. Residual or recurrence of tumor was found in 17 rabbits as hypointensity on T1WI and hyperintensity on T2WI, and irregular, thicker rim or nodular enhancing abnormalities. Conclusion MRI can effectively show the histopathological tissue changes of rabbit VX2 carcinoma after ablation and demonstrate the residual or recurrence of tumor.

Objective Retrospectively evaluate the effect of Z-axis tube-current modulation technique with desired noise level to improve image quality (image noise level) and decrease radiation doses of MSCT (16-slice CT) in chest scanning. Methods Consecutive two hundred patients whose CT scan projection radiographs showed no significant abnormal were randomly divided into two groups by the examination order: Z-axis tube-current modulation (ZTCM) group (odd number, test group) and constant tube-current (CTC) group (even number, contrast group). The desired noise level of ZTCM group was 10HU and the machine automatically set the dynamic tube-current in scanning according to attenuated information of chest acquired in scan projection radiographs, the tubo-current of CTC group was set at 200mA, while the other scan parameters remained totally the same. The maximum tube-current value,CTDIvol, DLP and the tube-current of the slice at the maximum breast level of female patients were recorded respectively. The noise of image at upper lung, aorta arch, left atrium and bottom lung level were measured and compared. The qualities of Images were classified in three levels (excellent, good, poor) with double blind method. Results The mean value of maximum mA, CTDIvol, DLP and mA of the slice at the maximum breast level of ZTCM group were (178.5±125.6) mA, (10.5±3.8) mGy, (231.6±24.3)mGy/cm and (116.0±22.5) mA, those of CTC were 200.0 mA, 12.8 mGy, (274.7±18.4)mGy/cm and 200.0 mA, ZTCM group decreased by 10.8%, 19.9%, 15.7% and 42.0%,respectively, as compared with CTC group. The image quality at upper lung and bottom lung level in ZTCM group was improved significantly (P < 0.05) and the cases of excellent images in ZTCM group was significantly higher than that of CTC group (P < 0.05). Conclusion ZTCM technique not only contributes to more rational distribution of radiation doses but also realizes individuation, decreases the total radiation doses and improves image quality in chest CT scanning. It is valuable and promising in chest CT scan.

Over-expression of CD151 was found to be associated with metastasis and poor prognosis of prostatic carcinoma. This study was designed to examine the mechanism by which CD151 promotes the proliferation and migration of prostatic cancer cells. The pAAV-CD151, pAAV-GFP and pAAV-CD151-AAA mutant plasmids were constructed and used to transiently transfect PC3 cells (a prostatic carcinoma 3 cell line) by the mediation of Fugene HD. Then, the cells were assigned to control group, pAAV-GFP group, pAAV-CD151 group, and pAAV-CD151-AAA group respectively. Cell proliferation was evaluated by using the 3-[4,5-dimet-hylthiazol-2-yl]-2,5, diphenyltetrazolium bromide (MTT) method. Cell migration assay was performed by using Boyden chambers. The formation of CD151-integrin α3/α6 complex was determined by the method of co-immunoprecipitation. The protein expression levels of CD151 and extracellular signal-regulated kinase (ERK) were measured by Western blotting. The results showed that transfection of pAAV-CD151 or pAAV-CD151-AAA mutant increased the expression of CD151 protein in PC3 cells. Co-immunoprecipitation showed that more CD151-integrin α3/α6 complex was formed in the pAAV-CD151 group than in the control group, the pAAV-GFP group and the pAAV-CD151-AAA mutant group. Furthermore, the proliferative and migrating capacity of PC3 cells was substantially increased in the pAAV-CD151 group but inhibited in the pAAV-CD151-AAA mutant group. CD151 transfection increased the expression of phospho-ERK. Taken together, it was concluded that CD151 promotes the proliferation and migration of PC3 cells through the formation of CD151-integrin complex and the activation of phosphorylated ERK.

Objective To investigate balanced steady-state free precession with flow-sensitive dephasing magnetization preparation (FSD-bSSFP) in the assessment of arteries of foot in diabetic patients.Methods The lower-extremity peripheral arteries of 43 diabetic patients were evaluated by FSD-bSSFP no contrast MRA and contrast-enhanced MRA (CE-MRA)in. Two experienced observers assessed the image quality, degree of venous contaminated and visibility of pedal artery branches by FSD-bSSFP and CE-MRA respectively in consensus. The signal intensity( SI), signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the source images of both groups were measured and Wilcoxon and t tests were performed. Results The image score of FSD-bSSFP group was 2.7 ± 1.1 and CE-MRA was 2.6 ± 0.8, there was no statistical difference ( Z = 0. 134, P ＞ 0. 05 ). The image score of demonstration of the pedal artery branches and degree of venous contamination on FSD-bSSFP were 3.2 ± 0. 9 and 1.8 ± 0. 4 respectively which were superior to that of CE-MRA (2.5 ± 0.9 and 2.1 ± 0.8 respectively). Significant statistical difference existed between the two groups in demonstration of pedal artery branches ( Z = 5.246, P ＜ 0.05 ) and degree of venous contamination (Z =2.541 ,P ＜0.05). SNR of FSD-bSSFP was 148.6 ±26.7, CNR was 88.3 ± 19.0. SNR of CE-MRA was 148.5 ± 45.6, CNR was 121.0 ± 41.0. No statistical difference existed between SNR between two methods (t = 0.013, P ＞ 0.05 ). But CNR of CE-MRA was superior to that of FSD-bSSFP and significant statistical difference existed between these two methods ( t = 5.113, P ＜ 0.01 ). Conclusion FSD-bSSFP without contrast could be used in the evaluation of foot arteries in patients of renal dysfunction and diabetes.

Objective: To investigate the clinicopathologic and prognostic features of Claudin-low breast cancers (CLBC). Methods: Tissue microarray sections were scored semiquantitatively for the immunohistochemical expression of claudin-1, -3, -4, -7 and -8 in 233 cases of invasive breast cancers collected from Qingdao Central Hospital from January 2010 to December 2011. Results: The expression rate of Claudin-3 (72/212, 33.9%) and -4 (56/212, 45.2%) was most similar, and Claudin-4 showed the highest expression. Twenty one cases (21/212, 9.0%) were diagnosed as CLBC, with triple-negative breast cancer (TNBC) accounted for the highest proportion (11/21, 52.4%). Among the CLBC cases, the invasive carcinoma no special type (66.7%, 14/21) and metaplastic carcinoma (14.3%, 3/21) were mostly seen, while metaplastic squamous carcinoma did not show Claudin-low pattern. Compared to the non CLBC in this cohort, CLBC had higher proportion of histologic grade 3 and tumors larger than 2 cm, and the proportions were slightly lower than TNBC. Patients with CLBC had lower 5 year disease-free(P>0.05) and overall survival rates(P=0.018). Conclusion CLBC shows distinct clinicopathologic and prognostic features comparing to other subtypes, and is associated with poor prognosis.

Over-expression of CD151 was found to be associated with metastasis and poor prognosis of prostatic carcinoma. This study was designed to examine the mechanism by which CD151 promotes the proliferation and migration of prostatic cancer cells. The pAAV-CD151, pAAV-GFP and pAAV-CD151-AAA mutant plasmids were constructed and used to transiently transfect PC3 cells (a prostatic carcinoma 3 cell line) by the mediation of Fugene HD. Then, the cells were assigned to control group, pAAV-GFP group, pAAV-CD151 group, and pAAV-CD151-AAA group respectively. Cell proliferation was evaluated by using the 3-[4,5-dimet-hylthiazol-2-yl]-2,5, diphenyltetrazolium bromide (MTT) method. Cell migration assay was performed by using Boyden chambers. The formation of CD151-integrin α3/α6 complex was determined by the method of co-immunoprecipitation. The protein expression levels of CD151 and extracellular signal-regulated kinase (ERK) were measured by Western blotting. The results showed that transfection of pAAV-CD151 or pAAV-CD151-AAA mutant increased the expression of CD151 protein in PC3 cells. Co-immunoprecipitation showed that more CD151-integrin α3/α6 complex was formed in the pAAV-CD151 group than in the control group, the pAAV-GFP group and the pAAV-CD151-AAA mutant group. Furthermore, the proliferative and migrating capacity of PC3 cells was substantially increased in the pAAV-CD151 group but inhibited in the pAAV-CD151-AAA mutant group. CD151 transfection increased the expression of phospho-ERK. Taken together, it was concluded that CD151 promotes the proliferation and migration of PC3 cells through the formation of CD151-integrin complex and the activation of phosphorylated ERK.
Cell Line, Tumor ; Cell Movement ; Cell Proliferation ; Humans ; Integrin alpha3 ; metabolism ; Integrin alpha6 ; metabolism ; Male ; Prostatic Neoplasms ; metabolism ; pathology ; Tetraspanin 24 ; metabolism

OBJECTIVETo analyze the cause of atypical manifestation of hepatocellular carcinoma (HCC) in triple-phase spiral CT enhanced scan.

METHODSTriple-phase spiral CT scan was performed in 75 patients with HCC. The hepatic arterial phase (HAP), portal venous phase (PVP) and delayed phase (DP) images were started at 25 to 30 s, 65 to 70 s and 3 tp 5 min after injection of contrast medium. The contrast enhanced patterns of lesion were observed and analyzed.

RESULTSNinety-two lesions were found in 75 patients. Typical enhanced findings such as hyperdense in HAP and hypodense in PVP and DP was found in 60 of 92 lesions. Atypical enhanced findings were observed in the other 32 lesions. Fourteen of 32 atypical enhanced lesions were hyperdense in HAP and isodense in PVP, of which 8 were seen in liver cirrhosis and 3 in fatty liver. In DP, 10 were hypodense and 4 still isodense. Eight of the 32 lesions were hyperdense both in HAP and PVP, of which 6 were seen in fatty liver. In DP, 3 were isodense and 5 were hypodense. Six of 32 lesions were isodense in HAP which became hypodense in PVP and DP. Four of 32 lesions were all hypodense in HAP, PVP and DP.

CONCLUSIONMultiple atypical enhanced manifestations are present by triple-phase spiral CT scan in HCC. Pattern of blood supply, scanning technique and pathophysiologic status are usually the cause of these findings.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; Contrast Media ; Humans ; Liver Neoplasms ; diagnostic imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

Objective:To analyze the accuracy of diagnostic indicators for perioperative venous thromboembolism（VTE）in orthopedic patients.Methods:A retrospective case-control study was conducted to analyze the clinical data of 109 patients who underwent initial total hip arthroplasty（THA），total knee arthroplasty（TKA）or proximal femoral nail antirotation（PFNA）in Hechuan District People ’s Hospital of Chongqing from January 2015 to September 2019. There were 55 males and 54 females，with age range of 18-76 years［（46.3 ± 11.2）years］. Of all，54 patients underwent unilateral THA due to femoral head necrosis and femoral neck fracture，36 patients underwent unilateral TKA due to osteoarthritis and 19 patients underwent PFNA due to proximal femoral fracture. VTE was confirmed in 47 patients（VTE group），and did not occur in 62 patients（non-VTE group）. Venous blood was collected from all patients on admission and at postoperative 1，3，5，7 days to measure levels of plasma D-dimer，serum interleukin（IL）-18 and vascular endothelial growth factor（VEGF）. The accuracy of the above indicators in VTE diagnosis was analyzed by using receiver operating characteristic（ROC）curve. Results:In both groups，preoperative levels of D-dimer，IL-18 and VEGF were significantly lower than those postoperatively，and each indicator showed significant difference at each time points after operation（ P < 0.05 or 0.01）. Moreover，levels of D-dimer，IL-18 and VEGF in VTE group were significantly higher than those in non-VTE group at each time after operation（ P < 0.05 or 0.01）. Area under the ROC curve（AUC）for D-dimer was 0.839（95% CI 0.729-0.887），with the optimal cut-off of 5.5 μg/ml，sensitivity of 87.0%，specificity of 79.0% and Youden index of 0.67. AUC for IL-18 was 0.817（95% CI 0.719-0.857），with the optimal cut-off of 293.5 pg/ml，sensitivity of 67.0%，specificity of 87.1% and Youden index of 0.457. AUC for VEGF was 0.837（95% CI 0.784-0.918），with the optimal cut-off of 510.8 pg/ml，sensitivity of 81.0%，specificity of 79.0% and Youden index of 0.583. AUC for combined D-dimer，IL-18 and VEGF was 0.870（95% CI 0.747-0.992），with the sensitivity of 87.2%，specificity of 83.4% and Youden index of 0.606. Conclusions:For diagnosis of perioperative VTE in orthopedic patients，serum VEGF is relatively accurate，while serum IL-18 has a low accuracy. However，the diagnostic rate of VTE can be improved by combining indicators of D-dimer，IL-18 and VEGF.

PURPOSE: The significance of neuroendocrine differentiation (NED) in gastric carcinoma (GC) is controversial, leading to ambiguous concepts in traditional classifications. This study aimed to determine the prognostic threshold of meaningful NED in GC and clarify its unclear features in existing classifications. MATERIALS AND METHODS: Immunohistochemical staining for synaptophysin, chromogranin A, and neural cell adhesion molecule was performed for 945 GC specimens. Survival analysis was performed using the log-rank test and univariate/multivariate models with percentages of NED (PNED) and demographic and clinicopathological parameters. RESULTS: In total, 275 (29.1%) cases were immunoreactive to at least 1 neuroendocrine (NE) marker. GC-NED was more common in the upper third of the stomach. PNED, and Borrmann's classification and tumor, lymph node, metastasis stages were independent prognostic factors. The cutoff PNED was 10%, beyond which patients had significantly worse outcomes, although the risk did not increase with higher PNED. Tumors with ≥10% NED tended to manifest as Borrmann type III lesion with mixed/diffuse morphology and poorer histological differentiation; the NE components in this population mainly grew in insulae/nests, which differed from the predominant growth pattern (glandular/acinar) in GC with <10% NED. CONCLUSIONS: GC with ≥10% NED should be classified as a distinct subtype because of its worse prognosis, and more attention should be paid to the necessity of additional therapeutics for NE components.
Adenocarcinoma ; Chromogranin A ; Classification ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Neural Cell Adhesion Molecules ; Prognosis ; Stomach ; Stomach Neoplasms ; Synaptophysin