10.3969/j.issn.1008-9691.2013.03.003

Objective To evaluate the safety of percutaneous radiofrequency ablation (RFA ) in hepatic malignant tumors under the guidance of ultrasonography .Methods The clinical data and the follow‐up radiographic images of the patients with hepatic malignant tumors treated by percutaneous RFA between January 2012 and February 2014 were retrospectively reviewed ,and the major or minor complications of RFA were both calculated .Results 1 568 lesions were ablated by 1 080 percutaneous RFA procedures in 900 patients with hepatic malignant tumors under the guidance of the sonography .The average size of the tumors was (2 6.± 1 2.)cm .The total complications rate of 1 080 RFA procedures was 5 9.3% (64/1 080) , which including intra‐abdominal bleeding 2 7.8% (30/1 080) ,hepatic abscess 0 7.4% (8/1 080) ,biliary tract damage 0 6.4% (7/1 080 ) ,vascular damage 0 5.6% (6/1 080 ) ,tract seeding 0 4.6% (5/1 080 ) ,pleural hemorrhage 0 3.7% (4/1 080) ,gastrointestinal damage 0 1.8% (2/1 080) ,hepatic encephalopathy 0 0.9% (1/1 080) ,and death 0 0.9% (1/1 080) .While major complications was 1 9.4% (21/1 080) vs minor 3 9.8% (43/1 080) .Sixty three patients with complications recovered after treatments including blood transfusion , ablation ,surgery ,interventional drainage procedure and liver transplantation ,only one patient died for irreversible liver failure .Conclusions RFA for hepatic malignant tumors under the guidance of sonography is a safe method with lower complications rate ,however ,the potential major complications and the indications of RFA liver malignant tumors should be carefully focused on .

Objective To evaluate the diagnostic value of contrast enhanced ultrasonogrphy(CEUS) and quantitative analysis in differentiating between thyroid solid malignant masses and solid benign masses.Methods 40 patients with thyroid solid mass were enrolled into this prospective study between March 2012 and June 2012.A total of 45 thyroid solid masses were evaluated by CEUS,and the final pathology diagnosis was confirmed by core biopsy or thyroidectomy.The diagnostic yield of enhancement patterns and quantitative parameters were assessed for differentiating between the solid malignant and benign masses.Results Enhancement patterns were classified into five types (nonenhancement,early hypo enhancement,hypo enhancement,isoenhancement,hyperenhancement).Two malignant masses had nonenhancement pattern,and 6 malignant masses had early hypoenhancement pattern,and 14 malignant and 4 benign masses had the hypo enhancement pattern,and 5 malignant and 7 benign masses had the isoenhancement pattern,and 1 malignant and 6 benign masses had the hyperenhancement pattern.There was a significant difference between malignant and benign enhancement patterns of thyroid solid masses (x2 =12.184,P =0.016).Nonenhancement,early hypoenhancement and whole phase hypoenhancement pattern predict thyroid solid malignant masses with sensitivity of 78.5 ％ and specificity of 76.5 ％.Among seven quantitative parameters used to predict thyroid malignant mass,the relative maximum intensity (IMAX％) of lesions had highest value in differentiating between the malignant and benign masses with sensitivity of 80.8 ％ and specificity of 82.6％,and area under receiver operating curve (AUC) of the IMAX％ was 0.878.RT (rising time),TTP (time to peak intensity),mTT (mean transit time) had almost non differentiation value with AUC of 0.619,0.601,0.656 separately.And mTT-Ratio (mTT of lesion/mTT of parametric area),RT-Ratio (RT of lesion/RT of parametric area),TTP-Ratio (TTP of lesion/TTP of parametric area) had less differential diagnostic value with AUC of 0.749,0.744,0.704 comparing with IMAX％.Conclusions Nonenhancement and early or whole phase hypoenhancement could be characteristic enhancement pattern of malignant thyroid solid masses,and IMAX％ had good diagnostic value in differentiating between malignant and benign masses among the quantitative parameters.

Objective To evaluate the short-term efficiency and risk factors for effects after percutaneous radiofrequency ablation (RFA) for hepatic malignant tumors under the guidance of sonography.Methods The clinical data and the follow-up radiographic images of the patients with hepatic malignant tumors treated by percutaneous RFA were reviewed between June 2011 and May 2012,and the short-term incomplete ablation rate,recurrance rate and tumor progression rate were calculated,and the factors affecting the incomplete ablation rate,recurrence rate and progression rate were analyzed.Results 610 lesions were ablated in the total of 462 RFA procedures for 405 patients under the guidance of sonography with percutaneous method.The average size of the tumor was (2.5 ± 1.1)cm.During at least 3-month follow-up,complete and incomplete ablation rate was 89.2％ (544/610) and 10.8％ (66/610)separately,and recurrance rate and progression rate of tumor was 17.5％ (81/462) and 23.8％ (110/462).The numbers (≥3) and the size (≥3 cm) and the location (close to vessels) of the lesions reduced the complete ablation rate.The numbers (≥3) of lesions affected the recurrence rate and progression rate of lesions as only risk factor.Recurrent hepatocellular carcinoma (HCC) and metstasis from gastrointestine or non-gastrointestine had higher recurrence rate and progression rate comparing with primary HCC.Conclusions RFA can effectively control local progression of hepatic maglinant tumors,and the tumor's size,number and location close to velssels could effect complete ablation rate,the number of tumors could effect the recurrence and porgression rate.Recurrent HCC and metstasis from gastrointestine or nongastrointestine had higher recurrence and progression rate comparing with primary HCC.

Objective To summarize the manifestation of autoimmune pancreatitis (AIP) on ultrasound and contrast-enhanced ultrasonography (CEUS).MethodsThe 2D ultrasound and CEUS images of 16 patients With AIP were retrospectively analyzed.Results On 2D ultrasound,AIP presented as diffusely(15 cases) or focally (1 case)swelling with low echo.13 cases revealed dilatation of the biliary tract.The choledochal wall showed thickening with a sandwich-pattern in 9 cases,which was also shown in 3 intrahepatic bile ducts and 3 gall bladders.On CEUS,6 AlP of diffuse form enhanced simultaneously and homogeneously.1 AIP with enlarged pancreatic head enhanced simultaneously,the enhanced degree in pancreatic head was higher than that of the surrounding pancreatic tissue in the vascular phase and equal to that in the parenchymatous perfusion phase.1 AIP of focal form enhanced slightly late compared with normal pancreatic tissue and the enhanced degree was lower in the vascular phase,while in parenchymatous perfusion phase.the pancreatic tissue enhanced homogeneously.ConclusionsThe manifestation of AIP on ultrasound and CEUS had some features which were helpful in diagnosis of AIP.

Objective To build the schema of combination between commercially available ultrasound contrast agent SonoVue and self-made liposomes,and determine its efficiency. Methods Microbubbles was labeled by carbocyanines dye DiI. The effect of DSPE-PEG-FITC labelling was determined by flow cytometer to evaluate the insertion efficiency of the amphipathic molecule DSPE-PEG(2000)Amine into lipid monomers shell. Aminated fluorescent liposomes were prepared by rotary evaporation and their size were determined by laser particle size analyzer. Liposomes and microbubbles were combined by two-step glutaraldehyde crosslinking. The impact of liposome concentration and DSPE-PEG (2000)Amine concentration on the construction efficiency of the complex of SonoVue conjugated to liposomes was determined by flow cytometer and multifunctional ELIASA respectively. Results The configuration of SonoVue microbubbles labeled by DiI and DSPE-PEG-FITC showed fine. The combination between liposomes and microbubbles was realized by glutaraldehyde crosslinking. The flow cytometer showed that 200 μl liposomes solution per 200 μl microbubbles suspension was the optimal proportion, with the peak positive rate as (87.80 ± 5.91)%. Multifunctional ELIASA showed that 150 μl DSPE-PEG (2000)Amine (100 μm) solution per 200 μl microbubbles suspension was the optimal proportion, with the peak carry efficiency as (83.41±2.21)%. Conclusions The amination of commercially available SonoVue is realized by the insertion of DSPE-PEG (2000) Amine molecule. Glutaraldehyde crosslinking the liposomes and microbubbles is feasible. Moreover, we can choose other active groups to modify the microbubbles and liposomes, construct more convenient methods with higher efficiency.

Objective To investigate clinical significance of combined detection of serum C 3bR and IL-6 in patients with traumatic brain injury.Methods 48 patients with TBI admitted in 371 Central Hospital of PLA from May 2016 to May 2017 were randomly selected as the subjects,including 26 males and 22 females,aged 25 to 60 years,with an average age of(43.7 ± 5.8)years.Admission according to the injury by Glasgow coma score(GCS):≤7 points in 18 cases,≥8 points in 30 cases.Another 30 healthy people who were admitted to the hospital for the same period were selected as the control group.Serum C3bR and IL-6 levels were meas-ured by ELISA in the study group at 1,3 and 7 days after admission,and the expression of C3bR and IL-6 were analyzed.Results The level of serum C3bR in the first and the third day after traumatic brain injury was significantly lower than that in the control group,and the level of IL-6 after craniocerebral injury was signifi-cantly higher than that of the control group(P<0.05).In the observation group,the level of C3bR was signif-icantly higher than that of ≤ 7,and the level of IL-6 was significantly lower than that of the severe GCS score ≥8(P<0.05).In this study,the serum C3bR,IL-6 and the two joint tests were 0.624,0.641 and 0. 900,respectively area.Conclusion Serum C3bR and IL-6 combined detection can significantly improve the sensitivity of traumatic brain injury diagnosis,so as to understand the severity of traumatic brain injury,w hich could help to assess the disease and determine the prognosis,and have important clinical value.

BACKGROUND:At present, liver transplantation is the best method to treat end-stage liver disease. UW solution is recognized as the best liver preservation solution, but it is expensive. Moreover, the extracel ular fluid of high K+condition is inconsistent with human physiology. Because transient hyperkalemia of UW solution often causes cardiac arrest, research and development of the new liver preservation solution already brook no delay. OBJECTIVE:To study the protective effect of self-designed KYL solution on ischemia reperfusion injury in macaque donor liver. METHODS:A total of eight recipient macaques and eight donor macaques were selected in this study. Each group contained KYL solution group (n=4) and UW solution group (n=4). Donor liver was perfused and cryopreserved for 4 hours and subjected to al ogenic orthotopic liver transplantation. At 30 minutes and 6 hours after transplantation, bile production was recorded. Blood was obtained and used to detect concentrations of aspartate aminotransferase, alanine aminotransferase, nitric oxide, endothelin-1 and tumor necrosis factor-α. Liver tissue was col ected and detected under the light microscope. RESULTS AND CONCLUSION:Bile secretion was found in both groups. Bile secretion production increased as time went on (P<0.05). At 30 minutes and 6 hours after donor liver reperfusion, serum aspartate aminotransferase and alanine aminotransferase concentrations were lower in the KYL solution group than in the UW solution group (P<0.05). No significant difference was found in levels of serum nitric oxide, endothelin 1 and tumor necrosis factor alpha between the two groups (P>0.05). Under light microscope, morphological observation of liver tissue revealed that cel ular edema was evident in the UW solution group than in the KYL solution group. Results suggest that the effect of KYL solution on preventing ischemia/reperfusion injury was identical to the UW solution, and partial effect was better than UW solution.

Objective To research the distribution and the characteristics of the plasmid mediated quinolone resistant genes in Shewanella algae. Methods The qnr, qepA, aac(6')-Ib-cr genes were amplified by PCR, then the positive PCR products were sequenced to determine the gene type. The transferability of plasmid mediated quinolone resistance was ensured by conjugation experiment. MICs were measured by E-test. qnrA gene was mapped to plasmids to locate it. Results The qnrA gene were detected in the Shewanella algae, this is a newfound subgroup qnrA7, the GenBank accession no. was GQ463707, qnrB, qnrS,qnrC, qnrD, qepA and aac(6')-Ib-cr genes were not detected. qnrA7 reside in a plasmid about 33 kb, conjugation experiment was unsuccessful. The strain was susceptible to quinolones. Conclusion It deserves paying close attention to the report of an original qnrA subgroup in an isolate of water-borne species of Shewanella algae.

Objective To sum up experience and lessons learnt from liver separation in two thoracoventropagus twins. Method By preoperative imaging it was verified that the two twins of thoracoventropagus named as AB and CD respectively having independent portal hepatic system and the digestive tract.Intraoperatively a separation line was delineated between the porta hepatis,the second porta hepatis.Liver parenchyma of the AB conjoined twin was separated under local blood control with both sides of the seperation line.Intraoperative bleeding was about 10ml,liver rough surface was suctured together,after ligation or suturing of blood vessels and bile ducts.The livers of CD conjoined twin were separated with blocking the first hepatic hilum firstly,and partial hepatic vascular exclusion secondly by part of the liver pressed with finger.There was intraoperative bleeding of about 200 ml. Results The two cases of conjoined twins were separated successfully,and there was no bile leakage,liver failure and infection.A and B are alive and well.D died of lung infection 78 days later.C died of lung and cavitas thoracis infection 9 months later. Conclusion Liver separation is feasible in a thoracoventropagus with independent porta hepatis system.Partial blocking of hepatic vasculature occlusion,in stead of portal triad clamping is preferred.During the separation of hepatic parenchyma finger press for the control of local hepatic blood flow is not always reliable.