Objective To investigate the correlation between the level change of serum homocysteine (HCY) and vascular endothelial growth factor (VEGF) with the degree of the coronary artery stenosis in the patients with acute coronary syndrome (ACS) .Methods A total of 157 ACS patients were divided into the ST‐elevation myocardial infarction (STEMI) group ,non‐ST el‐evation myocardial infarction (NSTEMI) group and unstable angina pectoris(UA) group based on the symptoms ,cardiac enzymes level and electrocardiogram changes .The cases were induded into the mild ,moderate and severe stenosis lesion groups according to the coronary arteriography examination;meanwhile the enzyme‐linked immunosorbent assay (ELISA) was used to detect the change of the serum VEGF concentration .The HCY level was determined by enzymatic cycling methods with the biochemical analyzer (BXC800 ,Beckman ,USA) .The differences in the concentrations of VEGF and HCY compared among different groups .Results The VEGF level had statistical differences among the mild ,moderate and sever stenosis groups(F=39 .9 ,P=0 .00) ,and between the UA group with the NSTEMI group and STEMI group(F=123 .3 ,P=0 .00) .The HCY level had statistically significant differ‐ence between the severe stenosis group with the mild and moderate stenosis groups (F=39 .7 ,P=0 .00);the HCY level had statis‐tically significant difference among the UA group ,NSTEMI group and STEMI group(F=102 .65 ,P=0 .00) .The VEGF and HCY levels in the mild stenosis group ,different degrees of coronary stenosis groups and different clinical diagnosis groups were positively correlated with the Gensini scores(r=0 .723 ,0 .716) .Conclusion The serum VEGF and HCY levels are correlated with the degree of the coronary artery lesion and myocardial necrosis in ACS patients ,furthermore are related with the Gensini scores .

In order to investigate the inhibitory effects of all trans-retinoitc acid (ATRA) on differentiation and apoptosis of Walker-256 hepatocellular carcinoma cells and the therapeutic effects of ATRA combined with transarterial chemoembolization (TACE) on rat Walker-256 transplanted hepatocarcinoma, Walker-256 hepatocarcinoma cell lines were treated with ATRA at different concentrations. After culture for 48 h, the inhibitory rate of cell proliferation was determined by MTT assay; the changes of Fas and Bcl-2 mRNA expression were determined by RT-PCR, and the expression levels of Caspase3 and Caspase8 proteins were detected by Western blot. Twenty-seven Wistar rat models of hepatocarcinoma were set up successfully by implanting Walker-256 cell lines. The tumor volume at the 11th day after implantation (V(preoperation)) was measured by magnetic resonance imaging (MRI). The 27 rats were randomly and equally divided into three groups, and the therapy scheme was performed as follows: group A (ATRA 0.1 mg+mitomycin 0.05 mL+lipiodol 0.05 mL+gelfoam powder 0.025 mg); group B (mitomycin 0.05 mg+lipiodol 0.05 ml+gelfoam 0.025 mg; group C (0.9% NaCl 0.2 mL). After another 11 days, MRI was performed once again to measure the tumor volume (V(postoperation)). The expression of factor and Ki VIII -67 in the tumor tissues was detected by immunohistochemistry. The results showed that ATRA could suppress proliferation of Walker-256 cell lines. After treatment of Walker-256 cell lines with ATRA, the expression of Fas mRNA was significantly up-regulated and the Bcl-2 mRNA was significantly down-regulated by ATRA at the concentration of 10 mumol/L as compared with the control group (P<0.05). After treatment with 10 mumol/L ATRA for 48 h, the Caspase3 and Caspase8 were significantly activated as compared with the control group (P<0.05). Significant difference existed in growth rate among the three groups (P<0.01) and between either two groups (P<0.05). The expression rate of factor VIII and Ki-67 was gradually increased from group A, group B to group C. The study suggests that ATRA could inhibit the proliferation of Walker-256 cells and the effectiveness of the combined therapy (ATRA+TACE) for treating transplanted hepatoma of rats is superior to that of TACE alone.

Objective To discuss the influence of different antitumor treatments on the survival time of patients with obstructive jaundice caused by cholangiocarcinoma located at middle-low segment of common bile duct after receiving PTCD. Methods During the period from Jan. 2012 to March 2013, a total of 60 patients with pathologically-proved cholangiocarcinoma located at the middle-low segment of common bile duct were admitted to authors’ hospital. According to tumor TNM staging, stage Ⅱ was seen in 9 cases, stage Ⅲ in 39 cases and stage Ⅳ in 12 cases. Based on the degree of cell differentiation, highly differentiated cancer was observed in 9 cases, moderately differentiated cancer in 37 cases, and poorly differentiated cancer in 14 cases. The 60 patients were enrolled in this study. Drainage tube placement and stent implantation were performed in all patients so as to relieve the symptoms of jaundice. According to the antitumor treatment used, the 60 patients were randomly and equally divided into three groups with 20 patients in each group. Draining procedure with subsequent regular arterial infusion chemotherapy was employed in the patients of group A; draining procedure with subsequent particle chain placement in biliary tract was performed in the patients of group B; and draining procedure with subsequent regular arterial infusion chemotherapy together with particle chain placement in biliary tract was carried out in the patients of group C. The results were analyzed using SPSS17.0 statistical software. The death factors of patients were statistically evaluated by using multivariate Cox proportional hazards regression analysis method, P<0.05 was considered that the difference had statistical significance. Results The median survival periods of group A, B and C were (186.0±36.4) days, (183.0±26.5) days and (252.0±43.6) days respectively. The death factors of cancer patients were analyzed by using multivariate Cox proportional hazards regression analysis method, which indicated that tumor stage was a risk factor for death (HR=8.434, 95%CI 3.41-20.090);the treatment mode was a protection factor of death (HR=0.616, 95%CI 0.429-0.884); while the degree of tumor differentiation was unrelated to death(score test,字2=0.197, P=0.657>0.05). The risk of death in group B was not significantly different from that in group A (HR=1.012, 95%CI 0.558-2.179); while the treatment mode of group C was a protection factor of death (HR=0.334, 95%CI 0.148-0.075). Conclusion The TNM stage and treatment mode can influence the survival time of patients with cholangiocarcinoma located at the middle-low segment of common bile duct. Therefore, for the treatment of obstructive jaundice caused by cholangiocarcinoma, combination use of regular arterial infusion chemotherapy and particle chain placement in biliary tract should be employed immediately after draining procedure as this therapeutic mode can effectively prolong patient’s survival time.

The onset of hepatocelluar carcinoma, one of the serious complications of primary Budd-Chiari syndrome, is associated with poor prognosis.Although so, the diagnosis and treatment of such disease has still not been standardized at recent.In this paper, we overviewed the recent advances on Budd-Chiari syndrome associated with hepatocelluar carcinoma.

Objective To evaluate the safety and efficacy of 125I seed strands cavity brachytherapy for ureteral carcinoma.Methods To tally 10 patients with ureteral carcinoma underwent Carm CT and DSA guided percutaneous nephrostomy with 125I seed strands cavity brachytherapy.The technical success rate,complications,tumor local control rate,ureteral patency andsurvival time,and compared the Karnofsky scores,Girignon grade,pain score before and after treatment were evaluated.The dose related parameters were compared between pre-and post-treatment.Results 125I seed strands implantation was successfully completed in all patients with technical success rate of 100％.The mean procedure time was (12.3 ±3.8) min.No severe complications such as ureteral perforation,infection,severe bleeding occurred.Local tumor response was CR in 4 cases and PR in 6 cases,showing local control efficiency (CR + PR) 100％ after 2-3 months.Ureteral patency rate was 50％ (5/10).Postprocedure Karnofsky scores,Girignon grades,and pain scores were significantly improved (Z =-2.72,-2.88,-2.83,P＜0.01).The average follow-up time was (14.6 ±6.5) months (5-25 months),tumor progression was observed in 3 cases,stable disease in 7 cases.Nine cases were alive and one died due to multiple organ failure.The differences of D90％,mPD,V100％,V150％,V200％,CI,EI,HI between the preand post-treatment were not statistically significant (P ＞ 0.05).Conclusions 125I seed strands cavity brachytherapy for ureteral carcinoma is an effective and safe procedure without serious complications,and an effective alternative treatment for patients who are unable to undergoor refuse surgery.

Embolization, Therapeutic ; Hemorrhage ; Humans ; Liver Cirrhosis

Objective To evaluate the feasibility and clinical outcomes of interventional treatment of Budd-Chiari syndrome (BCS) associated with simultaneous upper gastrointestinal hemorrhage.Methods The clinical data of 32 patients of BCS with upper gastrointestinal hemorrhage from October 2015 to April 2008 in First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.Variceal embolization and inferior vena cave (IVC) and/or hepatic veins (HV) angioplasty were performed simultaneously.Perioperative complications were observed.Portal vein pressures were measured through catheterization preand post-operation.Restenosis of IVC and HV,upper gastrointestinal hemorrhage were observed on followup.Results Percutaneous transluminal balloon angioplasty were successfully carried out in all patients:16 patients with IVC and 17 patients with HV stenosis underwent angioplasty without stent placement.Portography indicated one esophageal and gastric varices in 17 patients and two in 15 patients.All the varices were embolized successfully.The portal vein pressure reduced from (35.7±2.9) cmH2O to (31.2±2.5) cmH2O (P ＜ 0.05,1 cmH2O =0.098 kPa).Portal vein pressure reduced from (35.8± 3.0) cmH2O to (30.7±2.3) cmH2O in HV type BCS post-operation,and reduce from (35.6±3.0) cmH2O to (31.8±2.6) cmH2O in HV and IVC involved type,which indicated that portal vein pressure decreased more obviously after HV recanalization.On follow-up for 3 to 32 months (mean 11.7 ±7.8 months),7 patients with IVC and 5 patients with HV stenosis developed restenosis.Transluminal balloon angioplasty was performed.No upper gastrointestinal hemorrhage occurred during the follow-up period.Conclusion One-stage interventional treatment of BCS with upper gastrointestinal hemorrhage was safe and effective,and had satisfactory mediumlong term outcomes.

Objective To evaluate the clinical effect of endovascular interventional therapy in treating Cockett syndrome associated with deep vein thrombosis (DVT) of left lower extremity.Methods The clinical data of a total of 256 patients with Cockett syndrome complicated by DVT of left lower extremity,who were admitted to authors' hospital during the period from January 2011 to January 2015,were retrospectively analyzed.The patients were treated with catheter-directed thrombolysis,balloon dilatation of the occluded or narrowed venous segment,and/or stent implantation.The circumference differences of the affected limbs before and after treatment and the long-term patency rates were compared.Results Of the 256 patients with Cockett syndrome complicated by DVT of left lower extremity,complete dissolution of thrombus was achieved in 232 (90.6％) and partial dissolution of thrombus in 24 (9.4％).The circumference difference of thigh and calf was (7.12±2.15) and (4.57±2.81) cm respectively before and after treatment.Iliac vein reconstruction was carried out in 206 patients,among them simple balloon dilatation was employed in 46 and balloon dilatation together with stent implantation was adopted in 160.The patients were followed up for 9-24 months with a mean of 15 months.In simple balloon dilatation group,3 patients lost touch with the authors during the following-up period,26 patients (60.5％) developed iliac vein occlusion and post-embolization syndrome occurred in 21 patients (48.8％).In balloon dilatation plus stent implantation group,11 patients lost touch with the authors during the following-up period,stenosis or occlusion of the stent was seen in 13 patients (8.7％),post-embolization syndrome was observed in 15 patients (10.1％).The differences in vascular stenosis or occlusion and in the occurrence of post-embolization syndrome between the two groups were statistically significant (P＜0.001).Conclusion For the treatment of Cockett syndrome complicated by DVT of left lower extremity,catheter-directed thrombolysis and balloon dilatation combined with stent implantation carry definite clinical curative effect.

ObjectiveTo investigate the effect of arsenic trioxide-loaded CalliSpheres beads (CBATO) in transarterial chemoembolization (TACE) in the treatment of rabbits with VX2 liver tumor. MethodsA total of 120 tumor-bearing rabbits were divided into control group, CalliSpheres beads (CB) group (blank beads for TACE), CBATO group, and conventional TACE (cTACE) group (arsenic trioxide lipiodol for TACE) using a random number table, with 30 rabbits in each group. Five rabbits in each group were sacrificed at 12 hours and on days 3, 7, and 14 after TACE, and immunohistochemistry was used to measure the proliferation index and apoptosis percentage of tumor cells in the residual tumor area. The tumor necrotic volume was measure on day 7 after TACE, and the growth rate and necrosis rate of tumor cells were calculated. Ten rabbits were randomly selected from each group for the observation of survival time. An analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the Kaplan-Meier survival analysis was used to evaluate survival time, and the log-rank test was used for comparison. ResultsOn day 7 after TACE, the CBATO group had a significantly lower growth rate and a significantly higher necrosis rate of tumor cells than the cTACE group, the CB group, and the control group (all P＜0.05). At each time point after TACE, there were significant differences in the proliferation index and apoptosis percentage of tumor cells between the CBATO group and the other three groups (all P＜0.05). The median survival time was 26 days in the CBATO group, 18.5 days in the CB group, 22 days in the cTACE group, and 15.5 days in the control group, and the CBATO group had a significantly longer survival time than the other three groups (χ2=3.95, 8.99, and 13.47, P=0.049, P=0.003, and P＜0.01). ConclusionCBATO has a better effect than cTACE and CB in the treatment of rabbits with VX2 liver tumor and can significantly improve tumor necrosis rate, promote the apoptosis of tumor cells, and prolong the survival time of experimental animals.

Objective To evaluate the clinic effect of transcatheter arterial chemoembolization (TACE) by using arsenic trioxide (ATO) drug-bearing CalliSpheres beads (CB) in treating BCLC stage B hepatocellular carcinoma (HCC) . Methods The clinical data of 13 patients with advanced HCC, who received TACE by using CB loaded with ATO (CBATO) during the period from January 2017 to September 2017, were retrospectively analyzed. The clinical data, imaging materials, laboratory examinations, interventional complications, prognosis, etc., were summarized and evaluated. Results The patients were followed up for9-15 months, with a median period of 11 months. The survival rate was 100％. One, 3, 6 and 9 months after treatment, the disease remission (CR+PR) rates were 76.9％, 76.9％, 69.2％ and 61.5％ respectively, and the disease control rates were 92.3％, 92.3％, 92.3％ and 84.6％ respectively. In all 13 patients, no severe complications such as hepatic failure, renal insufficiency, bone marrow suppression, liver abscess, bile leakage complicated by infection and gastrointestinal bleeding occurred. Conclusion For the treatment of BCLC stage B HCC, TACE by using CBATO is safe and effective with reliable short-term effect.