Objective To investigate the efficacy of uterine artery chemoembolization in the treatment of locally advanced cervical cancer.Methods A total of 268 patients with locally advanced cervical cancer were treated with uterine artery chemoembolization in our department.The stage distribution among the patients included 132 stage Ⅰ B2,85 stage Ⅱ A1 and 51 stage Ⅱ A2.There were 223 patients of squamous cell carcinoma,24 patients of adenocarcinoma,9 patients of adenosquamous carcinoma,small cell carcinoma of the 7 patients,5 patients of neuroendocrine carcinoma.Transcatheter uterine artery infusion of paclitaxel and nedaplatin,gelatin sponge particles was applied for uterine artery embolization.The clinicopathological parameters were analyzed,and their impacts on tumor response were investigated.RECIST criteria were used to evaluate the response in solid tumors.Student t test was used to compare cervical tumor diameter before and after treatment,and Chi-square test was used for comparison of categorical data.Follow up examinations included pelvic ultrasound,gynecology,vaginal stump cell smears.Results Of the 268 patients,74 (27.6％) patients showed a complete response,160 (59.7％) patients had a partial response to uterine artery chemoembolization,and the overall response rate was 87.3％.A total of 258 (96.3 ％) patients underwent surgery,and pathological complete response were identified in 46 (17.2％).Forty (14.9％) patients were found to have lymph node metastasis after surgery.Response rates of stage Ⅰ B2 and Ⅱ A cases were 94.7％ and 80.1％,respectively,P ＜ 0.05.Patients with squamous cell carcinoma showed a better response rate than patents with other pathological types (94.2％ vs.53.3％),P ＜ 0.05.Initial tumor volume and cycles of preoperative uterine artery chemoembolization had no effect onthe response rate.Conclusions Uterine artery chemoembolization can increase the rate of surgical resectionof patients with locally advanced cervical cancer and can improve the reaction rate with tolerable side effect.It is an applicable option of treatment for patients with locally advanced cervical cancer in the neoadjuvanttreatment.

Objective To investigate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with covered stent in the treatment of portal hypertension in patients with hepatocellular carcinoma.Methods The clinical data of 46 patients with primary hepatocellular carcinoma and portal hypertension who received TIPS with stent treatment were retrospectively analyzed.After treatment,liver function,shunt patency,re-bleeding rate,hepatic encephalopathy,ascites,gastric intestinal symptoms, lifetime and causes of death were analyzed. Compare t test was performed for measurement data comparison among groups.The survival curves were used to analyse the cumulative stent shunt patency rate,the incidence of hepatic encephalopathy and the survival rate.Results After the operation,portal vein pressure significantly decreased compared with that before operation [(16.2 ± 4.6 )mmHg vs (28.3±5 .1)mmHg,1 mmHg=0.133 kPa],and the difference was statistically significant (t =21 .30, P <0.05).There was no significant difference in liver function before and after operation [(6.8 ±1 .8) score vs (6.9±1 .5)score,P >0.05].Cumulative stent shunt patency at 3,6,12,24,36 month after operation was 100.0%,95 .6%,93.5 %,91 .3% and 91 .3%,respectively.The cumulative incidence of hepatic encephalopathy was 6.5 %,8.7%,13.0%,17.4% and 26.1 %,respectively;cumulative survival rate was 95 .7%,82.6%,67.4%,43.5 % and 32.6%,respectively.In 10 cases of refractory ascites, ascites of all the patients reduced with different degree after operation and gastrointestinal uncomfortable symptoms were relieved.Conclusion In patients with primary hepatocellular carcinoma and portal hypertension,who have gastrointestinal bleeding or refractory ascites,treatment of TIPS with covered stents could effectively lower portal pressure,prevent re-bleeding and reduce the volume of ascites.

Objective To evaluate the technique of finger palpation in thoracoscopic localization in patients with pulmonary nodules,and to summarize its technical details,especially with exploit of chest computed tomography (CT) facilitating it.Methods 95 patients with total amount of 109 pulmonary nodes 20 mm or smaller in size shown with lung window of CT,were reviewed.They were located subpleurally,with a median depth of 8.2 mm and a median size of 10.0 mm.The value of their depth over their size (D/d value) could be used as the extent of localizing difficulty.Each node had its own radiographic fealures for being localized,which was built preoperatively.Under thoracoscopic vision,nodules were finger-palpated by index finger via the 4th or 5th intercostal space on anterior axillary line,followed by wedgectomy or lobectomy for instant histopathological diagnosis to further decide the final surgical type.The distance between the nodule and the origin of segmental bronchus (L value) were also calculated out,as it might be relevant to the way the nodule could be biopsied.Results All nodules were successfully localized and resected for biopsy goal,105 by wedgectomy,4 by lobectomy.After intraoperative diagnosis was made by the pathologist,VATS lobectomy and lymph node dissection were further performed in 55 patients.L value of 4 cases being biopsied by lobectomy ranged from 18.3 to 30.3 mm,averaging 26.1 mm.Conclusion Finger palpation is viable in any cases of pulmonary nodules.Detailed reference of CT digital information,and enough detachment of mediastinal pleura,can greatly facilitate thoracoscopic localization by finger palpation.Lobectomy or segementectomy is preferable when L value is less than 30 mm.

OBJECTIVE: To analyze external factors affecting auditory ability of infants and toddlers after cochlear implantation in the first year of switch-on. METHOD: Seventy-five infants and toddlers after cochlear implantation were selected as subjects, using LittlEARS Auditory Questionnaire to assess and analyze the correlations with auditory ability and external factors (including gender, cochlear implanted age, pre-implant hearing aid fitting, caregivers' education background, household income and rehabilitation modes) in different stages (before switch-on, and 3 months, 6 months, 9 months, 12 months after switch-on). RESULT: The mean scores of LittlEARS were significantly different in cochlear implanted age group, pre-implant hearing aid fitting group and rehabilitation modes group (P < 0.05), and there was no significant difference in other groups such as external factor gender, caregivers' education background and household income (P > 0.05). The correlations with the mean scores of LittlEARS and cochlear implantation age or pre-implant hearing aid fitting were significant at 3 months or 6 months after switch-on(/r/ ≥ 0. 3, P < 0.01). However, the correlation with the mean scores of LittlEARS and rehabilitation modes was significant at 12 months after switch-on(/r/ > ≥ 0.3, P < 0.01). CONCLUSION Cochlear implanted age and pre-implant hearing aid fitting were the important factors affecting auditory ability of infants and toddlers after cochlear implantation in the first year of switch-on. The effect of rehabilitation modes on auditory ability of infants and toddlers after cochlear implantation was slow.
Age Factors ; Child, Preschool ; Cochlear Implantation ; Cochlear Implants ; Deafness ; rehabilitation ; Hearing ; Hearing Aids ; Humans ; Infant ; Surveys and Questionnaires

Objective To compare the efficacy and side-effects of preoperative neoadjuvant uterine arterial chemoembolization and venous chemotherapy in treating cervical cancer in young female patients. Methods A total of 241 young females(≤35 years old) with cervical cancer were enrolled in this study. The clinical data were retrospectively analyzed. The patients were divided into group A (n=63) and group B (n=57). Patients in group A received preoperative neoadjuvant uterine arterial chemoembolization with subsequent surgery, while patients in group B were treated with preoperative neoadjuvant intravenous chemotherapy followed by surgery. The chemotherapy scheme included carboplatin (50 mg/m2) and gemcitabine (1 000 mg/m2). The short-term effect, the amount of blood loss during the surgery, pathological findings and the side-effects of the two groups were compared. The Kaplan-Meier method was used to calculate survival rate, and the log-rank test was used for survival difference analysis. Results The short-term response rate of group A was 90.5%, which was significantly higher than that of group B (71.9%), the difference between the two groups was statistically significant (χ2=7.5, P<0.05). The resection rate of group A was 95.2%, which was higher than that of group B (84.2%). The amount of intra-operative blood loss of group A and group B was (443±263) ml and (695±312) ml respectively, the difference was statistically significant (t=4.802, P<0.05). The pathological complete remission of group A and group B was 9.5%(6/63) and 5.3%(3/57)respectively; the differences in postoperative pathological results between the two groups were statistically significant (χ2=12.3, P<0.05). The side effect of group A was milder than that of group B (P<0.05). The 5-year progression-free survival (PFS) rate of group A and group B was 73.0% and 54.4% respectively (χ2=4.471, P<0.05);and the overall survival (OS) rate of group A and group B was 77.8%and 63.2%respectively (χ2=3.022, P>0.05). In both groups, the clinical stage, the pathological grade and the size (≥ 4 cm) of the tumor were the main factors that could influence the prognosis in young females with cervical cancer (P<0.05). Conclusion The short-term efficacy of preoperative uterine artery chemoembolization is better than that of preoperative intravenous chemotherapy for the treatment of cervical cancer in young female patients. Besides, this therapy carries mild side effect, and it can improve the 5-year progression-free survival rate, although the long-term survival rate has not been obviously improved.

Objective To investigate the clinical therapeutic effect of comprehensive treatment in young women with cervical car-cinoma.Methods A total of 52 young women with cervical carcinoma were treated with uterine artery chemoembolization.50 cases underwent radical hysterectomy and pelvic lymphadenectomy after interventional therapy.The patients with pathological risk factors were given supplementary radiotherapy.Results The clinical overall response rate was 88.5%.96.2% of patients underwent sur-gery and lymph node metastasis rate was 26.9%.The 2,5 year overall survival rates of patients were 91.5%,71.2% respectively. Conclusion The comprehensive treatment can improve overall survival rate and quality of life for young woman with cervical carci-noma.Postoperative patients with pathologically related risk factors should be treated with supplement chemoradiotherapy.

Objective To analyze the risk factors of post-ERCP pancreatitis (PEP) and to evaluate the relationship between cannulation time and PEP.Methods The data of cannulation time in 1 625 patients who underwent ERCP from 2010 to 2012 were retrospectively studied.The risk factors associated with PEP were analyzed by univariate and multivariate Logistic regression analysis.The effect of different cannulation time on PEP was evaluated.Results The incidence of overall PEP was 4.6％ (75/1 625) including 4.1％ (67/1 625)of mild and 0.5％ (8/1 625)of moderate-to-severe.Univariate analysis revealed that diabetes mellitus (P =0.02),choledocholithiasis (P =0.02),malignant biliary stenosis (P =0.007),duodenal stenosis (P =0.029),precut (P＜0.01),cannulation time ≥ 8 min (P＜0.01),blood platelet count ≥ 180× 109/L(P =0.089),alkaline phosphatase ≥ 120 U/L (P =0.083) and total bilirubin ≥ 17.1 μmol/L (P =0.094)were associated with PEP.Multivariate analysis revealed that precut (OR=1.93,95％CI:1.10-3.39,P=0.022),cannulation time ≥8 min (OR =3.50,95％CI:2.00-6.13,P＜0.01) and duodenum stenosis (OR=2.92,95％CI:1.08-7.86,P=0.034) were independent risk factors of PEP.Within 30 min of cannulation,longer cannulation time was accompanied with higher PEP rate.Conclusion The cannulation time is an independent risk factor of PEP.Overall PEP is increased when cannulation time is more than 8 min.

Objective To prepare a new kind of targeted liposome ultrasound contrast agent with small peptide K237 as the ligand which can combine specifically with KDR which is the main receptor of VEGF.and to test its capability in vitro. Methods Targeted bubbles(P-Bio-Av-Bio-Mbs) were formed through "biotin-avidin" bridge grafting, then they were incubated respectively with LOVO, HUVECs and LS174T which were KDR positive or negative expressed in various cells,meanwhile incubated LOVO cells with FITC- P-Bio-Av-Bio-Mbs,FITC-P-Mbs and FITC-Mbs respectively. After that, the rosette formation rate and fluorescence intensity of the combination between microbubbles and cells were observed with microscope and fluorescence microscope. After being incubated with small peptide K237 of 10 μg and 50 μg, LOVO cells were incubated with P-Bio-Av-Bio-Mbs for observing the distribution of microbubbles. Results In KDR sharply positive expressed LOVO cells, the surrounding rosette formation rate was as high as 90. 52% with the fluorescence intensity of grade 3, and it was 53. 46% with grade 2 fluorescence intensity rate in KDR positive expressed HUVECs cells, while in KDR negative expressed LS174T cells, there were few microbubbles surrounded with rosette formation rate of 5. 57% and fluorescence intensity rate of grade 0-1, therefore there were significant statistic differences in rosette formation rate among groups ( P < 0.05). After LOVO cells combined with FITC-P-Bio-Av-Bio-Mbs, FITC-P-Mbs and FITC-Mbs respectively,there were significant differences in their rosette formation rate, namely 89.62%, 7. 56% , 0 with the fluorescence rate of 3,0 - 1 and 0 respectively. Targeted cells pretreated with 10 pg K237 showed significant decreased rosette formation,and there was no formation in 50 ?g pretreated group. Conclusions KDR-Targeted liposome contrast agent with small peptide K237 liganded has been successfully prepared through biotin-avidin mediation and could combine specifically and high efficiently with targeted cells in vitro. The KDR-targeted molecular imaging of tumor neovascularizaiton may provide a new approach for early diagnosis of carcinoma.

Objective To evaluate super-selective renal arterial embolization(SRAE)in treating severe renal hemorrhage when conservative treatment had failed. Methods SRAE was performed in 111 patients with severe renal hemorrhage who had failed to respond the conservative management.The clinical data,the way of embolization,the medication and the follow-up findings were retrospectively analyzed.Results Excellent results were obtained in all patients after SRAE and no serious complications occurred.The technical successful rate with single session was 95.5%(106/111).Gross hematuria disappeared within 1-4 days after the treatment.Two patients developed shock after renal embolization and had to receive surgery after the shock was controlled.Three patients had a recurrence of hematuria,the blood urine subsided after SRAE was employed again.A follow-up with a mean period of 37.4 months was carried out in 92 patients,and the follow-up checkups showed that the renal function was well preserved in all patients.Conclusion Super-selective renal artery catheterization and embolization is a safe and effective treatment for severe renal hemorrhage,it can maximally preserve the healthy renal parenchyma as well as the renal function.Therefore,this technique should be regarded as the treatment of first choice for patients with severe renal hemorrhage.

Objective To investigate the effect of diabetes on clinical efficacy of transcatheter arterial chemoembolization (TACE) in the treatment of non-viral hepatitis hepatocellular carcinoma (HCC). Methods Retrospectively analyzed the clinical data of 367 non-hepatitis virus HCC patients treated by TACE, included 153 diabetes mellitus cases (test group) and blood glucose of 214 patients was normal (control group). To assess the treatment effect after 1 month of TACE based on response evaluation criteria in solid tumors, include complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), and calculate the disease control rate. Through 6 to 75 months follow-up to observed long-term efficacy, record the time to progression (TTP) and overall survival (OS) time. Survival rate were analyzed using Kaplan-Meier method and Log-rank analysis by SPSS 16.0. The single-factor analysis was used to analyze variables which variables that differed were analyzed by Cox regression. Results The disease control rate of test group was 69.9%(107/153) and control group was 74.3%(159/214), the difference was no statistically significant (P=0.125). The median time to progression (mTTP) and median overall survival (mOS) of test group were 10.0 and 15.0 months;and the mTTP and mOS of control group were 14.0 and 19.0 months, the difference were statistically significant (P=0.023 and P= 0.026). Tumor diameter ≥4.5 cm, numbers of tumor ≥3, invasion of blood vessels, α-fetoprotein≥200 μg/L, Eastern Cooperative Oncology Group score and diabetes were risk factors for OS of HCC patients. Conclusion Diabetes is unfavorable factors for overall survival of non-hepatitis HCC tread by TACE.