Objective To evaluate the safety and effectiveness of TACE with radiofrequency ablation (RFA) in treatment of renal cell carcinoma.Methods Data of 23 cases of renal cell carcinoma were retrospectively analyzed.Firstly all patients were treated with renal TACE,and then RFA under the guidance of ultrasound and CT was performed 3 to 4 weeks later.The therapeutic effects were evaluated by enhanced CT or MR scans during the follow-up period.Meanwhile,the changes of Karnofsky Performance Status (KPS) scores and renal functions between preoperative and postoperative periods were also evaluated.Results To the end of the follow-up,in all 23 patients 21 cases (21/23,91.30％) survived and 2 cases died (2/23,8.70 ％).KPS scores and serum creatinine levels were observed in all 23 patients at the initial stage and the end of the follow-up period,there were no significant differences (all P＞0.05).At the end of follow-up,16 cases were complete remission,5 were partial remission and 2 were progressive disease.Conclusion TACE combined with RFA is a safe and effective method in treatment of renal cell carcinoma with less trauma,less complication and more effective.

Objective To explore the clinical value of lidocaine combined with remifentanil intravenous anesthesia for radiofrequency ablation of liver tumors.Methods Totally 1 252 patients with hepatic tumors treated by radiofrequency ablation were analyzed.RITA cluster multipole radio needles were used in all cases.Local anesthesia with lidocaine was used before percutaneous puncture,and the dosage was 2 mg/kg of body mass.The initial dose of remifentanil was injected with pump at 0.05 μg/(kg · min) during operation.Mean arterial pressure (MAP),heart rate (HR) and saturation of peripheral oxygen (SPO2) were recorded 24 h before radiofrequency ablation (T0),at the beginning of operation (T1),30 min after operation (T2) and at the end of surgery (T3).Visual analogue scale (VAS) was used to assess the analgesic effect during the whole ablation procedure.Results Radiofrequency ablation were successfully performed in 1 250 patients (1 250/1 252,99.84％).The average time was (59.02 ±14.63) min.The average dosage of remifentanil was (242.22± 22.73)μg.The average VAS score was (2.42± 1.13) points.Compared with the preoperative T0 time point,SPO2 did not change significantly at each time of T1,T2 nor T3,but MAP and HR were significantly higher than those before operation (both P＜0.05).VAS scores were significantly higher in patients with tumors size ＞5 em than those in patients with tumors size ≤5 cm (P＜0.05).VAS scores were significantly higher in patients with lesions under hepatic capsule and in diaphragm dome than in patients with lesions in other parts (both P＜0.05).Severe anesthesia related complications occured in 2 patients,related to the respiratory inhibitory effect of remifentanil,and the patients were completely recovered after corresponding treatment.Conclusion Lidocaine combined with remifentanil intravenous anesthesia for radiofrequency ablation of liver tumors can effectively relieve the pain in patients.Tumor size and tumor location are the main impact factors on analgesic effect.

Objective:To investigate the relationship between mild cognitive impairment (MCI) and time in target range (TIR) and time below target glucose range (TBR) in elderly patients with type 2 diabetes.Methods:Ninety-five elderly patients with type 2 diabetes who were admitted to the Henan Provincial People′s Hospital from November 2017 to November 2018 were selected. Patients were assessed for cognitive function using the Montreal cognitive assessment (MoCA), and were classified into mild cognitive impairment group (MCI group) and non-mild cognitive impairment group (non-MCI group) according to the scores; all enrolled patients were scanned with a glucose monitoring system to record TIR and TBR within the first 24 hours of admission.Results:The MoCA score of the patients in the MCI group was (21.3±3.7)point, which was significantly lower than that in the non-MCI group (28.2±1.2)point, P<0.01); the TIR of the patients in the MCI group was significantly lower than that in non-MCI group [(50.6±24.5)% vs (65.8±28.7)%, P<0.01], the TBR of patients in the MCI group was significantly higher than that in the non-MCI group [(6.6±3.2)% vs (1.2±1.9)%, P<0.01]. Correlation analysis showed that MoCA score was negatively correlated with TBR ( r=-0.892, P<0.01) and positively correlated with TIR ( r=0.816, P=0.001). Multivariate linear regression analysis showed that when adjusted for diabetic duration and HbA 1C, TIR and TBR were independent risk factors for MoCA scores. Conclusion:The cognitive level of elderly patients with type 2 diabetes is closely related to TIR and TBR. At the same time, we must pay attention to TBR while increasing TIR.

Objective To understand effects of the interventional operation on thyroid,peripheral blood indexes and chromosomal aberrations (CA) of peripheral lymphocyte of children with congenital heart disease (CHD).Methods Follow-up studies were conducted in 70 child patients undergoing cardiac catheterization and 23 with open heart surgery as control from 2010 to 2013.Postoperative follow-up examinations included thyroid ultrasound,blood routine indexes and analyses of CAs.Results Difference in thyroid ultrasound abnormality rate was not statistically significant between children with cardiac catheterization and control group (40.0％ vs.43.5％,P ＞ 0.05).There was no significant difference in white blood cell (WBC) count between interventional group and control group (P ＞ 0.05).The effects of disease type and operation time on thyroid ultrasound and WBC count were not observed (P ＞ 0.05).The frequency of chromosome aberrations,including acentric fragment,dicentrics and translocation in interventional group [(0.76 ± 0.07) ％],was higher than in control group [(0.25 ± 0.07) ％,(Z =-3.631,P ＜ 0.05],and the rates of acentric fragment and translocation were also higher in interventional group (Z =-2.531,-2.397,P ＜ 0.05).Conclusions Effect of intervention therapy on thyroid structure and WBC count in children with CHD was not observed,but the genotoxic effects remain in children with cardiac catheterization.

Objective:To evaluate the safety and effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) in hepatocellular carcinoma (HCC) patients with Vp4 portal vein tumor thrombus (PVTT).Methods:Data of 15 patients undergoing TIPS for HCC with Vp4 PVTT and portal hypertension (PTN) in Peking University First Hospital from July 2018 to February 2023 were retrospectively analyzed, including 14 males and 1 female, aged (61.5±11.1) years old, ranging from 40 to 78 years old. The success rate of TIPS, portal pressure gradient (PPG) before and after procedure, perioperative adverse effects and complications were recorded. The survival status of patients was followed up by telephone review after surgery. Kaplan-Meier method was used for survival analysis.Results:The procedure of TIPS was performed uneventfully in all patients, with a technical success rate of 100% (15/15). PPG before and after TIPS were (31.73±5.48) mmHg (1 mmHg=0.133 kPa) and (17.60±3.66) mmHg, respectively, and the difference was statistically significant ( P<0.001). No perioperative death, hepatic artery or bile duct injury, acute liver failure or other major complications occurred. Compared with the preoperative status, the performance status scores [0(0, 0) vs. 3(3, 3)] and Child-Pugh scores [6(5, 8) vs. 9(8, 10)] were lower in patients one month after TIPS (all P<0.05). The median survival time was 228 d. Kaplan-Meier curves showed that the cumulative survival rates at 3, 6, 12 and 24 months after TIPS were 100%, 64.3%, 32.7% and 8.2%, respectively. Conclusion:TIPS could be safe and effective for HCC with Vp4 PVTT and severe PTN.

Objective To evaluate the diagnostic value of contrast-enhanced ultrasound in breast precancerous lesions . Methods Retrospectively analyzed the contrast-enhanced ultrasound model and angiographic predictive model of 465 cases of the A prospective multicenter study of breast nodules contrast-enhanced ultrasound" that led the Sichuan Provincial People′s Hospital from January 2016 to April 2017 ,which included 69 cases of breast precancerous lesions and 396 other types benign lesions ,and the sensitivity ,specificity and accuracy of the diagnosis of breast precancerous lesions were calculated . Results The sensitivity of ultrasound predictive model for the diagnosis of precancerous lesions was 60 .9％ and AUC was 0 .681 . Precancerous lesions mainly showed non-concentricity , increased homogeneity , and increased lesions;other types of benign lesions mainly showed non-centripetal ,high uniformity enhancement and lesion size unchanged . Conclusions Contrast-enhanced ultrasound shows a potential value in the differential diagnosis of precancerous lesions and other types of benign lesions ,that can help clinicians to take early intervention measures for breast precancerous lesions ,but there are still many problems to be solved .

ObjectiveTo reveal the effects of Huanglian Jiedutang （HLJDT） on the learning and memory abilities of APP/PS1 transgenic mice via hypoxia-inducible factor-1α （HIF-1α）/vascular endothelial growth factor （VEGF） signaling pathway. MethodForty 5-month-old β-amyloid precursor protein （APP）/presenilin 1（PS1） mice were randomized into the model， donepezil （0.001 g·kg^-1·d^-1）， and low-， medium-， and high-dose （1.5， 3， 6 g·kg^-1·d^-1， respectively） HLJDT groups， and 8 C57BL/6 mice were taken as the normal group. After 45 days of continuous administration， Morris water maze test was conducted， and the organ indexes were calculated. The morphological structure of cerebral vascular endothelial cells in mice was observed under a transmission electron microscope. Western blot was employed to measure the protein levels of APP， HIF-1α， VEGF，VEGFA， and brain-derived neurotrophic factor （BDNF） in the hippocampus. The mRNA levels of APP， HIF-1α， and VEGF were determined by real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the normal group， the model group showed prolonged escape latency （P<0.05）， reduced distance and time around the target platform （P<0.05）， decrease brain and spleen indexes （P<0.05）， vascular endothelial cells with karyopyknosis and not abundant cytoplasm， up-regulated protein levels of APP， HIF-1α， VEGF， and VEGFA （P<0.05）， down-regulated protein level of BDNF （P<0.05）， and up-regulated mRNA levels of APP， HIF-1α， and VEGF （P<0.05） in the hippocampus. Compared with the model group， high-dose HLJDT shortened the escape latency （P<0.05）， increased the distance and time around the target platform （P<0.05）， raised the brain and spleen indexes （P<0.05）， repaired the organelles of vascular endothelial cells， down-regulated the protein levels of APP， HIF-1α， VEGF， and VEGFA （P<0.05）， up-regulated the protein level of BDNF （P<0.05）， and down-regulated the mRNA levels of APP， HIF-1α， and VEGF （P<0.05） in the hippocampus. ConclusionHLJDT can improve the learning and memory abilities of mice by reducing the expression of HIF-1α and VEGF， thus protecting the nerves.