Objective To study blood supply by the internal mammary artery(IMA)for hepatic carcinoma and evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE)via IMA. Methods 86 cases of hepatic cancer(HCC)fed by the IMA underwent TACE of the IMA.All of the patients had previously undergone several TACE for HCC.16 patients had undertaken percutaneous microwave coagulation therapy in addition to TAE.4 patients had a history of surgery for upper abdomen.Plain and enhanced CT and MRI scannings were performed before operation.Internal mammary arteriography was carried out during the interventional procedure to clarify the feeding range and then the superselected catheterization of the feeding branch was done with TACE.The IMA angiographic features,tumor location,clinical observation, laboratory tests,imageology were evaluated,and finally were correlated with the angiographic findings of the IMA.Results All lesions were massive type and located at the ventral aspect and subcapsular region of the liver:57 cases in segment 4,5,8,and 29 cases in segment 5,7,8.Recurrent HCCs were supplied by the right IMA in 80 cases,from the left IMA in 5 cases and with the bilateral IMA in 1 case.Lipiodol-TACE of the IMA for HCC can be performed without skin complications in cases of subselective catheterization.Conclusion Tumors located ventrally and superficially in the liver may recruit blood supply through IMA collaterals,often occurring in massive type of HCC after several times of TACE.TACE of IMA is safe and has become technically feasible in almost all patients,although cutaneous damage should be cautious during the interventional procedure.(J Intervent Radiol,2007,16:816-819)

Objective To describe the manifestations of the inferior phrenic arteries(IPA)supply to the pulmonary hemorrhagic lesions and to evaluate the safety and efficacy of transcatheter arterial embolization(TAE)of the IPA.Methods The clinical data and imaging findings of eighteen patients with the additional blood supply to the pulmonary hemorrhagic lesions from the IPA were evaluated retrospectively.The causes of the bleeding were lung malignancies in 9,bronchiectasis in 7,and chronic inflammation in 2 patients.TAE supplementally was performed in patients with IPA supply to the pulmonary lesions,using polyvinyl alcohol particles,gelatin sponge particles,and microcoils.Results Selective arteriogram demonstrates an enlarged IPA,with numerous branches and hypervascularity in all 18 cases, with tumor staining in 9,the contrast material extravasation in 6,and non-specific staining in 2 cases.In addition,IPA-to-pulmonary shunting was found in 9 cases.All the lesions supplying by IPA were adjacent to the pleurae,including adjacent to the diaphragmatic pleura in 11,the mediastinal pleura in 5,and the lateral pleura of the lower lobe in 2 cases.Technical success of IPA embolization was achieved in the 18 cases.Embolization of other nonbronchial systemic arteries(the internal thoracic artery in 7 and intercostal artery in 3)was performed at the same session.All bleeding ceased immediately after supplemental IPA embolization.Follow-up time ranged from 8 months to 4 years.Mild recurrent hemoptysis occurred in 3 patients at 1,2,6 months respectively,after the embolization.These patients were responsive to conservative management.Recurrent bleeding did not occur in 15 patients during the follow-up. Conclusion The pulmonary hemorrhagic lesions,especially adjacent to the diaphragmatic and mediastinal pleurae,can be supplied by IPA,and may result in clinical failure following BAE.Supplemental TAE of IPA is a safe and effective adjunct to BAE in the management of bronchial bleeding supplied by IPA.

Objective To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries.Methods Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization.The causes of renal injury included post-renal biopsy in 5 patients,endovascular interventional procedure-related in 2,post-renal surgery in 1,and post-percutaneous nephrostomy in 1 patient.The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patienrs,severe flank pain in 7,and hematuria in 8 patients.Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography.The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients,associated with polyvinyl alcohol particles(PVA)in 5,and gelfoam panicles in 2 cases.Results Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases,intrarenal pseudoaneurysm in 2 cases,and the contrast media extravasation in 1 patient.The technical success of the arterial embolization was achieved in all 9 cases within a single session.All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent.Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms,and another 7 with severe flank pain got relief progressively.Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases,including transient aggrevation(n=3)and developed new renal dysfunction(n=2).Two of these patients required hemodialysis.Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures.Follow-up time ranged from 6-78 months(mean,38 months),4 patients died of other primary diseases of renal and multi-organ failures.Five patients are still alive without further intervention,and suffering no more of rebleeding and deterioration of renal function.Conclusions Transcatheter selective renal arterial embolization is safe and effective in the treatment of iatrogenic renal vascular injuries,resulting in permanent cessation of bleeding.(J Intervent Radiol,2007,16:807-810)

According to the super-position principle of the reinforcement of biological activities, a series of novel E-substituted 2, 3-diaryl propenoic acyloxy phosphonate derivatives were designed and synthesized. And the structures of the target compounds were confirmed by IR, 1H NMR, 13C NMR and elemental analysis. Furthermore, the cytotoxicities of all compounds on A-549, SGC-7901 and EC-109 in vitro were evaluated by MTT assay, and some of them showed good antitumor activity. Among the active compounds, especially, the IC50 value of compound 3e was (12.7 ± 1.9) μmol x L(-1) against A-549 cells, similar to cisplatin [IC50 = (8.0 ± 1.5) μmol x L(-1)], compounds 3g and 3k had better inhibition effect on EC-109 cells growth, with the IC50 values of (9.5 ± 1.8) μmol x L(-1) and (11.5 ± 0.9) μmol x L(-1) respectively, and compounds 3i and 3k exhibited good cytotoxic property on A-549, SGC-7901 and EC-109, which were worth further investigation.
Antineoplastic Agents ; chemical synthesis ; pharmacology ; Cell Line, Tumor ; Cell Proliferation ; Drug Design ; Humans ; Organophosphonates ; chemical synthesis ; pharmacology

Objective To observe the influence of dexmedetomidine applied in combined acupuncture-medication anesthesia on vomiting after thyroidectomy. Method Seventy patients who were going to receive thyroidectomy were randomized into group A and B, with 35 cases in each group. Combined acupuncture-medication anesthesia [electroacupuncture at Hegu (LI4), Neiguan (PC6) and Futu (ST32) plus intravenous infusions of sufentanil citrate injection (0.3 mg/kg) 20 minutes before operation]was adopted in both groups. Group A was additionally intervened by constantvelocity micropump infusion of dexmedetomidine hydrochloride injection (0.5 mg/kg) within 10 minutes before operation and remaining 0.4 mg/kg/min during operation, while group B was intervened by infusion of normal saline 10 minutes before operation. The observer's assessment of awareness/sedation (OAA/S) scores at different time points[lying in bed for 5 minutes before operation (T0), before the beginning of the operation (T1), 30 minutes after operation (T2), 60 minutes after operation (T3) and at the end of operation (T4)] in the two groups were observed. The additional times and total dose of sufentanil during operation, the number of cases using esmolol and urapidil, and the number of vomiting cases occurred within 2 hours after operation and 2～24 hours after operation in the two groups were recorded.Result The additional times and total dose of sufentanil during operation in group A were significantly different from those in group B (P<0.01). The utilization rate of esmolol and urapidil were respectively 31.4％ and 14.3％ in group A versus 77.1％ and 65.7％ in group B, and the between-group differences were statistically significant (P<0.01). The incidence of vomiting within 2 hours after operation and 2～24 hours after operation were respectively 20.0％ and 17.1％in group A versus 54.3％ and 42.9％ in group B, and the between-group differences were statistically significant (P<0.01). The OAA/S scores at different time points (T1, T2, T3 and T4) in group A were significantly different from those in group B (P<0.01). Conclusion Dexmedetomidine applied in combined acupuncture-medication anesthesia can reduce the additional times and total dose of sufentanil during thyroidectomy, and it can reduce the incidence of postoperative vomiting as well.

OBJECTIVETo carry out expert survey for traditional Chinese medicine (TCM) syndrome characteristics of different clinical types of coronary artery disease (CAD).

METHODSBy using Delphi method, we carried out two rounds of nationwide expert surveys for modern TCM characteristics of syndrome elements and syndrome types of CAD.

RESULTSBased on expert consensus, qi deficiency, blood stasis, phlegm turbidity, qi deficiency blood stasis, and intermingled phlegm and blood stasis are common TCM syndromes for different clinical types of CAD. Of them, qi stagnation, blood stasis, phlegm turbidity, heat accumulation, cold coagulation, yang deficiency, deficiency of both qi and yang were more often seen in patients with unstable angina than in those with stable angina. Qi deficiency, yin deficiency, and deficiency of both qi and yin were less seen. We could see more excess syndrome and less deficiency syndrome (such as qi deficiency, yin deficiency, etc.) in acute ST-segment elevation myocardial infarction (STEMI) than acute non-ST-segment elevation myocardial infarction (NSTEMI). Qi deficiency, blood stasis, water retention, yang deficiency, phlegm turbidity, yin deficiency, Xin-qi deficiency, and qi deficiency blood stasis induced water retention are the most common TCM syndrome types of CAD heart failure (HF). Blood deficiency, yin deficiency, heat accumulation, deficiency of both Xin and Pi, deficiency of both qi and blood, deficiency of both qi and yin, yin deficiency and fire hyperactivity were more often seen in CAD arrhythmias.

CONCLUSIONSTCM syndrome distributions of different clinical types of CAD have common laws and individual characteristics. Results based on the expert consensus supplied evidence and support for clinical diagnosis and treatment of CAD.

Angina Pectoris ; Angina, Unstable ; China ; Coronary Artery Disease ; diagnosis ; therapy ; Coronary Disease ; diagnosis ; Data Collection ; Heart Failure ; diagnosis ; Humans ; Medicine, Chinese Traditional ; methods ; Qi ; Syndrome ; Yang Deficiency ; diagnosis ; Yin Deficiency ; diagnosis

BACKGROUNDTranscatheter bronchial artery embolization (BAE) is widely used for the treatment of hemoptysis and the immediate success rate is high, but there are still some hemorrhage recurrences. One of the common reasons for failure of BAE is collateral branches as blood supply. The inferior phrenic artery (IPA) is one of the most common collateral branches that is scarcely reported. Our purpose was to observe manifestations of IPA supplying to hemoptysis and evaluate the efficacy and safety of IPA embolization.

METHODSAngiography during interventional treatment of 178 hemoptysis patients in the past 7 years confirmed that IPA hemorrhage resulted in hemoptysis in 25 patients (26 - 67 years old) who had: lung cancer (11 patients), bronchiectasis (11 patients), chronic lung inflammation (2 patients), and pulmonary tuberculosis (1 patient). Among the 25 patients, 7 patients had twice interventional operations within one week and 6 patients still experienced intraoperative hemoptysis after conventional embolization of the bronchial artery, the internal thoracic artery, and the intercostal artery, then had the second interventional operation immediately. The total number of cases were 191. Selective embolization of the IPA was performed using polyvinyl alcohol microspheres, gelatin sponge particles, and microcoil. The safety and clinical significance of IPA embolization were evaluated. The Pearson chi(2) test and Fisher's exact probability test were used in this study.

RESULTSSelective IPA angiography showed increased diameter of the IPA, disorganization of the branches, and varying degrees of angiogenesis. In 11 cases, contrast material was seen in vessels supplying the tumor and in the tumor. In 9 cases, contrast material had leaked into the area supplied by the IPA; in 8 cases, non-specific flake-like deposits of contrast material were seen; and in 14 cases, abnormal communication or shunt was visualized. Lesions were closely related to the pleura in 25 patients. Fifteen lesions were close to the diaphragmatic pleura, seven close to the mediastinal pleura, and three close to the lateral pleura of the lower lung. Eleven cases had inferior thoracic pleural thickening and adhesions. The IPA was embolized in 25 cases, and the success rate of hemostasis was 100%. The IPA was not embolized in the other 166 cases, and the success rate of hemostasis was 92.17 %. In the 25 cases with IPA embolization, the involvement of the IPA in the blood supply of the hemoptysis was correlated with the duration of the disease (P = 0.0344). The involvement of IPA in the blood supply of the hemoptysis was not correlated with the characteristic of the lung lesions (benign or malignant) (P = 1.0000). Duration of follow-up was 8 months to 5 years. Hemoptysis recurred in four patients 1, 2, 3, and 6 months after interventional operation, respectively, and was controlled by conservative treatment. Twenty-one patients had no recurrence of hemoptysis.

CONCLUSIONSBleeding from the IPA can result in hemoptysis and failure of BAE in the treatment of hemoptysis. If IPA hemorrhage contributes to hemoptysis, supplementary IPA embolization may be a safe and effective treatment.

Adult ; Aged ; Angiography ; Bronchiectasis ; complications ; diagnostic imaging ; Collateral Circulation ; Embolization, Therapeutic ; methods ; Female ; Hemoptysis ; diagnostic imaging ; etiology ; therapy ; Humans ; Lung Injury ; complications ; diagnostic imaging ; Lung Neoplasms ; complications ; diagnostic imaging ; Male ; Middle Aged ; Tuberculosis, Pulmonary ; complications ; diagnostic imaging

OBJECTIVETo investigate the association of interleukin 6 gene (IL-6) promoter region 634C/G (rs1800796) single nucleotide polymorphism (SNP) with the genetic susceptibility to endometriosis (Ems) in south Han Chinese women.

METHODSA case-control study was performed in 432 Ems patients and 499 control women to evaluate the SNP of IL-6 634C/G by using a fluorescent quantitative PCR-based high resolution melting (HRM) method.

RESULTSThere were statistical significances in the IL-6 634C/G alleles, whether or not to carry allele G and genotype distributions between Ems patients and control women (P=0.032, 0.014 and 0.045, respectively). Allele C enhanced the risk of Ems 1.057 times while allele G reduced the risk of Ems 0.835 time. Carrying allele G reduced the risk of Ems 0.822 time, whereas not carrying allele G enhanced the risk of Ems 1.143 times. Compared with genotype CC, the risk of Ems with genotype CG reduced 0.704 time (95% CI: 0.533-0.931). There was no significant difference in whether or not carrying allele G distribution between Ems patients and control women (P=0.729).

CONCLUSIONThe present study demonstrated significant association between the SNP of IL-6 634C/G and genetic susceptibility to Ems in south Han Chinese women.

Alleles ; Case-Control Studies ; Endometriosis ; genetics ; Female ; Genetic Predisposition to Disease ; genetics ; Genotype ; Humans ; Interleukin-6 ; genetics ; Polymorphism, Single Nucleotide ; genetics

OBJECTIVETo evaluate the efficacy and safety of transcatheter arterial embolization (TAE) of the ovarian arteries (OA) additionally supplying the tumor of pelvic cavity.

METHODSTAE of OA was performed in 63 patients with a pelvic tumor additionally supplied by the OA. The mean age of those patients was 43.6 years (range, 16 - 66 years). In this series, there were 28 cervical carcinomas, 22 uterus fibroids, 6 ovarian cancers, 3 choriocarcinomas, 2 uterine sarcomas, 1 fibrosarcoma, and 1 rectal carcinoma infiltrating the uterus and adnexa. Emergency TAE was performed in 8 patients due to colporrhagia. The embolization materials consisted of polyvinyl alcohol particles (PVA) in 24 patients, gelatin sponge particles in 10 cases, PVA + gelatin sponge particles in 26; and PVA + gelatin sponge particles + microcoils in 3 cases.

RESULTSThe OA embolization was successfully performed in all the 63 cases, including bilateral in 19 cases and unilateral in 44 cases (left 27, right 17). No complications related to the procedure were observed. Bleeding from the vagina in 8 patients ceased immediately after supplemental OA embolization, and no re-bleeding occurred in any of them during their hospital stay.

CONCLUSIONPelvic tumors may be supplied additionally by the ovarian arteries. Therefore, routine internal iliac artery/uterine artery chemoembolization or embolization may not effectively cure the tumors. Ovarian artery angiography should be routinely performed before interventional treatment. A supplementary selective ovarian artery chemoembolization or embolization is safe and effective in the management of pelvic tumors with additional blood supply from the ovarian arteries.

Adolescent ; Adult ; Aged ; Choriocarcinoma ; blood supply ; therapy ; Female ; Gelatin Sponge, Absorbable ; therapeutic use ; Humans ; Middle Aged ; Ovarian Neoplasms ; blood supply ; therapy ; Ovary ; blood supply ; Polyvinyl Alcohol ; therapeutic use ; Uterine Artery Embolization ; methods ; Uterine Cervical Neoplasms ; blood supply ; therapy ; Uterine Neoplasms ; blood supply ; therapy ; Young Adult

OBJECTIVETo evaluate the efficacy and safety of the interventional techniques in the treatment of renal vascular injury.

METHODSA total of 16 patients with renal vascular injuries were treated by superselective arterial embolization. The renal injuries resulted from renal biopsy in 7 patients, endovascular intervention in 2, percutaneous puncture and pyelostomy in 2, local resection of renal tumor in 1 and trauma in 4. With regards to clinical manifestations, there was hemorrhagic shock in 8 patients, severe flank pain in 14, and hematuria in 14. CT and ultrasonography confirmed that 15 patients had perirenal hematoma. The embolization was performed with microcoils in 13 and standard stainless steel coils in 3 patients, associated with polyvinyl alcohol particles (PVA) in 9, and gelfoam particles in 6 cases.

RESULTSRenal angiogram revealed arteriovenous fistula in renal parenchyma in 9 cases, pseudoaneurysm in 3 and extravasation of contrast media in 4. The arterial embolization was successful in all 16 cases in a single session. The angiography at the end of therapy showed that abnormal vessels had disappeared without other major intrarenal arterial branch occlusion. In 13 patients with hemodynamical compromise, blood loss-related symptoms were immediately relieved after blood transfusion. In 14 patients with severe flank pain, the pain was progressively relieved. Hematuria ceased in 14 patients 2-14 days after the embolization procedures. The renal function was impaired after the procedure in 6 cases, in which preoperative renal insufficiency was exacerbated in 3 and developed new renal dysfunction in 3, 2 of whom received hemodialysis. The ultrasonography showed that perirenal hematoma was gradually absorbed within 2-6 months after the procedure. All patients were followed up in 6-78 months (mean, 48 months). Six patients died of primary diseases (5 cases of renal failure and multiple organ failure and 1 case of malignant tumor). Ten patients survived without bleeding and further intervention. The deterioration of renal function did not occur and the serum creatinine and blood urea were in normal range.

CONCLUSIONTranscatheter selective renal arterial embolization is a safe and effective method in the treatment of renal vascular injuries.

Adult ; Aged ; Arteriovenous Fistula ; therapy ; Embolization, Therapeutic ; Emergency Medical Services ; Female ; Humans ; Iatrogenic Disease ; epidemiology ; Low Back Pain ; etiology ; Male ; Middle Aged ; Radiography ; Renal Artery ; diagnostic imaging ; injuries ; Renal Veins ; diagnostic imaging ; injuries