Purpose In order to find out a means that can both meet clinical requirements and reduce radiation dosage in the diagnosis of malignant biliary obstruction, the study aims to evaluate the image quality and the radiation dose of low tube voltage enhanced CT (100 kVp) in displaying malignant biliary obstruction in metal stents. Materials and Methods Between January 2012 and March 2014, 9 patients with highly suspected recurrent occlusion after biliary stent procedure were admitted in Peking Union Medical College Hospital and underwent high resolution three-phase dynamic enhanced CT scan. The CT images on portal veinal phase were reconstructed through the curved planar reformation and the CT values of 184 slices were evaluated along the pathway of the biliary stent. The reconstructed image quality was analyzed when the tube voltage was 140 kVp and 100 kVp respectively, and the different tumor-to-liver contrast-to-noise ratio (CNR) for each lesion, mean image noise, and figure of merit (FOM) between the two data sets were also compared. Results As the tube voltage decreased from 140 to 100 kVp, image noise increased from (19.88±3.62) HU to (24.22±4.24) HU (P<0.001), CNR increased by 15% and FOM improved by 50%. Conclusion A low tube voltage CT technique (100 kVp) improves tumor-to-liver CNR and significantly reduces radiation dose, therefore it is valuable in the manifestation of malignant obstruction in metal stents.

Objective To evaluate the application of embolic material, iron oxide nanoparticles?lipiodol?gelatin in the improvement of therapeutic effect of microwave ablation in vitrogelatin phantom model and in vivo VX2 renal tumors model. Methods After preparing new embolic material containing nano Fe2O3, in vitro model experiment was firstly conducted to verify the temperature distribution of the microwave ablation. Further verification was performed in bilateral renal VX2 tumors in rabbit model. A total of 10 (20 kidneys) New Zealand White rabbits bearing renal VX2 tumors were treated by renal artery embolization and CT guided microwave ablation, in which left kidneys were treated by material containing nano Fe2O3 in iodized oil and right kidneys were treated by renal embolization with super liquid iodized oil as a control. The same microwave ablation time and power were used for both kidneys. CT perfusion and histopathological examinations were performed to determine the renal perfusion parameters, tumor histopathology and tumor?related angiogenesis. Results In vitro experiments, when nano Fe2O3 was present in the local area at 1cm from the microwave needle at 20 and 60, the temperature reached(59.1 ± 1.7)° C, (95.5 ± 4.5)° C vs.(31.1 ± 2.5)and(45.6 ± 3.5)° C in the controls. Our present results strongly suggested that local nano Fe2O3 particles absorbed microwave and shielded microwave energy transferring to the surrounding tissue. Before and immediately after renal VX2 tumor embolization, blood flow significantly reduced from (31.4 ± 10.6) to (6.1 ± 9.9) ml · 100 ml-1 · min-1. Our pathology findings indicated nano Fe2O3?lipiodol-gelatin embolic agent stored in endovascular regions, while no penetration into the renal parenchyma happened. Conclusions This in vitro model and in vivo experiment suggest that the new embolic material containing nano Fe2O3 may help to improve heat efficiency of MWA microwave, and it is feasible to administer it through transcatheter arterial embolization approach for the microwave ablation therapy of kidney cancer.

Objective To investigate the efifcacy of interferon alpha (IFNα) followed by nucleotide analogues (NAs) treatment in patients with negative hepatitis B e antigen (HBeAg), undetectable serum HBV-DNA and low hepatitis B surface antigen (HBsAg) levels.Methods The enrolled HBeAg-negative chronic hepatitis B patients had undetectable HBV-DNA level (HBV-DNA<1000 copies/mL for at least 12 months) and low HBsAg level (HBsAg≤2000 U/mL) with long-term NAs treatment. These patients switched their therapy sequentially from NAs regimens to IFNα for 48 weeks. The treatment response was evaluated in terms of serum HBV DNA load, serological HBV markers, liver function tests and routine blood test before treatment and 12, 24 and 48 weeks of treatment. The patients were followed up for 24 weeks after treatment. The primary endpoint was HBsAg loss or seroconversion and HBsAg<10 U/mL. Logistic regression analysis was conducted to examine relevant predictive factors. Receiver operating characteristic curve was used to evaluate the value of prior HBeAg seroconversion and on-treatment HBsAg dynamics in predicting HBeAg seroconversion than in HBsAg persistence group (χ2=9.527,P=0.002). HBsAg loss was more likely in the patients who had HBsAg decline at least 0.5 log U/mL from baseline at week 12 of treatment (χ2=16.576,P<0.001). The area under the ROC curve for prediction of HBsAg loss was 0.810 (95 %CI, 0.686 to 0.935,P<0.001).Conclusions The HBeAg-negative chronic hepatitis B patients with positive virological response and low HBsAg level after NAs treatment are more likely to achieve HBsAg clearance when switched to IFNα treatment. Prior HBeAg seroconversion and on-treatment HBsAg dynamics are useful in predicting and guiding IFNα sequential therapy.

Objective To study the feasibility and effectiveness of liquid embolic agent HEMA-MMA in the arterial embolization therapy for the rabbit renal VX2 tumor models. Methods Renal VX2 tumor models were inoculated with the method of percutaneous CT-guided implantation of a small fragment of tumor into the inferior pole of the right kidney and were embolized when the max diameter was 1.5 cm. One model was embolized with the mixture of HEMA-MMA and carbonyl iron powder and was harvested immediately after embolization, the sample was fixed by paraformaldehyde for histopathological examination with methylene blue staining and HE staining to demonstrate the sizes of the vessels that the HEMA-MMA could reach. The remaining models were treated with pure HEMA-MMA by superselective or nonselective embolization (SSE or NSE). In SSE group, only the renal artery branch supplying the tumor was superselectively catheterized and embolized until the presence of“artery casting”change. In NSE group, the microcatheter was catheterized into the main renal artery then the whole renal artery branches and the renal capsular artery were embolized simultaneously until the presence of“artery casting”shape. Non-enhanced CT scans at immediate postoperation, on postoperative day 1 and day 3 were performed. The enhanced CT scans at the postoperative 1, 2 , 4 and 6 weeks were performed. Necrotic zone of the tumor was defined as non-enhancement in parenchyma phase, residual tumor was defined as delayed enhancement around the necrotic zone or obvious thickness and enhancement of the adjacent renal capsule. When detecting residual tumor, the model was followed up another 1 week and then harvested for histopathological examination. If there was no residual tumor and lung metastasis in 6 weeks follow-up after operation, we defined this as complete necrosis and then harvested the kidney for histopathological examination. Results Eleven of the 12 rabbits were successfully inoculated VX2 tumors. The mixture of HEMA-MMA and carbonyl iron powder deposited in the arterial vessels demonstrated mazarine in methylene blue staining and brownness in HE staining. The diameter of the tumor vessels which the agent could reach was 30—150 μm, there was no embolic agent detected in the venous blood vessels. 5 models were performed with superselective embolization and the other 5 were embolized with nonselective embolization. The embolic agent demonstrated high density and obviously deposited in the surrounding zone of the tumor on immediate postoperative CT images, density of the surrounding zone decreased accompanied by density increase in the central area of the tumor on the first day postoperative CT images. Density difference between the embolism zone and normal renal tissue disappeared on the third day postoperative CT images accompanied by swelling changes of the embolized area. Residual tumor was detected in all 5 superselectively treated cases (2 in 1 week, 3 in 2 weeks), which located in the area of junctional zone and subrenal capsule. The necrotic zone was demonstrated coagulative necrosis on histopathologic images, the boundary between the residual tumor and the necrotic zone was clearly showed both on histopathologic images and gross specimen. Renal capsular artery participating in the residual tumor blood supply was also shown on gross specimen. There was no residual tumor and lung metastasis detected in nonselective treated group during the period of 6 weeks follow-up. Atrophy of the whole tumor-burdened kidney was shown on gross specimen and complete coagulative necrosis of the total tumor and the renal capsule adjacent to the tumor was demonstrated on histopathologic images. Conclusions Liquid embolic agent HEMA-MMA can embolize tumor blood vessels with a diameter of 30—150 μm. The renal capsular artery participates in the blood supply of the VX2 kidney tumor, so only superselective embolization of the renal artery branch with this liquid embolic agent may not induce the whole necrosis of the tumor, but complete necrosis of the tumor can be obtained by embolizing of all the tumor vessels and the adjacent normal renal arteries with this liquid embolic agent.

Objective To evaluate the feasibility of interventional catheterization via saphenous artery route in treating hepatic and renal lesions, to compare its advantages and disadvantages with trans-femoral approach catheterization, and to discuss the feasibility of using saphenous artery route to replace femoral artery approach.Methods A total of 24 rabbits bearing VX2 liver and kidney tumor were randomly divided into via femoral artery catheterization group (control group,n=8) and via saphenous artery catheterization group (study group,n=16). Surface distribution and variation of saphenous artery were recorded. After the saphenous artery was isolated, blood vessel was punctured with a 22 G needle, through which a 0.018 inch micro guide wire together with a 5-F micro catheter sheath was inserted into the artery, then, a Y-valve was connected to the sheath. DSA was performed to determine the diameters of the saphenous artery, femoral artery and iliac artery. The used time for isolating the artery and indwelling the sheath, the depth of sheath insertion, the success rate of catheterization, the incision infection rate and the occurrence of claudication in both groups were recorded, and the results were compared. Results Saphenous artery could be clearly observed on body surface in 91.67%of rabbits (22/24). Successful insertion of catheter sheath was achieved in all rabbits of both groups. The used time of isolating artery, the depth of sheath insertion, the incision infection rate and the occurrence of claudication at 7 and 14 days after the treatment in the study group were(367.30±37.30) seconds, (20.20±2.60) mm, 0%, 6.25%and 0%respectively, while those in the control group were (978.20±156.30) seconds,(58.60±9.50) mm, 37.50%, 62.50% and 25% respectively. The differences in above mentioned measurement items between the two groups were statistically significant (P<0.05). The used time of indwelling the sheath and the occurrence of claudication at one day after the treatment in the study group and in the control group were (42.80 ±9.90) seconds, 70% and (43.60 ±7.0) seconds, 100%respectively, and no statistically significant differences existed between the two groups (P>0.05). The diameters of the saphenous artery, superficial femoral artery, common femoral artery, external iliac artery and common iliac artery were (1.29±0.12) mm,(1.91±0.27) mm, (2.18±0.15) mm, (2.22±0.13) mm and(2.39± 0.15) mm respectively. Conclusion In rabbits, the saphenous artery is usually superficially located, its anatomical variation rate is very low, and its internal diameter can match 5- F micro catheter sheath. Catheterization via saphenous artery is convenient, time-saving with less damage and fewer complications. Therefore, in treating hepatic and renal lesions in rabbits the catheterization via saphenous artery can be used as the technique of first choice to replace the femoral approach catheterization.

With the development of systemic therapy for the treatment of breast cancer, the incidence of brain metastases from breast cancer is gradually increasing. Treatment with surgery,stereotactic radiosurgery, and wholebrain radiotherapy (WBRT) are still the first-line therapies for the majority of patients with brain metastases. Recently, chemotherapy, hormone therapy and targeted therapy have been widely used for breast cancer. This review summarizes the efficiency of those strategies for the breast cancer patients with brain metastases.

Objective To investigate the key technical points of microvascular decompression (MVD)for the treatment of primary glossopharyngeal neuralgia (GPN)and its efficacy. Methods From July 2011 to October 2016,18 consecutive patients with primary GPN treated with MVD at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. All patients received magnetic resonance angiography (MRA)examination before procedure. The anatomical relationship between glossopharyngeal nerve / vagus nerve and peripheral blood vessels were identified. Seventeen of them were treated via suboccipital retrosigmoid approach,one were treated via far lateral approach. None of the patients were treated with nerve root rhizotomy. Results Eighteen patients had paroxysmal severe pain in tongue,pharynx,tonsil or deep ear canal and other parts before procedure. Preoperative MRA indicated and confirmed in the surgery that the offending vessels were the trunks or their branches of the posterior inferior cerebellar artery in this group of patients. During the operation,the offending vessels were removed from the out brainstem areas of the glossopharyngeal nerves and vagus nerves under the direct vision in order to ensure that the blood vessels and nerves no longer contacted with each other. There were no complications, such as disability and death,cerebrospinal fluid leakage,and intracranial infection. All the patients were followed up after procedure;the mean follow-up period was 1-62 months. The symptom of pain disappeared completely in 17 of them. The Numberical Rating Scale (NRS)score for pain were 0. The pain in one patient was not relieved. The NRS score was 8 at discharge;it was the same as before procedure. Three patients had mild hoarseness,throat discomfort after procedure. They were relieved gradually in the follow-up period. Conclusion MVD is a safe and effective method for the treatment of GPN. Posterior inferior cerebellar artery is the most common offending artery. Preoperative imaging examination and clear decompression during the procedure are very important. The cutting off of glossopharyngeal nerves and vagus nerves needs to be handled with care.

Objective To investigate the feasibility of using leukocytes that were filtered out by LeukoReduction System ( LRS) to replace conventional human peripheral blood leukocytes in experimental researches and to comparatively analyze the differences between them in vitro biological functions and pheno-types of T cells. Methods Mononuclear cells were isolated from LRS-separated leukocytes and whole blood sample that collected from the same person by using Ficoll. Fluorescence-activated cell sorting ( FACS) was performed to analyze the phenotypes of T cells. CD3+T cells were sorted out by using magnetic beads. The T cells that were collected by using two different ways were incubated with anti-CD3 and anti-CD28 antibodies and IL-2 in vitro for 10 days. Several assays including cell counting, FACS and cytometric beads array ( CBA) were performed to comparatively analyze the differences in biological functions and phenotypes of T cells that were isolated by different methods. Results The phenotypes of T cells isolated from LRS filter and whole blood sample were highly similar at the initial stage. The sorting rate of CD3+T cells form LRS filter reached a high level and met the requirements for experimental researches. No statistically significant differ-ences in cell count, phenotype, expression of costimulatory molecules and cytokine secretion were observed between T cells isolated from LRS filter and whole blood sample. Conclusion This study suggested that the T cells isolated from LRS filter could be used as an alternative to whole blood T cells for fundamental resear-ches since they were similar in cell vitality, phenotype and biological functions. It provided a new way to solve the problem of blood shortage in clinic and scientific research.

Objective To determine the clinical implications of internal mammary node biopsy for neoplasm stage,treatment,and prognosis in patients with breast cancer.Methods Internal mammary node biopsy via intercostal space was performed in 229 cases of breast cancer.Anatomical location of internal mammary nodes was recorded.Results Internal mammary node biopsy was successfully finished in 220 patients.There were 56 cases (24.45％ ) with internal mammary nodes metastasis,126 cases (55.02％ ) with axillary nodes metastasis,43 cases (34.13％ ) with regional metastases in both the axillary and internal mammary lymph nodes and 13 cases ( 12.62％ ) with internal mammary node metastasis only.Internal mammary node metastasis rate in patients with the number of positive axillary nodes ≥4 was 49.32％ (36/73).pN stage migration was seen in 56 patients with positive internal mammary nodes.There was no statistic relation between internal mammary nodes metastases and tumor location ( x2 =0.661,P =0.719).70.7％ patients with medial/central tumors and 50.7％ patients with the number of positive axillary nodes ≥4 were free from internal mammary node radiotherapy on account of internal mammary node biopsy.There was no complication such as pneumothorax or haemorrhagia.Conclusions Internal mammary node biopsy from intercostal space is a reliable surgical technique and can improve pN stage in some breast cancer patients.With internal mammary node biopsy,patients with a negative internal mammary node can be prevented from radiation to internal mammary nodal areas.

Objective To investigate the characteristics of blood donors’psychological activity,take reasonable intervention measures to improve the success rate of blood donation recruitment and the ratio of repeated blood donation.Methods The data of blood donors’psychological activity was collected by distributing questionnaires randomly,and the psychological characteristics and worries were analysed.Results In terms of the blood donation purpose,there were 62.73% of the blood donors who donate blood for the first time and take the“utility psychological”as the principal thing.There were 76.01% of the blood donors who donate blood repeatedly and take the“dedication psychological”as the principal thing.In terms of wor-ries,there was 72.69% of the blood donors who donate blood for the first time and take the“safety of blood donation”as the principal thing.There was 77.91% of the blood donors who donate blood repeatedly and take the “service quality of blood donation”as the principal thing.Conclusion The success rate of blood donation recruitment and the ratio of repeated blood donation could be effectively improved by attaching importance to the psychological needs and worries of blood do-nors,by taking different psychological intervention measures strategies for different kinds of blood donors,and by meeting their needs and eliminating their worries.