Objective:To investigate the efficacy and safety of fluoroscopically-guided percutaneous gastrostomy (FGPG) for establishing enteral nutrition access in the treatment of esophageal fistula after radiotherapy for cervical esophageal cancer (CEC).Methods:A retrospective analysis was conducted on the clinical data of 54 patients who underwent FGPG due to esophageal fistula after radiotherapy for CEC at our department from November 2009 to August 2019. All patients received endoscopy before radiotherapy, and CEC was pathologically confirmed. Enteral nutrition support was offered through a gastrostomy tube postoperatively. The success rate of FGPG, complications, and healing of perforation were recorded and analyzed.Results:FGPG was successfully performed in all 54 patients (100%). During the 12-month follow-up, 50 patients (92.6) survived while four (7.4%) died. Among 36 patients with esophagomediastinal fistula, 32 (88.9%) healed in a median of 12 weeks; of 18 patients with esophagotracheal fistula, 8 (44.4%) healed in a median of 18 weeks. Thus, patients with esophagomediastinal fistula had a significantly higher healing rate ( P<0.01) and shorter healing time ( P=0.017). Gastrostomy tube-related complications were minimal, and no serious complication was noted. Conclusions:FGPG is effective for the treatment of esophageal fistula after CEC radiotherapy and may be an alternative treatment for esophageal fistula.

Objective:To assess the cytotoxicity of self-adhesive resin cement RelyXTM U200 on human periodontal ligament fibro-blasts(HPDLFs)under different light treatment modes.Methods:The self-adhesive resin cement RelyXTM U200 was cured by immediate light(A),intermittent light(B),delayed light(C)and no light(D)treatment respectively.The HPDLFs were cultured with the specimen extracts under different light modes.The proliferation ability and apoptosis level of the cells in the groups were detected by CCK-8 test and flow cytometry apoptosis test.SPSS 20.0 software was used to analyze the cytotoxicity of specimens to HPDLFs.Results:At 24 h after light treatment the cytoxicity(grade)of group A,B,C and D was 1,2,3 and 4,at 72 h 1,2,2 and 3,respectively.At 72 h,the apoptosis index(％)of the cells in A,B,C and D groups was 6.38％±0.94％,16.34％±1.67％,24.13％±1.43％and 38.34％±2.75％respecitvely.Conclusion:The cytotoxicity of self-adhesive resin cement is the greatest under no light treatment mode and the least under immediate light treatment mode.

Objective:To assess the cytotoxicity of self-adhesive resin cement RelyXTM U200 on human periodontal ligament fibro-blasts(HPDLFs)under different light treatment modes.Methods:The self-adhesive resin cement RelyXTM U200 was cured by immediate light(A),intermittent light(B),delayed light(C)and no light(D)treatment respectively.The HPDLFs were cultured with the specimen extracts under different light modes.The proliferation ability and apoptosis level of the cells in the groups were detected by CCK-8 test and flow cytometry apoptosis test.SPSS 20.0 software was used to analyze the cytotoxicity of specimens to HPDLFs.Results:At 24 h after light treatment the cytoxicity(grade)of group A,B,C and D was 1,2,3 and 4,at 72 h 1,2,2 and 3,respectively.At 72 h,the apoptosis index(％)of the cells in A,B,C and D groups was 6.38％±0.94％,16.34％±1.67％,24.13％±1.43％and 38.34％±2.75％respecitvely.Conclusion:The cytotoxicity of self-adhesive resin cement is the greatest under no light treatment mode and the least under immediate light treatment mode.

Objective:To investigate the efficacy and safety of fluoroscopically-guided percutaneous gastrostomy (FGPG) for establishing enteral nutrition access in the treatment of esophageal fistula after radiotherapy for cervical esophageal cancer (CEC).Methods:A retrospective analysis was conducted on the clinical data of 54 patients who underwent FGPG due to esophageal fistula after radiotherapy for CEC at our department from November 2009 to August 2019. All patients received endoscopy before radiotherapy, and CEC was pathologically confirmed. Enteral nutrition support was offered through a gastrostomy tube postoperatively. The success rate of FGPG, complications, and healing of perforation were recorded and analyzed.Results:FGPG was successfully performed in all 54 patients (100%). During the 12-month follow-up, 50 patients (92.6) survived while four (7.4%) died. Among 36 patients with esophagomediastinal fistula, 32 (88.9%) healed in a median of 12 weeks; of 18 patients with esophagotracheal fistula, 8 (44.4%) healed in a median of 18 weeks. Thus, patients with esophagomediastinal fistula had a significantly higher healing rate ( P<0.01) and shorter healing time ( P=0.017). Gastrostomy tube-related complications were minimal, and no serious complication was noted. Conclusions:FGPG is effective for the treatment of esophageal fistula after CEC radiotherapy and may be an alternative treatment for esophageal fistula.

Objective To evaluate the current status in the implementation of GBZ/T 201.5-2015 Radiation shielding requirements for radiotherapy rooms-Part 5: Radiotherapy room of proton accelerators, identify issues in the application of its technical indicators, and provide a basis for the in-depth implementation and further revision of the standard. Methods In accordance with the Standardization Law of the People’s Republic of China and the Guidelines for Health Standards Tracking Evaluation (WS/T 536-2017), a combination of cluster sampling and stratified sampling methods was employed to select professionals involved in proton accelerator radiotherapy devices and facilities in three provinces (or municipalities directly under the central government) as the subjects of the survey. A questionnaire was developed to collect basic information about the subjects and their understanding and application of the technical indicators in the standard. A standard evaluation indicator system with a total score of 100 points was established to score the implementation of the standard (40 points), the technical content (30 points), and the effectiveness of the implementation (30 points). Results A total of 169 professionals from 107 institutions participated in the survey, with 79.88% of the respondents having at least 5 years of experience in radiation therapy and 74.56% holding intermediate or higher professional titles. The score of standard implementation was 18.3 points. The awareness rate exceeded 80%, indicating a high level of awareness about the standard. However, the scores for the dissemination and application of the standard were relatively low, accounting for 28% and 32% of their respective full marks. The technical content of the standard and the effectiveness of its implementation scored 27.0 and 26.6 points, respectively. The overall score in the evaluation of standard implementation was 72 points, with scores of 68.6, 72.3, and 75.0 for Beijing City, Shanghai City, and Jiangsu Province, respectively. Conclusion GBZ/T 201.5-2015 Radiation shielding requirements for radiotherapy rooms-Part 5: Radiotherapy room of proton accelerators is scientific and operable, and it is well-coordinated with relevant laws and standards. However, considering the development in FLASH technology and multi-chamber radiotherapy room, it is necessary to revise and improve the standard.

Objective:Quantified MRCP imaging data was used as a reference for design and preparation of a modified percutaneous transhepatic cholangio drainage (PTCD) tube.Methods:3.0 T upper abdominal MR and MRCP imaging data of 2 300 patients treated from July 2015 to July 2020 at the Department of Radiology of the Affiliated Cancer Hospital of Zhengzhou University were screened and a total of 381 patients diagnosed with biliary duct structures were identified. Causative etiologies among these patients included pancreatic adenocarcinoma (pancreatic head), cholangiocarcinoma, ampullary carcinoma, as well as intrahepatic and/or extrahepatic bile duct dilation. An improved PTCD tube was designed based on MRCP quantification of left and right hepatic and common hepatic duct length.Results:In the setting of biliary obstruction caused by malignancy, the distance of the left hepatic duct from its origin to the point of left and right hepatic duct confluence was 15.9±3.8 mm, while the distance of the right hepatic duct from its origin to the point of left and right hepatic duct confluence was 12.4±3.2 mm; the length of the bile duct from its origin to the point of left and right hepatic duct confluence was 34.0±8.1 mm. The improved PTCD tube design incorporated an altered length of the drainage orifice.Conclusion:MRCP imaging of the biliary tract is effective for measuring biliary tract length in the setting of pathological dilation. Based on our biliary tract measurements, a modified PTCD tube was designed to more effectively meet drainage requirements and manage biliary obstruction caused by Bismuth-Corlette type Ⅱ and Ⅲ malignancies.

Objective To discuss the safety and efficacy of arterial embolization combined with local ablation in the treatment of recurrent and refractory chest wall tumors.Methods The clinical data of 11 patients with chest wall tumor that recurred after surgery and progressed after treatment were retrospectively analyzed.On the basis of the original treatment regimen,DSA-guided arterial embolization and CT-guided local ablation were employed.VAS score of pain relief and postoperative complications were recorded,and the therapeutic efficacy was evaluated Results All the patients were follow up for a median time of 18.5 months.Successful DSA-guided arterial embolization was accomplished in all patients.Seven patients(9 lesions in total)initially received CT-guided radiofrequency ablation(RFA),and tumor reoccurred in 2 patients,who had to receive RFA once more.Four patients(5 lesions in total)initially received CT-guided microwave ablation(MWA),and tumor reoccurred in one patient,who had to receive MWA again.According to mRECIST criteria,the 6-month,12-month and 18-month objective response rates(ORR)were 72.7%(8/11),45.5%(5/11)and 18.2%(2/11)respectively,the 6-month,12-month and 18-month overall survival rates were 81.8%(9/11),63.6%(7/11)and 27.3%(3/11)respectively,with a median survival time of 13.2 months.The postoperative one-month and 3-month VAS scores were(2.42±1.25)points and(1.91±1.24)points respectively,which were strikingly lower than preoperative(6.78±1.13)points,the differences were statistically significant(P＜0.05).After surgery,3 patients developed pleural effusion,which disappeared after puncture and drainage treatment,and 2 patients developed fever,which was improved after symptomatic treatment.One patient died of respiratory failure six months after treatment.Conclusion Arterial embolization combined with local ablation can improve the symptoms of pain and prolong the survival time of patients with chest wall tumors.This combination therapy is less traumatic and clinically safe,and it can be used as an effective treatment for patients with recurrent and refractory chest wall tumors.

Objective:To evaluate the safety and efficacy of radiofrequency ablation guided by CT hepatic arteriography (CTHA) in the treatment of multiple nodular liver metastases of colorectal cancer.Methods:Clinical data of 32 patients with liver metastasis of colorectal cancer who underwent femoral arterial catheterization and percutaneous radiofrequency ablation guided by CT hepatic arteriography (CTHA) at the Affiliated Cancer Hospital of Zhengzhou University from March 2020 to September 2021 were retrospectively analyzed, including 21 males and 11 females, aged (53.2±9.9) years old. Before ablation, the angiography catheter were placed in the common or proper hepatic artery under the digital subtraction angiography (DSA). The patients were then transferred to a CT operating room. Under general anesthesia, contrast agent was injected into the indwelling angiography catheter and percutaneous radiofrequency ablation guided by CTHA was performed. The presentation of lesions, the dosage of contrast agent and complications during ablation were analyzed, and the treatment outcome was followed up outpatient or inpatient review.Results:All 32 patients uneventfully underwent DSA-guided angiography catheter placement, and CTHA-guided radiofrequency ablation was successfully performed in 97 lesions, with a technical success rate of 100% (97/97). The difference between CT values at the lesion enhancement site and peri-tumor hepatic parenchyma were greater than 25 HU. The total amount of contrast agent used during the procedure was 63.9±14.7 ml. All ablation-related complications were graded as A or B according to the Society of Interventional Radiology classification system. The complete ablation rate assessed by CTHA after the ablation was 100% (97/97). The rate of lesion necrosis was 100% evaluated by MRI one month after ablation. All patients were followed up and no recurrence was observed in 97 ablated lesions by the end of follow-up period.Conclusion:Radiofrequency ablation guided by CTHA is safe and feasible for the treatment of multiple nodular liver metastases of colorectal cancer, which could reduce the local recurrence of lesions after ablation.

Objective:To investigate the safety and efficacy of C-arm CT laser-guided puncture combined with digital subtraction angiography (DSA)for percutaneous renal pelvic catheter drainage in the treatment of hydronephrosis caused by pelvic malignancy.Methods:A retrospective analysis was performed on the data of 56 patients with ureteral obstruction caused by pelvic malignancy admitted to the Affiliated Cancer Hospital of Zhengzhou University from February 2020 to August 2021, including 10 males and 46 females. The mean age of the patients was (54.0±10.1)years old. The causes were colorectal cancer (7 cases), bladder cancer (3 cases), cervical cancer (36 cases), endometrial cancer (3 cases), ovarian cancer (2 cases), pelvic metastasis of gastric cancer (4 cases) and pelvic sarcoma (1 case). There were 71 sides of renal pelvis dilation in 56 patients, with the degree of dilation ranging from 1.2cm to 5.0cm.The degree of hydronephrosis was mild on 36 sides, moderate on 27 sides, and severe on 8 sides. Preoperative blood urea nitrogen(9.90±6.22)mmol/L and creatinine (155.80±146.83)μmol/L.During the puncture and catheter drainage, the patient was placed in the prone position, the C-arm CT scan was used to plan the puncture path, and the laser positioning of the DSA flat panel detector was used to determine the skin puncture point. With local anesthesia, the puncture direction of the puncture needle was adjusted to make the skin puncture point, the tail of the puncture needle, and the laser fixation point present a state of "three-points in one-line" when the patient stopped breathing temporarily at the end of expiratory breath in a non-fluoroscopic state, so as to achieve the preset puncture angle. Subsequently, pyelocentesis was completed according to the planned puncture depth. After successful pyelocentesis, percutaneous external renal drainage tube insertion or ureteral stents were performed under DSA. The number of renal pelvis puncture, puncture time, radiation dose, deviation of external renal drainage tube insertion angle from puncture angle, as well as postoperative hemoglobin changes, renal function recovery and complications were recorded.Results:In this group, 56 cases of 71 sides of renal pelvis puncture and catheter drainage were successfully completed, and the success rate of the operation was 100.0% (71/71). The success rate of the first needle puncture was 97.2% (69/71). Those who failed the first needle puncture succeeded in the second puncture during the operation. The puncture time of renal pelvis was (1.9±1.8) min.The intraoperative radiation dose was (2.7±1.5) mSV. The external drainage tube of the renal pelvis was placed on 53 sides, and the external drainage tube was placed on 29 sides with the same angle as the preset angle, and 24 sides with a deviation within 3°.On the first day after operation, there was no significant difference in hemoglobin compared with that before operation, urea nitrogen (5.31±1.99) mmol/L and creatinine (62.25±16.72) μmol/L were re-examined after operation, and the differences were statistically significant compared with those before operation ( P=0.008, P=0.002). No serious surgery-related complications occurred in any patient. Conclusion:C-arm CT laser-guided puncture combined with DSA percutaneous renal pelvic catheter drainage could be safe and effective in the treatment of ureteral obstruction caused by pelvic malignancy.

Most of the patients with hepatocellular carcinoma (HCC) in China are in the advanced stage at the time of diagnosis, and the treatment methods for HCC mainly include transarterial chemoembolization and systemic therapy. This article introduces the targeted drugs represented by sorafenib and lenvatinib, and the emergence of immunotherapy. Atezolizumab combined with bevacizumab has been approved as the first-line therapy for HCC, and meanwhile, studies on TACE combined with targeted therapy and/or immunotherapy have achieved a satisfactory treatment outcome, which brings better survival and prognosis for patients with advanced HCC. However, more studies are needed to solve the issues related to the prognosis of advanced HCC.