Clinically,renal angiomyolipoma(RAML)is a commonly-seen benign tumor of the kidney.Usually,it is accidentally found by physical examination or when the clinical relevant symptoms occur due to tumor rupture with bleeding or the tumor size becomes enlarged.Selective arterial embolization(SAE)has become the primary treatment for RAML.SAE can be used as a first-line treatment option in acute rupture with bleeding of RAML.Moreover,SAE is safe and effective in preventing RAML bleeding and other serious complications,which has already been proved.This review focuses on the indications and contraindications for SAE treatment of RAML,selection of embolization materials,evaluation of efficacy,complications and their prevention and treatment,etc.(J Intervent Radiol,2024,33:560-564)

Objective:To investigate whether blastulation time would impact maternal and neonatal outcomes following single euploid blastocyst transfer.Methods:A retrospective cohort study was conducted at the Centre for Reproductive Medicine of Renji Hospital, Shanghai Jiao Tong University School of Medicine between October 2017 and June 2021. Totally 893 patients who received preimplantation genetic testing for aneuploidies (PGT-A) and delivered singleton live birth after frozen single euploid blastocyst transfer were included. Patients were divided into day 5 (D5) group ( n=768) and day 6 (D6) group ( n=125) according to timing of blastulation. Propensity score matching (PSM) with a ratio of 2∶1 was conducted to balance potential confounding factors including female age, body mass index (BMI) and infertility duration. After PSM, there were 250 patients in D5 group and 125 patients in D6 group. Basic characteristics, ovarian stimulation and embryo transfer cycle characteristics, pregnancy complications and neonatal outcomes of the two groups were compared. Furthermore, patients were divided into <35 years old group and ≥35 years old group by maternal age to conduct stratified analysis. Results:There were no statistically significant differences in the baseline characteristics including female age, BMI, infertility duration and indication for infertility treatment between the two groups after PSM (all P>0.05). The number of oocytes retrieved and the number of two pronuclei (2PN) did not differ between the two groups (all P>0.05), while the number of embryos cryopreserved was significantly increased in D5 group than in D6 group [5.00 (3.00, 7.00) vs. 3.00 (2.00, 5.00), P<0.001]. The proportion of cycles transferring good-quality embryos was significantly higher in D5 group than in D6 group [81.6% (204/250) vs. 40.0% (50/125), P<0.001]. No significant differences were observed in the incidences of gestational diabetes, hypertensive disorders of pregnancy, thyroid diseases during pregnancy, premature preterm rupture of membranes, preterm delivery, placenta disorder and postpartum hemorrhage between the two groups (all P>0.05). The birth weight, gestational age, neonate sex, the incidences of low birth weight, macrosomia, small for gestational age, large for gestational age and birth defects did not differ as well (all P>0.05). In stratified analysis, there were no significant differences in maternal and neonatal outcomes between D5 group and D6 group for women who aged <35 years or ≥35 years (all P>0.05). Conclusion:Timing of blastulation in euploid blastocysts does not impact maternal and neonatal outcomes.

Objective:To investigate whether blastulation time would impact maternal and neonatal outcomes following single euploid blastocyst transfer.Methods:A retrospective cohort study was conducted at the Centre for Reproductive Medicine of Renji Hospital, Shanghai Jiao Tong University School of Medicine between October 2017 and June 2021. Totally 893 patients who received preimplantation genetic testing for aneuploidies (PGT-A) and delivered singleton live birth after frozen single euploid blastocyst transfer were included. Patients were divided into day 5 (D5) group ( n=768) and day 6 (D6) group ( n=125) according to timing of blastulation. Propensity score matching (PSM) with a ratio of 2∶1 was conducted to balance potential confounding factors including female age, body mass index (BMI) and infertility duration. After PSM, there were 250 patients in D5 group and 125 patients in D6 group. Basic characteristics, ovarian stimulation and embryo transfer cycle characteristics, pregnancy complications and neonatal outcomes of the two groups were compared. Furthermore, patients were divided into <35 years old group and ≥35 years old group by maternal age to conduct stratified analysis. Results:There were no statistically significant differences in the baseline characteristics including female age, BMI, infertility duration and indication for infertility treatment between the two groups after PSM (all P>0.05). The number of oocytes retrieved and the number of two pronuclei (2PN) did not differ between the two groups (all P>0.05), while the number of embryos cryopreserved was significantly increased in D5 group than in D6 group [5.00 (3.00, 7.00) vs. 3.00 (2.00, 5.00), P<0.001]. The proportion of cycles transferring good-quality embryos was significantly higher in D5 group than in D6 group [81.6% (204/250) vs. 40.0% (50/125), P<0.001]. No significant differences were observed in the incidences of gestational diabetes, hypertensive disorders of pregnancy, thyroid diseases during pregnancy, premature preterm rupture of membranes, preterm delivery, placenta disorder and postpartum hemorrhage between the two groups (all P>0.05). The birth weight, gestational age, neonate sex, the incidences of low birth weight, macrosomia, small for gestational age, large for gestational age and birth defects did not differ as well (all P>0.05). In stratified analysis, there were no significant differences in maternal and neonatal outcomes between D5 group and D6 group for women who aged <35 years or ≥35 years (all P>0.05). Conclusion:Timing of blastulation in euploid blastocysts does not impact maternal and neonatal outcomes.

Objective To summarize our experience in surgical intervention of patients with mediastinal hemangioma.Methods From January 1994 to August 2017,18 patients underwent surgical treatment were diagnosed with mediastinal hemangioma in our department.There were 9 females and 9 males,with the average age of(50.9 ± 14.0) years.Seven patients were seen with signs and symptoms related to the tumor,and the other 11 patients had no symptom.Three cases were located in the anterior mediastinum,1 case in the middle mediastinum and 14 cases in the posterior mediastinum.All of the cases experienced chest computed tomography(unenhanced or contrast-enhanced CT scan).Most mediastinal hemangiomas manifested as well-marginated masses at CT.Seven hemangiomas showed heterogeneous enhancement at contrast-enhanced CT.Calcifications were demonstrated in 2 patients.Preoperative diagnosis was not confirmed in all patients.Two cases were suspected to be hemangioma preoperatively,other cases were suspected to be thymoma,neurofibroma or malignancy.Eight cases were treated by video-assisted thoracic surgery approach,3 of those converted to thoracotomy due to high risk of hemorrhage.Ten cases experienced traditional thoracotomy.Results Seventeen patients had total excision,but one experienced biopsy because of hemorrhage.There were no operative death and major complications.The average operation time was(105.0 ± 49.6) minutes,and the average blood loss was(111.7 ± 138.9) ml.The postoperative hospital stay was (4.7 ± 3.5) days on average.Follow-up time ranged from 1 to 18 months(median,9.6 months).No recurrence was found in the patients with total excision at the time of follow-up.The patient undergoing biopsy showed no progression of the disease for 12 months.Conclusion Mediastinal hemangiomas were rare tumors,without relatively specific clinical manifestation.Calcification and phleboliths on CT scan were helpful in suggesting the vascular nature of the mass.Preoperative diagnosis of mediastinal hemangioma was usually very difficult.Mediastinal hemangiomas were mainly treated by surgical approach and had good prognosis.

Objective To detect the mutation frequency of EML4-ALK fusion gene in lung cancer patients, and to inves-tigate the distribution of mutation character for EML4-ALK fusion gene in Ⅰ stage lung cancer patients and clinical features as well as provide a reference for the individual treatment of lung cancer .Methods 256 fresh tumor tissue specimens of lung cancer patients were screened from the specimen bank of our hospital and all the patients had accepted the surgical treatment from February 2013 to December 2014.Total RNA was extracted and then be transcribed into cDNA, the amplification-refrac-tory mutation system(ARMS) was used to detect mutation of EML4-ALK fusion gene.The results according to the positive con-trol, negative control and RNA quality control for EML4-ALK fusion type were analyzed.Results During the 256 patients ofⅠ stage lung cancer, there were 17 patients(6.64%) had mutations in EML4-ALK fusion gene.In lung adenocarcinoma mu-tation rate(16/207, 7.73%) was higher than that of lung squamous cell mutation rate(1/39, 2.56%), lung adeno-squamous mutation rate(0/4, 0) and large cell carcinoma(0/5, 0) of the mutation rate;young lung cancer patients( <63 years) of the mutation rate(14/139, 10.07%) was significantly higher than the high age of lung cancer patients(≥63 years old) mutation rate(3/117, 2.56%), P =0.009.EML4-ALK fusion with tumor invasion and visceral pleura group incidence (9/80, 11. 25%) was significantly higher than that of non-invasive and visceral pleura group incidence rate(8/176, 4.55%), P =0.045.Conclusion The occurence of EML4-ALK fusion correlates with patients’ age as well as whether visceral pleura is in-vaded, type 1 EML4-ALK fusion was detected more in phase I lung cancer patients.

Objective Severe bronchial stricture due to endobronchial tuberculosis is often accompanied by complex complication,such as obstructiv pneumonia,destroyed lung and bronchiectasis.Its treatment is very diffucult.The present report is to investigate and analyze the indication and efficacy of surgical treatment of bronchial stricture due to severe endobronchial tuberculosis.Methods Reviewed the clinico-pathological records documenting the surgical outcomes in 81 bronchial stricture due to severe endobronchial tuberculosis who underwent lobectomy or pneumonectomy enrolled in our hospital between January 1990 and December 2010.There were 29 male and 52 female.Mean age was(36 ± 12) years (ranged 16-66 years).The three most common reasons of surgery were bronchial stricture accompanied by pulmonary atelectasis,destroyed lung and bronchiectasis(76 cases,93.8％).79 cases had elective operation,whereas one patients required emergency surgery.Pueumonectomy in 51,lobectomy in 16,sleeve resection in 11,segmental resection in 2,and exploratory thoracotomy in 1.If frozen pathological examination showed that endobronchial tuberculosis remained in the bronchial stump,it was covered with muscle flaps,including intercostal muscle flap in 6 cases,latissimus dorsi muscle flap in 5 cases,serratus anterior muscle flap in 5 cases.The mean operative time was 3.2 h (range between 2 h and 5.5 h) and the blood loss averaged 546 ml (range between 100ml and 4 000 ml).The post operative hospital stay averaged(12 ±8)days.Results No intraoperative or early postoperative death occurred.Nine patients developed complications,including BPF in 2,pulmonary infection in 2,empyema in 1,hemorragic shock in 1,hemothorax in 1,incision infection in 1,chylothorax in 1.All 9 cases recovered well after treatment.Pathological examination showed that tuberculosis bronchial remained in the brinchial stump in 13 cases.Neither BPF nor empyema occurred in all the 13 cases.Multivariate analysis revealed that destroyed lung was significant risk factor of postoperative complication.There were 3 late deaths.Five year survival rate was 96.2％.Conclusion Surgical treatment is still the recommeded treatment modatity for bronchial stricture caused by endobronchial tuberculosis due to its excellent results.It should be performed in time when the drug and intraluninal treatment were no effect for avoiding of being progeressed into destroyed lung.

Objective Lungs from non-heart-beating donors for transplantation require protection against warm ischemic damage.This study investigated the preservative effect of Ventilation with cooled carbon monoxide during warm ischemia in non-heart-beating donor rat lungs.Method 18 rats were divided into a CO group (n =6),which received ventilation with low-dose carbon monoxide at normal temperature during a 4-hour warm ischemic period; a Control group (n =6),which received no ventilation at normal temperature; a cooling CO group (n =6),which received ventilation with cooled carbon monoxide.PaO2,Myeloperoxidase (MPO) activity,Bronchoalveolar lavage (BAL) neutrophil count and the wet-to-dry (W/D) lung weight ratio were recorded in every group.Quantitative real-time RT-PCR was used to analysis the expression of IL-1β and caspase 3 mRNA in graft lung tissures.Result Endobronchial temperatures and lung surface temperatures in the Cooling CO group were lower than those in the corresponding Control group and CO group (P＜ 0.01).Lower wet/dry lung weight ratio,MPO activity,BAL neutrophil count,expression of IL-1β and caspase 3 mRNA in graft lung tissures were seen in the Cooling group compared with the Control group and CO group (P＜0.05).Conclusion Ventilation with cooled carbon monoxise can decrease lung temperature and improve the protecting effect on non-heart-beating donor rat lungs againt worm ischemic injury by inhibiting the expression of proimflammatory factor IL-1β and apoptosis-associated gene caspase 3.

Objective To evaluate prognostic factors for early bronchopleural fistula after pneumonectomy with non small cell lung cancer,and establish a validated clinical model to estimate the risk of early-BPF.Methods We reviewed the medical records of 429 patients who underwent pneumonectomy for NSCLC at our institution.We used univariate and multivariate analysis to identify potential independent risk factors for early-BPF after pneumonectomy for NSCLC.A model to estimate risk of early-BPF was developed by combining independent risk factors.Results The rate of early-BPF after pneumonectomy for NSCLC was 6.5％ (28/429).Three factors were independently associated with early-BPF:neoadjuvant therapy (HR:2.406),bleeding (HR:2.171)and diabetes (HR:1.144).A scoring system for early-BPF was developed by assigning 2 points for each major risk factor (neoadjuvant therapy and bleeding) and 1 point for each minor risk factor(diabetes).Scores were grouped as low (0-1),intermediate (2-3),and high (3),yielding the rate of early-BPF was 14％,27％,and 43％,respectively.Conclusion This clinical model is established on the basis of independent risk factors.This model can be used as a predictive tool for early-BPF after pneumonectomy for NSCLC.

ObjectiveBronchogenic carcinoma involving the carina or tracheobronchial angle still presents a challenge due to specific problems related to surgical technique and airway management.Aim of this paper is to examine complications and long-term survival of our personal series and those reported in literature.MethodsBetween 1985 and 2010,48 patients underwent carinal resection:a right tracheal sleeve pneumoneetomy was performed in 47 patients and a left tracheal sleeve pneumonectomy in 1 patient.The anastomosis was performed with aid of high-frequency jet ventilation or introfield tube ventilation.ResultsOverall morbidity and mortality rate was 25％ and 6.3％ respectively,and there was no death in operation.5-yearsurvival rate of patients with squamous and adenocarcinoma was 27.3％ and 12.5％,respectively,P =0.04.The overall 5-year survival rate was 24.3％.Patients without nodal involvement had a significantly better prognosis than N1 and N2 patients (5-year survival:52％,13％ and 0,respectively).Multivariate analysis showed that nodal status was the only independent prognostic factor( P =0.006 ).ConclusionWith careful selection of patients and meticulous surgical technique,Tracheal sleeve pneumonectomy for bronchogenic carcinoma can be accomplished with acceptable mortality and morbidity,proriding good long-term results.

Objective Bronchopleural fistula (BPF) is a common but potentially lethal complication after pulmonary resection.Currently,there is still controversy over the appropriate management strategy for BPF,especially when pleural space contamination develops.The purpose of this study was to evaluate the efficacy and safety of surgical repair fistulas combined with pedicled muscle flaps coverage in patients with early BPF after pulmonary resection based on our experience with 23 cases.Methods The clinical data for 23 patients who underwent surgical repair of early BPF from January 1999 to December 2010 at our hospital were reviewed.Thirteen patients had undergone a prior pneumonectomy and 10 patients had undergone a prior lobectomy.BPF occurred from postoperative day 5 to40 (mean postoperative day 21 ).Nine patients had a contaminated pleural space.After BPF was clearly diagnosed,prompt closed pleural drainage was instituted,followed by surgical repair of BPF.Four patients underwent a direct suture repair of fistula,ten patients underwent stump revision and suture closure,seven patients underwent stump revision and bronchoplasty or carina plasty,and a pedicled muscle flap was sewn to the edges of the fistula in two patients.The stump was covered with various muscle flaps,including interostal muscle flap in five cases,latissimus dorsi muscle flap in ten cases,serratus anterior muscle flap in six cases,and erector spinae muscle flap in two cases.Postoperatively,the pleural space was routinely irrigated and drained.Results No intraoperative or early postoperative death occurred.Four patients developed severs complications,including respiratory failure in two cases,pulmonary embolism in one case,and empyema in one case.All four cases recovered well after treatment.The mean duration of hospitalization was 33 days (range 8 - 120 days ).Surgical repair of BPF was successful in 21 cases (91.3％) but failed for 2 patients..BPF recurrence developed in only one patient two years postoperatively due to stump recurrence.He died of extensive metastatic disease 2 years after BPF recurrence.Conclusion Excellent results can be achieved by early surgical repair combined with stump pedicled muscle flaps coverage in patients with BPF who can tolerate reoperation,even if they have a contaminaled pleural space.