Objective: To investigate the risk factors affecting the patency time of the125I seeds stent in malignant obstructive jaundice. Methods: A retrospective analysis of 113 patients with malignant obstructive jaundice underwent biliary tract125I seeds stent implantation. The gender, age, obstruction site, type of125I seeds stent, primary tumor type, and postoperative response to treatment of tumor were enrolled for analysis to evaluate the related risk factors affecting the patency time of the stent. Results: Univariate analysis showed that the location of biliary obstruction, the type of125I seeds stent, the type of primary tumor, and the type of primary tumor were the main factors affecting the patency time of the stent(P<0.001); Cox multivariate regression analysis showed biliary obstruction location, the type of125I seeds stent, and whether the primary tumor treated were independent factors that affected the patency time of the stent(P<0.001). Conclusion Multi-factor analysis shows that the location of biliary obstruction, the type of125I seeds stent, and the primary tumor are independent risk factors that affect the patency of the stent for malignant obstructive jaundice, which shows important markers for evaluating the prognosis of patients treated with this method.

Adult ; Antibodies, Viral/isolation & purification* ; COVID-19/virology* ; Feces/chemistry* ; Female ; Humans ; Intestines/virology* ; Male ; RNA, Ribosomal, 16S/genetics* ; RNA, Viral/isolation & purification* ; SARS-CoV-2/pathogenicity*

OBJECTIVE： To study the inhibitory effect of modified Maimendong decoction combined with cisplatin on Lewis lung cancer transplantation model mice， and to explore its potential mechanism. METHODS： Lewis lung cancer transplantation mice model was induced via subaxillary inoculation of Lewis lung cancer cells. 60 mice were randomly divided into model group （normal saline， once a day， i.g.）， cisplatin group （6 mg/kg， once a week， i.p.）， modified Maimendong decoction group （20 g/kg. once a day， i.g.） and combination group （cisplatin 6 mg/kg， once a week， i.p.+modified Maimengdong decoction， once a day， i.g.）， with 15 mice in each group. All mice were treated for consecutive 2 weeks. After medication， tumor weight and thymus index were detected； HE staining was used to observe the pathological change of tumor tissue. TUNEL was used to detect apoptotic index of tumor tissue. The protein expressions of Bcl-2 and Bax were detected by Western blot assay. RESULTS： Compared with model group， tumor weight and protein expression of Bcl-2 were decreased significantly in modified Maimengdong decoction， cisplatin group and combination group （P＜0.05）， and thymus index， tumor apoptotic index and the protein expression of Bax were increased significantly （P＜0.05）. Tumor weight and protein expression of Bcl-2 in combination group were significantly lower than modified Maimengdong decoction group and cisplatin group （P＜0.05）； thymus index， tumor apoptotic index and the protein expression of Bax were significantly higher than addition and subtraction of modified Maimengdong decoction group and cisplatin group （P＜0.05）. HE staining showed that the density of tumor cells was decreased to certain degree in modified Maimengdong decoction group， cisplatin group and combination group； the area of necrosis area in the combination group was significantly larger than in modified Maimendong decoction group and cisplatin group. CONCLUSIONS： Modified Maimendong decoction can inhibit the growth of Lewis lung cancer transplanted tumor in mice by down-regulating the protein expression of Bcl-2 and up-regulating the protein expression of Bax.

Objective To compare the safety and clinical efficacy of recombinant human tissue plasminogen activator (rt-PA) and urokinase(UK)in catheter-directed thrombolysis(CDT)for the treatment of subacute iliofemoral deep venous thrombosis(DVT). Methods From June 2013 to June 2017, a total of 116 subacute DVT patients underwent consistent CDT with either rt-PA or urokinase, or simple anticoagulation treatment in this study.The patients were divided into three groups for comparison:rt-PA-CDT group(n=43), UK-CDT group(n=39)and anticoagulation group(n=34). The baseline data, thrombolysis duration, rt-PA or UK dosages, thrombolytic rate and clinical efficacy rate were compared among the three groups. Independent t-test(accorded to normal distribution)was used to analyze the thrombolysis duration.The quantitative data were analyzed with analysis of varianc and the qualitative data were compared by the chi-square test. Results There was no significant difference in general clinical features among the three groups(P>0.05). The thrombolysis duration, total dosages and thrombolytic rate (≥50)were(5.8±1.3)d,(49.7±16.1)mg,86.0% for rt-PA-CDT group,and(6.3±1.5)d,(440±99)×104 U, 66.7% for UK-CDT group.The difference of thrombolysis duration was not statistically significant between the rt-PA-CDT group and UK-CDT group(t=-1.868, P>0.05). The thrombolysis rate of rt-PA-CDT group was significantly higher than that of UK-CDT group(χ2=4.315, P<0.05). The time of obtaining grade Ⅲthrombosis rate was shorter for rt-PA-CDT group(4.7±0.9)d compared with UK-CDT group(6.0±1.2 d) (t=-2.343,P<0.05).The clinical efficacy rates of the rt-PA-CDT group[88.4%(38/43)]and UK-CDT group [76.9%(30/39)]were significantly higher than that of anticoagulation group[26.5%(9/34)](P<0.05).There was no statistical difference between the rt-PA-CDT group and UK-CDT group(χ2=1.893, P>0.05). No severe complications were found in all groups. The incidence rates of mild complication of the rt-PA-CDT group, UK-CDT group and anticoagulation group were 16.3%(7/43), 17.9%(7/39)and 8.8%(3/34), respectively, and there were no significant differences among the three groups(χ2=1.396, P>0.05). Conclusion The clinical efficacy of CDT using rt-PA and UK for subacute DVT is better than simple anticoagulation treatment.Thrombolytic rate of rt-PA is superior to UK.

Objective To assess the safety and efficacy of catheter-directed thrombolysis combined with percutaneous transluminal angioplasty (PTA) in treating acute thrombo-embolism of artificial arteriovenous fistula.Methods The clinical data of 64 patients with acute thrombo-embolism of artificial arteriovenous fistula (84 events in total),who were admitted to single medical center during the period from January 2012 to September 2016,were retrospectively analyzed.The diagnosis of acute thrombo-embolism of artificial arteriovenous fistula was confirmed by angiography via femoral approach in all patients.Mechanical thrombectomy of the thrombotic occlusion segment by using common guide wire was carried out first,which was followed by bolus injection of urokinase (125,000-375,000 units);if the thrombus was not completely dissolved the catheter would be retained and the urokinase would be continuously infused with a micro-pump until the thrombus was completely dissolved.Conventional balloon dilatation would be employed when the stenosis of artificial arteriovenous fistula lumen was ＞50％ or the stenosis impeded the performance of dialysis.Kaplan-Meier survival curve was used to estimate the primary and secondary cumulative patency rates after the first intervention.Results Of the 84 interventional procedures,technical success was achieved in 69 procedures (82.1％).A total of 14 conventional balloon dilatation procedures had to be conducted as the fistula was seriously narrowed,and up to 12 procedures (85.7％) were succeeded.The overall clinical success rate was 78.5％ (66/84).During the therapeutic course,bleeding event occurred in 7 procedures (8.3％),including major bleeding (n=3) and minor bleeding (n=4).After the treatment,the 3-,6-,12-,24-month primary and secondary patency rates were 76.1％,63.6％,40.8％,12.5％ and 81.3％,70.8％,47.0％,32.5％respectively.Conclusion For the treatment of acute thrombo-embolism of artificial arteriovenous fistula,catheter-directed thrombolysis is safe and effective,it can assist conventional balloon dilatation therapy to obtain satisfactory therapeutic result for internal fistula stenosis.

Objective: To investigate the safety and effectiveness of the Celect inferior vena cava filter (IVCF) in the treatment of deep venous thrombosis (DVT). Methods: CT follow-up examinations were performed in 72 patients who underwent Celect inferior vena cava filter placement between August 2015 and September 2017. Forty-five patients (62.5%) presented with DVT alone, 27(37.5%) with DVT and pulmonary embolism (PE). With filters in place, each patient was followed up with CT at least once, to visualize new pulmonary embolism, inferior vena cava occlusion, filter tilting, fracture of struts, migration and penetration of struts through the inferior vena cava. Caval penetration was graded on a five-point scale. Results: All Celect filters were successfully deployed. The interval between the filter placement and the CT was 5.0 to 695.0 days, mean (42.4±84.6)days. No new pulmonary embolism, cava occlusion, filter fracture and migration were found. Forty-two (58.3%) filters tilted, including tilt>15 degrees in 8 (11.1%) and tilt ≤15 degrees in 34 (47.2%). Caval penetration with 0 grade was observed in 47 (65.3%) and beyond grade 1 was observed in 25 (34.7%), including grade Ⅰ in 12 (16.7%), grade Ⅱ in eight (11.1%), grade Ⅲ in four (5.6%) and grade Ⅳ in one (1.4%). No patient presented with symptoms associated with caval penetration. Filter retrieval was attempted in 54(75.0%) patients,the indwell time was 5.0 to 111.0 days, mean(32.0±23.9) days. There were 52 (96.3%) filters successfully removed, including four filters tilted lead retrieval hook embedded the caval wall, which used the adjunctive retrieval techniques. Filter retrieval failure in two (3.7%) cases, including one case retrieval hook embedded the caval wall and the other with retrieval hook penetration. Conclusions Celect inferior vena cava filter can effectively prevent PE, but had a tendency to tilt and to penetrate caval wall, which affected the filter retrieval, and had the potential risk of serious complications such as abdominal aortic pseudoaneurysm. The filter should be removed as soon as the risk of PE is manageable. We advocate CT follow-up for patients with long-term inferior vena cava filter placement.

Objective To discuss the clinical application of mechanical thrombectomy with AngioJet system for acute lower limb arterial ischemia (ALI).Methods A total of 12 ALI patients,who underwent percutaneous mechanical thrombectomy with AngioJet systemn during the period from January 2015 to November 2016,were enrolled in this study.The clinical data were retrospectively analyzed.The blood flow classification score after thrombolysis in myocardial infarction (TIMI) was used to evaluate the blood perfusion condition,and Cooley standard of efficacy score was used to assess the clinical curative effect.Results The technical success rate of mechanical thrombectomy with AngioJet system was 91.7％ (11/12).The average restored perfusion time was (1.5±0.6) hours.The clinical success rate and limb salvage rate were 83.3％ (10/ 12) and 91.7％ (11/12),respectively.The TIMI flow scores were improved from preoperative grade 0 (n=8) and Ⅰ (n=4) to postoperative grade 0 (n=1),Ⅰ (n=3) and Ⅱ (n=8).In 11 patients (91.7％) the symptoms of lower limb arterial ischemia were strikingly improved after mechanical thrombectomy.In one patient,the postoperative TIMI flow score remained 0 as preoperative state and the symptoms of lower limb arterial ischemia were not improved although catheter directed thrombolysis therapy was employed for 24 hours,and above-knee surgical amputation had to be carried out.Cooley efficacy score showed that complete cure was seen in 4 patients (33.3％),good response in 6 patients (50.0％),general improvement in one patient (8.3％) and pool response in one patient (8.3％).No severe bleeding complications occurred.Conclusion Percutaneous mechanical thrombectomy with AngioJet can rapidly recover the blood perfusion in patients with ALI,thus,further deterioration of the disease can be prevented and the limb salvage rate can be improved.Therefore,this technique has good clinical application value.

Objective To assess the safety and efficacy of transcatheter thrombolysis combined with percutaneous puncture balloon dilatation for acute occlusion of forearm arteriovenous fistulas.Methods A total of 20 cases with acute thrombosed arteriovenous fistulas were treated with transcatheter thrombolysis therapy by distal puncture of the brachial artery,and the patients with arteriovenous fistulas stenosis more than 50％ were conducted percutaneous puncture balloon dilatation.Results Acute thrombosed arteriovenous fistulas was dredged in all 20 patients by transcatheter thrombolysis combined with percutaneous puncture balloon dilatation,without serious complications such as hemorrhage,pulmonary embolism and others.After follow-up for 3 to 6 months,16 cases maintained smooth,recurrent thrombosis was founded in 4 cases,among whom 2 were reopened after transcatheter thrombolysis in combination and percutaneous puncture balloon dilatation and 2 failed to dredged.Conclusion Transcatheter thrombolysis in combination with percutaneous puncture balloon dilatation is a safe and effective treatment for patients with acute thrombosed arteriovenous fistulas.

Objective To assess the safety and efficacy of transcatheter thrombolysis combined with percutaneous puncture balloon dilatation for acute occlusion of forearm arteriovenous fistulas.Methods A total of 20 cases with acute thrombosed arteriovenous fistulas were treated with transcatheter thrombolysis therapy by distal puncture of the brachial artery,and the patients with arteriovenous fistulas stenosis more than 50％ were conducted percutaneous puncture balloon dilatation.Results Acute thrombosed arteriovenous fistulas was dredged in all 20 patients by transcatheter thrombolysis combined with percutaneous puncture balloon dilatation,without serious complications such as hemorrhage,pulmonary embolism and others.After follow-up for 3 to 6 months,16 cases maintained smooth,recurrent thrombosis was founded in 4 cases,among whom 2 were reopened after transcatheter thrombolysis in combination and percutaneous puncture balloon dilatation and 2 failed to dredged.Conclusion Transcatheter thrombolysis in combination with percutaneous puncture balloon dilatation is a safe and effective treatment for patients with acute thrombosed arteriovenous fistulas.

Objective To investigate the effect of endovascular treatment to initial and long-term outcomes of postpartum deep venous thrombosis (DVT) . Methods The clinical data, venography and 3-yaer follow up data of 30 female patients with acute or subacute deep vein thrombosis in the postpartum period who received endovascular therapy consisting of catheter-directed thrombolysis with angioplasty (stenting for some patients with iliac vein compression syndrome (IVCS)) were retrospectively evaluated. Clot removal was graded as grade Ⅲ(>95%), grade Ⅱ(50% to 95%), and grade Ⅰ(<50%). Grade Ⅱ, Ⅲconsidered effective. Data from onset time, vaginal delivery or by elective, patients ages, IVCS or not and stenting or not were included in this analysis. And the χ2 test and survival analysis was used for statistical analysis of initial and long-term patency respectively. Results In 30 cases, the initial result included 14 cases(46.7%) of gradeⅢ, 12 cases(40.0%) of gradeⅡand 4 cases(13.3%) of gradeⅠ. Patients' onset time, vaginal delivery or by elective, patients ages and IVCS or not have no significant statistical difference to initial patency(χ2=0.88, 1.28, 1.15, 3.08,P>0.05).For 18 patients with IVCS, there was significant statistical difference between patients implanting stents(initial patency was 100.0%(7/7) and whom not
implanting stents(initial patency was 63.6%,7/11) (χ2=5.14, P<0.05). 1, 3, 6 months and 1, 2, 3 years follow-up showed: The primary patency of postoperative 1, 3, 6 months respectively were 86.7%, 70%(21/30),66.7%(20/30), and postoperative 1, 2, 3 years were all 66.7%. There was significant statistical difference between patients with IVCS implanting stents and whom not implanting stents (χ2=6.562, P<0.05), patients with IVCS not implanting stents and whom without IVCS (χ2=3.377, P<0.05). There was no significant statistical difference among patients with IVCS implanting stents and whom without IVCS(χ2=1.932, P>0.05). Conclusions Endovascular therapy consisting of catheter-directed thrombolysis with angioplasty could be considered as a primary therapeutic procedure in patients with acute or subacute postpartum DVT. Stenting for treatment of iliac compression which contributed to postpartum DVT is very valuable to ensuring higher long-term patency rate.