The clinical data and genetic test results of a 7-year-old female child with cerebral cavernoma were retrospectively analyzed. The child was admitted to the hospital due to a one-month headache. Brain MRI showed cerebral cavernoma. The genetic testing showed a pathogenic heterozygous mutation c.456T＞G (p.Tyr152Ter, 61) in the programmed cell death 10 (PDCD10) gene, while both parents had the wild-type at the locus. The child had no symptoms of epileptic seizures, cerebral hemorrhage, or neurological dysfunction, and received conservative treatment, with regular outpatient follow-up MRI scans.

Objective:To evaluate the safety and feasibility of intranodal lymphangiography combined thoracic duct embolization in the treatment of chylous leakage.Methods:The clinical data of ten patients with chylous leakage from July to December 2019 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 6 cases of chylothorax, 1 case of chylous ascites, and 3 cases of chylothorax combined with chylous ascites, respectively. Conservative treatment was invalid in all cases. The locations of cisterna chyli and thoracic duct were defined by percutaneous puncture intranodal lymphangiography. Then the percutaneous transabdominal puncture of cisterna chyli was performed and the microcatheter was inducted. The location of fistula was visualized by thoracic duct lymphangiography, and the embolization was performed by microcoils combined tissue adhesive agents. The post-operative curative effect and complications were recorded.Results:One patient did not receive thoracic duct embolization because it was failed to visualize cisterna chyli by intranodal lymphatic angiography; thoracic duct embolization was successfully performed in the other 9 patients after chylous leakage fistula was located. Percutaneous transabdominal puncture of cisterna chyli was successfully accomplished in 8 patients. As for the other patient, after repeated failure of puncture, fluoroscopy-guided retrograde puncture at the proximal thoracic duct was performed successfully. After the operation, the drain output was completely disappeared within 3 to 7 days in 8 patients, and decreased down to 120 ml/d in 1 patient. Mild abdominal hemorrhage was found in 1 patient after thoracic duct embolization, without any treatment. No serious complications was found in all cases.Conclusion:Intranodal lymphangiography and thoracic catheter embolization is safe and effective in the treatment of chylous leakage, with a low complication rate.

OBJECTIVES: To investigate the roles of cytoskeleton-associated protein 2 (CKAP2) in proliferation, apoptosis, and migration in liver cancer cells and the potential mechanisms. METHODS: Human normal hepatocyte L02 and liver cancer cell lines HepG2, Huh7, and SMMC-7721 were cultured. The CKAP2 expression was detected by real-time PCR and Western blotting. HepG2 cells were randomly divided into a control group, a negative control (NC) group, and a CKAP2 silencing (siCKAP2) group. CCK-8 and BrdU assays were used to evaluate cell viability and proliferation, respectively. Transwell assay was employed to determine cell migration and invasion. The protein levels of cleaved-caspase 3, Bax, E-cadherin, N-cadherin, Vimentin, phosphorylated Janus kinase 2 (p-JAK2), and phosphorylated signal transducer and activator of transcription 3 (p-STAT3) were determined by Western blotting. RESULTS: Compared with normal hepatocyte L02, CKAP2 was highly expressed in liver cancer cell lines HepG2, Huh7, and SMMC-7721 (all <0.05). Compared with the NC group, cell viability and proliferation rate of the siCKAP2 group were decreased (both <0.05). The apoptotic rate, protein expression of cleaved-caspase 3 and Bax in the siCKAP2 group were significantly higher than those in the NC group (all <0.05). Compared with the NC group, cell migration and invasion rates of the siCKAP2 group were significantly attenuated (both <0.05). Compared with the NC group, E-cadherin protein expression in siCKAP2 group was increased, while protein expression levels of Vimentin, N-cadherin, p-JAK2, and p-STAT3 were decreased (all <0.05). CONCLUSIONS CKAP2 gene silence inhibits proliferation, migration, and invasion, and promotes apoptosis in liver cancer cells, while JAK2/STAT3 signaling pathway may be involved in these processes.
Apoptosis ; Cell Line, Tumor ; Cell Movement ; Cell Proliferation ; Cytoskeleton ; Humans ; Liver Neoplasms ; genetics

Objective:To explore the influencing factors of fatigue after stent implantation in patients with airway stenosis.Methods:Totally 104 patients with airway stenosis hospitalized in a hospital from July 2016 to June 2019 were selected, and all the patients were planned to received stent implantation. The patients were evaluated with Identity-Consequence Fatigue Scale (ICFS) postoperatively, and divided into the fatigue group and the non-fatigue group according to the evaluate results. The data of the two groups were consulted, and their gender, age, primary tumor, combined underlying disease, postoperative physical activity, pathological staging, history of radical surgery before stenting, preoperative radiotherapy and chemotherapy, degree of stenosis, type of stenosis, infiltration juga, stent placement site, and re-intervention after stenting were analyzed. Univariate and Logistic regression analysis were performed over the above influencing factors.Results:All the 104 patients with airway stenosis completed postoperative fatigue evaluation. The total score of ICFS was (82.16±8.07) . The scores of postoperative fatigue, attention, vitality, energy, daily activities and the total score were higher than those before operation, and the differences were statistically significant ( P<0.01) . Among the 104 patients with airway stenosis, 28 developed postoperative fatigue, with an incidence of 26.92%. Univariate and multivariate Logistic analysis revealed that postoperative physical activity, pathological staging, infiltrating and re-intervention after stenting were the main influencing factors to fatigue after stent implantation in patients with airway stenosis ( P<0.05) . Conclusions:Patients with airway stenosis have a high incidence of fatigue after stent implantation, which is affected by many factors. Effective intervention measures should be formulated according to the risk factors in order to reduce the incidence of postoperative fatigue.

Objective To design a new integrated portable biliary internal-external drainage catheter carrying125 I seeds used for the treatment of malignant biliary obstruction lesions so as to achieve the dual curative effects of biliary drainage and brachytherapy. Methods A total of 15 patients with malignant obstructive jaundice, who were admitted to the First Affiliated Hospital of Zhengzhou University, China, during the period from September 2016 to January 2018, were enrolled in this study. Biliary stent implantation was performed in all patients, which was followed by insertion of a new integrated portable biliary internal-external drainage catheter carrying125 I seeds. The technical success rate, clinical success rate, complications, stent patency time and patient survival rate were evaluated. Results The placement of the drainage tube was simple and smooth, and the technical procedure was successful in all patients. One month after treatment, the bilirubin level was decreased significantly when compared with preoperative one (P<0.01), while the blood indexes and immunological indicators showed no obvious changes (P>0.05) . After treatment, 2 patients (13.3％) developed cholangitis and 2 patients (13.3％) had small amount of biliary bleeding, which returned to normal after symptomatic treatment. No severe complications such as perforation of bile duct, massive bleeding, radiation enteritis and radioactive source leakage, etc., occurred. The patients were followed up for 55-402 days, 6 patients (40.0％) developed biliary re-obstruction. The median patency time of stent was 255 days, and 6-month stent patency rate was 64.5％. Five patients died and 10 patients survived, the 9-month survival rate was 64.3％, the median survival time was 368 days. Conclusion By using the new integrated portable biliary internal-external drainage catheter carrying125 I seeds, the effects of bile drainage and brachytherapy can be simultaneously achieved. Preliminary clinical practice indicates that this new drainage catheter is feasible, safe and effective, although its long-term efficacy needs to be clarified with further follow-up observations and controlled studies.

Objective: To build an automatic bone age assessment system based on China 05 Bone Age Standard and the latest deep learning technology, and preliminary clinical verification was carried out. Methods: The left-hand radiographs of 5 000 children with suspected metabolic disorders were acquired from Wuxi Children′s Hospital. Among these cases, 2 351 patients were randomly chosen as training set, and 101 patients were randomly used as validation set. Four professional pediatric radiologists annotated the development stage according to the China 05 RUS-CHN standard with double-blind method. The mean value of the bone age assessed by experts was the reference standard which was used to train and validate the deep learning mothods based artificial intelligence (AI) model. Accuracy, mean absolute error (MAE), root mean squared error (RMSE) and time efficiency of bone age assessment were compared by using Chi-square test and t test and F test between resident doctors and AI model in the validation set. Results: The MAE and RMSE was (0.37±0.35) years and 0.50 years between AI model and reference standard, respeactively. When the error range was within ±1.0, ±0.7 and ±0.5 years, the accuracy of model on the validation set was 94.1% (95/101), 89.1% (90/101), 74.3% (75/101) respectively. The accuracy between two resident doctors and AI prediction wasn′t statistical significant (P>0.05). Conclusion The AI model of bone age assessment based on deep learning is feasible and has the characteristics of high accuracy and efficiency.

Objective To evaluate the necessity of prophylactic uterine artery embolization (UAE) before curettage in treatment of cesarean scar pregnancy (CSP).Methods A total of 142 patients with CSP were enrolled and divided into 3 groups according to Adler grading standard,including little vascularity (grade 0-Ⅰ,n=40),moderate vascularity (grade Ⅱ,n=41) and rich vascularity groups (grade Ⅲ,n=61).All patients were treated with curettage or prophylactic UAE before curettage.The differences of age,times of cesarean section,time to last cesarean section,intraoperative blood loss and success rate of therapy were compared between different treatment methods in each group.Results There was no statistical difference of age,times of cesarean section,time to last cesarean section,intraoperative blood loss and success rate of therapy between curettage and prophylactic UAE before curettage in little vascularity group and moderate vascularity group (all P＞0.05).Compared with curettage,the success rate of prophylactic UAE before curettage was higher and the intraoperative blood loss was lower in rich vascularity group (both P＜0.05).There was no statistical difference of age,times of cesarean section nor time to last cesarean section in rich vascularity group (all P＞0.05).Conclusion It is necessary to perform prophylactic UAE before curettage for cesarean scar pregnancy patient with rich vascularity,which is helpful to reduction of intraoperative blood loss.

Objective To investigate the effect and clinical value of interventional therapy in the treatment of gestational trophoblastic neoplasia(GTN).Methods 28 cases of GTN were selected,of which 18 cases were treated with fluorouracil +dactinomycin(5-Fu+KSM)for 2 courses,however,the level of β-HCG and uterine lesions did not significantly reduced.The remained 10 cases were treated with etoposide+actinomycin-D+ methotrexate+ tetrahydrofolate+ vincristine+ cyclophosphamide(EMA-CO)chemotherapy for 2 courses,Ⅳ degree of myelosuppression and severe gastrointestinal reactions appeared and had to cease the next cycle of treatment. All patients were treated with uterine artery and/or ovarian arterial infusion(cisplatin,etoposide,bleomycin)for 2 courses,meanwhile, the gelatin sponge particles were used for embolization of uterine arteries and/or ovarian arteries.The β-HCG level,tumor volume, and the changes of sex hormones were tested before and one year after interventional therapy.Results 28 patients underwent transcatheter uterine arterial and/or ovarian arterial chemoembolization and embolization,the internal iliac arteriography showed significant tumor staining.20 patients underwent double uterine arterial infusion and embolization,and 8 patients underwent bilateral uterine arterial and unilateral ovarian arterial infusion and embolization.β-HCG and lesion size were measured on the 18th day after intervention.The results showed that the β-HCG decreased significantly after 2 courses of treatment,and the uterine lesion was reduced or disappeared,with a significant statistical difference,however,sex hormone levels did not changed significantly before interventional therapy and during one year follow-up.Conclusion The interventional treatment of GTN is less invasive,effective,and worthy of clinical application.

Objective To evaluate the safety and efficacy of 125I seed strands cavity brachytherapy for ureteral carcinoma.Methods To tally 10 patients with ureteral carcinoma underwent Carm CT and DSA guided percutaneous nephrostomy with 125I seed strands cavity brachytherapy.The technical success rate,complications,tumor local control rate,ureteral patency andsurvival time,and compared the Karnofsky scores,Girignon grade,pain score before and after treatment were evaluated.The dose related parameters were compared between pre-and post-treatment.Results 125I seed strands implantation was successfully completed in all patients with technical success rate of 100％.The mean procedure time was (12.3 ±3.8) min.No severe complications such as ureteral perforation,infection,severe bleeding occurred.Local tumor response was CR in 4 cases and PR in 6 cases,showing local control efficiency (CR + PR) 100％ after 2-3 months.Ureteral patency rate was 50％ (5/10).Postprocedure Karnofsky scores,Girignon grades,and pain scores were significantly improved (Z =-2.72,-2.88,-2.83,P＜0.01).The average follow-up time was (14.6 ±6.5) months (5-25 months),tumor progression was observed in 3 cases,stable disease in 7 cases.Nine cases were alive and one died due to multiple organ failure.The differences of D90％,mPD,V100％,V150％,V200％,CI,EI,HI between the preand post-treatment were not statistically significant (P ＞ 0.05).Conclusions 125I seed strands cavity brachytherapy for ureteral carcinoma is an effective and safe procedure without serious complications,and an effective alternative treatment for patients who are unable to undergoor refuse surgery.

Objective To design a kind of nasal feeding nutritional tube that can carry 125I particles,to use this tube for the treatment of upper digestive tract malignant occlusive disease in order to achieve double effect of nasal feeding nutrition and brachytherapy.Methods 125I particles were put into a 3F catheter,then both ends of the catheter were sealed off to make 125I particle chain.By using binding technology,the 125I particle chain was fixed on the nasal feeding tube.Under DSA guidance,the nasal feeding tube carrying 125I particle chain was inserted into the esophagus,with the 125I particle chain segment crossing over the section of esophageal stenosis or occlusion to conduct brachytherapy.This technique was employed in 6 patients with advanced esophageal carcinoma.The technical success rate,operation time and complications were recorded.Two months after the treatment,the Karnofsky score,visual analogue scale (VAS) pain score,Neuhaus dysphagia grading,esophagus patency on esophageal radiography,and local tumor control rate were determined.Results The preparation of nasal feeding nutritional tube carrying 125I particle chain was simple.The technical success rate was 100％,the mean operation time was 15.5 min,no serious complications such as bleeding or infection occurred.Two months after the treatment,the Karnofsky score,VAS pain score and Neuhaus dysphagia grading were significantly improved when compared with the preoperative data (P＜0.O1).On esophageal radiography,the contrast agent passed through the narrow area smoothly.Partial remission (PR) of local tumor was obtained in all patients,and the local tumor control rate was 100％.The patients were followed up for 2-6 months,one patient developed recurrent obstruction.Conclusion It is simple and easy to prepare a nasal feeding nutritional tube carrying 125I particle chain,the use of this kind of tube can achieve both parenteral nutrition and brachytherapy at the same time.Therefore,this technique opens a new way for the treatment of esophageal malignant tumor.