Objective Todiscusstheangiographicfeaturesofhepaticneuroendocrineneoplasm(NEN),and to analyze the survival time of patients.Methods The clinical data of 60 patients with hepatic NEN were retrospectively reviewed.Transcatheter arterial chemoembolization (TACE),used as main therapy,was employed in 17 patients,22 patients received palliative treatment with no use of TACE,and 21 didn't receive any related treatment.The angiographic features of hepatic NEN were analyzed.Kaplan-Meier method was used to calculate the survival rate,and the survival prognostic factors were evaluated by Cox multivariate analysis method.Results Angiography showed that most neuroendocrine tumors (NETs) were characterized by hypovascular lesion,while neuroendocrine carcinomas (NECs) were manifested as hypervascular mass.The median overall survival time of 60 patients was 13.8 months.The 6-month,one-,2-and 3-year cumulative survival rates were 85.0％,52.0％,40.0％ and 33.8％,respectively.Cox regression analysis indicated that pathological grade of tumor (P=0.001) and treatment mode (P＜0.001) were the independent prognostic factors.Conclusion The rich or poor vascularity of hepatic NEN is helpful for the judgment of tumor grading.Patients whose hepatic NENs belong to high pathological grade (grade Ⅲ) usually have a poor prognosis.TACE is an effective therapy for hepatic NEN.

Objective To develop a kind of gelatin microspheres which is capable of being visualized on radiography,CT and MR examinations.Methods Emulsion chemical cross-linking method was used to prepare gelatin microspheres that carried only solid Fe3O4 nanoparticles.Optical microscope was adopted to observe the morphology,particle diameter and the dispersity of the gelatin microspheres.Using thermogravimetric analysis method,the loading rate of Fe3O4 nanoparticles encapsulated in the gelatin microspheres was calculated.The multimodal visualization ability of the gelatin microspheres was evaluated by radiography,CT and MR examinations.The blood in rabbit heart and human vascular endothelial cells were used to make microsphere hemolysis test and in vitro cytotoxicity test.The elastic characteristics and the swelling characteristics of the gelatin microspheres were determined,and the sterile technique was tested.Results The optimal synthesis condition of microspheres was to use 2:1 of Fe3O4-to-gelatin quality ratio,under this situation,the microspheres showed a roundness appearance with satisfactory dispersion,the spherulization rate was high (up to 77％),the drug loading rate was very high (up to 73.27％),the particle diameter was moderate (199.78±142.90 μm),and the microspheres had multimodal visualization ability for radiography,CT and MR examinations.The optimization CT value of microspheres could be up to (1 028.0± 69.5) Hu (when concentration=25 mg/ml).Hemolysis test and in vitro cytotoxicity test showed that no statistically significant differences in the hemolysis rate and absorption value existed between the study group and the control group (P＞0.05).In acid solution,the microspheres exhibited swelling characteristics,while in ethanol the microspheres showed no swelling phenomenon.Conclusion Using solid Fe3O4 nanoparticles as visualization material as well as gelatin as polymer materials,a special gelatin microspheres can be prepared with emulsion chemical cross-linking method.This kind of microspheres carries the following features:high drug loading,regular in shape,smooth surface,not easy to agglomerate,stronger multimodal visualization ability (radiography,CT and MR),high biological safety and convenient disinfection.

Objective To investigate the clinical effect of polyvinyl alcohol (PVA) particles combined with chemoembolization using chemotherapeutic agents or chemotherapeutic agents lipiodol emulsion (CALE)in the treatment of hepatocellular carcinoma (HCC) complicated by hepatic arteriovenous shunt (HAVS) and related prognostic factors.Methods A retrospective analysis was performed for the clinical data of 133 patients with HCC complicated by HAVS.HAVS was classified into slow-flow HAVS,intermediate-flow HAVS,and high-flow HAVS,which were treated with 300-500 μm,500-710 μm,and 710-1000 μm PVA particles,respectively.The patients with slow-flow and intermediate-flow HAVS underwent embolization with PVA combined with chemotherapeutic agents followed by CALE,while those with high-flow HAVS underwent the treatment with PVA combined with chemotherapeutic agents alone.The survival time,progression-free survival time,and postoperative complications were followed up and analyzed.The Kaplan-Meier method was used to calculate cumulative survival rate and the Cox proportional hazards model was used to determine prognostic factors.Results The median overall survival (OS) of 133 patients was 9.1 months,and the 6-,12-,and 24-month survival rates were 73.7％,36.2％,and 10.2％,respectively.The median OS of slow-flow group (36 patients),intermediate-flow group (58 patients),and high-flow group (39 patients) were 7.3,9.1,and 10.8 months,respectively.And the 6-and 12-month survival rates were 69.2％/19.0％,72.4％/39.2％,and 77.8％/42.7％,respectively.There was no significant difference in survival time between the patients with different types of HAVS (x 2 =2.865,P =0.239).The incidence rates of postoperative gastroesophageal variceal bleeding and acute liver failure were 1.1％ and 0.4％,respectively.The results of Cox regression analysis showed that preoperative alpha-fetoprotein level ≥ 400 ng/ml (HR =2.105,P =0.006) was an independent risk factor,while multiple embolizations (H7 =0.482,P =0.011),tumor remission (HR =0.431,P =0.041),and multimodality therapy (HR =0.416,P =0.004) were independent protective factors.Conclusion PVA particles combined with chemotherapeutic agents or CALE is safe and effective in the treatment of HCC complicated by HAVS.Patients with multiple embolizations,tumor remission,and multimodality therapy tend to have good prognosis,while those with a high level of alpha-fetoprotein before embolization often have poor prognosis.

Objective To discuss the clinical complications caused by inferior vena cava abnormality and their interventional management. Methods The clinical data and interventional therapeutic results of 4 patients with complications due to abnormalities of the inferior vena cava were retrospectively analyzed. Results Duplicate inferior vena cava deformity was confirmed in two cases; one of them was complicated by right inferior vena cava with deep venous thrombosis of right lower extremity;and the other case had bilateral inferior vena cava thrombosis secondary to tumor thrombus within the intrahepatic segment of inferior vena cava, for which interventional treatment was not employed. Left-sided inferior vena cava was observed in 2 cases; clinically, one showed microscopic haematuria and lower back pain, and interventional treatment was not adopted; the other case had abdominal pain, and the symptom showed no obvious improvement after receiving stent implantation in the crossing segment of the left-sided inferior vena cava. Conclusion Clinically, the complications caused by abnormalities of inferior vena cava are rare. The diagnosis and the treatment of its complications should be based on the imaging manifestations, the related clinical symptoms, blood flow dynamics, etc. and the misdiagnosis and mistreatment should be avoided.

Objective To compare the therapeutic efficacy of preventive transcatheter arterial chemoembolization (TACE) with that of preventive transhepatic arterial infusion (TAI) for patients with primary hepatocellular carcinoma (HCC) after hepatectomy. Methods During the period from June 2011 to June 2012 at authors’ hospital, preventive transhepatic interventional therapy was employed in 79 HCC patients within three months after hepatectomy. The followed-up endpoint was in June 2013. The clinical data were retrospectively analyzed. The patients were divided into TACE group (n=41) and TAI group (n=38). No significant differences in age, sex, preoperative liver function, Child-Pugh scores, tumor size and AFP level existed between the two groups. During interventional procedure , catheterization of proper hepatic artery was performed first, which was followed by angiography in order to clarify that there were no newly-developed tumor vessels or tumor lesions in the residual liver, then the chemotherapeutic agents were infused through the catheter. The emulsion of iodized oil with chemotherapeutic agent was used in the patients of TACE group, while only chemotherapeutic agent was adopted in the patients of TAI group. By using Chi-square test the one-year recurrence rate was determined. Kaplan-Meier estimation method was used to calculate the disease-free survival time, and t test was adopted to estimate the mean hospitalization days. The results were compared between the two groups. Results Of the 79 patients, postoperative recurrence was confirmed in 11, and the overall one-year recurrence rate was 13.9%. The one-year recurrence rate of TACE group and TAI group was 12.20% and 15.79% respectively , and no significant difference in one- year recurrence rate existed between TACE group and TAI group (χ2= 0.213, P = 0.645). The average disease-free survival time of TACE group and TAI group was (21.60 ± 1.52) months and (17.38 ± 3.01) months respectively, the difference between the two groups was of statistical significance (P = 0.038). The mean hospitalization days of TACE group and TAI group were (6.30 ± 1.84) days and (5.89 ± 2.08) days respectively, and the difference between the two groups was not statistically significant (P = 0.522). Conclusion No significant difference in one-year recurrence rate exists between the patients receiving preventive TACE and the patients receiving preventive TAI after hepatectomy for HCC. Nevertheless , preventive TACE can probably improve the disease-free survival time after hepatectomy.

Objective To investigate the causes and managements of dys-seal syndrome (DSS) developed after esophageal stent placement. Methods From June 2001 to June 2008, esophageal stenting was performed in 98 consecutive patients with malignant esophageal obstruction. A total of 99 metallic stents were used. Of 98 patients. gastroesophageal anastomosis stricture was seen in 19, preoperative radiotherapy history in 26 and tracheoesophageal fistula in 34. Results DSS occurred in 7 patients, with an occurrence rate of 7.14% ,which was significant higher than that in patients with preoperative radiotherapy history and in patients showing marked dilated esophagus proximal to the obstructed site (X~2=0.017, 0.005, P=0.036, 0.013, respectively). After treatment, such as fasting, IPN or nasogastric feeding,only 1 case retumed to semi-liquid diet. Among the rest 6 cases of DSS, an additional stent was employed in one (but in vain), nasogastric feeding tube was used in 2, and removal of the stent under endoscopic guidance was carried out in 3. Conclusion DSS is one of the complications developed after esophageal stent placement, its prognosis is rather poor. Removal of the inserted stent may be the optimal treatment. The prevention of DSS includes proper pre-operation evaluation, selection of suitable stent, enhancement of perioperative nutritional support, etc.

Objective To investigate the effects of transcatheter arterial chemoembolization(TACE) on the expression of nm23, tissue inhibitor of metalloproteinase-2 (TIMP-2) and extrahepatic metastasis in hepatocellular carcinoma (HCC). Methods The specimens were collected from resectable HCC in 72 patients. Patients were divided into two groups. In one group, TACE was performed before tumor resection (Group A, n=36). In another group, the tumors were resected directly without preoperative TACE (Group B, n=36). The expression and distribution of nm23, TIMP-2 in the tumor tissue and liver parenchyma in the two groups were compared. All patients were followed up for 24 months,and the incidence of extrahepatic metastasis was compared between the two groups. Chi-square test was applied to compare the expression levels of nm23-H1 and TIMP-2. Results The number of cases of strong, moderate and no expression of nm23 were 24, 6 and 6 cases in group A respectively, and were 9, 6 and 21 cases in group B. Statistical differences were found between the two groups(X~2=15.52, P<0.01). The number of cases of strong, moderate and no expression of TIMP-2 were 21,3 and 12 cases in group A respectively, and were 9, 9 and 18 cases in group B. Statistical differences were demonstrated between them (X~2=9.00, P<0.05). There were 13 cases in group A and 15 cases in group B being diagnosed to have extrahepatic metastasis within 24- month period of follow up, but there was no significant difference between the two groups(X~2= 0.23, P>0.05). Conclusions TACE could enhance the expression of nm23-H1 and TIMP-2 in tumor tissues. Therefore, the potential of metastasis of tumor cells might be prohibited by TACE.

Objective To evaluate the conditions and risk factors of esophageal stent dys-seal phenomenon (ESDP) .Methods Ninety-eight patients with malignant esophageal obstruction underwent metallic stent placement and 7 patients with ESDP were analyzed.The possible contributing factors,including age,gender,obstruction segment,esophagorespiratory fistula,surgical intervention,radiotherapy,the degree of upper obstruction segment expansion,stent with bellmouth,application of covered stent were investigated.All factors mentioned above were analyzed with Logistic regression analysis.Results ESDP was observed in 7 patients (7/98,7.14%) and defined as a space between the esophageal wall and the proximal part of stent without contrast agent obstruction within stent.The clinical situations of patients with ESDP included dysphagia,bucking and constantly chest pain,especially at foodintake.The results of Logistic regression analysis indicated radiotherapy (P=0.005) and the degree of upper obstruction segment expansion (P=0.017) were significantly correlated with ESDP.Conclusion ESDP is one of the complications after esophageal stent placement.It is prudent to implant esophageal stent for those patients with radiotherapy and significant upper obstruction segment expansion.

Objective To evaluate the efficacy of Fluency stent-graft (Bard Corp) in transjugular intrahcpatic portosystemic shunt (TIPS).Methods The clinical data of 21 consecutive patients treated by TIPS using Fluency stent-grafts were retrospectively reviewed.All of them were recurrent variceal bleeding secondary to portal vein hypertension,1 was bleeding secondary to primary hepatic carcinoma with port vein thrombns,and 1 was Budd-Chiari syndrome.They were followed-up after (10.1 ± 4.6) months (2.0 to 24.0 months).Stent-grafts patancy,portal vein pressure and liver function were recorded and compared.Results Twenty-five stent-grafts were successfully implanted in 21 patients,23 stent grafts were 8 mm 2 were 10 mm in diameter.The covered length of the stents varied from 6 to 8 cm.The bleeding was stopped and the portal vein pressure decreased significantly from (25.4 ± 3.5) mm Hg to (15.4 ± 2.8) mm Hg (t = 12.495,P < 0.01).During the follow-up period,The patient with primary HCC and portal vein thrombosis died 4 months after the procedure. One case had a new primary HCC during the follow-up and died 24 months after the procedure.One ease with variceal bleeding secondary to portal vein hypertension died of muhisystem organ failure.One case occluded in the hepatic vein and had another stcnt graft implanation.The other 17 cases had no stenosis after 7 to 17 months follow-up.Ultrasound showed that the stents were patent 1 week before the patients died.Three cases had transient symptoms of hepatic encephalopathy and recovered after treatment.The Child scores of the 19 patients survived more than 6 months were 6.3 ±1.4 before and 6.4 ± 1.9 after the procedure without significant difference (t = 0.645,P > 0.05).Conclusion The Fluency stent-grafts could increase the patency of the TIPS,but its efficacy on the long-term effect and hepatic encephalopathy need further investigation.

Objective To investigate the change of ATM phosphorylation in HepG2 cells following a condnuous low dose-rate irradiation.Methods Cells were pemistendy exposed to low dose-rate(8.28 cGy/h) irradiation.Indirect immunofluorescence and Western blot were used to detect the expression of ATM phosphorylated proteins.Colony forming assay Was used to observe the effect of a low dose-rate irradiation on HepG2 cell survival.Results After 30 min of low dose-rate irradiation.the phosphorylation of ATM occurred.After 6 h persistent irradiation,the expression of ATM phosphorylated protein reached the peak value,then gradually decreased.After ATM phosphorylation was inhibited with Wortmannin,the surviving fraction of HepG2 cells was lower than that of the irradiation alone group at each time point(P<0.05).Conclusions Continuous low dose-rate irradiation attenuated ATM phosphorylation.suggesting that continuous low dose-rate irradiation has a potential effect for increasing the radiosensitivity of HepG2 cells.