Chinese expert consensus on transradial access in percutaneous peripheral interventions

Transradial access(TRA)is a safe and comfortable approach and the preferred access for percutaneous coronary intervention.However,TRA is not widely used for peripheral interventions.Currently,there is a lack of data on patient selection,appropriate medical devices,complication prevention,and TRA adoption.Therefore,the Chinese Society of Interventional Oncology of the China Anti-Cancer Association organized nationwide experts to establish a Working Group of China Expert Consensus on TRA in percutaneous peripheral interventions in 2022,and jointly formulated this consensus to better promote the application of TRA in peripheral interventions to guide clinicians on patient selection,technical recommendations,and physician training.This consensus mainly focuses on the current situation,advantages and limitations of TRA in peripheral interventions,anatomical characteristics of the radial artery,patient selection,technical aspects,prevention and management of complications,radiation dose,and learning curve.A consensus was reached through a literature evaluation and by referring to the opinions of the expert group.

Microwave ablation combined with transarterial chemoembolization containing doxorubicin hydrochloride liposome for treating primary and metastatic liver cancers

Aims:To determine the safety and efficacy of microwave ablation(MWA)and transarterial chemoembolization(TACE)with doxorubicin hydrochloride liposome(DHL)in patients with primary liver cancer(PLC)and metastatic liver cancer(MLC).Materials and methods:The medical records of patients with primary or metastatic liver cancer who underwent MWA combined with TACE containing DHL from March 2019 to March 2022 were collected and analyzed.Treatment-related adverse events(AEs)were recorded.Local tumor response was evaluated according to the modified RECIST criteria.Local tumor progression-free survival(LTPFS)and overall survival(OS)were calculated using the Kaplan-Meier method.Results:Altogether,96 patients with liver cancer were included(PLC,n=45;MLC,n=51).Forty(41.7%)patients experienced AEs during treatment,and eight(8.3%)patients developed grade 3 AEs.Compared to before treatment,the serum total bilirubin level and neutrophil to lymphocyte ratio significantly increased after treatment.The median LTPFS was 14.5 months in patients with PLC and 10.7 months in patients with MLC.The median OS was not reached in patients with PLC or MLC.The 1-month and 3-month disease control rates reached more than 80%in both groups.Conclusion:MWA combined with TACE with DHL may be a safe and effective method for the treatment of liver cancer.

Bronchial artery embolization for hemoptysis:A systematic review and meta-analysis

Objective:To assess the safety and efficacy of bronchial artery embolization(BAE)for hemoptysis.Methods and materials:Databases with articles published in English,including Pubmed,Embase,Web of science and Chochrane library,were comprehensively searched to get accurate,up-to-date and sufficient literature about BAE for hemoptysis until March 2020.The technical success rates,immediate control rates,recurrence rates,mortality rates,and total complication rates(minor and major complication rates)extracted from the articles were pooled to estimate and assess the efficacy and safety of BAE using random-effect and fixed-effect models.Results:21 articles published between 2008 and 2019,which include a total of 2511 patients,were studied to evaluate the safety and efficacy of BAE.The technical success and immediate control rates are 99.9%(95%CI:99%-100%)and 99.5%(95%CI:97.8%-99.2%),respectively.This study showed hemoptysis recurrence in 23.7%(95%CI:18.5%-28.9%)with a mortality rate of 2%(95%CI:0-3%).Additionally,the assessment of complications revealed a total complication rate of 13.4%(95%CI:7.6-19.2%),in which 0.2%(95%CI:0.2-0.4%)were major complications and 10%(95%CI:4.7-9.6%)were minor complications.Conclusion:BAE is an effective,safe,and feasible procedure with a low complication rate for hemoptysis patients.However,recurrence of hemoptysis is still at high risk after BAE due to different underlying diseases.

Precise localization of small pulmonary nodules using Pre-VATS with Xper-CT in combination with real-time fluoroscopy-guided coil:report of 15 patients

Purpose: This study aimed to evaluate the value of precise localization of nodules using pre-video-assisted thoracic surgery(VATS) Xper–CT in combination with real-time fluoroscopy-guided coil in the resection of pulmonary nodules using VATS. Materials and Methods: Precise localization of nodules using Xper-CT in combination with real-time fluoroscopy-guided coil and wedge resection using VATS were conducted on 15 patients with 17 small pulmonary nodules(diameter 0.5–1.5 cm) from April 2015 to January 2016. The value of localization was evaluated in terms of procedure time, type of coils, associated complications of localization, and VATS success rate. Results: The success rate of coil localization was found to be 100% in the primary stage(as shown by the CT scan), and the average procedure time was 30–45 min(35.6 ± 3.05 min). No deaths or major complications occurred. Minor complications included five incidents of pneumothorax(the morbidity was 29.4%, 5/17; no patient required chest tube drainage). The dislocation of coil was found in one patient. The results of pathological examination of 17 small pulmonary nodules revealed 11 primary lung cancers, 1 mesenchymal tumor, 3 nonspecific chronic inflammations, 1 hamartoma, and 1 tuberculosis. Two patients with primary lung cancer underwent lobectomy with mediastinal lymph node dissection. Conclusion: The preoperative precise localization of small pulmonary nodules using Xper-CT-guided coil is an effective and safe technique. It helps in the resection of nodules using VATS. It increases the rate of lung wedge resection with few complications and allows for proper diagnosis with a low thoracotomy conversion rate.

Application of contrast-enhanced ultrasound in minimally invasive ablation of benign thyroid nodules

Objective:This study aimed to investigate the application value of contrast-enhanced ultrasound(CEUS)before and after minimally invasive ablation procedures for benign thyroid nodule(s)(BTN).Methods:This prospective study included patients with BTNs scheduled to undergo ultrasound-guided minimally invasive ablation treatment.CEUS was performed before and after ablation(at 1 day,and 1,6,and 12 months after ablation).Changes in microvascular perfusion and the volume of BTNs were noted and assessed.Results:Sixty-two patients(62 BTNs),who underwent ablation procedures between June 2016 and August 2020,were included.All lesions were confirmed by biopsy,and histopathological results were obtained before ablation treatment.On preoperative CEUS,the lesions exhibited hyperenhancement(53.23%)or iso-enhancement(46.77%)during the arterial phase,and all lesions exhibited iso-enhancement in the venous and late phases.One day after ablation,none of the BTNs exhibited obvious enhancement on CEUS.One(1.61%)lesion was retreated due to a nodule-like enhancement area detected by CEUS at the 6-month follow-up.The mean nodular volume reduction rate(VRR)at 1,6,and 12 months follow-up demonstrated no significant difference between the two ablation groups(microwave ablation versus radiofrequency ablation).Twelve months after ablation,the mean(±SD)VRR of all BTNs was 60.3±10.3%.Conclusion:CEUS helped guide treatment decisions for BTNs before ablation treatment.Moreover,it could also be used to accurately and noninvasively evaluate treatment efficacy.

Percutaneous microwave ablation combined with simultaneous transarterial chemoembolization for hepatocellular carcinoma with macrovascular invasion or extrahepatic metastases

Objective:To evaluate the safety and efficacy of percutaneous microwave ablation(MWA)combined with simultaneous transarterial chemoembolization(TACE)in patients with hepatocellular carcinoma(HCC)patients with microvascular invasion(MVI)or extrahepatic metastases(EHM).Methods:Between August 2012 and April 2017,101 patients with MVI/EHM of HCC underwent percutaneous MWA combined with simultaneous TACE at our center.The clinical data were collected and analyzed for survival and prognostic factors.Results:The mean follow-up time was 23.6±14.7 months.One patient had grade 3 complications,and the median overall survival was 12.0 months(95%confidence interval 9.7-14.3).Multivariate analysis showed that ChildPugh class,serum alpha-fetoprotein level,and Eastern Cooperative Oncology Group performance status were independent factors of survival.Conclusion:Our results suggest that percutaneous MWA combined with simultaneous TACE is a safe and effective treatment for HCC with MVI/EHM.

Deficiency of betaine-homocysteine methyltransferase activates glucose-6-phosphate dehydrogenase(G6PD)by decreasing arginine methylation of G6PD in hepatocellular carcinogenesis

Betaine-homocysteine methyltransferase(BHMT)regulates protein methylation and is correlated with tumorigenesis;however,the effects and regulation of BHMT in hepatocarcinogenesis remain largely unexplored.Here,we determined the clinical significance of BHMT in the occurrence and progression of hepatocellular carcinoma(HCC)using tissue samples from 198 patients.BHMT was to be frequently found(86.6%)expressed at relatively low levels in HCC tissues and was positively correlated with the overall survival of patients with HCC.Bhmt overexpression effectively suppressed several malignant phenotypes in hepatoma cells in vitro and in vivo,whereas complete knockout of Bhmt(Bhmt^(−/−))produced the opposite effect.We combined proteomics,metabolomics,and molecular biological strategies and detected that Bhmt^(−/−)promoted hepatocarcinogenesis and tumor progression by enhancing the activity of glucose-6-phosphate dehydrogenase(G6PD)and PPP metabolism in DEN-induced HCC mouse and subcutaneous tumor-bearing models.In contrast,restoration of Bhmt with an AAV8-Bhmt injection or pharmacological inhibition of G6PD attenuated hepatocarcinogenesis.Additionally,coimmunoprecipitation identified monomethylated modifications of the G6PD,and BHMT regulated the methylation of G6PD.Protein sequence analysis,generation and application of specific antibodies,and site-directed mutagenesis indicated G6PD methylation at the arginine residue 246.Furthermore,we established bidirectionally regulated BHMT cellular models combined with methylation-deficient G6PD mutants to demonstrate that BHMT potentiated arginine methylation of G6PD,thereby inhibiting G6PD activity,which in turn suppressed hepatocarcinogenesis.Taken together,this study reveals a new methylation-regulatory mechanism in hepatocarcinogenesis owing to BHMT deficiency,suggesting a potential therapeutic strategy for HCC treatment.

5 kW-level single-mode fiber amplifier based on low-numerical-aperture fiber

A low-numerical-aperture(NA)concept enables large-mode-area fiber with better single-mode operation ability,which is beneficial for transverse mode instability and nonlinear effects suppression.In this contribution,we reported a high-power fiber amplifier based on a piece of self-developed large-mode-area low-NA fiber with a core NA of 0.049 and a core/inner cladding diameter of 25/400μm.The influence of the pump wavelength and fiber length on the power scaling potential of the fiber amplifier is systematically investigated.As a result,an output of 4.80 kW and a beam quality factor of~1.33 were finally obtained,which is the highest output power ever reported in a fiber amplifier exploiting the low-NA fiber.The results reveal that low-NA fibers have superiority in power scaling and beam quality maintenance at high power levels.

One-year status of hepatic venous pressure gradient measurement from 85 hospitals in China

Aims:Surveys and research on the applications of the hepatic venous pressure gradient(HVPG)are important for understanding the current status and future development of this technology in China.This article aimed to investigate the status of hepatic venous pressure gradient measurement in China in 2022.Methods:We investigated the overall status of HVPG technology in China-including hospital distribution,hospital level,annual number of cases,catheters used,average cost,indications,and current challenges by using online questionnaire.By counting the number and percentages of cases of these results,we hope to clarify the current status of HVPG measurements in China.Results:According to the survey,85 hospitals in China used HVPG technology in 2022 distributed across 29 provinces.A total of 4989 HVPG measurements were performed in all of the surveyed hospitals in 2022,of which 2813 cases(56.4%)were measured alone.The average cost of HVPG measurement was 5646.8±2327.9 CNY.Of the clinical teams who performed the measurements(sometimes multiple per hospital),94.3%(82/87)used the balloon method,and the majority of the teams(72.4%,63/87)used embolectomy catheters.Conclusions:This survey clarified the clinical application status of HVPG in China and confirmed that some medical institutions in China have established a foundation for this technology.It is still necessary to continue promoting and popularizing this technology in the future.

Transverse mode instability mitigation in a high-power confined-doped fiber amplifier with good beam quality through seed laser control

In this work,a confined-doped fiber with the core/inner-cladding diameter of 40/250μm and a relative doping ratio of 0.75 is fabricated through a modified chemical vapor deposition method combined with the chelate gas deposition technique,and subsequently applied in a tandem-pumped fiber amplifier for high-power operation and transverse mode instability(TMI)mitigation.Notably,the impacts of the seed laser power and mode purity are preliminarily investigated through comparative experiments.It is found that the TMI threshold could be significantly affected by the seed laser mode purity.The possible mechanism behind this phenomenon is proposed and revealed through comprehensive comparative experiments and theoretical analysis.Finally,a maximum output power of 7.49 kW is obtained with the beam quality factor of approximately 1.83,which is the highest output power ever reported in a forward tandem-pumped confined-doped fiber amplifier.This work could provide a good reference and practical solution to improve the TMI threshold and realize high-power high-brightness fiber lasers.

Development of a Novel Endovascular Brachytherapy Stent:A Proof-of-concept Study

Background and Aims:Endovascular implantation of iodine-125(125I)seeds strand combined with stent is an effective method of treatment for portal vein tumor thrombosis.The aim of this study was to develop a novel endovascular brachytherapy stent(EVB-Stent)and to evaluate its feasibility of use.Methods:An EVB-Stent was implanted into the main portal vein(MPV)in a live porcine model via the percutaneous transhepatic route.Blood samples were collected and tested before and after operation,as well as before euthanasia.Single-photon emission computed tomography(SPECT)combined with CT(SPECT/CT)scan were performed directly after operation and CT scan was performed 2 months after implantation.After the CT scan was performed,all animals were euthanized and histologically examined.Results:The novel stent was successfully positioned in all six pigs.No deterioration of liver function was observed during the 2-month follow-up period.SPECT/CT revealed the uniform distribution of radiation around the seeds strand,and the hottest spot was near the center of the MPV.The patency of the stented MPV was confirmed using CT scans.The tissue-accumulated absorbed dose was 31,822.11 mGy at 10 mm transversely away from the midpoint of the 125I seeds strand,with a half-life of 59.4 days.Pathological examination results showed no significant atrophy or inflammation of adjunct liver tissue,and no obvious intima thickening or thrombosis were detected in the stented MPV.Conclusions:A liver porcine model was used to demonstrate that the transhepatic placement of a novel endovascular brachytherapy stent,EVB-Stent,is both technically feasible and safe.

Spectrally U-shaped profile of beam propagation factor in all-solid photonic bandgap fiber

We found the beam quality factor M^(2)of the fundamental mode as a function of wavelength is U-shaped in the working photonic bandgap(PBG) of an all-solid PBG fiber(AS-PBGF) for the first time,to the best of our knowledge,and our simulation results also match well with the phenomenon.The normal band that is near the high-frequency edge of the third PBG integrates the lowest M^(2)and single-mode operation simultaneously,while the other two edge regions suffer from anomalous variation of M^(2)versus wavelength.The general applicability of this finding can be further extended to other PBGs and also other representative structures in the AS-PBGF field.

Expert Guidance on the Overall Management of Liver Cancer During the COVID-19 Pandemic

The COVID-19 pandemic remains complex,with concentrated and sporadic cases in multiple locations.During COVID-19 outbreaks,the routine diagnosis and treatment of liver cancer patients can be affected to a significant degree.For liver oncologists,it is important to identify strategies and protocols to reduce the risk of COVID-19 infection among patients and medical staff,use limited medical resources to maximally ensure access to anti-tumor treatment and related emergency treatment,and provide support for patients during the disruption caused by the pandemic.Given this requirement,eleven experts in liver cancer treatment-related disciplines from Zhongshan Hospital,Fudan University have written the Expert Guidance on the Overall Management of Liver Cancer During the COVID-19 Pandemic,which aims to provide a reference to assist liver oncologists in conducting clinical work safely and effectively while implementing COVID-19 prevention and control strategies and offer guidance on supporting liver cancer patients during the pandemic.

2×3 kW bidirectional output fiber oscillator employing spindle-shaped ytterbium-doped fiber

A 2×3 kW-level bidirectional output fiber oscillator is realized by combining the specially designed spindle-shaped ytterbium-doped fiber,non-wavelength-stabilized 976-nm LDs,and grating bandwidth optimization to balance transverse mode instability and stimulated Raman scattering.The maximum output powers at both ends are 3265 and 2840 W,respectively,with a total efficiency of 73.2%.The M^(2) factors of the lasers at both ends are about 1.98 and 2.38,respectively.The beam profile at both ends shows that a bidirectional output annular beam fiber oscillator has been realized,which has great potential in practical applications.