Lenvatinib,sintilimab combined interventional treatment vs bevacizumab,sintilimab combined interventional treatment for intermediate-advanced unresectable hepatocellular carcinoma

BACKGROUND Bevacizumab and sintilimab combined interventional treatment(BeSiIT)and L envatinib and sintilimab combined interventional treatment(LeSiIT)are two commonly used therapeutic regimens for intermediate-advanced hepatocellular carcinoma(HCC)in clinical practice.AIM To compare the clinical efficacy and safety of BeSiIT and LeSiIT for the treatment of intermediate and advanced HCC.METHODS Patients diagnosed with intermediate-advanced HCC and initially treated with BeSiIT or LeSiIT in the Tianjin Medical University Cancer Institute and Hospital between February 2020 and July 2021 were included.The primary endpoint was progression-free survival(PFS),and the secondary endpoints were overall survival(OS),objective response rate(ORR),disease control rate(DCR),conversion rate,and treatmentrelated adverse events.RESULTS Total 127 patients met the inclusion criteria and were divided into BeSiIT and LeSiIT groups.Twenty-eight and fifty patients in the BeSiIT and LeSiIT groups,respectively,were assessed after 1:2 propensity score matching.PFS and OS rates were not significantly different between the two groups.No significant variations were noted in ORRs or DCRs according to the Response Evaluation Criteria in Solid Tumors(RECIST),and modified RECIST.BeSiIT group showed a better conversion rate than the LeSiIT group(P=0.043).Both groups showed manageable toxicity profiles.Multivariate analysis showed that the independent factors associated with PFS were alphafetoprotein levels and carcinoembryonic antigen score.CONCLUSION In intermediate-to-advanced HCC,the BeSiIT and LeSiIT groups exhibited acceptable toxicities and comparable PFS,OS,and ORR.

Analysis of the Significance of Key Points of Patient Interventional Psychological Care and Pain Care

Interventional therapy has become increasingly popular in clinical practice due to advancements in medical technology.However,patients often experience psychological and physiological pressure due to its invasive nature.The management of patient discomfort and tension is crucial to ensure effective treatment.Psychological and pain management are essential components of interventional therapy,as they significantly impact patient recovery and prognosis.This article discussed the importance of interventional psychological and pain care for patients,starting with the development and spread of interventional therapy.The significance of providing high-quality nursing services to patients and improving their quality of life was also discussed.

Analysis of The Impact of Interventional Nursing on The Therapeutic Effect, Negative Emotions, and Quality of Life of Patients Undergoing Cardiovascular and Cerebrovascular Interventional Therapy

Objective: To explore the impact of interventional nursing on the therapeutic effect, negative emotions, and quality of life of patients undergoing cardiovascular and cerebrovascular interventional therapy. Methods: A total of 106 patients who underwent cardiovascular and cerebrovascular interventional treatment were collected and randomly divided into Group A (control) and Group B (observation), with 53 cases each. Group A received the routine nursing intervention and Group B received the interventional nursing intervention. The clinical efficacy, complications, negative emotions, quality of life, and nursing satisfaction of the two groups of patients were evaluated. Results: The total clinical effective rate of Group B (52/98.12%) was higher than that of Group A (45/84.91%) (χ^(2)= 4.371, P < 0.05). The total incidence of complications in Group B (2/3.78%) was lower than that of Group A (9/16.98%) (χ^(2)= 4.970, P < 0.05). The self-rating anxiety (SAS) score and self-rating depression (SDS) of Group B were lower than those of Group A (P < 0.001). The quality of life of Group B was significantly higher than that of Group A (P < 0.001). The nursing satisfaction of group B (51/96.22%) was higher than that of group A (43/81.13%) (χ^(2)= 6.014, P < 0.05). Conclusion: In the care of patients undergoing cardiovascular and cerebrovascular interventional therapy, interventional nursing intervention effectively improved the patient’s clinical efficacy, reduced the incidence of complications, reduced negative emotions, improved the quality of life, and increased nursing satisfaction.

Interventional treatment for symptomatic acute-subacute portal and superior mesenteric vein thrombosis

AIM: To summarize our methods and experience with interventional treatment for symptomatic acute-sub-acute portal vein and superior mesenteric vein throm-bosis (PV-SMV) thrombosis. METHODS: Forty-six patients (30 males, 16 females, aged 17-68 years) with symptomatic acute-subacute portal and superior mesenteric vein thrombosis were ac-curately diagnosed with Doppler ultrasound scans, com-puted tomography and magnetic resonance imaging. They were treated with interventional therapy, including direct thrombolysis (26 cases through a transjugular intrahepatic portosystemic shunt; 6 through percutane-ous transhepatic portal vein cannulation) and indirect thrombolysis (10 through the femoral artery to superior mesenteric artery catheterization; 4 through the radial artery to superior mesenteric artery catheterization). RESULTS: The blood reperfusion of PV-SMV was achieved completely or partially in 34 patients 3-13 d after thrombolysis. In 11 patients there was no PV-SMV blood reperfusion but the number of collateral vessels increased signif icantly. Symptoms in these 45 patients were improved dramatically without severe operationalcomplications. In 1 patient, the thrombi did not respond to the interventional treatment and resulted in intestinal necrosis, which required surgical treatment. In 3 patients with interventional treatment, thrombi reformed 1, 3 and 4 mo after treatment. In these 3 patients, indirect PV-SMV thrombolysis was performed again and was successful. CONCLUSION: Interventional treatment, including direct or indirect PV-SMV thrombolysis, is a safe and effective method for patients with symptomatic acutesubacute PV-SMV thrombosis.

Interventional treatment of acute hepatic artery occlusion after liver transplantation

BACKGROUND: With the development of the associated technology, interventional treatment has become an important method for the treatment of hepatic artery occlusion in some countries. This study was undertaken to evaluate the role of interventional methods in the diagnosis and treatment of acute hepatic artery occlusion after liver transplantation. METHODS: The diagnosis and treatment of 9 cases of acute hepatic artery occlusion after liver transplantation were retrospectively analyzed. RESULTS: In 109 cases of liver transplantation, 9 were diagnosed by angiography. Among them, 7 were diagnosed by Doppler ultrasound. After transcatheter thrombolysis, the hepatic arteries were partially or totally patent again in 6 cases of hepatic artery occlusion after liver transplantation, and stent placements in the hepatic artery were performed in 5 cases. All stents proved patent and no patient required another liver transplantation. CONCLUSIONS: Angiography plays an important role in diagnosing hepatic artery complications after liver transplantation. Interventional therapy is a valuable method in the treatment of acute hepatic artery occlusion after liver transplantation.

Interventional treatments for hepatic hemangioma:A state-of-the-art review

Hepatic hemangiomas(HHs)are the most common benign tumors of the liver.These tumors are mainly asymptomatic and do not require treatment.Nevertheless,there are some special cases that require therapeutic intervention,and surgery and intervention are currently the primary treatment modalities.Despite significant advances in the development of minimally invasive techniques and their popularization,interventional treatment of HH is still the preferred choice.In the present review,we discuss the pathological properties,type of blood supply,and treatment indications for HH and assess the status and progress of the existing interventional treatments.

Guidelines and standards for comprehensive clinical diagnosis and interventional treatment for diabetic foot in China(Issue 7.0)

Diabetic foot(DF)is one of the most common complications of diabetes and is associated with high morbidity,disability,lethality and low cure-rate.The clinical diagnosis and treatment of DF need to be standardized.The Chinese Diabetic Foot Cell and Interventional Therapy Technology Alliance has released six editions of guidelines and standards for clinical diagnosis and interventional treatment of DF,which filled the gap in the domestic DF treatment standard and played an important role in improving the level of diagnosis and treatment in China.In line with the latest developments in diagnosis and treatment,the Alliance,along with other 89 institutions,developed and issued the new edition based on the sixth edition to help standardize the clinical diagnosis and treatment of DF in China.

Clinical practice guidelines for the interventional treatment of advanced pancreatic cancer(5^(th)edition)

Pancreatic cancer has become a major disease affecting people’s health because of its insidiousness,rapid progression and poor prognosis.Based on the practical needs of clinical work,combined with domestic multi-center research and experience,this guideline provides constructive suggestions for the interventional treatment of pancreatic cancer.

Renal Angiomyolipoma：Diagnosis with B－ultrasonography，CT Scanning，DSA and Its Interventional Treatment

From 1989.15 cases of renal angiomyolipoma (AML) have been diagnosed by ultrasonography, CT scanning and digital subtraction angiography (DSA) at our hospital. In 8 patients with uneven hyperechoes on B-mode ultrasonography (B-US)(8/15) and 7 with low density of fat on CT scanning (7/12)accurate diagnosis was established preoperatively. DSA revealed the 'berry-like'pseudoaneurysms in the arterial phase (14 cases), the defined lucent area in the nephrogram phase (10 cases) and the 'onion-peel appearances' during venous phases (8 cases),correct diagnosis was achieved in all patients. 8 cases were surgically treated and 7 treated by subselective embolization of renal artery. Effects in all cases were good. The diagnostic value of B-US. CT scanning, DSA and interventional treatment of AML was discussed. It was believed that the diagnosis with DSA was a technique with high specificity, and embolization therapy was simple and effective for AML.

Multidisciplinary diagnosis and treatment nutritional support intervention for gastrointestinal tumor radiotherapy:Impact on nutrition and quality of life

BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,quality of life,and prognosis of patients with gastrointestinal tumors.AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment(MDT)nutrition intervention model on patients with gastrointestinal tumors.METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023.Using a random number table,120 patients were randomly divided into MDT and control groups with 60 patients in each group.To analyze the effect of MDT on the nutritional status and quality of life of the patients,the nutritional status and quality of life scores of the patients were measured before and after the treatment.RESULTS Albumin(ALB),transferrin(TRF),hemoglobin(Hb),and total protein(TP)levels significantly decreased after the treatment.The control group had significantly lower ALB,TRF,Hb,and TP levels than the MDT group,and the differences in these levels between the two groups were statistically significant(P<0.05).After the treatment,the MDT group had significantly more wellnourished patients than the control group(P<0.05).The quality of life total score,somatic functioning,role functioning,and emotional functioning were higher in the MDT group than in the control group.By contrast,pain,fatigue,nausea,and vomiting scores were lower in the MDT group than in the control group(P<0.05).CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients.The study provides a rigorous theoretical basis for improving the prognosis of cancer patients.In the future,we intend to provide additional treatment methods for improving the quality of life of patients with cancer.

Partial hepatectomy versus interventional treatment in patients with hepatitis B virus-related hepatocellular carcinoma and clinically significant portal hypertension: a randomized comparative clinical trial

Background:The widely accepted view that portal hypertension(PHT)is a con-traindication to hepatectomy for patients with hepatocellular carcinoma(HCC)is being increasingly challenged.The long-term survival outcomes and safety of partial hepatectomy versus interventional treatment using ablation with or without pre-ablation transarterial chemoembolization(TACE)in patients with HBV-related HCC within the Milan criteria and with clinically significant PHT were compared in this study.Methods:This open-label randomized clinical trial was conducted on consecu-tive patients with clinically PHT and hepatitis B virus(HBV)-related HCC with tumors which were within the Milan criteria.These patients were randomized 1:1 to receive either partial hepatectomy or interventional treatment between December 2012 and June 2018.The primary endpoint was overall survival(OS);secondary endpoints included recurrence-free survival(RFS)and therapeutic safety.Results:Each of the 2 groups had 80 patients.The 1-,3-and 5-year OS rates in the partial hepatectomy group and the interventional treatment group were 95.0%,86.2%,69.5%versus 93.8%,77.5%,64.9%,respectively(P=0.325).The corresponding RFS rates were 78.8%,55.0%,46.2%versus 71.3%,52.5%,45.0%,respectively(P=0.783).The partial hepatectomy group had a higher compli-cation rate compared to the interventional group(67.5%vs.20%,P<0.001).However,the differences were mainly in Clavien-Dindo Grade Ⅰ complications(P<0.001),while not significant in Grade Ⅱ/Ⅲ/Ⅳ/Ⅴ(All P>0.05).Conclusions:This study shows that partial hepatectomy treatment did not meet prespecified significance for improved OS and RFS compared to interventional treatment for patients with HBV-related HCC within the Milan criteria and with clinically significant PHT.However,partial hepatectomy is still a safe procedure and should be considered as a treatment option rather than a contraindication.

Serum midkine levels for the diagnosis and assessment of response to interventional therapy in patients with hepatocellular carcinoma

Objective:To explore the clinical significance of serum midkine(MDK) levels for the diagnosis of hepatocellular carcinoma(HCC) and evaluate the efficacy of interventional therapy.Methods:Eighty-four patients with HCC were enrolled in this retrospective study.They received an interventional treatment.A follow-up was performed every 2 months,using magnetic resonance imaging,to determine whether the treatment should be continued.Serum alpha-fetoprotein(AFP) and MDK levels were measured at the first diagnosis and during the follow-ups,and the HCC detection rates based on the cutoff values of these two measurements were compared.The relationships between AFP and MDK and the clinical tumor characteristics and changes in APK and MDK before and after treatment were also compared using a rank sum test and χ2 test,respectively.The prognostic significance of MDK for HCC was determined through regression analysis.A twosided P <0.05 was considered statistically significant.Results:MDK expression was detected in 95.24% of the cases.Subgroup analysis revealed MDK expression in95.35%,95.12%,85.19%,86.67%,and 83.33% of the AFP-positive,AFP-negative,stage A Barcelona clinic liver cancer(BCLC-A),BCLC-A/AFP-positive,and BCLC-A/AFP-negative cases,respectively.MDK expression after the interventional treatment(66.7%) was significantly lower than that before the treatment(95.2%).The mean posttreatment MDK level was 0.67 ng/mL in patients with a positive response to therapy as compared with 3.66 ng/mL in those with no positive response.All patients were followed up for 18 months,and those positive for MDK expression before the intervention were more likely to relapse than patients without MDK expression.Subgroup analysis revealed the highest recurrence rate for patients who were positive for MDK expression before and after treatment.Conclusions:Serum MDK may serve as a powerful complement to AFP in the diagnosis of HCC.MDK measurement may improve the detection rate of BCLC-A and AFP-negative HCC.Serum MDK may help to determine the vascular invasion and poor clinical staging of HCC tumors.Patients with MDK-positive HCC before treatment may be more prone to postoperative tumor progression.

Effect of Jiangtang Bushen Recipe (降糖补肾方) in Intervention Treatment of Patients with Impaired Glucose Tolerance

Objective:To evaluate the intervention effect of diet, exercise and Jiangtang Bushen Recipe (JBR, 降糖补肾方), a Chinese herbal recipe, in preventing the progress of patients with impaired glucose tolerance ( IGT ) to diabetes mellitus (DM) type 2. Methods: Fifty-one IGT patients with their diagnosis conformed to the diagnosis standard of WHO, 1999, were randomly divided into the control group (n = 26) and the TCM group (n=25). Patients in the control group attended to the educational course for DM and received dietotherapy and kinetotherapy, and to those in the TCM group, under these treatments, JBR was given additionally. Oral glucose tolerance test (OGTT), body weight index (BWI), levels of blood lipids and fasting insulin of all the patients were examined after 3 months, 6 months and 12 months of treatment. The total observation time was 1 year. Results:Except the 6 cases out of the 51 patients (11.7%), on whom the observa-tion discontinued, in the control group, as compared with before treatment, levels of fasting insulin and fasting blood glucose after treatment were not changed significantly ( P > 0. 05 ) , also insignificant difference was shown in levels of total cholesterol (TC) and triglyceride (TG), thoughthe two indexes lowered slightly after treatment (P>0. 05), but significant difference was shown in comparison of OGTT/2h, blood glucose and BWI (P<0. 05). While in the TCM group, fasting blood glucose was changed insignificantly (P> 0. 05) , but there was significant difference in comparison of fasting insulin, TC, BWI, OGTT/2h and plasma glucose levels (P<0. 01) respectively before and after treatment. At the end of the stud-y, the cumulative cases with conversion to diabetes were 3 (13. 6%) in the control group, and 1 (4. 3%) in the TCM group, x2 test showed insignificant difference in comparison of diabetes conversion rate between the two groups (P>0. 05), however, the TCM group showed a better year conversion rate of normal glucose tolerance than that in the control group (x2 = 8. 31, P<0. 01). Conclusion: TCM intervention is possibly effective in delaying the conversion of IGT to DM type 2, and plays integrative effeciency in impelling IGT patients to health. The favorable education and treatment of DM controlling, including dieto- and kineto-therapy may also be advantageous in IGT intervention, but could not be effective in blocking the advance of IGT.Original article on CJITWM (Chin) 2004 ;24 (4): 317

Effect of intervention treatment from different stages on prognosis in children with central coordination disturbance

BACKGROUND： Central coordination disturbance is regarded as the early-stage symptom of brain injury-induced cerebral palsy. This disease manifests itself as motor disorder, abnormal attitudinal reflex and muscular tension. Early intervention may improve its prognosis. OBJECTIVE： To observe the effects of intervention treatment from different stages on the prognosis of central coordination disturbance following brain injury in children patients. DESIGN： A contrast observation experiment SETTING： Department of Neurology and Rehabilitation, Urumqi Children＇s Hospital PARTICIPANTS ： Totally 151 children who were diagnosed as central coordination disturbance from January 2002 to December 2003 in the Department of Neurology and Rehabilitation of Urumqi Children＇s Hospital were recruited. All the children patients, including 101 male and 50 female, aged from 3 months to 1 year old, met the diagnosis criteria of central coordination disturbance from Vojta. They were divided into slight, moderate and severe abnormity according to Vojta attitudinal reflex. All 151 patients were divided into 2 groups according to their age at diagnosis： 3-6 months old group （n=74）, 62 severe, 10 moderate and 2 slight; 7-12 months old group （n=77）, 66 severe, 7 moderate and 4 slight. All the relatives of children patients were informed of the experiment. METHODS： ① Both groups received physical training （PT） as the main treatment; Hand training was given if necessary. All of the patients received additional hyperbaric oxygen therapy, bioelectric therapy, scalp acupuncture, drug treatment and family training. The importance of integration of hospital and family based rehabilitation was stressed. Those who did not catch up with the normal development or had abnormal reflexes continued to receive treatment. ② Around the age of 2 years old, all children did a final evaluation using Bayley Scales of Infant Development （BSID）. Mental development index （MDI） and physical development index （PDI） were taken as evaluative criteria. Children with scores 80 and above on MDI and PDI were considered to have normal motor and mental development; 79 and below were considered delayers. The Diagnostic Criteria of Cerebral Palsy and Infantecondary School Social Adaptation Scale were used in the final evaluation[scores ≤5 was extremely severe （extremely severe cerebral palsy）, 6 was severe（severe cerebral palsy）, 7 was moderate（moderate cerebral palsy）, 8 was slight（slight cerebral palsy）, 9 was borderline（slight cerebral palsy）, 10 was normal, 11 was above average, 12 was excellent and ≥13 was extremely excellent]. ③ Final evaluative results of 2 groups were compared. And u test was used for the comparison of Bayley development index and Chi-square test for the comparison of normalization rate. MAIN OUTCOME MEASURES： BSID MDI and PDI as well as the normalization rate of motor function and mental behavior of children patients at 2 years old. RESULTS： Totally 151 children patients entered the stage of result analysis. ①Two groups of children patients were given integrated rehabilitation therapy , and evaluated at 2 years old . The 3-6 months old group had higher MDI and PDI than the 7-12 months old group （91.81＋19.99 vs 71.93＋18.98;91.55＋23.61 vs 68.95＋23.51, u=6.265,5.894,P 〈 0.01 ）.②After being given integrated rehabilitation therapy, children patients of 3-6 months old group had significantly higher normalization rate of motor function and mental behavior than 7-12 months old group （73% ,27%,X2=29.723 9,P 〈 0.01 ）. ③Six slight and 17 moderate central coordination disturbance children of 2 groups all completely recovered; After intervention treatment, among 128 severe central coordination disturbance children, 52 recovered and 76 were still abnormal, in which, 43 slight cerebral palsy, 18 moderate cerebral palsy, 5 severe cerebral palsy and 10 extremely severe cerebral palsy. CONCLUSION： To perform integrated intervention treatment before 6 months old can better improve and promote mental and physical development levels of children patients with central coordination disturbance after brain injury than 6 months later.

Pulmonary and tricuspid regurgitation after Tetralogy of Fallot repair: A case report

BACKGROUND Tetralogy of Fallot(TOF)is one of the most common congenital heart defects,and surgery is the primary treatment.There are no precise guidelines on the treatment protocol for tricuspid regurgitation(TR)as a common complication of TOF repair.The timing for treatment in patients presenting with valve regurgitation after TOF repair is often difficult to determine.Here,we report the first case of sequential treatment of pulmonary and TR using interventional therapy.CASE SUMMARY We present the case of a 52-year-old female patient,who had a history of TOF repair at a young age.A few years later,the patient presented with pulmonary and tricuspid regurgitation.The symptoms persisted and TR worsened following percutaneous pulmonary valve implantation.Preoperative testing revealed that the patient’s disease had advanced to an intermediate to advanced stage and that her general health was precarious.Because open-heart surgery was not an option for the patient,transcatheter tricuspid valve replacement was suggested.This procedure was successful,and the patient recovered fully without any adverse effects.This case report may serve as a useful resource for planning future treatments.CONCLUSION Treatment of both valves should be considered in patients with tricuspid and pulmonary regurgitations following TOF repair.The interventional strategy could be an alternative for patients with poor general health.

Recurrent hemoptysis in pediatric bronchial Dieulafoy’s disease with inferior phrenic artery supply:A case report

BACKGROUND Bronchial Dieulafoy’s disease(BDD)is characterized by the erosion of an anomalous artery in the submucosa of the bronchus.The etiology of pediatric BDD is mainly congenital dysplasia of bronchus and pulmonary arteries,which is different from chronic inflammatory injury of the airway in adult patients.The internal thoracic artery,subclavian artery,and intercostal artery are known to be involved in the blood supply to the BDD lesion in children.CASE SUMMARY We report a case of BDD in a 4-year-old boy with recurrent hemoptysis for one year.Selective angiography showed a dilated right bronchial artery,and anastomosis of its branches with the right lower pulmonary vascular network.Bronchoscopy showed nodular protrusion of the bronchial mucosa with a local scar.Selective embolization of the bronchial artery was performed to stop bleeding.One month after the first intervention,the symptoms of hemoptysis recurred.A computed tomography angiogram(CTA)showed another tortuous and dilated feeding artery in the right lower lung,which was an abnormal ascending branch of the inferior phrenic artery(IPA).The results of angiography were consistent with the CTA findings.The IPA was found to be another main supplying artery,which was not considered during the first intervention.Finally,the IPA was also treated by microsphere embolization combined with coil interventional closure.During the one-year follow-up,the patient never experienced hemoptysis.CONCLUSION The supplying arteries of the bleeding lesion in children with BDD may originate from multiple different aortopulmonary collateral arteries,and the IPA should be considered to reduce missed diagnosis.CTA is a noninvasive radiological examination for the screening of suspected vessels,which shows a high coincidence with angiography,and can serve as the first choice for the diagnosis of BDD.

Research Progress on the Prediction of TACE Efficacy by Lipiodol Deposition

Primary hepatocellular carcinoma is one of the most common and deadliest malignant tumors in the world, and most patients are diagnosed after missing the optimal treatment period. TACE (Transcatheter arterial chemoembolization) is currently the preferred treatment for advanced HCC (Hepatocellular Carcinoma), as it can induce local ischemic necrosis of the tumor while reducing the systemic side effects of drugs by embolizing the tumor-feeding arteries. Lipiodol, with its unique comprehensive properties of imaging, drug loading, and embolization, has become a key component in the process of TACE. Therefore, analyzing the deposition of lipiodol in hepatic tumor tissues after TACE can effectively evaluate the treatment efficacy. This article summarizes and analyzes the metabolism of lipiodol in tumors and the clinical application of lipiodol deposition status in predicting patient prognosis, aiming to provide clearer diagnostic and treatment strategies for clinical doctors.

Therapeutic options for intermediate-advanced hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignancies, ranking the sixth in the world, with 55% of cases occurring in China. Usually, patients with HCC did not present until the late stage of the disease, thus limiting their therapeutic options. Although surgical resection is a potentially curative modality for HCC, most patients with intermediate-advanced HCC are not suitable candidates. The current therapeutic modalities for intermediate-advanced HCC include: (1) surgical procedures, such as radical resection, palliative resection, intraoperative radiofrequency ablation or cryosurgical ablation, intraoperative hepatic artery and portal vein chemotherapeutic pump placement, two-stage hepatectomy and liver transplantation; (2) interventional treatment, such as transcatheter arterial chemoembolization, portal vein embolization and image-guided locoregional therapies; and (3) molecularly targeted therapies. So far, how to choose the therapeutic modalities remains controversial. Surgeons are faced with the challenge of providing the most appropriate treatment for patients with intermediate-advanced HCC. This review focuses on the optional therapeutic modalities for intermediateadvanced HCC.

Research and clinical translation of trilayer stent-graft of expanded polytetrafluoroethylene for interventional treatment of aortic dissection

The aortic dissection(AD)is a life-threatening disease.The transcatheter endovascular aortic repair(EVAR)affords a minimally invasive technique to save the lives of these critical patients,and an appropriate stent-graft gets to be the key medical device during an EVAR procedure.Herein,we report a trilayer stent-graft and corresponding delivery system used for the treatment of the AD disease.The stent-graft is made of nitinol stents with an asymmetric Z-wave design and two expanded polytetrafluoroethylene(ePTFE)membranes.Each of the inner and outer surfaces of the stent-graft was covered by an ePTFE membrane,and the two membranes were then sintered together.The biological studies of the sintered ePTFE membranes indicated that the stent-graft had excellent cytocompatibility and hemocompatibility in vitro.Both the stent-graft and the delivery system exhibited satisfactory mechanical properties and operability.The safety and efficacy of this stent-graft and the corresponding delivery system were demonstrated in vivo.In nine canine experiments,the blood vessels of the animals implanted with the stent-grafts were of good patency,and there were no thrombus and obvious stenosis by angiography after implantation for 6months.Furthermore,all of the nine clinical cases experienced successful implantation using the stent-graft and its postrelease delivery system,and the 1-year follow-ups indicated the preliminary safety and efficacy of the trilayer stent-graft with an asymmetric Z-wave design for interventional treatment.

Renal and perinephric abscesses in West China Hospital:10-year retrospective-descriptive study

AIM： To elucidate the clinical, radiological and laboratory pro？les of renal abscess （RA） and perinephric abscess （PNA）, along with related treatment and outcome.METHODS： Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identi？ed from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition （ICD-10） codes （RA： N15.101, PNA： N15.102） between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients’ characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance pro？les, treatment approaches, and clinical outcomes were collected and analyzed.RESULTS： The mean age of the patients was 46.49 years with a male to female ratio of 41：57. Lumbar pain （76.5%） and fever （53.1%） were the most common symptoms. Other symptoms and signs included chills （28.6%）, anorexia and vomiting （25.5%）, lethargy （10.2%）, abdominal pain （11.2%）, fank mass （12.2%）, fank ？stula （2.0%）, gross hematuria （7.1%）, frequency （14.3%）, dysuria （9.2%）, pyuria （5.1%） and weight loss （1.0%）. Painful percussion of the costovertebral angle （87.8%） was the most common physical ？nding. The main predisposing factors were lithiasis （48.0%）, diabetes mellitus （33.7%） followed by history of urological surgery （16.3%）, urinary tract infections （14.3%）, renal function impairment （13.3%）, liver cirrhosis （2.0%）, neurogenic bladder （1.0%）, renal cyst （1.0%）, hydronephrosis （1.0%）, chronic hepatitis B （1.0%）, post-discectomy （1.0%） and post-colectomy （1.0%）. Ultrasound （US） and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice.Escherichia coli （51.4%）, Staphylococcus aureus （10.0%） and Klebsiella pneumoniae （8.6%） were the main causative microorganisms. Intravenous antibiotic therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders. CONCLUSION： Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.