Identification of the key genes and mechanisms associated with transcatheter arterial chemoembolisation refractoriness in hepatocellular carcinoma

BACKGROUND Transcatheter arterial embolisation(TACE)is the primary treatment for intermediate-stage hepatocellular carcinoma(HCC)patients while some HCC cases have shown resistance to TACE.AIM To investigate the key genes and potential mechanisms correlated with TACE refractoriness in HCC.METHODS The microarray datasets of TACE-treated HCC tissues,HCC and non-HCC tissues were collected by searching multiple public databases.The respective differentially expressed genes(DEGs)were attained via limma R package.Weighted gene co-expression network analysis was employed for identifying the significant modules related to TACE non-response.TACE refractoriness-related genes were obtained by intersecting up-regulated TACE-associated and HCC-associated DEGs together with the genes in significant modules related to TACE nonresponse.The key genes expression in the above two pairs of samples was compared respectively via Wilcoxon tests and standard mean differences model.The prognostic value of the key genes was evaluated by Kaplan-Meier curve.Multivariate analysis was utilised to investigate the independent prognostic factor in key genes.Single-cell RNA(scRNA)sequencing analysis was conducted to explore the cell types in HCC.TACE refractoriness-related genes activity was calculated via AUCell packages.The CellChat R package was used for the investigation of the cell–cell communication between the identified cell types.RESULTS HCC tissues of TACE non-responders(n=66)and TACE responders(n=81),HCC(n=3941)and non-HCC(n=3443)tissues were obtained.The five key genes,DLG associated protein 5(DLGAP5),Kinesin family member 20A(KIF20A),Assembly factor for spindle microtubules(ASPM),Kinesin family member 11(KIF11)and TPX2 microtubule nucleation factor(TPX2)in TACE refractoriness-related genes,were identified.The five key genes were all up-regulated in the TACE non-responders group and the HCC group.High expression of the five key genes predicted poor prognosis in HCC.Among the key genes,TPX2 was an independent prognostic factor.Four cell types,hepatocytes,embryonic stem cells,T cells and B cells,were identified in the HCC tissues.The TACE refractoriness-related genes expressed primarily in hepatocytes and embryonic stem cells.Hepatocytes,as the providers of ligands,had the strongest interaction with embryonic stem cells that provided receptors.CONCLUSION Five key genes(DLGAP5,KIF20A,ASPM,KIF11 and TPX2)were identified as promoting refractory TACE.Hepatocytes and embryonic stem cells were likely to boost TACE refractoriness.

Experimentelle Embolisation unterschiedlicher hepatischer Gefaβe beim Hund mit Bletilla striata

Diese vergleichende Untersuchung uber Embolisation differenter hepatischer GefaBe bei Hunden mit Bletilla striata und Gelfoam ergab,d aB letilla striala als Embolisationsmaterial bessere Erfolge zeigt als Gelfoam.Die Mechanismen der Embolisation mit Bletilla striata sind folgende :1)Bletilla striata wird nicht leicht von Geweben absorbiert;2)Bletilla striata bewirkt mechanische Blockierung;3)Bletilla striata beeinflt das Gerinnungssystem und dasAntikoagulationssystem;4)Bletilla siriata kann die Geafwandschadigen und dadurch sekundare Blockierung auslosen.

Effect of angioembolisation versus surgical packing on mortality in traumatic pelvic haemorrhage: A systematic review and meta-analysis

BACKGROUND: The management of complex pattern of bleeding associated with pelvic trauma remains a big challenge for trauma surgeons. We aimed to conduct a comprehensive meta-analysis to compare the outcomes of angioembolisation and pelvic packing in patients with pelvic trauma.METHODS: We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the CENTRAL; the World Health Organization International Clinical Trials Registry; Clinical Trials.gov; ISRCTN Register, and bibliographic reference lists. The primary outcome was defined as mortality. Combined overall effect sizes were calculated using randomeffects models. Results are reported as the odds ratio(OR) and 95% confidence interval(CI).RESULTS: We identified 3 observational studies reporting a total of 120 patients undergoing angioembolisation(n=60) or pelvic packing(n=60) for pelvic trauma. Reporting of the Injury Severity Score(ISS) was variable, with higher ISS in the pelvic packing group. The risk of bias was low in two studies, and moderate in one. The pooled analysis demonstrated that angioembolisation did not significantly reduce mortality in patients with pelvic trauma compared to surgery(OR=1.99; 95% CI= 0.83–4.78, P=0.12). There was mild between-study heterogeneity(I^2=0%, P=0.65).CONCLUSION: Our analysis found no significant difference in mortality between angioembolisation and pelvic packing in patients with traumatic pelvic haemorrhage. The current level of evidence in this context is very limited and insufficient to support the superiority of a treatment modality. Future research is required.

Preoperative transarterial Embolisation in bone tumors

Bone tumors include a variety of lesions, both primary and metastatic. The treatment modalities for bone tumors vary with the individual lesion, but in general surgical excision is the treatment of choice with other adjunctive therapies. However, surgery for many bone tumors is complex due to several factors including tumor bulk, vascularity, vicinity to vital structures and potentially inaccessible location of the lesion. Transarterial Embolisation (TAE) is one of the important adjuvant treatment modalities and in some cases it may be the primary and curative treatment. Preoperative TAE has proved to be effective in both primary and metastatic bone tumors. It reduces tumor vascularity and intraoperative blood loss, the need for blood transfusion and associated complications, allows better definition of tissue planes at surgery affording more complete excision, and hence reduced recurrence. Preoperative chemoEmbolisation has also been shown to increase the sensitivity of some tumors to subsequent chemotherapy and radiotherapy. There are several techniques and embolic agents available for this purpose, but the ultimate aim is to achieve tumor devascularization. In this review, we discuss the techniques including the choice of embolic agent, application to individual lesions and potential complications.

Superselective embolisation of bilateral superior vesical arteries for management of intractable hematuria in context of metastatic bladder cancer

Hematuria due to locally advanced or metastatic bladder cancer is a common condition and is often a management problem.Percutaneous embolisation is a mini-invasive option to handle this situation.We report a case of a patient with a metastatic bladder cancer and who presented with an abundant hematuria and severe anemia.After failure of endoscopic resections and“flush”of radiotherapy haemostatic and refusal of cystectomy by the patient,he was treated by superselective embolisation of bilateral superior bladder arteries with excellent immediate results.The technique is safe and effective in the short term.The longterm effectiveness requires further investigation.

Percutaneous coil embolisation of congenital hepatic arteriovenous malformations in two patients with congenital heart disease and review of the literature

Congenital hepatic arterio-venous malformations (AVM) are rare vascular anomalies and have rarely been reported in the presence of congeni-tal heart disease. The reported cases are mostly hemangiomas fed either by the hepatic artery itself or by one of its branches. We present two unique hepatic AVM cases in the presence of congenital heart defects in which the AVM was not fed by the hepatic arterial system. Transcatheter coil embolisation was successfully carried out in both of them by using non-detachable Gianturco coils. Complete occlusion was achieved without any sequel.

Eine neue Anwendungsmglichkeit des Ballonkatheters bei der Gefβembolisation

Eine neue Technik mit Ballonkatheter bei der GefaBembolisation von einem Aneurysma und einer arterioportalen Fistel wird betrichtet. Es handelte sich um zwei Falle, bet denen ein Kobrakatheter als Embolisationskatheter und ein Dilatationskatheter als temporarer Okklusionskatheter zur Embolisation angewendet wurden. Durch diese Masnahme konnten die Aneurysmata und die arterioportale Fistel ohne Spiralreflux verschlossen werden. Die Anwendung von einem Kobrakatheter zusammen mit einem Dilatationskatheter zur GefaBembolisation ist effektiv. Komplikationen stud relativ selten.

Complications, imaging results, and midterm clinical outcomes of pipeline embolisation device in the treatment of cerebral aneurysms

Background: The introduction of pipeline embolisation device (PED) has improved the feasibility of endovascular treatment of intracranial aneurysms. The device allows for endoluminal reconstruction across the aneurysm neck but is permeable enough that flow is preserved across the pressure gradients into sidebranch arteries. In spite of higher rates of aneurysm occlusion, there is lack of data concerning medium to long-term clinical and imaging results. Methods: This study was a prospective single center analysis of complications, imaging results, and medium term clinical outcomes after PED treatment of intracranial aneurysms. We included cases over a 17-month period in a tertiary interventional neuroradiology center. We collected data on demographics, vascular risk factors, clinical presentation, angiographic results post treatment, angiographic follow-up and clinical follow-up. Results: Thirty-three patients were included, 25 females and 8 males, with mean age of 55 years;3 presented with acute subarachnoid hemorrhage and 30 for elective treatment. Thirty-seven aneurysms were treated: 35 Internal Carotid Artery (ICA), 1 basilar trunk fusiform, and 1 vertebral artery intradural dissecting aneurysms. No deaths have occurred. Five patients suffered transient neurological complications (15%). Overall aneurysm occlusion was demonstrated in 85% of patients at the end of one year. Discussion:?Overall, the technique of flow diversion and endoluminal reconstruction differs greatly from the established endosaccular packing techniques of standard coiling, balloon remodeling, or stent assisted coiling. Our midterm follow-up confirms that, the rates of clinically significant complications compare favorably with published data on stent assisted coiling, potentially making these devices a truly revolutionizing technique.

Embolisation of Bleeding Renal Angiomyolipoma in Pregnancy

Bleeding from renal angiomyolipoma in pregnancy can be catastrophic to both mother and fetus. Selective arterial embolisation is considered more superior than conventional surgery in these patients. Our case report exemplifies how a bleeding angiomyolipoma was halted with embolisation in our pregnant patient.

Use of Interventional Neuroradiology Devices (Solitaire AB and Cascade Net) in the Treatment of Complex Renal Aneurysms through Stent-Assisted Coil Embolisation

Introduction: The risk of rupture of true renal artery aneurysms is low but when they are bigger than 2 - 2.5 cm it increases significantly, making treatment essential. The need to use alternatives to conventional techniques in order to avoid predictable complications as coil migration is mandatory. Discussion: Routinely-used techniques in interventional neuroradiology such as flow diverters or those assisted with an occlusion balloon or stent have are suitable alternatives for complex aneurysms. Conclusion: Interventional neuroradiology devices such as the Cascade Net stent (Perflow Medical and Grupo Logsa) and Solitaire AB stent retriever (Medtronic) are valid and safe options. We describe the technique of such devices.

Associating liver partition and portal vein ligation or combined transarterial chemo-embolisation and portal vein embolisation for staged hepatectomy for HBV-related hepatocellular carcinoma

Many patients with hepatocellular carcinoma are diagnosed with large tumours at an advanced stage.In addition,conditions such as liver fibrosis,cirrhosis,portal hypertension,viral load,and portal vein thrombosis due to either non-neoplastic or portal vein tumour thrombus limit the indications for surgical management to a select subset of individuals(1).

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the experts.The Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this meeting.This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients.This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation.The diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreato-graphy.Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis.However,histopathologic confirmation is not always required before resection.Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging.The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification.Selected patients with unresectable hCCA can be considered for liver transplantation.Adjuvant chemotherapy should be offered to patients with a high risk of recurrence.The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions.Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage.Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

Damage control orthopaedics: State of the art

Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised(the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains.Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too,normalised parameters associated with the acid-base system have been proposed,under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.

Current insights on haemorrhagic complications in percutaneous nephrolithotomy

Objective:Percutaneous nephrolithotomy(PCNL)is the standard procedure for the management of large and complex renal stones.Blood loss during PCNL may occur during puncture,tract dilatation,and stone fragmentation.Therefore,despite recent advances in PCNL,haemorrhagic complication still occurs.This study aims to enlighten on various aspects of haemorrhagic complication in PCNL,mainly focusing on risk factors and management of this dreadful complication.Methods:Literature search for the study was carried out using advanced search engines like PubMed,Cochrane,and Google Scholar,combining keyword“percutaneous lithotomy”with other keywords like“bleeding”,“haemorrhage”,“complications”,“stone scoring systems”,“mini-PCNL vs.standard”,“dilatation techniques”,“supine vs.prone”,“USG-guided”,“endoscopic combined intra-renal surgery”,“papillary vs.non-papillary puncture”,“bilateral”,and“angioembolization”.The articles published between January 1995 and September 2020 were included for the review.Results:A total of 3670 articles published from January 1995 to September 2020 were screened for the review.Although not consistent,multiple studies have described various preoperative and intraoperative risk factors related to significant bleeding in PCNL.Identification of these risk factors help urologists to anticipate and promptly manage haemorrhagic complications associated with the procedure.A conservative approach suffices to control bleeding in most cases;nevertheless,bleeding can be life-threatening and few still need surgical intervention in the form of angiographic embolisation or open surgical exploration.Conclusion:As hemorrhagic complication in PCNL is associated with considerable morbidity and mortality,prudent intraoperative decision and postoperative care are necessary for its timely prevention,detection,and management.

Pitfalls in histoacryl glue injection therapy for oesophageal, gastric and ectopic varices:A review

Histoacryl glue is used increasingly for the treatment of gastric and ectopic varices, and there is experience in its use for oesophageal varices. It is an effective treatment, yet numerous reports of complications have accumulated. This review of the literature describes the technique, explores circulatory and vascular consideration unique to portal hypertension and categorises the complications into: "Embolisation", "local venous thrombosis", "fistulisation and extravascular injection", "ulceration, erosion and extrusion", and "nidus of infection". A case is then made for standardisation of the technique and the consent process.

Preoperative embolization of primary bone tumors:A case control study

AIM:To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss,intraoperative blood transfusion volume and surgical time.METHODS:Thirty-three patients underwent preoperative embolization of primary tumors of extremities,hip or vertebrae before resection and stabilization.The primary osseous tumors included giant cell tumors,aneurysmal bone cyst,osteoblastoma,chondroblastoma and chondrosarcoma.Twenty-six patients were included for the statistical analysis(embolization group)as they were operated within 0-48 h within preoperative embolization.A control group(non-embolization group,n = 28)with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison.RESULTS:The mean intraoperative blood loss was 1300 mL(250-2900 mL),the mean intraoperative blood transfusion was 700 m L(0-1400 m L)and the mean surgical time was 221 ± 76.7 min for embolization group(group Ⅰ,n = 26).Non-embolization group(group Ⅱ,n = 28),the mean intraoperative blood loss was 1800 m L(800-6000 m L),the mean intraoperative blood transfusion was 1400 mL(700-8400 mL)and the meansurgical time was 250 ± 69.7 min.On comparison,statistically significant(P < 0.001)difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion.There was no statistical difference between the two groups for the surgical time.No patients developed any angiography or embolization related complications.CONCLUSION:Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume.

The Role of Interventional Radiology in Splenic Trauma

The purpose of this case report is to discuss the different treatment options available in splenic trauma patients by following the story of Mr. H. I will focus particularly on the role of splenic arterial embolisation (SAE)—an interventional radiological procedure—and how it weighs up against its surgical counterparts. In order to give a balanced view this case report includes a literature review around splenic artery embolisation. This report concludes that when managing splenic trauma, interventional radiology (IR) is a useful tool particularly when used in conjunction with surgery. The future of this field needs to allow SAE to become a stand-alone therapy. Furthermore, research needs to investigate which cohorts of patients are best suited to which intervention such that we can capitalise on the advantages of each intervention for the benefit of all.

Lumbar Artery Pseudo-Aneurysm after Spinal Trauma and Transpedicular Fixation: A Case Report

Introduction: A case of lumbar artery pseudo-aneurysm after surgery for lumbar vertebra burst fracture is presented. Only two cases secondary to spinal trauma and revealed after surgery have been described in the literature. A review of literature was conducted and a possible relationship with burst fracture or reduction maneuvers was discussed. Case Presentation: Here, we report a post traumatic lumbar burst facture with incomplete motor deficit of lower limbs after a fall. Surgical reduction and stabilization via posterior approach were performed. Post-operatively, a hemorrhage through surgical wound had been noticed. Pseudo-aneurysm of the lumbar artery at L3 level was diagnosed and embolisation was performed. Conclusion: This is a rare case of pseudo-aneurysm occurring in the setting of surgical stabilisation after a trauma. It was revealed by a hemorrhage discovered as a late complication. We should be aware of such potential complication as a delayed post surgery event in order to adapt the care.

Successful Treatment of Spontaneous Rupture of the Spleen by Embolization of Splenic Artery in a Patient with Acute Promyelocytic Leukaemia and COVID-19 Infection

Spontaneous rupture of the spleen (SRS) is a rare clinical entity with a potentially poor medical outcome. In most cases, SRS is caused by neoplastic disorder. Acute promyelocytic leukaemia is a rare but important cause of SRS that physicians are required to assess for. We present a 28-year-old woman with APL and COVID-19 pneumonia, who successfully underwent embolisation of the splenic artery for spontaneously occurring splenic rupture during induction chemotherapy. After the intervention the patient completed induction chemotherapy and achieved complete remission. Our case demonstrates that emergent transcatheter arterial embolisation can be lifesaving even in the unfavourable condition of a patient with severe immune deficiency.

Treatment strategies and indications for interventional management of pseudoaneurysms

Background Pseudoaneurysms （PAs） are common vascular abnormalities predominantly arising from a disruption in the integrity of the arterial wall. The potential complications of PAs are usually unpredictable and carry high rates of morbidity and mortality. This paper presents our experience with various treatment strategies for PAs. Methods Fifty-four patients with 55 PAs were diagnosed by non-invasive imaging examination. The etiology of PAs included trauma （33/55）, infection （5/55）, iatrogenic （6/55）, and idiopathic （11/55）. Different procedures including ultrasound （US）-guided compression, endovascular treatment, and surgery were performed depending on the location of PAs, size of the sac and neck, and characteristics of the donor artery. The methods of endovascular treatment included embolization of parent artery, the PA sac, or implantation of a stent-graft. Follow-up was performed using US or CT and ranged from 1 day to 24 months （average 16.7 months）. Results In all 54 patients, 3 patients with superficial PAs were treated by US-guided compression, while 44 patients with 45 PAs located in the head and neck （n=20）, viscera （n=-10） or extremities （n=15） were treated by endovascular treatment. Nine patients with PAs located in the head and neck （n=2） or extremities （n=-7） were treated by surgery. Among them, one patient underwent endovascular treatment combined with surgery and 1 was treated by surgery after unsuccessful US-guided compression. In the 3 patients treated with US-guided compression, 2 were successfully treated while the remaining patient required additional surgery. Primary technical success of endovascular management was 97.7% （43/44） and the cure rate was 95.5% （42/44）. In the surgery group, 4 patients recovered well, 1 patient was cured by endovascular treatment combined with surgery, 2 cases underwent amputation, 1 patient died of multi-organ failure and 1 patient was paralysed. Conclusions Minimally invasive interventional techniques are established treatment methods for PA with favorable success rates and minimal morbidity. The therapeutic options should be tailored to the location, size and rupture risk of PA, condition of the donor artery and existing comorbidity.