A clinical analysis of uterine artery embolisation in the treatment of placenta praevia or placenta praevia state

The aim of this study was to investigate the efficiency of uterine artery embolisation (UAE) for postpartum haemorrhage (PPH) related to placenta praevia. A total of 45 women with placenta praevia or placenta praevia state underwent UAE before inducing labour. The locations of uterine artery and placenta were determined through selective and super-selective catheterisation into the internal iliac artery and uterine artery digital subtraction angiography (DSA). The target arteries were then super-selectively catheterised and embolised using small pieces of gelatin sponge. The above processes were repeated until the darkly stained areas of placenta were no longer developing. The success rate of UAE was 100%. There was no longer haemorrhage after embolisation for all the cases of labour induction and the average volume of blood loss was 56 ml. UAE is an effective, reliable and minimally traumatic treatment method for preventing postpartum haemorrhage after induction of labour in patients with placenta praevia state.

Survey and analysis of visual acuity of Kazakhs in different lighting environments

The effect of different lighting environments on the vision and refractive error were investigated in 427 Kazakhs (828 eyes) aged from 40 to 60 years old, of which 279 were pastoral (546 eyes) and 148 were urban (282 eyes). Pastoral Kazakhs use natural illumination, whereas city Kazakhs mainly use artificial illumination. Of all cases, 19.1% (54 cases) had a vision of 0.4 to 0.5, 20.9% (59 cases) had 0.6 to 0.8, and 17.7% (50 cases) had above 1.0. However, the visual acuity distribution of the pastoral Kazakhs had a more obvious characteristic, which was mainly concentrated above 0.6. The vision of 25.1% (137) of cases was 0.6 to 0.8, whereas 58.4% (319) of cases had vision above 1.0. There were more cases with vision above 1.0 in the pastoral Kazakhs compared to the city Kazakhs (P < 0.05). The diopter of the city Kazakhs was between 0 D and -4.0 D, whereas that of the pastoral Kazakhs was between +2.0 D and -2.0 D. Diopters between +2.0 D and 0 D or less than 3.0 D differed significantly between the two groups. Daylight lamps were the main illumination photosources of the city Kazakhs. Artificial light illuminated 70.9% (105 cases) of the city Kazakhs for more than 6 h. By contrast, natural light illuminated 75.3% (210 cases) of the pastoral Kazakhs for an outdoor activity time of more than 9 h. These results suggest that poor lighting environment is a very important factor contributing to refractive error.

Design and performance of a scanning ptychography microscope

We have designed and constructed a dedicated instrument to perform ptychography measurements and characterization of multilayer Laue lenses nanofocusing optics. The design of the scanning microscope provides stability of components and minimal thermal drifts, requirements for nanometer scale spatial resolution measurements. We performed thorough laboratory characterization of the instrument in terms of resolution and thermal drifts with subsequent measurements at a synchrotron. We have successfully acquired and reconstructed ptychography data yielding 11 nm line focus.

Strategy and long-term outcomes of endovascular treatment for Budd-Chiari syndrome complicated by inferior vena caval thrombosis

OBJECTIVES

The aim of this study was to evaluate the strategy and long-term outcomes of endovascular treatment of Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis.

METHODS

The treatment strategy and outcomes of BCS complicated by IVC thrombosis were retrospectively evaluated in a single-center study. The treatment was aimed at the IVC thrombus, not hepatic vein occlusion. All 133 patients with BCS complicated by IVC thrombosis from February 2003 to March 2013 underwent endovascular treatment. For the fresh thrombus group (n=75) recanalization was performed after transcatheter thrombolysis with urokinase. For the mixed thrombus group (n=19) a small balloon pre-dilation of the IVC was performed first, followed by transcatheter thrombolysis using urokinase and a large balloon dilation of the IVC. For the old thrombus group (n=39) a large balloon dilation or/and stent placement was performed directly. Pre- and post-treatment follow-ups were recorded.

RESULTS

The endovascular treatment was successful in 131 out of 133 patients (98.5%). Thirty seven patients had synchronous hepatic vein occlusion. The incidence of serious complications was 4.5% (6/133). Symptomatic pulmonary embolism occurred in three cases, cerebral hemorrhage in two, and cardiac tamponade in one. The cumulative 1-, 5-, and 10-year primary patency rate was 96.3%, 84.0%, and 64.6%, respectively. The cumulative 1-, 5-, and 10-year secondary patency rate was 99.0%, 96.1% and 91.3%, respectively. Segmental occlusion of the IVC and duration of anticoagulant therapy less than 6 months were independent risk factors for reocclusion.

CONCLUSIONS

For patients with BCS complicated by IVC thrombosis, an individualized treatment strategy based on the property of the thrombus can result in excellent long-term patency.

Spontaneous neuronal activity predicts intersubject variations in executive control of attention

Executive control of attention regulates our thoughts, emotion and behavior. Individual differences in executive control are associated with task-related differences in brain activity. But it is unknown whether attentional differences depend on endogenous (resting state) brain activity and to what extent regional fluctuations and functional connectivity contribute to individual variations in executive control processing. Here, we explored the potential contribution of intrinsic brain activity to executive control by using resting-state functional magnetic resonance imaging (fMRI). Using the amplitude of low-frequency fluctuations (ALFF) as an index of spontaneous brain activity, we found that ALFF in the right precuneus (PCUN) and the medial part of left superior frontal gyrus (msFC) was significantly correlated with the efficiency of executive control processing. Crucially, the strengths of functional connectivity between the right PCUN/left msFC and distributed brain regions, including the left fusiform gyrus, right inferior frontal gyrus, left superior frontal gyrus and right precentral gyrus, were correlated with individual differences in executive performance. Together, the ALFF and functional connectivity accounted for 67% of the variability in behavioral performance. Moreover, the strength of functional connectivity between specific regions could predict more individual variability in executive control performance than regionally specific fluctuations. In conclusion, our findings suggest that spontaneous brain activity may reflect or underpin executive control of attention. It will provide new insights into the origins of inter-individual variability in human executive control processing.

Analysis of drug resistance-associated proteins expressions of patients with the recurrent of acute leukemia via protein microarray technology

INTRODUCTION

To detect the expressions of drug-resistance related proteins in bone marrow mononuclear cells of acute leukemia (AL) patients using protein microarray and to analyze the clinical value of protein microarray in predicting prognosis of AL patients.

PATIENTS AND METHODS

A total of 48 AL patients received chemotherapy were divided into four groups: recurrent acute myeloid leukemia group (R-AML; n=15); AML continue remission group (AML-CR; n = 13); recurrent acute lymphocytic leukemia group (R-ALL; n=13); and ALL-CR group (n=7). Fifteen age-matched patients with non-hematologic disease were used as controls.

RESULTS

Expression levels of P-gp, LRP/MVP, BCL-2, GST-π, PCNA, CXCR4 were increased significantly in both AML-R and ALL-R groups (p < 0.05). Besides, LFA-1 and TRAIL-R were also up-expressed significantly in ALL-R group (p < 0.05). In addition, the levels of P-gp, GST-π expressed in AML-R group were higher than those in AML-CR group (p < 0.05) and P-gp, LRP/MVP, GST-π, LFA-1 and CXCR4 in ALL-R were expressed higher than those in ALL-CR group (p < 0.05).

CONCLUSIONS

The recurrent of AL were related closely to the over expression of drug resistance-related proteins. Protein microarray can be used in the prediction of AL recurrence and would be beneficial in guiding individual therapy and patient prognosis.

Creatinine clearance rate and serum creatinine concentration are related to delayed methotrexate elimination in children with lymphoblastic malignancies

Methotrexate (MTX) is an effective treatment for childhood acute lymphoblastic leukemia (ALL) or Non-Hodgkin lymphoma (NHL); however, toxicity can arise with high doses MTX (HDMTX), especially in patients with delayed MTX elimination. Routine monitoring of plasma MTX concentrations is clinically important, but unfortunately is not always feasible. The aim of this study was to examine the relationship between MTX elimination and renal function to identify parameters that may be useful for predicting delayed MTX elimination in Chinese children with ALL and NHL. A total of 105 children with ALL and NHL were included in the study. Each patient received HDMTX (3 or 5 g/m2) over 24 hours. Plasma MTX concentrations were measured at 24, 48, and 96 hours. Delayed elimination was indicated by plasma MTX concentrations ≥1.0 at 48 hours or ≥0.1 μmol/L at 96 hours. Creatinine clearance rate (CCr) and serum Cr concentrations were measured at 0, 24, and 48 hours. There were 39 patients (37.1%) with delayed MTX elimination. For patients with delayed MTX elimination, the 24 hour plasma MTX concentration was negatively correlated with the 24 hour CCr (P=0.019). The 48 hour plasma MTX concentration was positively correlated with 24 and 48 hour serum Cr concentrations (P=0.001 and P<0.001, respectively), and negatively correlated with the 24 and 48 CCr (both P<0.001). Both MTX concentrations and elimination time decreased with increasing CCr (P<0.05 and P<0.001, respectively). Receiver operating characteristic curves revealed that the best predictors of delayed MTX elimination were 24 hour CCr 36 mmol/L (sensitivity: 64.7%; specificity: 77.4%) (both P < 0.001). CCr and serum Cr concentration may be useful for monitoring plasma MTX concentrations in children receiving HDMTX for ALL and NHL and for predicting delayed MTX elimination.

Abstract P4-01-20: Explore the differences and relationships between normal, ADH tissues and DCIS, IDC in breast by shell-isolated nanoparticle-enhanced Raman spectroscopy (SHINERS)

Background: The mechanism that ADH changes to DCIS and even IDC is still not clear now. Raman spectroscopy is a powerful, non-invasive analytical tool which can provide detailed and meaningful information about biochemical composition of tissues at molecular level. Our aim was to find the differences and relationships between normal, ADH tissues and DCIS, IDC in breast based on their various biochemical characteristics by Raman spectroscopy.

Methods: The frozen sections were collected from 39 patients (all female; ages 27-74) who underwent surgical resection or mammotome biopsy at the Department of Breast Surgery, the First Hospital of Jilin University. After operation the samples were immediately frozen at -20∼-25°C and two contiguous sections (6 μm thickness) were cut from a sample by freezing microtome. One was stained with haematoxylin and eosin for routine histopathological analysis; the other was detected by Microscopic confocal Raman spectrometer (HORIBA JY Lab800, 633nm) with its mirror image (the H&E section). After the spectra we needed had been obtained, the Au@SiO2 shell-isolated nanoparticles (SHINs) were added to the surface of frozen sections immediately and then the spectra with SHINs were collected.

Results: A total of 475 Raman spectra and 470 SHINERS spectra were obtained from 9 normal breast tissues, 7 ADH, 8 DCIS, and 15 IDC breast tissues. The Raman signals were significantly enhanced by SHINs. The main spectral features of normal tissues at around 1301, 1442, 1654, and 1743 cm−1 are attributed to lipids. Meanwhile, no strong protein peaks emerged. The peaks of ADH, DCIS and IDC tissues located at 1004, 1033, 1610 and 1658 cm−1 from vibrational modes of proteins shows more stronger. 830, 880, 970, 1090 and 1157cm−1, representing DNA feature peaks, hold the same rules.

Table 1: Peak assignments of the Raman spectra of Breast tissues (wavenumbers in cm-1)NBADHDCISIDCMajor Assignments 880878880O-P-O stretch, DNA1003100410041003phenylalanine1092109210911090O-P-O stretch, DNA1301,14421302,14421303,14431303,1442CH2 twist and CH2 deformation, lipids  15261527C = C stretch of carotene 165816581658Amide I, α-helix1743174717451747C = O stretch, lipids

These show that diseased tissues contained more proteins and nucleic acids. The spectra of DCIS and IDC tissues contained 1527 cm−1, stemming from C = C stretching of carotene. The spectral features between ADH, DCIS and IDC tissues are described as followings: firstly, the concentrations of proteins, nucleic acids and carotene increased gradually but lipids content reduced from ADH to IDC. Secondly, ADH and DCIS tissues have extraordinary strong band of amide I, but in IDC tissues the peak almost cannot observed. Additionally, DCIS tissues have the red shifted and broad peak of CH2, which explains acyl backbone of lipids and proteins has fractured.

Conclusion: The changes including content and molecular structure of lipids, carotene, proteins and nucleic acids accompany with deterioration, indicating the Raman spectroscopy can be used to explore the differences and relationships between normal, ADH tissues and DCIS, IDC in breast. Simultaneously, it might be used to discover the mechanism that ADH convert to DCIS.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-20.

Abstract P5-14-15: Discovery and validation of simple heart measurements to screen patients who will benefit from deep inspiration breath hold for left breast irradiation

Purpose:

Deep inspiration breath hold (DIBH) using active breath control in left-sided breast irradiation (RT) can significantly reduce radiation dose to heart and coronary arteries in selected patients. At our institution, a cutoff of V50% &gt;10cc is currently used to identify patients who require DIBH. This dose-volume cutoff requires generation of a radiation plan in order to select patients. The purpose of this study was to identify simple 2-D measurements of the heart at the time of CT simulation that can help screen patients for DIBH in order to streamline the process for left-sided breast RT.

Methods:

This study evaluated CT simulation scans from 50 left-sided breast cancer patients treated with tangent RT alone, where 50% of patients were treated with DIBH. On each CT dataset, a tangential line was drawn between the medial and lateral tattoos. The following heart measurements were recorded by a blinded observer at 2, 3, 4, and 5 cm below the tattoos: (1) maximal heart distance (MHD) perpendicular to this line and (2) heart length (HL) along this line. Predictive models were created using two strategies; (1) step wise approach utilizing the most significant factor and (2) principle component analysis. Using C-statistics, 3 cutoffs with the highest correlations with heart dose were determined from the model. These cutoffs were validated in a cohort of 100 consecutive patients treated from Jan-May 2012.

Results:

Data from 49 patients in the derivation cohort were analyzable. The HL at 2 cm had the strongest correlation with V50 (R2 = 0.45; p &lt;0.0001). Other values that were associated with V50 were HL at 3 cm (R2 = 0.37; p = &lt;0.0001), MHD at 2cm (R2 = 0.25; p = 0.0003), MHD at 3 cm (R2 = 0.23; p = 0.0006) and HL at 4 cm (R2 = 0.17, p = 0.0035). The predictive model using HL at 2 cm gave an adjusted R2 = 0.4385 (P&lt;0.0001). Adding other variables into the predictive model did not improve the adjusted R2. The following 3 cutoffs for HL at 2 cm with respective (sensitivity; specificity) were identified: 3.92 cm (0.955; 0.48), 7.65 cm (0.32; 0.48), and 6.5 cm (0.5; 0.8). In the validation cohort, 22/100 had V50% &gt; 10 cc. Validation of the 3 derived cutoffs for HL at 2 cm yielded the following sensitivities and specificities: 1.0 and 0.28 for 3.92 cm; 0.53 and 0.93 for 7.65 cm; 0.58 and 0.69 for 6.5 cm. Positive predictive value (PPV) and negative predictive value (NPV) were as follows: 3.92 cm (PPV = 0.25; NPV = 1.00). 7.65 cm (PPV = 0.63; NPV = 0.89), and 6.5cm (PPV = 0.30; NPV = 0.87).

Conclusions:

A simple 2-D heart measurement, heart length at 2 cm below the tattoos, had moderate correlation with the irradiated heart volume. Although HL at 2 cm did not have both high specificity and sensitivity to predict who would benefit from DIBH, cut-offs could be selected to maximize sensitivity (3.92 cm for sensitivity 1.0) or specificity (7.65 cm for specificity 0.93). For example, in departments that routinely acquire both free-breathing and DIBH CT simulation scans for all left-sided patients, a cutoff of 3.92cm would minimize the number of unnecessary DIBH scans.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-15.