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Qiang W, Shi H, Sun B, Wang H, Wang C, Yuan Y, Hu W. Clinical efficacy and prognostic factors of CT-guided radioactive iodine-125 seed implantation for the treatment of superficial soft tissue metastasis: a 12-year retrospective analysis. Radiat Oncol 2024; 19:79. [PMID: 38915062 PMCID: PMC11194874 DOI: 10.1186/s13014-024-02475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 06/17/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Superficial soft tissue metastasis (S-STM) of malignant tumors is uncommon and often brings great pain to patients. However, current treatment options are limited. The purpose of this study was to explore the clinical efficacy and prognostic factors of CT-guided radioactive iodine-125 (125I) seed implantation (RISI) for the treatment of S-STM. METHODS We retrospectively evaluated 132 patients with S-STM who received RISI between June 2010 and July 2022. Local tumor progression-free survival (ltPFS), tumor response, pain control and complication were analyzed. The independent factors affecting ltPFS were screened out using a layered Cox proportional hazards model. RESULTS The median follow-up time was 8.3 months (interquartile range [IQR], 4.5-15.3 months). The objective response rate (ORR) was 81.8%. The median ltPFS was 9.1 (95% CI: 6.6, 11.6) months. The Cox proportional hazard regression model revealed that the independent factors influencing ltPFS included KPS score, primary tumor, metastases, boundary, density and postoperative D90 (All P < 0.05). After RISI, the rate of pain relief was 92.3%. 66 (84.6%) patients reported pain marked relief, and 6 (7.7%) experienced pain moderate relief. No severe adverse events associated with RISI were observed during follow-up. CONCLUSIONS CT-guided RISI was associated with high local control and pain relief without severe adverse events and should be considered as a reliable palliative treatment modality for S-STM. TRIAL REGISTRATION Trial registration Retrospectively registered.
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Affiliation(s)
- Weiguang Qiang
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Hongbing Shi
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Bai Sun
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Hao Wang
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Chao Wang
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Ye Yuan
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
| | - Wenwei Hu
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China.
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Qiu Z, Yu C, Qiu X, Li Q, Li J, Chen Z, Chang S, Zhang S, Fan G, Wang S. Safety and Efficacy of CT-Guided Iodine-125 Brachytherapy for Portal Vein Tumor Thrombus in Hepatocellular Carcinoma. Acad Radiol 2023; 30 Suppl 1:S53-S60. [PMID: 36882354 DOI: 10.1016/j.acra.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 03/08/2023]
Abstract
RATIONALE AND OBJECTIVES Portal vein tumor thrombus (PVTT) seriously reduces the survival of patients with hepatocellular carcinoma (HCC). CT-guided iodine-125 (125I) brachytherapy has the advantage of a high local control rate and is minimally invasive. This study aims to evaluate the safety and efficacy of 125I brachytherapy for treating PVTT in HCC patients. MATERIALS AND METHODS Thirty-eight patients diagnosed with HCC complicated with PVTT and treated with 125I brachytherapy for PVTT were included in this retrospective study. The local tumor control rate, local tumor progression-free survival, and overall survival (OS) were analyzed. Cox proportional hazards regression analysis was performed to identify predictors affecting survival. RESULTS The local tumor control rate was 78.9% (30/38). The median local tumor progression-free survival was 11.6 (95% confidence interval [CI]: 6.7, 16.5) months, and the median overall survival was 14.5 (95% CI: 9.2, 19.7) months. Multivariate Cox analysis showed that age <60 years (hazard ratio [HR] = 0.362; 95% CI: 0.136, 0.965; p = 0.042), type I+II PVTT (HR = 0.065; 95% CI: 0.019, 0.228; p < 0.001), and tumor diameter <5 cm (HR = 0.250; 95% CI: 0.084, 0.748; p = 0.013) were significant predictors of OS. There were no serious adverse events related to 125I seed implantation during the follow-up period. CONCLUSION CT-guided 125I brachytherapy is effective and safe for treating PVTT of HCC, with a high local control rate and no severe adverse events. Patients younger than 60 years old with type I+II PVTT and a tumor diameter less than 5 cm have a more favorable OS.
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Affiliation(s)
- Zhenkang Qiu
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Chunpeng Yu
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Xiaofei Qiu
- Qingdao Municipal Center For Disease Control & Prevention, Qingdao Institute of Preventive Medicine, Qingdao, Shandong Province, China
| | - Qun Li
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Jian Li
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Zhao Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuai Chang
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Shuo Zhang
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China
| | - Gang Fan
- Department of Interventional Medicine, Jimo District Qingdao Hospital of Traditional Chinese Medicine, Qingdao, Shandong, China
| | - Song Wang
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, 16 Jiangsu, 266003, Qingdao, Shandong Province, China.
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Wang Y, Li F, Hu Y, Sun Y, Tian C, Cao Y, Wang W, Feng W, Yan J, Wei J, Du X, Wang H. Clinical outcomes of intra-arterial chemotherapy combined with iodine-125 seed brachytherapy in the treatment of malignant superior vena cava syndrome caused by small cell lung cancer. Cancer Radiother 2023:S1278-3218(23)00068-9. [PMID: 37230904 DOI: 10.1016/j.canrad.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/29/2022] [Accepted: 01/14/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Currently there is a lack of effective treatment strategies for malignant superior vena cava syndrome (SVCS). We aim to investigate the therapeutic effect of intra-arterial chemotherapy (IAC) combined with the Single Needle Cone Puncture method for the 125I brachytherapy (SNCP-125I) in treating SVCS caused by stage III/IV Small Cell Lung Cancer (SCLC). MATERIALS AND METHODS Sixty-two patients with SCLC who developed SVCS from January 2014 to October 2020 were investigated in this study. Out of these 62 patients, 32 underwent IAC combined with SNCP-125I (Group A) and 30 patients received IAC treatment only (Group B). Clinical symptom remission, response rate, disease control rate, and overall survival of these two groups of patients were analyzed and compared. RESULTS The remission rate of symptoms including dyspnea, edema, dysphagia, pectoralgia, and cough of malignant SVCS in Group A was significantly higher than that in Group B (70.5 and 50.53%, P=0.0004, respectively). The disease control rates (DCR, PR+CR+SD) of Group A and B were 87.5 and 66.7%, respectively (P=0.049). Response rates (RR, PR+CR) of Group A and Group B were 71.9 and 40% (P=0.011). The median overall survival (OS) of Group A was significantly longer than that in Group B which was 18 months compared to 11.75 months (P=0.0360). CONCLUSIONS IAC treatment effectively treated malignant SVCS in advanced SCLC patients. IAC combined with SNCP-125I in the treatment of malignant SVCS caused by SCLC showed improved clinical outcomes including symptom remission and local tumor control rates than IAC treatment only in treating SCLC-induced malignant SVCS.
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Affiliation(s)
- Y Wang
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - F Li
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China; Core Laboratory, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China.
| | - Y Hu
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China; Shanxi Mecidal University, Graduate Research Institute, 030604 Shanxi, China
| | - Y Sun
- Department of Melanoma, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - C Tian
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - Y Cao
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - W Wang
- Department of Pathology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - W Feng
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - J Yan
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - J Wei
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - X Du
- Department of Melanoma Oncology, Tianjin BeiChen Hospital, Beiyi Road, Beichen District, 300400 Tianjin, China
| | - H Wang
- Department of Oncology, Tianjin Union Medical Center, 300191 Tianjin, China; Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
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Ying J, Xiao R, Xu L, Yan M. Transcutaneous Electrical Nerve Stimulation (TENS) for Opioid-Induced Constipation in Palliative Care: A Systematic Review and Network Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:5383821. [PMID: 37123082 PMCID: PMC10132909 DOI: 10.1155/2023/5383821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 05/02/2023]
Abstract
Background Opioid-induced constipation (OIC) has become increasingly prevalent with the rise of prescription opioid use, particularly in patients with advanced illnesses. Existing literature suggests that transcutaneous electrical nerve stimulation (TENS) could be applied to treat cancer pain and reduce OIC incidence. However, there need to be more systematic review studies on the effectiveness of TENS in treating OIC. Objective In order to fill the gap of TENS in treating OIC in current knowledge, we have conducted a systematic review and network meta-analysis. Methods The comprehensive computer retrieval PubMed, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), Chinese Biomedical (CBM), and Wanfang Database were used to collect literature for relevant studies of TENS treatment of OIC, in accordance with the standard of literature filtering, data extraction, and quality evaluation. The data were meta-analysed using ReviewManager 5.3 software recommended by Cochrane. Results A total of 180 pieces of literature were yielded through original search. Based on the inclusion and exclusion criteria, a total of 9 articles were included in this study. Our analysis of seven studies has revealed that TENS (28.18%) significantly reduces the incidence rate of OIC compared to control (52.45%) (I 2 = 57%, P=0.03; OR = 0.66 (95% CI, 0.53 to 0.82), Z = 3.70, P < 0.01). The results of two studies indicated that TENS significantly improved the quality of life compared to the control group (i.e., treatment-as-usual only) (I 2 = 80%, P=0.03; OR = -1.91; 95% CI, -2.54 to -1.29, Z = 6.00, P < 0.01). Conclusion The administration of TENS therapy holds the potential to mitigate the occurrence of OIC and augment the quality of life for individuals suffering from cancer. Particularly, TENS therapy proves to be appropriate for propagation within community and domestic environments. Nevertheless, advanced clinical randomized controlled trials of superior quality are necessary to authenticate the comprehensive clinical efficiency and safety of this therapy. Further investigation is indispensable to comprehend its mechanism in greater detail and establish the optimum therapeutic strategy.
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Affiliation(s)
- Jianyue Ying
- Campus Hospital of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China
| | - Renzhong Xiao
- Hunan Royal Pharmaceutical Technology Co. Ltd., Changsha, Hunan, China
| | - Lili Xu
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Mei Yan
- Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China
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Zhu W, Zhong Z, Yan H, Guo H, Xiao M, He X, Gao F, Zhang F. Clinical efficacy of CT-guided 125I brachytherapy in patients with local residual or recurrent hepatocellular carcinoma after thermal ablation. Insights Imaging 2022; 13:185. [PMID: 36471084 PMCID: PMC9723008 DOI: 10.1186/s13244-022-01327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Treatment methods of local residual or recurrent hepatocellular carcinoma (HCC) after thermal ablation are limited. Therefore, our study aimed to explore the efficacy and prognostic factors of 125I brachytherapy for local residual or recurrent lesion after thermal ablation. METHODS A total of 114 patients with 212 local residual or recurrent HCC tumors after thermal ablation underwent 125I brachytherapy. Local progression-free survival (LPFS) and prognostic factors were analyzed by Kaplan-Meier curves and the Cox model. RESULTS After a 6-month follow-up, the percentage of patients who achieved complete response (CR), partial response (PR), and stable disease (SD) was 57%, 13.2%, and 5.2%, respectively. The 1-, 2-, and 3-year LPFS rates were 58.7%, 50.0%, and 41.2%, respectively. Portal vein tumor thrombus (PVTT) (p = 0.03), the number of intrahepatic tumors (p = 0.01), and AFP level (p = 0.02) were independent risk factors for local tumor progression (LTP). The median LPFS in patients without PVTT (22 months) was much longer compared to those with PVTT (10 months). The median LPFS in patients with less than three intrahepatic lesions improved from 17 to 24 months. The median LPFS was only 5 months in the high AFP group, but was prolonged with a decrease in AFP level (24 months). No severe complications were recorded. All complications were controllable and treatable. CONCLUSIONS CT-guided 125I brachytherapy was a safe and effective treatment for patients with local residual or recurrent HCC after thermal ablation to improve local control rate.
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Affiliation(s)
- Wenliang Zhu
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Zhihui Zhong
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Huzheng Yan
- grid.12981.330000 0001 2360 039XDepartment of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630 People’s Republic of China
| | - Huanqing Guo
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Meigui Xiao
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Xu He
- grid.452930.90000 0004 1757 8087ZhuHai Interventional Medical Center, ZhuHai People’s Hospital (ZhuHai Hospital Affiliated With Jinan University), Jinan University, ZhuHai, 519000 Guangdong People’s Republic of China
| | - Fei Gao
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Fujun Zhang
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
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Dong R, Lu J, Zeng CH, Li H, Guo JH. Safety and Efficacy of Computed Tomography-Guided Iodine-125 Brachytherapy as a Salvage Treatment for Locoregional Lymph Node Recurrence of Esophageal Cancer. J Vasc Interv Radiol 2022; 33:1399-1407. [PMID: 35863631 DOI: 10.1016/j.jvir.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/09/2022] [Accepted: 07/10/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To investigate the clinical safety and efficacy of computed tomography (CT)-guided iodine-125 (125I) brachytherapy as a salvage treatment for esophageal cancer with locoregional lymph node recurrence (LNR). MATERIALS AND METHODS This retrospective study included patients with esophageal cancer who developed locoregional LNR after initial curative resection followed by CT-guided 125I brachytherapy as a salvage treatment (January 2014 to January 2020). Local tumor progression-free survival (LTPFS) was assessed using Response Evaluation Criteria in Solid Tumors, v1.1. Clinical response was evaluated with the Numerical Rating Scale pain score, and adverse events were evaluated with the Common Terminology Criteria for Adverse Events (v5.0). A layered Cox proportional hazards model was used to determine independent factors affecting LTPFS. RESULTS A total of 52 patients (mean age, 60 years) were included in this study. The median follow-up was 9.3 months (range, 4.3-12 months). The median LTPFS was 7.0 months (interquartile range, 5.0-9.5 months). The local control rates were 100%, 94.2%, 59.6%, and 13.4% at 1, 3, 6, and 12 months, respectively. The overall survival rates were 100%, 100%, 82.6%, and 36.5% at 1, 3, 6, and 12 months, respectively. The number of locoregional LNRs (hazard ratio [HR], 2.38 [95% confidence interval {CI}, 1.11-5.10]; P = .026), clinical stage at diagnosis (HR, 8.12 [95% CI, 3.19-20.66]; P < .001), and pathologic stage (HR, 5.74 [95% CI, 2.14-15.39]; P = .001) were independent factors for LTPFS. The rate of pain relief was 96.4% (27 of 28). Treatment-related death was not observed. CONCLUSIONS CT-guided 125I radioactive seed implantation resulted in pain relief and short to midterm local control.
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Affiliation(s)
- Rui Dong
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, People's Republic of China
| | - Jian Lu
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, People's Republic of China
| | - Chu-Hui Zeng
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Hang Li
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, People's Republic of China
| | - Jin-He Guo
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, People's Republic of China.
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He W, Li Q, Lu Y, Ju D, Gu Y, Zhao K, Dong C. Cancer treatment evolution from traditional methods to stem cells and gene therapy. Curr Gene Ther 2021; 22:368-385. [PMID: 34802404 DOI: 10.2174/1566523221666211119110755] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/25/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer, a malignant tumor, is caused by the failure of the mechanism that controls cell growth and proliferation. Late clinical symptoms often manifest as lumps, pain, ulcers, and bleeding. Systemic symptoms include weight loss, fatigue, and loss of appetite. It is a major disease that threatens human life and health. How to treat cancer is a long-standing problem that needs to be overcome in the history of medicine. METHOD Traditional tumor treatment methods are poorly targeted, and the side effects of treatment seriously damage the physical and mental health of patients. In recent years, with the advancement of medical science and technology, the research on gene combined with mesenchymal stem cells to treat tumors has been intensified. Mesenchymal stem cells carry genes to target cancer cells, which can achieve better therapeutic effects. DISCUSSION In the text, we systematically review the cancer treatment evolution from traditional methods to novel approaches that include immunotherapy, nanotherapy, stem cell theapy, and gene therapy. We provide the latest review of the application status, clinical trials and development prospects of mesenchymal stem cells and gene therapy for cancer, as well as their integration in cancer treatment. Mesenchymal stem cells are effective carriers carrying genes and provide new clinical ideas for tumor treatment. CONCLUSION This review focuses on the current status, application prospects and challenges of mesenchymal stem cell combined gene therapy for cancer, and provides new ideas for clinical research.
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Affiliation(s)
- Wenhua He
- Department of Anatomy, Medical College of Nantong University, Nantong 226001. China
| | - Qingxuan Li
- Department of Anatomy, Medical College of Nantong University, Nantong 226001. China
| | - Yan Lu
- Department of Anatomy, Medical College of Nantong University, Nantong 226001. China
| | - Dingyue Ju
- Department of Anatomy, Medical College of Nantong University, Nantong 226001. China
| | - Yu Gu
- Department of Anatomy, Medical College of Nantong University, Nantong 226001. China
| | - Kai Zhao
- Department of Anatomy, Medical College of Nantong University, Nantong 226001. China
| | - Chuanming Dong
- Department of Anatomy, Medical College of Nantong University, Nantong 226001. China
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