High Residual Tumor Rate for Early Breast Cancer Patients Receiving Vacuum-assisted Breast Biopsy

Purpose: The objective of study is aiming to investigate the residual tumor rate after Vacuum-assisted Breast Biopsy (VABB) for early breast cancer excision and the efficacy of mammogram and ultrasound in detecting residual tumor.

Methods: Patients who underwent VABB and were confirmed with breast cancer in Sun Yat-sen University Cancer Center from 2010 to 2015 were reviewed retrospectively. The residual tumor rate determined by histological examination was calculated, and then was compared with the results estimated by mammogram and ultrasound which were performed post VABB but before subsequent surgery. Univariate and multivariate analysis (logistic regression) were carried out to identify the independent risk factors associated with residual tumor.

Results: In total, 126 eligible patients with early breast cancer were recruited for this study, of whom 79 (62.7%) had residual tumor and 47 (37.3 %) underwent complete excision. The residual tumor rates for lesions < 10mm, lesions 10 to 20 mm and lesions >20mm in size were 55.0%, 68.9% and 53.1%, respectively. The complete excision rates estimated by mammogram and ultrasound were 76.5% and 73.9%, with a negative predictive value of only 46.2% and 50.6%, respectively. In the multivariate logistic regression analysis, no specific factors were found associated with risk of residual tumor (all P > 0.05).

Conclusions: There was a high residual tumor rate after VABB in early breast cancer. Both mammogram and ultrasound could not effectively detect the residual tumor after VABB.

Prognostic value of tissue inhibitor of metalloproteinase-2 expression in patients with non-small cell lung cancer: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Tissue inhibitor of metalloproteinase-2 (TIMP-2) is a small secretory glycoprotein with anti-matrix metalloproteinase activity. Data on the value of TIMP-2 as a prognostic factor in non-small cell lung cancer (NSCLC) are discordant and remain controversial. A systematic review and meta-analysis was performed to explore this issue.

METHODS

We identified the relevant literature by searching the PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, SinoMed, and Wanfang Data databases (search terms: "non-small cell lung cancer" or "NSCLC" or "Lung Carcinoma, Non-Small-Cell", "Tissue Inhibitor of Metalloproteinase-2" or "TIMP-2", and "prognosis" or "prognostic" or "survive") for updates prior to March 1, 2014. The pooled hazard ratio (HR) of overall survival with a 95% confidence interval (95% CI) was used to evaluate the strength of the association between positive TIMP-2 expression and survival in patients with NSCLC.

RESULTS

We included 12 studies in our systematic review; five studies involving 399 patients with NSCLC were meta-analyzed. The pooled HR of all included patients was 0.57 (95% CI: 0.43-0.77), and the HRs of subgroup analysis according to stage (I-IV), testing method (immunohistochemistry) and high TIMP-2 expression percentage (<50%) were 0.63 (95% CI: 0.43-0.92), 0.55 (95% CI: 0.41-0.74), and 0.50 (95% CI: 0.28-0.88), respectively. These data suggested that high TIMP-2 expression is associated with favorable prognosis in NSCLC. The meta-analysis did not reveal heterogeneity or publication bias.

CONCLUSIONS

TIMP-2 expression indicates favorable prognosis in patients with NSCLC; as a protective factor, it could help predict outcome and may guide clinical therapy in the future.

Metastatic axillary lymph node ratio (LNR) is prognostically superior to pN staging in patients with breast cancer--results for 804 Chinese patients from a single institution

The number of axillary lymph nodes involved and retrieved are important prognostic factors in breast cancer. The purpose of our study was to investigate whether the lymph node ratio (LNR) is a better prognostic factor in predicting disease-free survival (DFS) for breast cancer patients as compared with pN staging. The analysis was based on 804 breast cancer patients who had underwent axillary lymph node dissection between 1999 and 2008 in Sun Yat-Sen University Cancer Center. Optimal cutoff points of LNR were calculated using X-tile software and validated by bootstrapping. Patients were then divided into three groups (low-, intermediate-, and high-risk) according to the cutoff points. Predicting risk factors for relapse were performed according to Cox proportional hazards analysis. DFS was estimated using the Kaplan-Meier method and compared by the log-rank test. The 5-year DFS rate decreased significantly with increasing LNRs and pN. Univariate analysis found that the pT , pN, LNR, molecule type, HER2, pTNM stage and radiotherapy well classified patients with significantly different prognosis. By multivariate analysis, only LNR classification was retained as an independent prognostic factor. Furthermore, there was a significant prognostic difference among different LNR categories for pN2 category, but no apparent prognostic difference was seen between different pN categories in any LNR category. Therefore, LNR rather than pN staging is preferable in predicting DFS in node positive breast cancer patients, and routine clinical decision-making should take the LNR into consideration.

Utility of diffusion-weighted imaging to assess hepatocellular carcinoma viability following transarterial chemoembolization

The purpose of the present study was to evaluate whether diffusion-weighted imaging (DWI) can be used to assess hepatocellular carcinoma (HCC) viability following transarterial chemoembolization (TACE). A total of 41 consecutive patients were treated according to chemoembolization protocols. The follow-up was performed between six and eight weeks post-chemoembolization by multidetector computed tomography [or enhanced magnetic resonance imaging (MRI)] and DW-MRI on the same day. The presence of any residual tumor and the extent of tumor necrosis were evaluated according to the European Association for the Study of the Liver. The apparent diffusion coefficient (ADC) values of the entire area of the treated mass and the vital and necrotic tumor tissues were recorded. Correlation coefficients were also calculated to compare the percentage of necrosis with ADC values. The mean ADC values of the necrotic and vital tumor tissues were 2.22±0.31×10^-3 mm²/sec and 1.42±0.25×10^-3 mm²/sec, respectively (Mann-Whitney U test, P<0.001). The results from the receiver operating characteristic analysis showed that the threshold ADC value was 1.84×10^-3 mm²/sec with 92.3% sensitivity and 100% specificity for identifying the necrotic tumor tissues. A significant linear regression correlation was identified between the ADC value of the entire area of the treated mass and the extent of tumor necrosis (r=0.58; P<0.001). In conclusion, DWI can be used to assess HCC viability following TACE.

High Expression of p300 in Human Breast Cancer Correlates with Tumor Recurrence and Predicts Adverse Prognosis

OBJECTIVE

Transcriptional coactivator p300 has been shown to play a variety of roles in the transcription process and mutation of p300 has been found in certain types of human cancers. However, the expression dynamics of p300 in breast cancer (BC) and its effect on BC patients' prognosis are poorly understood.

METHODS

In the present study, the methods of tissue microarray and immunohistochemistry (IHC) were used to investigate the protein expression of p300 in BCs. Receiver operating characteristic (ROC) curve analysis, Spearman's rank correlation, Kaplan-Meier plots and Cox proportional hazards regression model were utilized to analyze the data.

RESULTS

Based on the ROC curve analysis, the cutoff value for p300 high expression was defined when the H score for p300 was more than 105. High expression of p300 could be observed in 105/193 (54.4%) of BCs, in 6/25 (24.0%) of non-malignant breast tissues, respectively (P=0.004). Further correlation analysis showed that high expression of p300 was positively correlated with higher histological grade, advanced clinical stage and tumor recurrence (P<0.05). In univariate survival analysis, a significant association between high expression of p300 and shortened patients' survival and poor progression-free survival was found (P<0.05). Importantly, p300 expression was evaluated as an independent prognostic factor in multivariate analysis (P<0.05).

CONCLUSION

Our findings provide a basis for the concept that high expression of p300 in BC may be important in the acquisition of a recurrence phenotype, suggesting that p300 high expression, as examined by IHC, is an independent biomarker for poor prognosis of patients with BC.

Assessment of the feeding arteries by three-dimensional computed tomography angiography prior to multi-arterial infusion chemotherapy for lung cancer

The aim of this study was to evaluate the efficacy of multi-detector row helical computed tomography (MDCT) angiography in the detection of feeding arteries prior to multi-arterial infusion for lung cancer. A total of 59 consecutive patients (44 males and 15 females; age range, 27-86 years; median age, 62 years) with non-small cell lung cancer underwent MDCT angiography of the thorax prior to multi-arterial infusion for lung cancer. Findings on CT angiograms, including CT scans, maximum intensity projections and three-dimensional volume-rendered images, were used to evaluate the depiction of bronchial and non-bronchial systemic arteries. The results of detecting the feeding arteries for lung cancer by MDCT angiography and conventional angiography were compared. Among the 59 patients treated with multi-arterial infusion chemotherapy, a total of 80 feeding arteries (62 bronchial feeding arteries and 18 non-bronchial systemic arteries) were detected by conventional angiography and/or MDCT angiography. In 56 (70%) feeding arteries (including 44 bronchial feeding arteries and 12 non-bronchial systemic arteries) for lung cancers, concordant findings were observed with the two modalities. In 23 (29%) cases, MDCT angiography could not be used to define feeding arteries, but was used to identify the ostia of these feeding arteries. In one (1/80, 1.3%) case, the CT-defined feeding artery was not selectively catheterized. MDCT angiography of the chest is able to provide an overview for successful catheterization in multi-arterial infusion chemotherapy for lung cancer.

A case report of primary small cell carcinoma of the breast and review of the literature

Primary small cell carcinoma (SCC) of the breast, an exceedingly rare and aggressive tumor, is often characterized by rapid progression and poor prognosis. We report a case of primary SCC of the breast that was diagnosed through pathologic and immunohistochemical examinations. Computed tomography (CT) scans failed to reveal a non-mammary primary site. Due to the scant number of relevant case summaries, this type of tumor is proved to be a diagnostic and therapeutic challenge. Therefore, we also reviewed relevant literature to share expertise in diagnosis, clinicopathologic characteristics, treatment, and prognosis of this type of tumor. Future studies with more cases are required to define more appropriate treatment indications for this disease.

Folate receptor-mediated targeted polymeric gadolinium complexes for magnetic resonance imaging in pulmonary tumor xenografts

Targeted delivery is a highly desirable strategy for diagnostic imaging due to enhanced efficacy and reduced dosage/toxicity. The need to develop target-specific magnetic resonance imaging (MRI) contrast agents to aid in disease characterization is highly essential. In this study, a specific contrast agent, Gd-DTPA-poly-L-lysine (PL-Gd-DTPA)-folate, was synthesized and evaluated for its efficacy as a targeted agent for the imaging of tumors that overexpress the folate receptor. Folic acid was conjugated to PL-Gd-DTPA via the ε-amino groups. The receptor binding properties of folate-PL-Gd-DTPA were studied in cultured tumor cells that overexpressed the folate receptor. The tumor-selecting properties of folate-PL-Gd-DTPA were then evaluated in BALB/c mice bearing subcutaneously implanted folate receptor-positive tumors. Tissue MR signal intensities were measured at six different time-points. In the in vitro study, the folate-PL-Gd-DTPA was able to bind to these cells, which overexpressed the folate receptor, as with free folic acid. Excellent tumor selectivity was also shown in the animal model; after the success of injection of folate-PL-Gd-DTPA, a maximum intensity increase of 125.4% was observed from pre-injection compared to post-injection images of the tumor at the 48 h time-point. The liver enhancement was non-specific and the muscle signal intensity at any time-point after injection showed no statistical difference with that observed before injection. Folate-PL-Gd-DTPA is a promising, novel receptor-specific MRI contrast agent with potential applications in the imaging of human folate receptor-positive tumors.

Characterization of solitary pulmonary nodules: Use of washout characteristics at contrast-enhanced computed tomography

The purpose of this study was to determine whether computed tomographic scans and attenuation measurements on contrast material-enhanced and non-enhanced computed tomographic scans could be used to characterize solitary pulmonary nodules and, in particular, to characterize these lesions using washout characteristics on contrast-enhanced computed tomography. A total of 63 patients (38 males, 25 females; age range, 21-80 years; mean age, 58±13.2 years) with pulmonary nodules revealed on contrast-enhanced computed tomography underwent 20-min delayed enhanced scans. The mean diameter of the pulmonary nodules was 1.8±0.6 cm (range, 0.8-2.9). Region-of-interest measurements were obtained at non-enhanced, dynamic enhanced and delayed enhanced computed tomography and were used to calculate a relative percentage washout as follows: 1 - (Hounsfield unit measurement on delayed image/Hounsfield unit measurement on dynamic image) × 100%. There was a mean relative washout of 33% on the delayed computed tomographic scans (range, 12-46) in benign solitary pulmonary nodules; and a mean relative washout of 7% (range, -36-51) in malignant solitary pulmonary nodules (Mann-Whitney U test, p<0.001). Results of the receiver operating curve analysis revealed that a threshold relative washout of 14.5% had 74.3% sensitivity and 92.9% specificity for identifying malignant nodules. Calculation of the relative percentage washout on dynamic and delayed enhanced computed tomographic scans may lead to a highly specific test for solitary pulmonary nodule characterization and reduce the need for, and possibly obviate, follow-up imaging or biopsy.

Pulmonary malignant focal ground-glass opacity nodules and solid nodules of 3cm or less: comparison of multi-detector CT features

INTRODUCTION

To evaluate the different multi-detector computed tomography (MDCT) features between pulmonary malignant focal ground-glass opacity (fGGO) nodules and solid nodules of 3cm or less in diameter.

METHODS

One hundred and five malignant solid nodules and 48 malignant fGGOs confirmed by pathology were retrospectively analysed with regard to the patient's demographic data, nodule size and MDCT features (shape, margin, interface, internal characteristics and adjacent structure). Differences were analysed using the Fisher exact test or Mann-Whitney U-test.

RESULTS

The male to female ratio of patients with malignant solid nodules (60:45) was higher than that with malignant fGGOs (18:30) (P<0.05). There was no significant difference in either patient's age (P>0.05) or nodule size (P>0.05). The frequency of irregular shape (4% vs. 21%), spiculation (57% vs. 40%), vacuole sign (11% vs. 52%) and natural air bronchograms (0% vs. 24%) was significantly different between malignant solid nodules and fGGOs. No differences were found in the frequency of lobulation, cusp angle, spine-like process, interface and adjacent structure between the two groups (P>0.05).

CONCLUSION

Malignant fGGOs and solid nodules showed mostly similar MDCT features. For malignant fGGOs, the frequency of irregular shape, vacuole sign and natural air bronchograms was higher than that in solid nodules, but the frequency of spiculation was lower than that in solid nodules.

Prognostic significance of Oct4 and Sox2 expression in hypopharyngeal squamous cell carcinoma

Background

Oct4 and Sox2 are two major transcription factors related to the stem cell self-renewal and differentiation. The aim of this study was to examine the association between Oct4 and Sox2 expression levels with both the clinicopathological characteristics and prognoses of patients with hypopharyngeal squamous cell carcinoma.

Method

Tumor tissue samples from 85 patients with hypopharyngeal squamous cell carcinoma were collected, and the clinical follow-up data of these patients were recorded, and expression status of Oct4 and Sox2 were examined in these tissue samples by immunohistochemistry (IHC).

Results

Oct4 expression was found to be an independent predictive factor for overall survival (p = 0.004) in patients with hypopharyngeal squamous cell carcinoma and was independently related to loco-regional control (p = 0.001). Although Sox2 expression status showed no significant association with overall survival (p = 0.166), disease-free survival (p = 0.680) or loco-regional control (p = 0.383), when using a subgroup analysis, the subgroup with both high Oct4 and Sox2 expression had the best prognosis (p = 0.000). Sox2 expression could be a potential prognostic predictor for patients with hypopharyngeal squamous cell carcinoma. Simultaneous analyses of Oct4 and Sox2 expression could be more effective in evaluating the prognoses of patients with hypopharyngeal squamous cell carcinoma.

Conclusion

Oct4 expression is an independent predictive factor for patients with hypopharyngeal squamous cell carcinoma, suggesting that Oct4 expression may be a useful indicator for predicting the prognosis of hypopharyngeal squamous cell carcinoma.

Role of magnetic resonance diffusion-weighted imaging in evaluating response after chemoembolization of hepatocellular carcinoma

OBJECTIVE

To investigate the value of hepatocellular carcinoma pretreatment apparent diffusion coefficients (ADCs) and its ADCs changes after treatment in predicting and early monitoring the response after chemoembolization.

MATERIALS AND METHODS

Twenty-five responding and nine nonresponding hepatocellular carcinoma lesions were prospectively evaluated with magnetic resonance diffusion-weighted imaging in 24 h before and in 48 h after chemoembolization. Quantitative ADC maps were calculated with images with b values of 0 and 500 s/mm(2).

RESULTS

Nonresponding lesions had a significantly higher pretreatment mean ADC than did responding lesions (1.726+/-0.323 x 10(-3) mm(2)/s vs.1.294+/-0.18510(-3) mm(2)/s, P< or =0.001). The results of receiver operator characteristic (ROC) analysis for identification of nonresponding lesions showed that threshold ADC value of 1.618 x 10(-3) mm(2)/s had 96.0% sensitivity and 77.8% specificity. After transarterial chemoembolization, responding lesions had a significant increase in %ADC values than did nonresponding lesions (32.63% vs. 5.24%, P=0.025). The results of ROC analysis for identification of responding lesions showed that threshold %ADC value of 16.21% had 72% sensitivity and 100% specificity. No significant change was observed in normal liver parenchyma (P=0.862) and spleen (P=0.052).

CONCLUSION

High pretreatment mean ADC value of hepatocellular carcinoma was predictive of poor response to chemoembolization. A significant increase in %ADC value was observed in lesions that responded to chemoembolization.

[Radiologic-pathologic study on bronchial changes in peripheral solitary pulmonary lesions]

BACKGROUND & OBJECTIVE

At present, the diagnosis and differential diagnosis of peripheral solitary pulmonary lesions is a hot-spot in researches of thoracic imageology, and bronchial changes is the morphologic basis of peripheral solitary pulmonary nodules, especially peripheral lung cancer. This study was to investigate the value of multi-slice CT (MSCT) in evaluating bronchial changes of peripheral solitary pulmonary lesions through a radiologic-pathologic study.

METHODS

Thirty patients with solitary pulmonary lesions were scanned using MSCT. Image data were reconstructed to display bronchial changes, and were compared with the results of postoperative pathology.

RESULTS

CT bronchial sign was positive in all patients. The bronchus on pathologic section was showed in 19 (63.3%) patients, but not in 11 (36.7%) patients. Among the 15 patients with bronchial cutoff and bronchial wall thickening on CT, 11 lung cancer patients had bronchial wall invasion on pathology. Among the seven patients with normal bronchial wall on CT, five lung cancer patients had no bronchial wall invasion on pathology. Among the five lung cancer patients with air bronchogram, one had bronchial wall invasion, and one showed bronchial epithelial hyperplasia. Among the three patients with bronchus distributed at the periphery of the lesion, one lung cancer patient had bronchial wall invasion on pathology.

CONCLUSION

MSCT can evaluate accurately the bronchial changes of peripheral solitary pulmonary lesions, and may be helpful for diagnosis and differential diagnosis of solitary pulmonary lesions.

[Folate-poly-L-lysine-Gd-DTPA as MR contrast agent for tumor imaging via folate receptor-targeted delivery]

OBJECTIVE

To study folate-conjugated Gd-DTPA-Poly-L-Lysine (folate-PL-Gd-DTPA) as MR targeting agent to tumor cells via folate receptor, to evaluate feasibility and effectiveness by observing MR signal variations and imaging feature of pulmonary tumor xenografts in nude mice using this contrast material.

METHODS

(1) Using Poly-L-Lysine (PL) as linker, after PL was tethered with caDTPA, GdCl(3) was added to label DTPA-PL, then PL-Gd-DTPA was conjugated to folate, a specific MR contrast agent, was thus prepared. (2) Using high performance liquid chromatography (HPLC) to evaluate the conjugate purity, and the ICP-AES to test Gd(3+) concentration, while the activity evaluated by competitive folate receptor binding with folic acid. (3) Folate-PL-Gd-DTPA as specific contrast agents (study group, n = 6) and Gd-DTPA as non-specific contrast agents (control group, n = 4) was injected respectively into caudal vein of the nude mice which was pulmonary tumor xenografts as experimental model in the study. MRI was performed with plain scans, enhanced scans at 30 minutes, 3 hours, 6 hours, 14 hours, 24 hours, 38 hours, 48 hours, 62 hours and 72 hours after the success of injection. Signal intensities of tumors and muscles were measured.

RESULTS

(1) folate-PL-Gd-DTPA was successfully synthesized with high affinity to folate receptor and high concentration of Gd(3+) (56 Gd(3+)/folate). (2) folate-PL-Gd-DTPA had an excellent tumor selectivity in pulmonary tumor xenografts in the animal model. After injection, the tumor signal intensity in the study group was significantly higher than that observed before injection; An average intensity increase of 125.4% was observed from pre-contrast to post-contrast images of the tumor, which was observed at 24 - 48 hours after injection; The muscle signal intensity at any time-point after injection showed no statistically difference with that observed before injection. In control group, the tumor signal intensity showed statistically difference with that observed before injection at 0.5 hour and 3 hours, the biggest difference appeared at 0.5 hour; The muscle signal intensity at 0.5 hour time-point showed statistically difference with that observed before injection.

CONCLUSION

Folate-PL-Gd-DTPA could be combined to tumor cells appetencially via folate receptor and significantly targeted to tumor cells with rich folate receptors for MR imaging.

Establishment of a porcine model of patent foramen ovale

OBJECTIVE

To investigate the feasibility of developing an animal model of patent foramen ovale (PFO) in piglets by percutaneous atrial septal puncture and balloon dilation.

METHODS

A standardized percutaneous atrial trans-septal puncture and balloon dilation was conducted in 11 healthy piglets under general anesthesia. A Rups-100 system inserted through a femoral vein was used for the transseptal puncture, and subsequent balloon dilatation was performed at the puncture site to imitate a PFO. Euthanasia and autopsy were performed on day 1 in one piglet (early autopsy), and on day 21 in the remaining ten piglets (late autopsy).

RESULTS

Artificial PFO was successfully created in all piglets and verified by fluoroscopy. No major technical difficulty or complication was encountered except in one which developed mild hemopericardium. In the piglet that had early autopsy, the artificial foramen was measured 0.8 x 0.7 cm(2) in cross-section and aggregates of erythrocytes were revealed over its rim under light microscopy. In the late autopsy group (n=10), seven piglets had the created foramens healed and sealed off, while the other three showed relatively small residual lumens measured 0.1 x 0.2 cm(2), 0.2 x 0.2 cm(2) and 0.1 x 0.3 cm(2) in cross-section, respectively. Histological examination of specimens from the late autopsy group showed variable neointima hyperplasia, cardiac muscle necrosis and focal fibrosis at the puncture site, regardless of the course of healing.

CONCLUSION

Artificial creation of PFO in piglets is feasible by percutaneous atrial septal puncture and balloon dilation. This protocol may serve as a research model for PFO-related stroke in human.

Portal venous stent placement for treatment of portal hypertension caused by benign main portal vein stenosis

AIM: To evaluate the value of endovascular stent in the treatment of portal hypertension caused by benign main portal vein stenosis.

METHODS: Portal vein stents were implanted in six patients with benign main portal vein stenosis (inflammatory stenosis in three cases, postprocedure of liver transplantation in another three cases). Changes in portal vein pressure, portal vein patency, relative clinical symptoms, complications, and survival were evaluated.

RESULTS: Six metallic stents were successfully placed across the portal vein stenotic or obstructive lesions in six patients. Mean portal venous pressure decreased significantly after stent implantation from (37.3±4.7) cm H₂O to (18.0±1.9) cm H₂O. The portal blood flow restored and the symptoms caused by portal hypertension were eliminated. There were no severe procedure-related complications. The patients were followed up for 1-48 mo. The portal vein remained patent during follow-up. All patients survived except for one patient who died of other complications of liver transplantation.

CONCLUSION: Percutaneous portal vein stent placement for the treatment of portal hypertension caused by benign main portal vein stenosis is safe and effective.

[Clinical value of brachytherapy of malignant biliary obstruction after implanting expandable metallic biliary endoprothesis (EMBE)]

BACKGROUND & OBJECTIVE

For malignant biliary obstruction,drainage is the only procedure to cope with jaundice itself. It does not work for neoplasm. Patient will die of disease progress in a short time.With after-loading radiotherapy,radiofrequency ablation(RFA) and port catheter system(PCS) chemotherapy,we can directly apply these methods to treat neoplasm. This study is to investigate the value of after-loading treatment through biliary drainage and local chemotherapy embolism of PCS and RFA on treatment of malignant biliary obstruction after Expandable Metallic stent placement. Materials and Methods 49 cases with malignant biliary obstruction can not or do not be suit for surgical treatment, including hepatic portal tumor 25 cases (17 with primary hepatocellular carcinoma,8 with metastasis carcinoma), biliary carcinoma 11 cases, pancreatic carcinoma 6 cases, Clastkin tumor 7 cases. These patients were divided into four groups in random sampling. One underwent EMBE, the second underwent both EMBE and after-loading treatment,the third group underwent both EMBE and RFA, The last underwent both EMBE and PCS. EMBE of Percutaneous biliary drainage were placed in these patients first. The second group was given after-loading treatment then. The third group was given RFA after EMBE. PCS were done in the last group. Chemotherapeutic agents were infused through PCS according to characteristics of biology and pharmacokinetics.

RESULTS

49 cases were successfully placed EMBE. In 49, 13 cases underwent EMBE, 16 cases underwent after-loading treatment after EMBE, 9 cases received RFA treatment, 11 cases underwent PCS after EMBE. Follow-up time was 1-12 months. For group EMBE: 6 cases (46.1%) developed re-obstruction in 1-3 months, 8 cases(61.5%)died in 2-6 months ,11 cases (84.6%)died in 12 months; for group after-loading:4 cases (25.0%) reobstructed in 1-3 months, 5 cases(31.25%) died in 2-6 months, 6 cases(37.5%) died in 12 months; for group EMBE and RFA: 2 cases (22.2%) reobstructed in 1-3 months ,2 cases (22.2%) died in 2-6 months, 3 cases (33.3%) died in 12 months;for group EMBE and PCS:3 cases (27.27%) reobstructed in 1-3 months ,5 cases (45.45% ) died in 2-6 months, 6 cases (54.54%) died in 12 months. The four groups have significant difference in reobstruction rate and mortality rate, by T-test (P< 0.01). conclusion EMBE combined with brachytherapy is more effective methods than EMBE in treatment of malignant biliary obstruction.

Treatment of malignant digestive tract obstruction by combined intraluminal stent installation and intra-arterial drug infusion

AIM: To study the palliative treatment of malignant obstrution of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs.

METHODS: A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus, stomach, duodenum and jejunum), per anal (colon and rectum) and percutaneous transhepatic (biliary) installation of metallic stent. Among them, 203 cases received drug infusion by cannulation of tumor supplying artery with Seldinger’s technique.

RESULTS: Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8-43 weeks among those with intra-arterial drug infusion, which was later than 4-26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3-105) weeks, which was significantly longer than 13 (3-24) weeks of the latter group.

CONCLUSION: Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.

[Correlation between synaptic protein phosphorylation in hippocampi and shuttle box avoidance behavior]

The present investigation was undertaken to detect whether protein phosphorylation levels of hippocampal synaptosomes in mice trained on shuttle box avoidance task would show some changes. The synaptosomes were prepared at different times after the conclusion of training and labelled with gamma-32P-ATP for in vitro determination. The results are as follows: (1) No significant differences were found in the phosphorylation of synaptosomal proteins in different brain areas in normal mice before training. (2) Immediately after the conclusion of shuttle box avoidance task there appears a correlation between protein phosphorylation levels in hippocampal synaptosomes and the degree of success of training. (3) 24 h after the completion of training the above relationship is more significant, and protein phosphorylation levels of right hippocampus in Good Score Group is markedly higher than that of left one, but in the Inferior Score Group, the left-right difference is reverse. The formation of such asymmetry in protein phosphorylation in hippocampi is unknown. These data indicate that the synaptic protein phosphorylation in hippocampi might be a molecular mechanism of acquisition.

Neuropeptides related to neurohypophyseal hormones interfere with apomorphine-induced behavioral changes

The interaction between peptides related to neurohypophyseal hormones and brain dopaminergic systems was studied by investigating in rats the effect of these peptides on behavioral changes induced by graded doses of the specific dopamine agonist apomorphine. Low doses of this drug induce hypoactivity of the animals, while higher doses result in hyperactivity and stereotyped sniffing. Desglycinamide9[Arg8]vasopressin (DG-AVP), prolyl-leucyl-glycinamide (PLG) and oxytocin did not interfere with the behavioral responses induced by the higher doses of apomorphine. Peptide treatment made the rats more sensitive to apomorphine with respect to the drug induced hypoactivity. PLG and especially DG-AVP were more effective than oxytocin. It is concluded that these peptides may have a selective action on distinct dopaminergic receptor systems in the brain, that are presumably located presynaptically in the nucleus accumbens area.