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Abstract:Surveillance programs and widespread use of medical imaging have increased the detection of hepatic tumors. When feasible, surgical resection is widely accepted as the curative treatment of choice, but surgical morbidity and mortality have spurred the development of minimally invasive ablative technologies over the last 2 decades. Microwave ablation has emerged as a promising thermal ablation modality with improving oncologic efficacy due to technical improvements and image guidance strategies. In this article, we overviewed microwave application in liver tumors, and discussed currently available equipment, clinical efficacy and safety, and provided comparisons with other commonly used therapies. We also introduced advanced ablative techniques and combination therapies that may help achieve precise ablation and further enhance the efficacy of microwave ablation.

Abstract:Objective To evaluate the efficacy, safety and survival influencing factors of focused ultrasound ablation (FUA) in elderly patients with advanced pancreatic cancer (aged more than 60 years). Methods Clinical data of the patients over 60 years old with advanced pancreatic cancer admitted in Affiliated Hospital to Academy of Military Medical Sciences from September 2010 to September 2015 were retrospectively collected and analyzed. They were all treated with a JC high intensity focused ultrasound (HIFU) system. The local ablation efficacy, pain relief and occurrence of complications were evaluated. The overall survival rate (OSR) and median survival time (MST) were statistically analyzed. The main factors affecting MST were analyzed. Results The obtained 44 patients received totally 47 treatments of FUA. The patients who achieved complete response (CR) accounted for 6.8% (3/44), partial response (PR) for 77.2% (34/44), stable condition (SD) for 13.6% (6/44), and progress condition (PD) for 2.3% (1/44). The pain relief rate was 97.4% (38/39), with the pain scores decreased significantly postoperatively (P<0.001). For the patients with stage Ⅲ and Ⅳ pancreatic cancer, the MST were 16.5 (6.1-51) and 9.8 (3-24.4) months, and the 1-and 2-year cumulative survival rates were 62.9% and 21.0%, and 39.1% and 4.3%, respectively. The overall incidence of complications was 50.0% (22/44), among which 95.5% (21/22) were mild complications, and no severe complication was seen. Cox multivariate analysis indicated that the main factors affecting prognosis were clinical stage, ablation efficacy and combination treatment. The MST reached to 24.2 months in the patients with stage Ⅲ who combined chemotherapy and radiotherapy. Conclusion FUA is a good option for advanced pancreatic cancer in the elderly patients, with better efficacy of local ablation, obvious pain relief, and prolonged survival time. The complications can be controlled. It is worth of further study.

Abstract:Objective To investigate the safety and efficacy of microwave ablation (MWA) in the treatment of primary hyperparathyroidism (PHPT). Methods Clinical data of 6 patients with totally 6 PHPT nodules managed by MWA in our center from August 2014 to July 2015 were collected and retrospectively analyzed. They underwent multiple point ablation therapy at a power of 25-30 W. After MWA, ultrasound examination was used to evaluate the efficacy of the ablation. The changes in intact parathyroid hormone (iPTH), and serum levels of calcium and phosphorus before and after the operation were detected and analyzed. Results The ablation time of one PHPT nodule was 550-840 (638±138) s. In 1 d after MWA, the level of iPTH was decreased from (479.2±477.3)ng/L preoperatively to (69.3±49.8)ng/L (P>0.05), while that of calcium was declined from (2.57±0.13)mmol/L to (2.08±0.15)mmol/L (P<0.05). Their levels were slightly increased at the end of follow-up (P>0.05). There was no obvious change in the serum level of phosphorus before and after MWA (P>0.05). No complication was found during and after MWA treatment. Conclusion MWA is safe and effective in the treatment of PHPT, and can obviously decrease the levels of iPTH and serum calcium. It might become an alternative for surgical treatment in the management of PHPT.

Abstract:Objective To investigate the feasibility and perioperative safety of microwave ablation for the elderly with benign thyroid nodules under ultrasound guidance. Methods A retrospective analysis was carried out on 471 elderly over 60 years old with benign thyroid nodules (totally 1000 nodules) who underwent microwave ablation under the ultrasound guidance in our department from July 2009 to October 2015. Intraoperative and postoperative adverse reactions and corresponding treatment measures were recorded. The ablation range was assessed by contrast-enhanced ultrasound examination after operation. Results Ultrasound guided percutaneous microwave ablation was successfully performed on all the 471 patients under local anesthesia. Among them, 453 patients with 979 nodules were ablated completely, and 18 patients with 21 nodules were ablated mostly because nodules grew behind the sternum. The ablation time for single nodule was (150±103)s. After the end of ablation, contrast enhanced ultrasound examination showed that the volume of no contrast agent filling area was (8.45±16.26)cm3, which had no significant difference with the preoperative mean volume of nodules ［(8.66±15.61)cm3, P>0.05］. This indicated that tumor tissues were completely ablated, with no obvious residual, and the nodules achieved complete ablation. All patients had good tolerance, and no adverse effects and pain terminated the surgical treatment. There were 432 patients having pain grade of 0-5. After operation, 1 case suffered from left heart failure, and the other one from bronchial spasm. No severe complications were found in the subjects. Conclusion Percutaneous microwave ablation under ultrasound guidance is a safe and effective approach for the elderly with benign thyroid nodules. It is worthy of promotion in clinical practice.

Abstract:Objective To investigate the efficacy, feasibility and safety of the one-step ultrasound-guided percutaneous transhepatic cholangiographic drainage (PTCD) in treatment of bile duct obstruction in aged patients (>60 years old). Methods Clinical data of 147 old patients who underwent one-step PTCD with bile duct obstruction in our department from December 2012 to August 2015 were collected and retrospectively analyzed. The operation time, cost, duration of the disease, incidence of complications, preoperative and postoperative levels of serum total bilirubin (STB), were analyzed. The success rate of one-step puncture, and the incidence of complications were compared in different groups of gender, age, duration of the disease, preoperative STB level, preoperative diameter of bile duct and the causes of obstruction. Results There were 127 (86.4%) cases undergoing successful one-step PTCD. No significant difference was seen in the success rate of operation among the patients of different genders and with different causes of obstruction, but obvious differences were observed in patients at different ages and with different duration of disease, preoperative STB level, and preoperative diameter of bile duct (P<0.05). There were 17 patients experiencing postoperative complications, and significant differences were seen among those of different STB level and of benign and malignant obstruction (P<0.05). Conclusion One-step PTCD is a safe and effective treatment for bile duct obstruction in aged patients. Its success rate of puncture is associated with the duration of disease, severity and cause of bile duct obstruction. The incidence of complications is closely related to the preoperative level of STB and causes of obstruction.

Abstract:Objective To compare the roles of B-mode ultrasonography and spectral-domain optical coherence tomography (SD-OCT) in the diagnosis of senile posterior vitreous detachment (PVD). Methods A total of 62 old patients (over 60 years old, 70 eyes), with no obvious eye diseases or surgery history, refractive power within ±3 Diopter, and main complaint of flickering shadows, who admitted in Outpatient Department of our hospital from May to September 2015 were randomly enrolled in this study. All the patients underwent routine eye examination, B-mode ultrasonography, and SD-OCT, and the results of B-mode ultrasonography and SD-OCT were compared for the diagnosis of PVD. Results B-mode ultrasound results showed there were 39 cases of complete PVD (43 eyes, 61.4%) and 23 cases of incomplete PVD (27 eyes, 38.6%). OCT showed 19 cases were incomplete PVD (23 eyes, 32.8%), which was consistent with the results of B-mode ultrasound examination. OCT indicated that there were 43 cases (47 eyes, 67.1%) having no PVD, and all identified PVD were incomplete PVD. OCT results indicated that there were 11 eyes (15.7%) of macular epiretinal membrane, 4 eyes (5.7%) of macular hole, and 6 eyes (8.6%) of vitreomacular traction, and 9 eyes (12.8) of early age-related macular degeneration. Conclusion B-mode ultrasonography provides a significant higher detection rate of senile PVD than SD-OCT. But SD-OCT has more advantages than ultrasound in detecting the early incomplete PVD. Combination of B-mode ultrasonography and SD-OCT significantly improves the detection rate of PVD.

Abstract:Objective To determine the therapeutic effect of percutaneous microwave ablation (PMWA) on the elderly patients with liver cancer and investigate the precautionary measures for its complications. Methods A total of 207 elderly patients(>65 years old) with 374 lesions of liver cancer were enrolled in this study. They were divided into 2 groups according to tumor size and number, that is, group A (the tumor diameter less than 4 cm with number less than 3) and group B (over 3 tumors with diameter greater than 4 cm, or a single lesion over 6 cm in size). The patients of both groups were treated with PMWA. The curative effect and complications were observed after surgery, and contrast enhanced ultrasound examination or MR imaging were employed to evaluate the complete ablation. The patients were regularly followed up for 6 to 60 months after treatment. PMWA was carried out again for those with local tumor progression or recurrence. Results In 1 month after PMWA, totally 326 lesions were completely ablated, accounting for 87.2% (326/374). The 1-, 2-, 3-, 4-and 5-year survival rates were 95.3%, 84.6%, 82.5%, 79.2% and 68.8% respectively for group A, and 62.5%, 55.6%, 31.2%, 27.3%, and 0.0% for group B, and significant differences were found between the 2 groups (P=0.021). There were 4 cases (1.07%, 4/374) out of group B having serious complications, including abdominal bleeding in 2 cases and liver abscess in 2 cases. No gastrointestinal and bile duct injury, biliary fistula, or needle tract implantation were found in the subjects. Conclusion PMWA is an effective treatment for liver cancer in the elderly. Tumor size and number, and liver function are main factors for postoperative survival. Ablation needle types, and regimens of power and time are effective measures to prevent the injuries of gastrointestinal tract, bile duct and diaphragm. Postoperative systemic support, anti-abdominal infections and other comprehensive treatment can reduce fatal complications.

Abstract:Objective To evaluate the security and efficiency of bedside interventional ultrasonography in the diagnosis and treatment of critically ill elderly patients. Methods A total of 85 critically ill elderly patients admitted in the Internal Medicine Ward of the Fujian Provincial Hospital from January 2013 to August 2015 were recruited in this study. With the aid of portable ultrasound system, bedside ultrasonography guiding biopsy or catheter drainage was performed on all of them. Results In the 15 patients undergoing biopsy, correct diagnoses were obtained in 13 cases, and the other 2 cases were unable to get a clear pathological diagnosis. In the group of catheter drainage (n=70), 23 cases of non-infectious effusion obtained patency drainage, and the corresponding symptoms disappeared thereafter. For the 47 cases of infectious effusion, their conditions were improved, and their symptoms, including temperature, heart rate, white blood cell count and depth of effusion, were significantly relieved after drainage (P<0.05). Medium dosage of bleeding was observed in 2 cases after thorax drainage. Conclusion Bedside interventional ultrasonography is safe and convenient in the diagnosis and treatment of the critically ill elderly patients, and has good value in clinical practice.

Abstract:Objective To analyze the factors affecting the diagnostic yield of ultrasound guided cutting needle pleural biopsy for tuberculous pleurisy. Methods A total of 200 cases of tuberculous pleurisy confirmed by pleural biopsy (206 biopsies) or during follow up in our hospital from March 2011 to December 2014 were enrolled in this retrospective study. The influencing factors for the diagnostic yield of ultrasound guided pleural biopsy were analyzed. Results The overall diagnostic yield was 79.6% (164/206) for ultrasound guided cutting needle biopsy for pleural tuberculosis. Patient’s age, disease duration, and pleural thickness had statistical significances for the diagnostic yield of pleural biopsy (P<0.05). Multivariate logistic regression analysis showed that the pleural thickness ≥3 mm, duration ≥21 d, and age ≥40 years were independent risk factors for the diagnostic yield. For the patients with pleural thickness ≥3 mm, the diagnostic yield of aspiration biopsy was approximately 5 times higher than those with the thickness ＜3 mm (OR=4.77, P=0.001). The yield was almost 4 times higher in the patients with duration ≥21 d than those with the duration ＜21 d (OR=3.65, P=0.018), and was almost 3 times higher in the patients younger than 40 years old than those older (OR=2.69, P=0.012). Conclusion Ultrasound guided cutting needle biopsy is a safe, simple, and economical approach with high diagnostic yield for tuberculous pleurisy. Age, disease duration and pleural thickness are the important factors to influence the diagnostic yield of pleural tuberculosis.

Abstract:Objective To investigate the efficacy of ultrasound-guided aspiration and sclerotherapy with lauromacrogol and ethanol in treatment of hepatic and renal cysts in the elderly. Methods A total of 116 elderly patients with hepatic and renal cyst admitted in our department from January 2013 to December 2014 were subjected in this study. According to their sclerotherapeutic agents, they were divided into lauromacrogol and ethanol groups, with 58 cases in each group. Ultrasound-guided aspiration and sclerotherapy with lauromacrogol and ethanol were respectively given to corresponding patients. Length of hospital stay, therapeutic outcomes and side effects were observed and compared between the 2 groups. Results The length of hospital stay was (5.78±0.89)d, and the effective rate was 89.66% (52/58) for the lauromacrogol group. And the length was (6.16±1.45)d and the rate was 94.83%(55/58) for the ethanol group. No significant differences were seen between the 2 groups (P>0.05). There were 2 cases of adverse reaction in the former group, and 9 in the latter, with statistical differences between the 2 groups (P<0.05). ConclusionUltrasound-guided aspiration and sclerotherapy, no matter with lauromacrogol or ethanol, is effective and easy to operate, in treatment of hepatic and renal cysts in the elderly. But the former agent has lower incidence of adverse reaction, so it is the best choice for elderly patients with hepatic and renal cyst.

Abstract:Objective To assess the long-term efficacy of enhanced ablation in pulmonary vein antrum (PVA) guided by remote magnetic navigation (RMN) in the patients with atrial fibrillation (AF). Methods From January 2013 to June 2015, 49 consecutive patients with refractory non-valvular AF who undergoing radiofrequency catheter ablation and voluntarily taking part in this study in our hospital were recruited in this study. They were randomized into a conventional ablation group (CAG, n=24) and an enhanced ablation group (EAG, n=25). PVA isolation was achieved by creating a single ablation circle in the patients of CAG group, and was double ablation circles at PVA in those of EAG group. An irrigated magnetic ablation catheter, CARTO 3 mapping system and Niobe magnetic navigation were used in both groups. A Lasso mapping catheter was used to confirm PVA isolation. Regular Holter monitoring was used to follow up all patients. Results PVA isolation succeeded in all the patients. Ablation energy delivery time was obviously longer in EAG group than in CAG group ［(45.66±6.59) vs (40.10±3.48) min, P<0.01］. There were no significant differences in fluoroscopic time, procedure time and venous NT-proBNP level between the 2 groups (P>0.05). During the follow-up of (19.3±5.6) months, Holter monitoring showed that the AF recurrence rate was remarkably lower in EAG group than in CAG group (8.00% vs 33.33%, P<0.05). Reconnection between left atrium and PV was confirmed in 8 relapsed patients during re-ablation, and reoperation was successful in all of them. Conclusion Enhanced PVA ablation effectively improves the long-term outcomes of AF and reduces the recurrence rate.

Abstract:Objective To observe and evaluate the efficacy of combined lipoic acid and statins in the elderly who suffered from atherosclerosis. Methods A total of 80 patients with atherosclerosis from Department of Geriatrics of our hospital during September 2014 and September 2015 were recruited in this study. They were randomly divided into control group and lipoic acid group, with 40 cases in each group. The control group received conventional drugs such as atorvastatin calcium, while the lipoic acid group took lipoic acid preparations besides the conventional drugs. The efficacy were evaluated by determining the blood lipid levels, such as tryglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and high sensitivity C-reactive protein (hs-CRP), and by carotid internal artery intima-media thickness (IMT) and brachial-ankle artery pulse wave velocity (baPWV) through carotid color Doppler ultrasound and arteriosclerosis in four limbs in 6 months after the treatment. Results The levels of TG, TC, LDL-C, hs-CRP, IMT and baPWV were greatly improved in the both groups after 6 months’ treatment when compared with the values before treatment. What’s more, the above results were more significantly in the lipoic acid group than in the control group (all P<0.05). There were some adverse reactions in both groups, including infusion site pain, phlebitis, dizziness or headache, hypoglycemia, and purpura, but with no significant difference between the two groups.Conclusion Combination therapy of lipoic acid and statins can reduce the levels of TG, TC, LDL-C and hs-CRP, elevate the level of HDL-C, and improve IMT and baPWV. It has good clinical efficacy, causes no serious adverse reactions, and should be promoted for clinical application.

Abstract:Objective To investigate the feasibility of gastric emptying measured by ultrasonography in guiding enteral feeding in critically ill patients receiving mechanical ventilation. Methods A total of 76 critical patients who received mechanical ventilation for over 24 h and underwent enteral nutrition admitted in our department between May 2014 and November 2015 were recruited in this study. These patients were prospectively randomized into ultrasound assessment group (n=38) and gastric fluid withdrawing group (n=38). The therapeutic strategy of enteral nutrition was adjusted based on gastric emptying and gastric motility index measured by ultrasonography every 4 h for the patients from the former group, while was based on the gastric residual volume by withdrawing gastric fluid every 4 h for those of the latter group. The time of reaching 80% total enteral nutrition (TEN), incidence of ventilator-associated pneumonia (VAP), numbers of reflux and diarrhea, serum level of prealbumin, time of weaning, and length of stay in ICU were recorded and compared for the efficiency of enteral nutrition. Results The time of reaching 80% TEN was significantly shorter ［(36.4±6.2) vs (45.1±7.8) h, P<0.05］, and the incidences of VAP (13.2% vs 36.8%) and of enteral nutrition related complications (28.9% vs 55.3%) were significantly lower in the ultrasound assessment group than in the gastric fluid withdrawing group (P<0.05). What’s more, the time of weaning ［(3.6±1.1) vs (5.8±2.0) d］, and the length of stay in ICU ［(9.2±2.6) vs (12.3±3.7 d)］ were also obviously shorter in the former group (P<0.05). Conclusion Ultrasonography-measured gastric emptying is optimal in guiding the therapeutic strategy of enteral nutrition for the critical patients receiving mechanical ventilation, in improving the efficiency, reducing the related complications, and shortening the durations of ventilation and ICU staying.

Abstract:Objective To analyze the thyroid function changes among the patients with different Wagner grades of diabetic foot disease (DF), and compare the results with the diabetic patients with non-diabetic foot (NDF) for the relationship between the severity of diabetic foot and thyroid function in type 2 diabetic patients. Methods A retrospective study was carried out on 481 DF patients and 445 NDF admitted in the Department of Endocrinology of the Chinese PLA Hospital No.306 from June 2009 to June 2015. According to the Wagner ulcer grade classification scale, the DF patients were divided into 4 groups, that is, Wagner grade 1, 2, 3, and 4-5 groups. The thyroid function was determined for all the patients, and the results were statistically analyzed among the groups by SPSS 21.0. Results The DF patients had higher incidence of thyroid dysfunction than the NDF patients (17.67% vs 12.36%, χ2=5.082, P<0.05). The subclinical hypothyroidism and euthyroid sick syndrome (ESS）were common in both the NDF and DF groups (6.07% and 8.73%). Significant differences were seen in the levels of three triiodothyronine (TT3), total thyroxine (TT4), three free triiodothyronine (FT3) between the DF and NDF groups (P<0.01). With the increase of Wagner grade, the levels of TT3 and FT3 became lower in the DF patients (P<0.01), and the percentage of ESS became higher (2.00%, 2.55%, 9.24% and 18.33% respectively for the 4 Wagner grade groups, t=24.455, P<0.05). The diabetic patients with ESS stayed in hospital longer than the others, but there was no statistical significance. Logistic regression analysis indicated that gender, length of hospital stay, high sensitivity C-reactive protein, and TT4 were the independent risk factors for DF (OR=2.938,1.178, and 1.222,1.047;P<0.01), but albumin, FT3 and 2-hour postprandial glucose level were the protective factors for DF (OR=0.881, 0.899 and 0.406; P<0.01). Conclusion There is higher incidence of ESS in DF patients, especially in those with Wagner grade 3 and above. Thyroid function test is helpful to evaluate the DF severity, and estimate the prognosis.

Abstract:Objective To compare the application of endoscopic retrograde cholangiopancreatography (ERCP) in the patients at different ages in order to explore the safety and efficacy of the approach in the elderly. Methods A total of 360 patients undergoing ERCP in our hospital between January 2012 and January 2015 were collected and retrospectively studied. They were divided into very old group (≥75 years old, n＝120), old group (60-75 years old, n＝123), and the non-elderly group (≤60 years old, n＝117). Their operation conditions and complications were investigated and compared among the 3 groups. Results There were overall 377 ERCP procedures performed in the 360 cases. There were no significant differences in the success rate of ERCP procedure and incidence of complications among the 3 groups (P＞0.05). Conclusion Diagnostic and therapeutic ERCP exerts similar efficacy in the elderly as in the non-elderly patients. ERCP is safe and effective in the patients at different ages.

Abstract:Objective To detect the expression of survivin in normal lung and non-small cell lung cancer (NSCLC) tissues, and investigate the relationship of its expression with the clinical pathological characteristics of NSCLC as well as the cancer cell cycle. Methods Immunohistochemical SP staining was used to detect the expression of survivin in 43 samples of NSCLC tissues and 10 samples of normal lung tissues. The relationship of survivin expression and clinicopathological characteristics of NSCLC was analyzed. In order to evaluate the correlation of survivin expression with cancer cell cycle, flow cytometry was used to detect the cells isolated from 6 NSCLC samples with 6 samples without survivin expression to calculate the values of S-phase fraction (SPF) and proliferation index (PI). Results (1) The positivity rate of survivin expression was 51.16% in NSCLC tissues, and 0.00% in normal lung tissues, with significant difference between them (P<0.05). (2) The expression of survivin was obviously correlated with patient’s gender and lymph node metastasis (P<0.05), but not with patient’s age, pathological classification and T staging (P>0.05). (3) The results of flow cytometry indicated that there were statistical significances in PI value (11.80±4.25 vs 5.68±2.56) and SPF value (13.93±3.21 vs 6.44±2.52) between the cells isolated from the NSCLC samples with or without survivin expression (P<0.05). Conclusion (1) The expression of survivin is significantly higher in the NSCLC tissue than in normal lung tissue. (2) Survivin expression is obviously correlated with gender and lymph node metastasis. (3) The PI and SPF values are significantly higher in survivin positive than negative NSCLC cells, which indicate that survivin positive expression promotes the proliferative activity of tumor cells through inhibition of apoptosis.

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Abstract:Heart failure (HF) is a serious condition representing the end-stage of myriad of cardiovascular diseases. With high prevalence, HF is one of the major focuses in global prevention and management of chronic cardiovascular diseases. Significant progress has been made in pharmacotherapy of HF in past decades, but chronic HF remains to be associated with substantial morbidity and mortality. The recent approval by the US FDA of LCZ696, the first of a new class of drugs with dual angiotensin receptor blocker(ARB) and neprylisin(NEP) inhibition mechanisms, for the treatment of heart failure with reduced left ventricular ejection fraction(HFrEF), represents a major breakthrough in the development of novel pharmacotherapy for HF. In the landmark PARADIGM HF trial, LCZ696 demonstrated significantly improved morbidity and mortality over enalapril, a standard of care in HFrEF. In this review, we discussed the pharmacology, efficacy and clinical application of this new drug.

Abstract:The pathophysiological basis of heart failure (HF) is ventricular remodeling on the basis of inflammation and fibrosis. In recent years, evidence shows that galectin-3 plays an important role in the mechanism of cardiac regulation and has been recognized as a biological predictor for HF prognosis because its expression level reflects the severity and hierarchical of HF. However, its effect in the treatment of HF remains unclear. This article reviewed the studies on the correlation of galectin-3 and HF in order to provide new therapy ideas for clinicians.