1.The Basic And Clinical Study Of The Foot-head Direction Puncture Approach In Ablation Of The Liver Tumor Adjacent To Diaphragm 2.The Study Of Anti-angiogenesis Of Capillary Wormwood Herb Water Extract On Zebra Fish By Targeting Vascular Endothelial Prot

Background:Thermal ablation therapy is considered to be an important means of treatment of liver cancer,but for the tumor lesions adjacent to diaphragm which is affected by diaphragmatic muscle,lung tissue and costophrenic angle,rib,there is a high incidence of complication and the ablation procedure remains difficult to carry out.Objects:The aim of this study is to evaluate the accessibility and difficulty of puncturing standard lesions in the fashion of foot-head direction,based on construction of a standard lesion of the liver under the diaphragm using CT reconstruction image and the statistical description and analysis of parameters about the puncture pathway in the fashion of foot-head direction in the analog means.Methods:The sagittal and coronal plane reconstructions were carried out in image-processing software and the standard lesion model below diaphragm were established in the analog means.Foot-head direction was adopted to puncture these standard lesions in the analog means.The height of the diaphragm,the length of the puncture path,and the distance between the puncture paths were measured.According to the distribution of the needle in the standard lesions,the accessibility of the lesions was divided into full access,partial access and no access.And the tolerance of puncture was evaluated when the accessibility was full access.And statistical analysis was used.Results:One hundred and thirty four patients with upper abdominal CT scan from June 2015 to June 2016 were collected,of which 86 cases were included and 48 cases were excluding.Of the all standard lesion A in sagittal plane 1,24.39%(20/82)were no access,23.17%(19/82)were partial access and 52.43%(43/82)were full access.The median length of the puncture pathway for the lesions with full access is 10.39 cm and the median width is 2.1cm between two needles.Of the all standard lesion B in sagittal plane 1,19.51%(16/82)were no access,19.51%(16/82)were partial access and 60.97%(50/82)were full access.Of all the lesions with full access,9 were through the dorsal pathway and the median length of puncture pathway for is 12.66cm;41 were through ventral pathway and the median length is 12.66 cm.The median width between two needles in the lesions with full access is 2.1cm.Of the all standard lesion C in sagittal plane 1,6.97%(6/86)were no access,54.65%(47/86)were partial access and 38.37%(33/86)were full access.The median length of the puncture pathway for the lesions with full access is 13.15 cm and the median width is 2.06 cm between two needles.Of the all standard lesion D,2.35%(2/85)were no access,44.70%(38/85)were partial access and 52.94%(45/85)were full access.The median length of the puncture pathway for the lesions with full access is 8.88 cm and the median width is 2.11 cm between two needles.Of the all standard lesion B',2.35%(2/85)were no access,34.11%(29/85)were partial access and 63.53%(54/85)were full access.The median length of the puncture pathway for the lesions with full access is 11.26 cm and the median width is 2.145 cm between two needles.Of the all standard lesion E,23.08%(3/13)were no access,76.92%(10/13)were full access.The median length of the puncture pathway for the lesions with full access is 9.81 cm and the median width is 2.12 cm between two needles.Of the all standard lesion F,28.57%(2/7)were no access,71.42%(5/7)were full access.The median length of the puncture pathway for the lesions with full access is 10.7 cm and the median width is 2.11 cm between two needles.The main reasons for blocking the puncture path are anatomical structures such as ribs,kidney,gallbladder,costophrenic angle and so on.Conclusions:By measuring the puncture approach for the standard lesions in analog form,the(1)the puncture approach in the fashion of foot-head direction for the standard A,B,D and B' have high full access rate with high puncture tolerance,which deserves further application in clinical practice.(3)The standard C has lower full access rate.(2)The proportion of standard lesion E and F that is in need of the puncture approach in the fashion of foot-head direction is not high.Background:It is difficult to ablate the tumor adjacent to diaphragm and the complication rate is high.While quite a few methods were worked out to deal with it,this problem still remain unresolved satisfactorily.According to the author's previous study,the approach of foot-head direction is a feasible route in the theory with the advantage of avoiding damaging diaphragm,vital important organs as well as with good tolerance.Objective:The aim of this study is to evaluate safety,difficulty,feasibility and effectiveness of the foot-head direction puncture approach in performing the cryoablation of hepatocellular carcinoma adjacent to diaphragm.Methods:The location of tumor lesions were analyzed in the patients with hepatocellular carcinoma proved by pathology or clinical diagnosis criteria and the tumor lesions which are above the costophrenic anglelevel were divided into foot-head direction group,in which the lesions were punctured in the fashion of foot-head direction and the tumor lesions which are below the costophrenic angle level were divided into control group,in which the lesions were punctured within the plane of cross-section.After the satisfactory position of probes was achieved,the cryoablation was carried out and the length of puncture route,the times of CT scan,complete ablation rate after procedure in the two groups were measured and recorded.The intra-procedure complications and post-procedure complications were recorded.The contrast CT or MRI scan were used to remark the local recurrence of the lesions after 2-3 months follow-up.All the data were analyzed statistically.Results:A total of 81 patients met the criteria of diagnosis for hepatocellular carcinoma.Twenty four of 81 were excluded and 57 patients with 68 lesions were included in this study.Of the 37 lesions in the foot-head direction group and 29 lesions in the control group,the technological success rate is 91.89%(34/37)and 93.64%(29/31)(equivalence test,P<0.05),respectively and average length of puncture route is 10.97 cm and10.13cm(equivalence test,P<0.05),respectively.The average times of CT scan is 14.42 and14.01(equivalence test,P<0.05),respectively.After cryoablation,the complete ablation rate in the foot-head direction group and control group is 82.35%(28/34)and 79.31%(23/29),P>0.05,respectively and no serious complication occurred.In the 2-4 months follow-up after procedures,the local recurrence rate in the foot-head direction group and control group is 24.13%(7/29)and 20.83%(5/24)P>0.05.Conclusion:Compared with the lesions below the costophrenic angle level,the foot-head direction puncture approach is a safe and feasible route in the ablation of hepatocellular carcinoma above the costophrenic angle level without the increased difficulty and compromising the efficacy of ablation.Background and AimsRegulation of angiogenesis has become the latest research direction of common diseases such as malignant tumors,cardiovascular and cerebrovascular diseases,but human beings have only a preliminary understanding of specific pathways and signal transduction mechanisms.Before 2000,traditional Chinese medicine began to be used in the treatment of tumors.It is necessary to further study the specific mechanism of heat clearing and detoxicating herbs in anti-tumor.Heat-clearing and detoxifying is a major solution treatment of tumors.So these Chinese herbs deserve further study in terms of antiangiogenic effect.In this study,the transgenic zebrafish was treated with water extract of capillary wormwood herb,and the green fluorescent protein was developed to observe the inhibitory effect on the neovascularization of zebrafish.Furthermore,the regulation mechanism of Artemisia capillaris inhibiting angiogenesis in zebrafish was studied.Methods:1?The fertilized embryos of TG strain of fli1a-EGFP transgenic zebrafish were divided into 3 groups.The zebrafish embryos were treated with capillary wormwood extract,0.1%DMSO(blank control group)and Wata Rani(positive control group),then the vascular phenotypes were observed and photographed under the body fluorescence microscope to observe the zebrafish groups in order to analyze the effect of intersegmental vascular(ISVs)formation.2?The rt-PCR technology was adopted to exam the expression of ptp-rb?nr2f1a?VE-cadherin?S1P1?CD146?pik3r2?netrin1a?fgfr1a?fgfr2?fgfr3?fgfr4,which are associated with the function of vascular endothelial cell and adhesion each other in the zebrafish embryos that have been treated by the capillary wormwood herb water extract.And the possible mechanism was discussed.Results:1?The intervention of capillary wormwood herb water extract with zebrafish embryos have abnomal fluorescence expression of ISVs and DLAV,suggesting that the water extract has an inhibition on angiogenesis of zebrafish.2?The extract of capillary wormwood herb can significantly decrease the expression level of ptp-rb in zebrafish embryos(P<0.001).The down regulation of expression level of nr2f1 a caused by extract of capillary wormwood herb has no significantly difference compared with the control group and the up-regulations of VE-cadherin?S1P1?CD146?pik3r2?netrin1a?fgfr1a,fgfr2,fgfr3,fgfr4 genes also have no significantly difference compared with the control group.It can be deduced that the inhibition of zebra angiogensis caused by capillary wormwood herb depends on down regulation of expression level of ptp-rb and the decreased amount of vascular endothelial PTP.Conclusions:1?The capillary wormwood herb water extract can have anti-angiogenic effects in zebrafish.2 ? The mechanism of anti-angiogenic effects is associated with the down-regulation of expression of ptp-rb.And the decreased amount of VE-PTP capillary and the suppressed dephosphorylation degree of VE-caderin could be involved in the anti-angiogenic effect.