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Two-photon Hong-Ou-Mandel (HOM) interference is a fundamental quantum effect with no classical counterpart. The existing research on two-photon interference was mainly limited in one degree of freedom (DOF); hence, it is still a challenge to realize quantum interference in multiple DOFs. Here, we demonstrate HOM interference between two hyperentangled photons in two DOFs of polarization and orbital angular momentum (OAM) for all 16 hyperentangled Bell states. We observe hyperentangled two-photon interference with a bunching effect for ten symmetric states (nine boson-boson states and one fermion-fermion state) and an antibunching effect for six antisymmetric states (three boson-fermion states and three fermion-boson states). More interestingly, expanding the Hilbert space by introducing an extra DOF for two photons enables one to transfer the unmeasurable external phase in the initial DOF to a measurable internal phase in the expanded two DOFs. We directly measured the symmetric exchange phases being 0.012±0.002, 0.025±0.002, and 0.027±0.002 in radian for the three boson states in OAM and the antisymmetric exchange phase being 0.991π±0.002 in radian for the other fermion state, as theoretical predictions. Our Letter may not only pave the way for more wide applications of quantum interference, but also develop new technologies by expanding Hilbert space in more DOFs.

Developing high-efficiency microwave absorbers remains challenging in the broadband range, particularly in the low-frequency range containing the L band and even lower. To overcome this challenge, a hybrid metamaterial absorber comprising a conventional magnetic absorbing material and a multi-layered meta-structure predesigned with graphene films is proposed to realize wideband absorption performance starting from ultra-low frequencies (0.79-20.9 GHz and 25.1-40.0 GHz). The high absorption ability of the proposed device originates from fundamental resonance modes and their coupling. The experimental results agree well with the simulated ones, proving the effectiveness of our design method. In addition, owing to the use of low-density polymethylacrylimide foam and graphene films with outstanding mechanical properties, our design is lightweight and environmentally adaptable, which reflects its engineering value.

High-spin conjugated radicals have great potential in magnetic materials and organic spintronics. However, to obtain high-spin conjugated radicals is still quite challenging due to their poor stability. We report the successful synthesis and isolation of a stable triplet conjugated diradical, 10,12-diaryldiindeno[1,2-b:2',1'-e]pyrazine (m-DIP). With the m-xylylene analogue skeleton containing electron-deficient sp 2 -nitrogen atoms, m-DIP displays significant aromatic character within its pyrazine ring and its spin density mainly delocalizes on the meta-pyrazine unit, making it a triplet ground state conjugated diradical. Our work provides an effective "spin density tuning" strategy for stable high-spin conjugated radicals., (© 2020 Wiley-VCH GmbH.)

Solution-processable highly conductive polymers are of great interest in emerging electronic applications. For p-doped polymers, conductivities as high a nearly 10 5 S cm -1 have been reported. In the case of n-doped polymers, they often fall well short of the high values noted above, which might be achievable, if much higher charge-carrier mobilities determined could be realized in combination with high charge-carrier densities. This is in part due to inefficient doping and dopant ions disturbing the ordering of polymers, limiting efficient charge transport and ultimately the achievable conductivities. Here, n-doped polymers that achieve a high conductivity of more than 90 S cm -1 by a simple solution-based co-deposition method are reported. Two conjugated polymers with rigid planar backbones, but with disordered crystalline structures, exhibit surprising structural tolerance to, and excellent miscibility with, commonly used n-dopants. These properties allow both high concentrations and high mobility of the charge carriers to be realized simultaneously in n-doped polymers, resulting in excellent electrical conductivity and thermoelectric performance., (© 2020 Wiley-VCH GmbH.)

The core-shell structure of endohedral fullerene-based anisotropic magnetic molecules of high spin with long coherence time could help scale up quantum systems. In this research, by amination of Gd@C 82 with morpholine, three derivatives are functionalized with 5, 7 and 9 morpholine groups providing an interesting model to investigate the relationship between the quantum coherence and the spin environment. The original radical located on the carbon cage is successfully quenched, affording a quantum phase memory times ( T M ) over 5 μs at 5 K. By increasing the number of substitution groups, spin-lattice relaxation times ( T 1 ) also show significant enhancement due to the interaction variation between the molecules and the environments. We found that the T M of the three molecules show no obvious difference below 10 K, while they are limited by T 1 at higher temperatures. In this work, the variable functional groups are able to tune both T 1 and T M , offering the possibility for application of high-spin magnetic molecules in the field of quantum information processing., Competing Interests: The authors declare no conflict of interest., (This journal is © The Royal Society of Chemistry.)

Objective: To explore the predictive values of the combination of preoperative data, including medical history and physical examination, and results of sleep oximetry performed early after the surgery (one week) in predicting the treatment outcomes of uvulopalatopharyngoplasty (UPPP) in adult patients with obstructive sleep apnea hypopnea syndrome (OSAHS)., Methods: All the patients who were diagnosed with OSAHS, underwent UPPP treatment and had complete follow-up data in our institution between Jan 2013 and May 2016 were enrolled in our study. The pre-operative data of these patients, including age, physical examination, and polysomnography (PSG) data, were all exactly collected for analysis. All these patients had received the evaluation of subjective efficacy scale and the sleep oximetry test in early post-operative days (within one week). The long-term efficacy evaluations including PSG and subjective efficacy scale were all finished at least three months after the surgery., Results: In the research 61 patients were finally studied, including 25 responders (41.0%) and 36 non-responders (59.0%). Regression analysis revealed that the pre-operative Friedman stage and early post-operative oxygen desaturation index of ≥4% (ODI4) were found to be independently predictive parameters for the UPPP treatment outcomes (P<0.05). The ROC curve analysis was used to estimate the predictive values of ODI4 to the treatment outcomes, and it was calculated with an area under the curve of 0.822. Using the ODI4 of 15 as the cutoff value, the sensitivity and specificity of that calculated were up to 0.778 and 0.760 respectively. The response rate among the patients with an early post-operative ODI4 of <15 was 70.4%, which was significantly higher than that of the patients with an early post-operative ODI4 of ≥15, whose response rate was 17.6% (P<0.05). The similar results could also be obtained in the patients with pre-operative Friedman stage II (87.5% vs.25.0%) and Friedman stage III (33.3% vs. 6.7%)., Conclusion: The combination of early post UPPP operation oximetry parameters, especially ODI4, and pre-operative Friedman stage could be used in better evaluating the potential surgical outcomes of UPPP.

As one of the most promising semiconductor oxide materials, titanium dioxide (TiO 2 ) absorbs UV light but not visible light. To address this limitation, the introduction of Ti 3+ defects represents a common strategy to render TiO 2 visible-light responsive. Unfortunately, current hurdles in Ti 3+ generation technologies impeded the widespread application of Ti 3+ modified materials. Herein, we demonstrate a simple and mechanistically distinct approach to generating abundant surface-Ti 3+ sites without leaving behind oxygen vacancy and sacrificing one-off electron donors. In particular, upon adsorption of organodiboron reagents onto TiO 2 nanoparticles, spontaneous electron injection from the diboron-bound O 2- site to adjacent Ti 4+ site leads to an extremely stable blue surface Ti 3+ ‒O -· complex. Notably, this defect generation protocol is also applicable to other semiconductor oxides including ZnO, SnO 2 , Nb 2 O 5 , and In 2 O 3 . Furthermore, the as-prepared photoelectronic device using this strategy affords 10 3 -fold higher visible light response and the fabricated perovskite solar cell shows an enhanced performance., (Copyright © 2019 The Author(s). Published by Elsevier Inc. All rights reserved.)

Low n-doping efficiency and inferior stability restrict the thermoelectric performance of n-type conjugated polymers, making their performance lag far behind of their p-type counterparts. Reported here are two rigid coplanar poly(p-phenylene vinylene) (PPV) derivatives, LPPV-1 and LPPV-2, which show nearly torsion-free backbones. The fused electron-deficient rigid structures endow the derivatives with less conformational disorder and low-lying lowest unoccupied molecular orbital (LUMO) levels, down to -4.49 eV. After doping, two polymers exhibited high n-doping efficiency and significantly improved air stability. LPPV-1 exhibited a high conductivity of up to 1.1 S cm -1 and a power factor as high as 1.96 μW m -1  K -2 . Importantly, the power factor of the doped LPPV-1 thick film degraded only 2 % after 7 day exposure to air. This work demonstrates a new strategy for designing conjugated polymers, with planar backbones and low LUMO levels, towards high-performance and potentially air-stable n-type polymer thermoelectrics., (© 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Magnetic circular dichroism (MCD) and magnetic linear dichroism (MLD) have been investigated in a photoemission electron microscopy (PEEM) system excited by a deep ultra-violet (DUV) laser (with λ = 177.3 nm and hυ = 7.0 eV) for the first time. High resolution PEEM magnetic images (down to 43.2 nm) were directly obtained on a (001)-oriented magnetic FePt film surface with a circularly-polarized light under normal incidence. Furthermore, a stepped Cr seeding layer was applied to induce the formation of large-area epitaxial FePt films with (001) and (111) two orientations, where MLD with large asymmetry was observed in the transition area of two phases. It demonstrates that DUV laser can be a powerful source for high resolution magnetic imaging in the laboratory in absence of synchrotron facilities., (Copyright © 2019 Elsevier B.V. All rights reserved.)

To understand the adaptative strategies of different tree species to drought and nutrient-deficient environment in coastal sandy site, leaf functional traits and nutrient resorption of four major silviculture tree species, i.e., Casuarina equisetifolia, Pinus elliottii, Acasia crassicarpa and Eucalyptus urophylla × E. grandis were analyzed. Leaf area and specific leaf area of coniferous species (C. equisetifolia and P. elliottii) were significantly lower, and leaf dry matter content and leaf thickness were significantly higher than those of broadleaved species (A. crassicarpa and E. urophy-lla × E. grandis). Nitrogen and P contents of mature leaf and leaf litter in broadleaved species were higher than those in coniferous species. Nitrogen and P contents of mature leaf were higher than those in leaf litter, but N:P was lower than that in leaf litter. Nitrogen and P resorption efficiencies were higher in coniferous species than those in broadleaved species. The P resorption efficiency in all species was significantly higher than N resorption efficiency. The N resorption efficiency of C. equisetifolia, P. elliottii, A. crassicarpa and E. urophylla × E. grandis was 64.2%, 63.1%, 47.0% and 16.8%, and the P resorption efficiency was 92.5%, 81.6%, 80.3% and 18.0%, respectively. The specific leaf area was significantly positively correlated with leaf N and P contents, but negatively correlated with leaf dry matter content, leaf thickness, and nutrient resorption efficiency. Leaf dry matter content was significantly positively correlated with leaf thickness and nutrient resorption efficiency. Therefore, C. equisetifolia and P. elliottii belonged to slow investment species with a higher nutrient resorption efficiency, while A. crassicarpa and E. urophylla × E. grandis belonged to fast investment species with lower nutrient resorption efficiency. Different tree species developed different adaptive strategies to coastal sandy environments through the interactions between leaf functional traits and nutrient resorption.

A mononuclear low spin ( S = 1/2) Co(II) molecule crystallized in a 4-fold symmetry is fully investigated by CW and pulsed EPR on a single crystal sample. The quantum phase memory time of the molecule around 1 μs at 5 K is direction-independent, while the Rabi oscillation frequency is anisotropic. The spin Hamiltonian analyses reveal that the anisotropic Landé factor and hyperfine tensor do not influence the anisotropy apparently when the microwave magnetic field is applied along a certain direction. It is considered that the possibly involved nuclear spin forbidden transitions may be responsible for the small distinction of Rabi frequencies in two directions.

Organic semiconductors for spin-based devices require long spin relaxation times. Understanding their spin relaxation mechanisms is critical to organic spintronic devices and applications for quantum information processing. However, reports on the spin relaxation mechanisms of organic conjugated molecules are rare and the research methods are also limited. Herein, we study the molecular design and spin relaxation mechanisms by systematically varying the structure of a conjugated radical. We found that solid-state relaxation times of organic materials are largely different from that in solution state. We demonstrate that substitution of a lower gyromagnetic ratio nucleus (e. g. D, Cl) on the para-position of the aryl rings in the triphenylmethyl (TM) radical can significantly improve their coherence times (T m ). Flexible thin films based on such radicals exhibit ultra-long spin-lattice relaxation times (T 1 ) up to 35.6(6) μs and T m up to 1.08(4) μs under ambient conditions, which are among the longest values in films. More importantly, using the TM radical derivative (5CM), we observed room-temperature quantum coherence and Rabi cycles in thin film for the first time, suggesting that organic conjugated radicals have great potentials for spin-based information processing., (© 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Cisplatin (CDDP)-based systematic chemotherapy remains the mainstay of treatment for muscle-invasive bladder cancer (MIBC). However, acquired resistance to CDDP, a multifactorial process governed by an array of signals acting at different levels, is the major problem in BC treatment. Here, we report for the first time that, expression of Paired-box gene 5 (PAX5), a B-cell essential transcription factor, was significantly induced in CDDP-resistant BC tissues and in experimentally-induced CDDP-resistant BC cells. Inhibition of PAX5 expression by shRNA treatment effectively improved CDDP sensitivity in BC cells, whereas overexpression of PAX5 potentiated CDDP resistance through supporting BC cell survival. Mechanistically, using luciferase reporter and chromatin immunoprecipitation assays, we identified prostaglandin-endoperoxide synthase 2 (PTGS2, also called COX2), a potent enzyme responsible for prostanoids formation and inflammatory response, as the direct down-stream target of PAX5. PAX5 exerted its oncogenic function during the pathogenesis of CDDP resistance via stimulation of PTGS2 transcription. These observations collectively suggest that dysregulation of PAX5/PTGS2 cascade plays a causal role in the induction of CDDP resistance and gene silencing approaches targeting this pathway may therefore provide a novel therapeutic strategy for overcoming CDDP resistance in BC., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Herein we report a general electrochemical strategy for the Sandmeyer reaction. Using electricity as the driving force, this protocol employs a simple and inexpensive halogen source, such as NBS, CBrCl 3 , CH 2 I 2 , CCl 4 , LiCl and NaBr for the halogenation of aryl diazonium salts. In addition, we found that these electrochemical reactions could be performed using anilines as the starting material in a one-pot fashion. Furthermore, the practicality of this process was demonstrated in the multigram scale synthesis of aryl halides using highly inexpensive graphite as the electrode. A series of detailed mechanism studies have been performed, including radical clock and radical scavenger study, cyclic voltammetry analysis and in situ electron paramagnetic resonance (EPR) analysis.

Inspired by the cubic Mn 4 CaO 5 cluster of natural oxygen-evolving complex in Photosystem II, tetrametallic molecular water oxidation catalysts, especially M 4 O 4 cubane-like clusters (M=transition metals), have aroused great interest in developing highly active and robust catalysts for water oxidation. Among these M 4 O 4 clusters, however, copper-based molecular catalysts are poorly understood. Now, bio-inspired Cu 4 O 4 cubanes are presented as effective molecular catalysts for electrocatalytic water oxidation in aqueous solution (pH 12). The exceptional catalytic activity is manifested with a turnover frequency (TOF) of 267 s -1 for [(L Gly -Cu) 4 ] at 1.70 V and 105 s -1 for [(L Glu -Cu) 4 ] at 1.56 V. Electrochemical and spectroscopic study revealed a successive two-electron transfer process in the Cu 4 O 4 cubanes to form high-valent Cu III and Cu III O . intermediates during the catalysis., (© 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

An anisotropic high-spin qubit with long coherence time could scale the quantum system up. It has been proposed that Grover's algorithm can be implemented in such systems. Dimetallic aza[80]fullerenes M 2 @C 79 N (M = Y or Gd) possess an unpaired electron located between two metal ions, offering an opportunity to manipulate spin(s) protected in the cage for quantum information processing. Herein, we report the crystallographic determination of Gd 2 @C 79 N for the first time. This molecular magnet with a collective high-spin ground state (S = 15/2) generated by strong magnetic coupling (J Gd-Rad = 350 ± 20 cm -1 ) has been unambiguously validated by magnetic susceptibility experiments. Gd 2 @C 79 N has quantum coherence and diverse Rabi cycles, allowing arbitrary superposition state manipulation between each adjacent level. The phase memory time reaches 5 μs at 5 K by dynamic decoupling. This molecule fulfills the requirements of Grover's searching algorithm proposed by Leuenberger and Loss.

We investigate the spin Hall magnetoresistance (SMR) in a gadolinium iron garnet (GdIG)/platinum (Pt) heterostructure by angular dependent magnetoresistance measurements. The magnetic structure of the ferromagnetic insulator GdIG is non-collinear near the compensation temperature, while it is collinear far from the compensation temperature. In the collinear regime, the SMR signal in GdIG is consistent with the usual [Formula: see text] relation well established in the collinear magnet yttrium iron garnet, with [Formula: see text] the angle between magnetization and spin Hall spin polarization direction. In the non-collinear regime, both an SMR signal with inverted sign and a more complex angular dependence with four maxima are observed within one sweep cycle. The number of maxima as well as the relative strength of different maxima depend strongly on temperature and field strength. Our results evidence a complex SMR behavior in the non-collinear magnetic regime that goes beyond the conventional formalism developed for collinear magnetic structures.

Mechanistic insight into estrogen deficiency by polycystic ovary syndrome (PCOS) remains a longstanding challenge in reproductive medicine. Recent advance suggest that Wingless-type MMTV integration site family members (WNTs), in concert with its Frizzled (FZD) receptors, regulate normal folliculogenesis, luteogenesis and ovarian steroidogenesis. However, no studies have so far investigated any causality between WNT-FZDs interactions and disrupted estrogen synthesis under certain pathological conditions. Here, we show that (i) FZD3 expression was significantly up-regulated in the cumulus cells (CCs) from PCOS patients. This up-regulation, along with the activation of WNT2/β-Catenin pathway, was tightly associated with insulin resistance and estrogen deficiency, two hallmarks of PCOS. (ii) Overexpression of exogenous FZD3 in human granulosa cell COV434 impaired long-term FSH incubation-induced CYP19A1 transactivation and the recruitment of β-Catenin onto CYP19A1 promoter, and subsequently compromised FSH-stimulated estrogen production. (iii) Conversely, inhibition of FZD3 expression exhibited a therapeutic effect on estrogen synthesis in PCOS CCs. Thus, excessive FZD3 expression in CCs may act as a brake on steroidogenic activation that is normally overcome by FSH stimulation. Future endeavor in this field should help to elucidate the complicated crosstalk between energy metabolism and endocrine cells through WNT/FZD signaling molecules., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The core-shell structure of endohedral fullerenes results in good protection of the encapsulated spin carriers from the environment. In this research, the quantum coherence behavior of the endohedral fullerene Sc 3 C 2 @C 80 in CS 2 solution is characterized from 5 K to room temperature. Below the critical temperature of around 140 K, the inner group is hindered, and the EPR spectrum consists of a single broad line. The spin carriers display a maximum phase memory time of 17.2(7) μs at 10 K. In the high temperature region, the inner group is mobile, and the EPR spectrum consists of 22 homogeneously broadened lines due to isotropic hyperfine coupling. The maximum phase memory time for each transition is around 139(1) ns at 200 K which allows arbitrary superposition state manipulations to be performed. This research demonstrates that Sc 3 C 2 @C 80 displays temperature-crossover behaviour due to weak interaction between the Sc 3 C 2 core and the C 80 shell.

Members of the Drosophila behavior/human splicing protein family, including splicing factor proline/glutamine rich (SFPQ), non-POU domain-containing octamer-binding protein (NONO), and paraspeckle protein component 1 (PSPC1), are abundantly expressed in testicular Sertoli cells (SCs), but their roles remain obscure. Here, we show that treatment with mono-(2-ethylhexyl) phthalate (MEHP), a well-known SC toxicant, selectively stimulates the expression levels of NONO and PSPC1. Simultaneous inhibition of NONO and PSPC1 expression in SCs enhances MEHP-induced oxidative stress and potentiates SC death. Mechanistically, NONO and PSPC1 transcriptionally activate aldehyde dehydrogenase 1 (Aldh1a1), by synergistically binding to the distinct CCGGAGTC sequence in the Aldh1a1 promoter. Together, the NONO/PSPC1-ALDH1A1 cascade may serve as an indispensable defense mechanism against MEHP insult in SCs., (© 2017 Federation of European Biochemical Societies.)

Cancer Stem-like Cells (CSCs) are a subpopulation of cancer cells with self-renewal capacity and are important for the initiation, progression and recurrence of cancer diseases. The metabolic profile of CSCs is consistent with their stem-like properties. Studies have indicated that enzymes, the main regulators of cellular metabolism, dictate functionalities of CSCs in both catalysis-dependent and catalysis-independent manners. This paper reviews diverse studies of metabolic enzymes, and describes the effects of these enzymes on metabolic adaptation, gene transcription and signal transduction, in CSCs.

Abnormal perpetual inflammatory response and sequential cytokine-induced prostaglandin E2 (PGE2) play important roles in the pathogenesis of rheumatoid arthritis (RA). The underlying regulatory mechanism, however, remain largely unknown. Here, we discovered that expression level of Metastasis associated protein 1 (MTA1), an important chromatin modifier that plays a critical role in transcriptional regulation by modifying DNA accessibility for cofactors, was upregulated in human rheumatoid synovial tissues. Furthermore, a knockdown of MTA1 by siRNA in the human fibroblast-like synovial cell line MH7A was found to impair the 4-hydroxynonenal (4-HNE)-induced transcriptional expression levels of certain proinflammatory cytokines including IL-1β, TNF-α and IL-6. Moreover, endogenous MTA1 was required for the cytokines-induced PGE2 synthesis by rheumatoid synoviocytes. Collectively, the coordinated existence of MTA1 inside distinct cascade loops points to its indispensable role in the modulation of the integrated cytokine network along the pathogenesis of RA. Further exploration of the functional details of this master transcriptional regulator should be an attractive strategy to identify novel therapeutic target for RA and warrants execution., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Primary hepatic carcinosarcoma is a rare tumor and is comprised of a mixture of carcinomatous and sarcomatous elements. We present a case of primary carcinosarcoma of the liver in a 59-year-old woman, which was confirmed by pathology following surgical resection. Using contrast-enhanced ultrasonography, the tumor showed peripheral nodular hyperenhancement in the arterial phase with two feeding arterial vessels and a large internal non-enhancing portion in the center. The peripheral nodular portion of the tumor showed hypoenhancement in the later phase.

Background/aims: Despite great progress in the treatment of hepatocellular carcinoma (HCC) over the last-decade, intrahepatic recurrence is still the most frequent serious adverse event after all the treatments including microwave ablation. This study aimed to predict early recurrence of HCC after microwave ablation using serum proteomic signature., Methods: After curative microwave ablation of HCC, 86 patients were followed-up for 1 year. Serum samples were collected before microwave ablation. The mass spectra of proteins were generated using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS). Serum samples from 50 patients were randomly selected as a training set and for biomarkers discovery and model development. The remaining serum samples were categorized for validation of the algorithm., Results: According to preablation serum protein profiling obtained from the 50 HCC samples in the training set, nine significant differentially-expressed proteins were detected in the serum samples between recurrent and non-recurrent patients. Decision classification tree combined with three candidate proteins with m/z values of 7787, 6858 and 6646 was produced using Biomarker Patterns Software with sensitivity of 85.7% and specificity of 88.9% in the training set. When the SELDI marker pattern was tested with the blinded testing set, it yielded a sensitivity of 80.0%, a specificity of 88.5% and a positive predictive value of 86.1%., Conclusions: Differentially-expressed protein peaks in preablation serum screened by SELDI are associated with prognosis of HCC. The decision classification tree is a potential tool in predicting early intrahepatic recurrence in HCC patients after microwave ablation.

Primary liver cancer and liver metastases are among the most frequent malignancies worldwide, with an increasing number of new cases and deaths every year. Traditional surgery is only suitable for a limited proportion of patients and imaging-guided percutaneous thermal ablation has achieved optimistic results for management of hepatic malignancy. This synopsis outlines the first clinical practice guidelines for ultrasound-guided percutaneous microwave ablation therapy for hepatic malignancy, which was created by a joint task force of the Society of Chinese Interventional Ultrasound. The guidelines aim at standardizing the microwave ablation procedure and therapeutic efficacy assessment, as well as proposing the criteria for the treatment candidates.

Objective: To determine the incidence and risk factors associated with needle tract seeding after percutaneous microwave ablation (MWA) of liver cancer under ultrasound guidance., Materials and Methods: Over a 14-year period, a total of 1462 patients with 2530 malignant nodules were treated by MWA. The influence of age, sex, Child-pugh classification, tumor size, tumor position, previous biopsy, insertion number and antenna type on the risk of neoplastic seeding was assessed. The survival of seeding patients after the MWA was analyzed., Results: Eleven patients with 12 nodules (0.47% per tumor, 0.75% per patient) were identified with needle tract seeding with an interval time of 6-37 (median 10) months after MWA. The mean size of the seeding nodule was 2.3 ± 0.7 cm (from 1.3 to 3.9 cm). Only previous biopsy was significantly associated with neoplastic seeding (P=0.02). All the seeding lesions were successfully treated by resection, MWA, radiation or high intensity focus ultrasound. The median survival period of the 11 patients after the MWA was 36.0 months. The cumulative survival rates of the 11 patients after the MWA at 1-, 2-, 3-, 4- and 5-year were 90.9%, 72.7%, 62.3%, 31.2% and 15.6%, respectively., Conclusion: The results showed that the neoplastic seeding was a low risk complication of percutaneous MWA of liver cancer and was considered acceptable in general., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To evaluate the efficiency and feasibility of microwave (MW) ablation assisted by a real-time virtual navigation system for hepatocellular carcinoma (HCC) undetectable by conventional ultrasonography., Methods: 18 patients with 18 HCC nodules (undetectable on conventional US but detectable by intravenous contrast-enhanced CT or MRI) were enrolled in this study. Before MW ablation, US images and MRI or CT images were synchronized using the internal markers at the best timing of the inspiration. Thereafter, MW ablation was performed under real-time virtual navigation system guidance. Therapeutic efficacy was assessed by the result of contrast-enhanced imagings after the treatment., Results: The target HCC nodules could be detected with fusion images in all patients. The time required for image fusion was 8-30 min (mean, 13.3 ± 5.7 min). 17 nodules were successfully ablated according to the contrast enhanced imagings 1 month after ablation. The technique effectiveness rate was 94.44% (17/18). The follow-up time was 3-12 months (median, 6 months) in our study. No severe complications occurred. No local recurrence was observed in any patients., Conclusions: MW ablation assisted by a real-time virtual navigation system is a feasible and efficient treatment of patients with HCC undetectable by conventional ultrasonography., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objective: The purpose of this study was to investigate the characteristics of focal hypoechoic tumors of fatty liver using conventional ultrasonography and contrast-enhanced ultrasonography (CEUS)., Methods: Sixty-four hypoechoic tumors of fatty liver in 52 patients were examined by both conventional ultrasonography and CEUS. Contrast pulse sequencing and a sulfur hexafluoride contrast agent were used for CEUS. The enhancement patterns were evaluated in real time. Results. Hypoechoic tumors of fatty liver showed posterior echo enhancement, including 71.4% (25 of 35) of hemangiomas, 73.3% (11 of 15) of metastases, and 50.0% (3 of 6) of hepatocellular carcinomas (HCCs) on conventional ultrasonography. During the early arterial phase, 62.5% (5 of 8) of focal nodular hyperplasia lesions showed a central spoked wheel enhancement pattern, whereas the remaining 37.5% (3 of 8) showed eccentric spoked wheel enhancement. During the arterial phase, 97.1% (34 of 35) of hemangiomas showed peripheral enhancement and centripetal fill-in, including ringlike peripheral enhancement (12 of 35), small nodular peripheral enhancement (19 of 35), and massive irregular peripheral enhancement (3 of 35). In total, 76.5% (26 of 34) of hemangiomas were completely filled in. All HCCs showed complete enhancement from 9 to 24 seconds during the arterial phase and began to wash out from 21 to 114 seconds. During the arterial phase, 40.0% (6 of 15) of metastases showed ringlike enhancement; 26.7% (4 of 15) showed slight hyperenhancement; 13.3% (2 of 15) showed hyperenhancement quickly; and the remaining 20.0% (3 of 15) showed heterogeneous hyperenhancement. All metastatic tumors began to wash out from 25 to 40 seconds. In total, 92.2% (59 of 64) of focal hypoechoic tumors of fatty liver were diagnosed as the correct pathologic type with CEUS., Conclusions: With CEUS, characterization of hypoechoic tumors of fatty liver is greatly improved.

Objective: To investigate the local cellular immune response after injection of superantigen, the highly agglutinative staphylococin (HAS), into the tumor bed after ultrasound-guided percutaneous microwave coagulation therapy (PMCT) in the liver cancer patients., Methods: Ninety-two patients with pathologically proven primary liver cancer were divided into two groups: 45 in group A were treated by PMCT alone and 47 in the group B by combined with ultrasound-guided percutaneous injection of highly agglutinative staphylococin (HAS). Before and after PMCT and HAS treatment, the patients underwent ultrasound-guided percutaneous biopsy from the tumor bed and the samples were examined by pathology and immunohistochemistry. The infiltration of CD3+, CD4+, CD57+ and CD68+ lymphocytes in treatment zone was compared between the two groups. Moreover, the infiltrating immunocytes were observed by transmission electron microscopy., Results: One week after HAS injection, the densities of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 54.50 +/- 18.44, 38.14 +/- 12.44, 33.38 +/- 10.79 and 45.56 +/- 16.53, respectively. All the above mentioned parameters increased significantly in varying degrees compared with that before PMCT or HAS injection (P < 0.05). Four weeks after HAS injection, the density of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 32.67 +/- 10.42, 23.43 +/- 6.99, 18.63 +/- 7.89 and 30.01 +/- 11.05, respectively, still significantly higher than those before PMCT (P < 0.05). Five weeks after PMCT and HAS injection, the densities of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 54.50 +/- 18.44, 38.14 +/- 12.44, 33.38 +/- 10.79 and 45.56 +/- 16.53, versus 32.03 +/- 8.11, 15.67 +/- 8.32, 15.23 +/- 8.26 and 29.67 +/- 11.98 in the group A, respectively, still with a significant difference between the two groups (P < 0.05). A lot of lysosomes, endoplasmic reticulum and mitochondria in the immune cells after injection of HAS were observed by transmission electron microscopy., Conclusion: The local cellular immunity in liver cancer treatment area can be significantly improved by ultrasound-guided injection of highly agglutinative staphylococin after percutaneous microwave coagulation therapy.

Purpose: To investigate the vascular characteristics of focal fatty infiltration (FFI) in the liver using color Doppler sonography (CDUS) and contrast-enhanced sonography (CEUS)., Methods: We prospectively examined 25 areas of FFI of the liver in 20 patients via conventional gray-scale sonography, CDUS, and CEUS. Cadence contrast pulse sequencing and the contrast agent SonoVue were used for CEUS examination. CEUS criteria for diagnosis of FFI were isoenhancement or hypoenhancement in the arterial phase and homogeneous isoenhancement in the portal and late phases., Results: CDUS revealed a draining vein in 4 of 9 (44%) lesions in the hepatic hilum, whereas CEUS revealed a draining vein in 8 (89%) lesions. A vein was associated with the 2 lesions located at the edge of segment II on both CDUS and CEUS. Blood flow was seen on both CDUS and CEUS in the 2 lesions adjacent to the falciform ligament. In one patient, CDUS and CEUS revealed the mid-hepatic vein coursing between 2 FFIs. In the arterial phase of CEUS, the lesions were hypoenhancing in 44% (11/25), iso-enhancing in 44% (11/25), and hyperenhancing in 12% (3/25). In the portal phase and in the late vascular phase, all 25 lesions (100%) were iso-enhancing. Sensitivity of combined sonography and CDUS in the diagnosis of FFI was 44%, and overall accuracy was 81%. The sensitivity of CEUS in the diagnosis of FFI was 88%, and its overall accuracy was 96%., Conclusion: FFI in the porta hepatis is correlated with aberrant venous drainage. FFI around the falciform ligament may be related to divergence of the portal vein or unusual blood supply. In the arterial phase of CEUS, FFI lesions were iso-enhancing as often as they were hypoenhancing., ((c) 2008 Wiley Periodicals, Inc.)

Objective: The purpose of this study was to investigate whether focal fatty sparing (FFS) formation in the liver relates to aberrant blood flow., Methods: Sixty-three FFSs of the liver in 52 patients were examined by color Doppler flow imaging and contrast-enhanced microvessel display sonography. The 63 FFSs included 16 FFSs in the porta hepatis, 14 FFSs around the gallbladder fossa, and 33 other FFSs. The control group included patients with a diagnosis of fatty liver but no FFSs or focal lesions near the porta hepatis., Results: Fourteen of 16 FFSs in the porta hepatis showed venous blood toward those areas that were differentiated from the portal and hepatic veins. Focal fatty sparings in the hilus hepatis correlated with aberrant veins, having a statistical significance compared with the control group (P < .0001). Seven of 14 FFSs around the gallbladder fossa contained blood vessels, 5 of them veins and the remaining 2 arteries. Two FFSs were located around hemangiomas. Three FFSs were located around maldeveloped vessels., Conclusions: The blood supply to an FFS in the porta hepatis may be correlated with aberrant veins. Focal fatty sparings around the gallbladder fossa may be associated with aberrant blood flow.

Purpose: This study aims to analyze the long-term therapeutic results of small HCC less than 5 cm in diameter after microwave ablation (MA) or hepatic resection (HR) and choose factors that could predict metastasis and recurrence of small HCC., Materials and Methods: The metastasis and recurrence of 194 patients with one HCC less than 5 cm in diameter who underwent curative HR or MA between January 1995 and December 2004 were reviewed retrospectively; immunohistochemistry was used to analyze the expressions of VEGF, bFGF, and c-Met in HCC tissues. Posttreatment prognostic factors were evaluated by multivariate analysis using Cox's proportional hazards model. The variables included the expressions of these three proteins in HCC tissues, the clinical and pathologic characteristics of the patients., Results: The retrospective study showed that 1-, 3-, and 5-year disease-free survival rates of patients with single HCC of diameter <5 cm were 71.3, 57.0 and 32.5%, respectively. Furthermore, 1-, 3-, and 5-year disease-free survival rates of the patients in MA group and resection group were 72.8, 54.0 and 33.0%; 68.5, 60.0, and 25.6%, respectively. There was no significant difference in disease-free survival rates between these two groups. The result of multivariate analysis showed that differentiation degree of HCC and the expressions of VEGF and c-Met in HCC tissues could be as the independent prognostic factors affecting metastasis and recurrence in patients with small HCC, whereas the methods of therapy had no impact on prognosis., Conclusions: The metastasis and recurrence rate after MA is similar to that after HR, and the methods of therapy do not affect the prognosis of small HCC. The metastasis and recurrence of patients with small HCC will differ depending on tumor differentiation, expressions of VEGF and c-Met in HCC tissues.

Objective: To explore therapeutic results of local microwave ablation for hepatic metastasis and the factors influencing the survival after percutaneous microwave ablation therapy., Methods: From July 1995 to June 2005 128 patients with 282 hepatic metastases nodules with the primary diseases of upper gastrointestinal tumor (n = 26), colorectal tumor (n = 44), breast carcinoma (n = 19), pulmonary carcinoma (n = 15), and malignant tumor in other part of the body (n = 24), underwent percutaneous microwave ablation therapy and were followed up for 29.7 +/- 19.9 months (1 - 103 months). The largest diameter of the metastatic nodules was 3.5 +/- 1.6 cm (0.7 - 8.6 cm). Sixty-four cases had 140 nodules 3.0 cm in diameter. Forty-seven patients had single nodule, 44 patients had 2 nodules, and 93 patients had 3 or more nodules. Fifty-seven patients had tumor of low differentiation, 53 had tumor of middle differentiation, and 18 had highly differentiated tumors. Kaplan-Meier method was used to calculate the cumulative survival rate. Statistical comparison of the effects of potential predictive factors on survival rate was performed using log-rank analysis. Multivariate analysis of the survival rates was performed by using Cox's proportional hazard model., Results: The 1, 2, 3, 4, and 5-year cumulative survival rates of all 128 patients were 90.88%, 73.84%, 51.09%, 36.14%, and 31.89% respectively. Univariate analysis showed that tumor size (P = 0.028), tumor differentiation (P = 0.026) and local recurrence or new metastases (P < 0.001) significantly affected the survival. Multivariate analysis revealed that tumor size (P = 0.035), recurrence or new metastases (P = 0.001) and tumor differentiation (P = 0.038) each had a significant effect on survival., Conclusion: There is a significantly higher probability of long-term survival for patients with well-differentiated tumors 3.0 cm or less in diameter and without recurrence or new metastasis after percutaneous microwave ablation.

Objective: To evaluate the long-term results of percutaneous microwave coagulation therapy in the treatment of early hepatocellular carcinoma., Methods: From May 1994 to June 2004, a total of 216 patients with 275 nodules of hepatocellular carcinoma whose diameter

Objective: To study the influence of percutaneous microwave ablation (PMA) and surgical resection for patients with small primary hepatocellular carcinoma (PHC) on dissemination of tumor cells in peripheral blood determined by AFP mRNA., Methods: Forty patients with small PHC (The maximal diameter < or = 5 cm) confirmed histologically were included in this study. All the patients had single tumor nodule only without metastasis. Of the 40 patients, 19 were treated by PMA and 21 by surgical resection. Blood samples were collected and tested immediately before treatment, 30 min after the mass ablated/resected, 1 d and 7 d later by RTD-Nested-RT-PCR for AFP mRNA. The CD3, CD4, CD8 and CD4/CD8 in blood, and hepatic function were tested at the same time points as well., Results: After treatment, ALT and AST in peripheral blood increased in both groups, but more intensely in the surgical group. The CD3, CD4 and CD4/CD8 in peripheral blood decreased at 30 min, 1 day and 7 days after surgical resection, and the lowest value was at 30 min after surgery. The immune function was kept at the same level as pre-treatment in the PMA group. AFP mRNA copies in blood could be detected in 27 of 40 patients (67.5%) in two groups before treatment, and the copy number was increased after treatment. There was no significant difference between the two groups. The patients were followed up for 1 - 16 months. AFP mRNA copies in blood could be detected persistently in the 4 patients with extrahepatic metastasis or liver recurrence., Conclusion: Surgical resection and microwave ablation may cause PHC cells dissemination into the blood circulation in patients with small PHC, and there was no difference between the two treatment groups. The cellular immune function in peripheral blood is decreased after surgical resection, but is maintained at the same level as pre-treatment in the PMA group. The impairment of liver function is less severe after PMA treatment than surgical resection. PMA may provide certain value for clinical management of small hepatocellular carcinoma.

Objective: The purpose of this study was to evaluate the difference between central and ventral peripheral positions and the difference between left and right lobes in rabbit liver with gray scale contrast enhancement., Methods: An in vivo model of perfusion was studied with a sulfur hexafluoride contrast agent and low-mechanical-index, real-time, gray scale harmonic imaging. The contrast agent (0.1 mL/kg body weight) was applied respectively in 10 rabbits by intravenous bolus injection. The time-intensity curve was used to obtain flow-related parameters such as time to enhancement (ET), time to peak intensity (PIT), peak signal intensity (PSI), enhancement duration (ED), and area under the curve (AUC)., Results: There was a significant difference in parameters of the time-intensity curve between central and peripheral ventral positions of liver parenchyma (P < .05), except for the ED in the left liver. The ET and PIT were earlier, the PSI higher, the ED longer, and the AUC larger in the central position of parenchyma than in the peripheral position. In addition, the ET and PIT were earlier, the PSI higher, the ED longer, and the AUC larger in the right lobe of liver parenchyma than in the left lobe. There was a significant difference in parameters of the time-intensity curve between the left and right lobes of liver parenchyma (P < .05), except for the ET of the peripheral position., Conclusions: Flow parameters are different between central and ventral peripheral positions and between left and right lobes of hepatic parenchyma.

Objective: The purpose of this study was to delineate the hemodynamic features of VX2 tumor and perineoplastic liver parenchyma and to evaluate the potential usefulness of single-level dynamic ultrasonography in the diagnosis of tumors by the analysis of time-intensity curves., Methods: An in vivo animal model was studied using a low mechanical index in conjunction with single-level dynamic contrast-enhanced ultrasonography. A sulfur hexafluoride contrast agent (SonoVue; Bracco SpA, Milan, Italy) was applied in 8 rabbits by intravenous bolus injection. Data were acquired before and after VX2 tumor induction. Corresponding parameters of the time-intensity curve were measured using wash-in/wash-out curve software., Results: No significant difference was found in the time to enhancement, time to peak intensity, peak signal intensity, and enhancement duration between liver parenchyma before and after VX2 tumor induction (P > .05). The typical enhancement pattern of VX2 tumors was hyperechoic relative to liver parenchyma during the early phase and hypoechoic during the later phase. The curves obtained in carcinomas revealed an early arrival time and time to peak intensity with an irregular and sharp decrease of the intensity signal and a very early return to baseline, presenting a much more rapid wash-in and wash-out of ultrasonographic contrast agents. There was a significant difference in the time to enhancement, time to peak intensity, peak signal intensity, and enhancement duration between the VX2 tumors and perineoplastic liver parenchyma (P < .001)., Conclusions: Single-level dynamic contrast-enhanced ultrasonography with a low mechanical index level could provide real-time and continuous enhanced images and fully delineate the typical enhancement pattern of liver tumors. The analysis of time-intensity curves may provide useful, complementary, and quantitative information. This technique may be useful for the diagnosis of liver tumors, especially those showing an atypical enhancement pattern on biphasic helical computed tomographic scanning.

Aim: The aims of this study were to explore individualized treatment method for hepatocellular carcinoma (HCC) patients whose maximum tumor size was less than 5 cm to improve prognosis and survival quality., Methods: Thirty cases of primary HCC patients undergoing tumor resection were retrospectively analyzed (resection group). All the tumors were proved as primary HCC with pathologic examination. The patients were divided into two groups according to follow-up results: group A, with tumor recurrence within 1 year after resection; group B, without tumor recurrence within 1 year. Immunohistochemical stainings were performed using 11 kinds of monoclonal antibodies (AFP, c-erbB2, c-met, c-myc, HBsAg, HCV, Ki-67, MMP-2, nm23-H1, P53, and VEGF), and expressing intensities were quantitatively analyzed. Regression equation using factors affecting prognosis of HCC was constructed with binary logistic method. HCC patients undergoing percutaneous microwave coagulation therapy (PMCT) were also retrospectively analyzed (PMCT group). Immunohistochemical stainings of tumor biopsy samples were performed with molecules related to HCC prognosis, staining intensities were quantitatively analyzed, coincidence rate of prediction was calculated., Results: In resection group, the expressing intensities of c-myc, Ki-67, MMP-2 and VEGF in cancer tissue in group A were significantly higher than those in group B (t = 2.97, P = 0.01; t = 2.42, P = 0.03<0.05; t = 2.57, P = 0.02<0.05; t = 3.43, P = 0.004<0.01, respectively); the expressing intensities of 11 kinds of detected molecules in para-cancer tissue in groups A and B were not significantly different (P>0.05). The regression equation predicting prognosis of HCC is as follows: P(1) = 1/[1+e(-(3.663-0.412mycc-2.187Ki-67c-0.397vegfc))]. It demonstrates that prognosis of HCC in resection group was related with c-myc, Ki-67 and VEGF expressing intensity in cancer tissue. In PMCT group, the expressing intensities of c-myc, Ki-67 and VEGF in cancer tissue in group A were significantly higher than those in group B (t = 4.57, P = 0.000<0.01; t = 2.08, P = 0.04<0.05; t = 2.38, P = 0.02<0.05, respectively); the expressing intensities of c-myc, Ki-67 and VEGF in para-cancer tissue in groups A and B were not significantly different (P>0.05). The coincidence rate of patients undergoing PMCT in group A was 88.00% (22/25), in group B 68.75% (11/16), the total coincidence rate was 80.49% (33/41)., Conclusion: The regression equation is accurate and feasible and could be used for predicting prognosis of HCC, it helps to select treatment method (resection or PMCT) for HCC patients to realize individualized treatment to improve prognosis.

Objectives: To explore the effect of c-Myc, Ki-67, MMP-2 and VEGF expression on prognosis of hepatocellular carcinoma (HCC) patients who had tumor resection., Methods: Primary HCC patients who underwent tumor resection were retrospectively analyzed. The maximum size of their mononodular tumors was less than 5 cm, and no intrahepatic arterial chemotherapy was performed before the resections. They were followed up after resection and the time of recurrence was recorded. They were divided into 2 groups: group A (15 cases): tumor recurred within 1 year after tumor resection; group B (15 cases): with tumor recurrence after 2 years or without it. Paraffin sections of the tumors were remade from their old blocks. Immunohistochemistry stainings were performed with c-Myc, Ki-67, MMP-2 and VEGF monoclonal antibodies. Staining intensity of the tumor and paracancer tissues was quantitatively analyzed., Results: c-Myc, Ki-67, MMP-2 and VEGF expressing intensities in cancer tissues in group A were higher than those in group B, and their expressed intensities in paracancer tissue in group A and B were not significantly different., Conclusion: The expressions of c-Myc, Ki-67, MMP-2 and VEGF in cancer tissues of the patients are related to the recurrence of their HCC after tumor resection.

Aim: To explore the effect of c-myc, Ki-67, MMP-2 and VEGF expression on prognosis of hepatocellular carcinoma (HCC) patients undergoing tumor resection., Methods: Primary HCC patients underwent tumor resection were retrospectively analysed. The maximum size of the tumor was less than 5 cm, there was only one nodule in each patient. No chemoembolization was performed before resection. They were followed up after resection, and the time of recurrence was recorded. They were divided into 2 groups: group A (15 cases): tumor recurrence within 1 year after tumor resection, and group B (15 cases): with or without tumor recurrence 2 years after tumor resection. Pathological slices were made with tumor wax-sample. Immunohistochemistry staining was performed with c-myc, Ki-67, MMP-2 and VEGF monoclonal antibodies. Staining intensity was quantitatively analysed with a pathological diagram-writing analyzing system. The expressing intensity differences of stained molecules in cancer tissue and para-cancer were analysed., Results: c-myc, Ki-67, MMP-2 and VEGF expressing intensities in cancer tissue in group A were higher than those in group B (P values were 0.010, 0.030, 0.022 and 0.004, respectively), but they were not significantly different in para-cancer tissue in groups A and B (P values were 0.334, 0.343, 0.334 and 0.334, respectively)., Conclusion: The expression of c-myc, Ki-67, MMP-2 and VEGF in cancer tissue is related to the recurrence of HCC after tumor resection.

Objective: To analyze the therapeutic results and prognostic factors of hepatic metastases treated by ultrasound-guided percutaneous microwave coagulation., Methods: Seventy-four patients with 149 nodules of hepatic metastases were given percutaneous microwave coagulation therapy. The longest diameter of the metastatic nodule ranged from 0.7 - 6.8 cm (mean, 3.1 +/- 1.8 cm). The cumulative survival rate was analyzed by Kaplan-Meier method and the difference between groups was compared with log-rank test. Cox proportional hazard model was used to determine potential prognostic variables., Results: The follow-up period for the 74 patients was 5 - 83 months (mean, 25.1 +/- 11.4 months). The overall 1-, 3-, and 5-year cumulative survival rates were 91.4%, 46.4% and 29.0%, respectively. The log-rank test showed that number of metastases, tumor size, tumor cell differentiation and local recurrence or new metastases were statistically significant prognostic factors; while age, sex and site of primary tumors were not significant prognostic factors. Multivariate analysis revealed that tumor differentiation, number of metastases and recurrence or new metastases were statistically significant prognostic factors., Conclusion: Ultrasound-guided percutaneous microwave coagulation therapy for hepatic metastases in patients with single metastasis, well-differentiated tumor, and without recurrence and new metastases could achieve long-term survival.

Objective: To study the effect of hepatic artery embolization on the microwave coagulated area, an in vivo animal experiment., Methods: Twenty-four suitable hepatic lobes of ten dogs were divided into two groups: microwave coagulation alone 12 lobes (control group) and hepatic artery occlusion with iodized oil and gelatin sponge particles followed by microwave coagulation 12 (experiment group). Microwave coagulation was delivered with an output of 50 W for 300 or 400 seconds with thermal needles introduced parallel to and 5 approximately 20 mm from the puncture needle. After sacrifice of the dogs, their hepatic lobes were sectioned along the puncture line. Then, the appearance and size of the coagulated area were recorded. The tissue specimens were fixed in formalin for light microscopic evaluation., Results: A decline in temperature gradient was detected from the center to the periphery of the affected tissue after the application of microwave coagulation, which was sharper in the control group than in the experimental group. Single polar microwave coagulation at 50 W for 300 seconds produced a necrotic volume of 25 approximately 33 mm in longitudinal diameter and 13 approximately 22 mm in transverse diameter in control group, 33 approximately 44 mm and 24 approximately 32 mm in the experimental group. The coagulation area was slightly bigger when the duration of coagulation was 400 seconds than 300 seconds, without significant difference., Conclusion: Hepatic artery occlusion, inhibiting the heat loss caused by hepatic arterial blood flow, is able to significantly enlarge the necrotic volume of microwave coagulation.

Purpose: To evaluate sequential pathologic and immunologic changes and their prognostic significance after percutaneous microwave coagulation therapy (PMCT) of hepatocellular carcinoma (HCC)., Methods: Eighty-nine nodules in 82 consecutive patients were studied. The 89 nodules were divided into two groups: a treatment group, with 82 primary nodules (average dimension was 3.4 +/- 1.2 cm) in 82 patients, and a control group, of seven nodules (average dimension was 1.4 +/- 0.6 cm) in seven patients. The criteria for a nodule's inclusion in the control group was that the nodule was one of two nodules in the same patient and that the two nodules were located in different liver lobes. This guarantees that while one nodule is treated by PMCT, the distant one will not be directly affected by the microwave thermal field. The control group nodules were treated after the study was completed. Specimens were taken with ultrasound-guided liver biopsy from the treated nodule and the control nodule, pre- and post-PMCT. Infiltration by T-lymphocytes, B-lymphocytes, NK cells and macrophages in the tumour tissue were observed immunohistochemically using a panel of monoclonal antibodies against CD3, CD45RO, CD20, CD56 and CD68. The extent of immune cell infiltration was compared both before and after PMCT, as well as between the treated and control nodules. The relationship between the prognosis and the extent of immunocyte infiltration was analysed., Results: The patients were followed for 2-26 months (mean 14.6 +/- 6.3) post-treatment. The recurrence rates at 1 and 2 years were 20.4% and 28.1% within the liver in treatment group, respectively. The survival rates at 1 and 2 years were 92.5% and 75.3% for the treatment group. T-cells, NK cells and macrophages increased significantly in both treated and untreated nodules after PMCT, albeit less markedly within untreated nodules when compared to the treated ones. There is a statistically significant correlation between survival outcome and the extent of immunocyte infiltration., Conclusions: For inoperable HCC patients, PMCT is one of the treatment choices shown to be effective. Apart from its tissue coagulation effect, an increased systemic immune response directed against the tumour may also play an important role in improved survival.

Objective: Percutaneous microwave coagulation was performed with a modified system in animal experiments and in a clinical study to evaluate this technique as a treatment option for liver cancer., Subjects and Methods: As an in vitro study, a microwave electrode was inserted 5-6 cm into separated egg white, homogenate of pig liver, and pig liver, with different power outputs and different lengths of inner conductors. In the animal experiment, the sonographically guided coagulation was performed percutaneously nine times and at laparotomy 43 times on 17 adult dogs. The thermal needles were placed parallel to and 5 mm, 8-12 mm, and 15 mm from the electrode. Clinically, 41 patients with hepatocellular carcinoma and 10 patients with hepatic metastases were treated with a 60-W microwave emission for 240-300 sec., Results: Microwave coagulation using the modified system at 60 W for 300 sec produced a necrosis volume of 3.7 x 2.6 x 2.6 cm. The coagulated volume was elliptic when the exposed inner conductor of the electrode was 27 mm. The temperature at the periphery was 62.0 +/- 5.8 degrees C. During a mean follow-up period of 23 months, in 41 patients with hepatocellular carcinoma, 79% (46/58) of lesions became smaller, and the intratumoral blood flow disappeared in 89% (47/53). All tumors showed decreased density on unenhanced CT, and 84% (32/38) of tumors showed no enhancement on contrast-enhanced CT. In 21 patients with an elevated alpha-fetoprotein level, the level decreased in all 21 and was normalized in 17. A second biopsy on 19 patients showed complete destruction of tumor in 18. In 10 patients with hepatic metastases, the mean follow-up period was 13 months. Shrinkage of lesions occurred in 84% (21/25), and the blood flow inside the tumor disappeared in 75% (12/16) of lesions. Seventy-three percent (8/11) of the nodules showed no enhancement. A second biopsy on six patients showed complete necrosis in five., Conclusion: Sonographically guided microwave coagulation performed with this modified system was an effective and safe treatment for liver cancer.

Unlabelled: Treatment of liver malignancies, in particular hepatocellular carcinoma, remains a serious problem because of the difficulty of delivering adequate therapeutic agents to the lesions while sparing the surrounding normal tissue. In an attempt to overcome this obstacle, intratumoral injection of 90Y, a beta-emitter, was performed., Methods: Twenty-seven hepatocellular carcinomas and six liver metastases were studied, most of which had failed other therapeutic modalities. Guided by ultrasound, 90Y-glass microspheres (GMS) were carefully injected into predetermined tumor sites. The procedure was repeated at 3--4-wk intervals where indicated. Echographic, clinical and laboratory follow-up was conducted at regular intervals., Results: Twelve to 32 mo after treatment, 27 patients were still alive, with dramatic improvement of their clinical condition: 90.6% of the tumor foci became smaller, with echogenic or blood flow changes on liver sonograms. Serum titers of alpha-FP in 10 of 13 patients returned to normal levels. Repeat biopsy in nine patients showed complete tumor destruction in eight. Six patients died of either end-stage disease or wide dispersion of the tumor., Conclusion: The intratumoral administration of 90Y-GMS under ultrasound guidance yielded a higher cure rate for liver malignancy with no severe side effects. The higher radiation dosage delivered by injected 90Y to the periphery of the lesions (up to 28,215-75,720 cGy) was thought to account for the successful outcome. These results show that intratumoral radionuclide injection is feasible for treatment of malignant lesions inside the body.

Thirteen cases of primary adenocarcinoma of the gallbladder (GB), 1 of malignant fibrous histocytoma, 3 of metastatic adenocarcinoma, 5 of adenoma, 5 of polypus, 2 of xanthogranuloma, 6 of chronic cholecystitis, 4 of acute cholecystitis, and 8 of subacute cholecystitis were studied by image-directed and color Doppler ultrasonography (CDUS). All of the 14 cases of primary GB cancer (10 masses, 4 thickening wall) were found to have a high velocity arterial blood flow signal in the wall of the GB. In contrast, the 3 cases of metastatic cancer of the GB had no blood flow signal in the wall of the GB. For the 30 cases of benign lesions of the GB, only in 12 cases was a low velocity blood flow signal found. Nine of 10 cases of primary GB malignancy were found to have high velocity arterial blood flow signals in the tumor masses. No blood flow signal was observed in the masses of 13 cases (3 of metastatic adenocarcinoma, 5 of adenoma, 5 of polypus). An abnormal high velocity arterial blood flow signal observed within masses in the GB or in the GB wall is a significant feature of primary GB cancer and thus helps to differentiate primary GB cancer from metastatic and benign lesions of the GB.