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Purpose: We report our experience of the safety of partial recanalization of the portal vein using a novel endovascular radiofrequency (RF) catheter for portal vein tumor thrombosis. Methods: Six patients with liver cancer and tumor thrombus in the portal vein underwent percutaneous intravascular radiofrequency ablation (RFA) using an endovascular bipolar RF device. A 0.035-inch guidewire was introduced into a tributary of the portal vein and through which a 5G guide catheter was introduced into the main portal vein. After manipulation of the guide catheter over the thrombus under digital subtraction angiography, the endovascular RF device was inserted and activated around the thrombus. Results: There were no observed technique specific complications, such as hemorrhage, vessel perforation, or infection. Post-RFA portography showed partial recanalization of portal vein. Conclusions: RFA of portal vein tumor thrombus in patients with hepatocellular carcinoma is technically feasible and warrants further investigation to assess efficacy compared with current recanalization techniques. [ABSTRACT FROM AUTHOR]

Background : Hepatocellular carcinoma (HCC) is the most common type of liver cancer, with 10-40% of cases involving portal vein tumor thrombosis (PVTT), leading to poor outcomes and a short survival. The effectiveness of PVTT treatment in patients with HCC is still controversial. Methods : This prospective dual-center study cohort comprised 60 patients with HCC and PVTT who underwent PVR-EPRFA-ST using a novel intravascular radiofrequency system followed by vascular stent placement across the PVTT stenosed segment under fluoroscopy guidance. Results : PVR-EPRFA-ST was technically and clinically successful in 54/60 (90%) and 37/54 (68.5%) patients, respectively. The mean tumor size, PVTT length, post-ablation luminal diameter, and median duration of the recanalized PV patency were 8.6 ± 3.4 cm, 4.1 ± 2.1 cm, 10.3 ± 1.8 mm, and 13.4 months. Higher technical and clinical success rates were associated with a longer survival (177 ± 17.3 days, HR: 0.3, 95%CI 0.12-0.71, p = 0.04; and 233 ± 18.3 days, HR: 0.14, 0.07-0.27, p < 0.001). A shorter survival was associated with Child-Pugh C (HR: 2.7, p = 0.04), multiple tumors (HR: 1.81, p = 0.03), and PVTT length (HR: 1.16, p = 0.04). Conclusions : PVR-EPRFA-ST was feasible and effective for the treatment of selected patients with PVTT, especially in patients with Child-Pugh A/B, single tumors, or a shorter PVTT length.

We reviewed the reported imaging findings of myocarditis in the literature following COVID-19 vaccination on cardiac imaging by a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), and Google Scholar. In total, 532 cases of myocarditis after COVID-19 vaccination were reported (462, 86.8% men and 70, 13.2% women, age range 12 to 80) with the following distribution: Pfizer-BioNTech: 367 (69%), Moderna: 137 (25.8%), AstraZeneca: 12 (2.3%), Janssen/Johnson & Johnson: 6 (1.1%), COVAXIN: 1 (0.1%), and unknown mRNA vaccine: 9 (1.7%). The distribution of patients receiving vaccine dosage was investigated. On cardiac MR Imaging, late intravenous gadolinium enhancement (LGE) was observed mainly in the epicardial/subepicardial segments (90.8%, 318 of 350 enhancing segments), with the dominance of inferolateral segment and inferior walls. Pericardial effusion was reported in 13.1% of cases. The vast majority of patients (94%, 500 of 532) were discharged from the hospital except for 4 (0.7%) cases. Post-COVID-19 myocarditis was most commonly reported in symptomatic men after the second or third dose, with CMRI findings including LGE in 90.8% of inferior and inferolateral epicardial/subepicardial segments. Most cases were self-limited.

Radiofrequency ablation (RFA) has widespread popularity due to its immune-modulation effects in many cancers. Optimal settings to apply RFA in pancreatic cancer, in which the advanced stage of the tumor at the diagnosis makes various therapeutic approaches fail, are still demanding. We report the case of a patient with unresectable pancreatic cancer in which 3 repetitive RFA has been applied over a period of 3 months. Results revealed an improvement in the patient's clinical condition associated with the reduced incidence of CD4+CD45RO+ T lymphocytes and declined TGF-β level in serum. The good quality of life and disease-free survival were maintained for the next months. Booster application of RFA procedure might be a promising option to improve the quality of life in pancreatic cancer patients., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Purpose: The main goal of this systematic review was to assess the technical and clinical success, adverse events (AEs), surgery, and overall mortality proportion after percutaneous catheter drainage (PCD) of two pancreatic lesions., Methods: An extant search in online databases including Scopus, PubMed (Medline), Embase (Elsevier), Web of Science, Cochrane library, and Google Scholar, was conducted to recognize all studies that used PCD intervention in the management of pancreatic necrosis (PN) and pancreatic pseudocysts (PP). Random effects meta-analysis was performed, and Cochrane's Q test and I 2 statistic were utilized to determine heterogeneity. In addition, meta-regression was used to explore the influence of categorical variables on heterogeneity., Results: Thirty-two studies (1398 patients) including PN in 26 (1256 cases, 89.8%) studies and PP in 6 (142 cases, 10.2%) studies were identified. Technical success proportion was 100% (95% confidence interval [CI] 100%-100%, I 2 : 0.0%), clinical success 63% (95% CI 55%-71%, I 2 : 92.9%), AEs 26% (95% CI 21%-31%, I 2 : 78%), surgery after PCD intervention 33% (95% CI 25%-40%, I 2 : 92.4%), and overall mortality was 13% (95% CI 9%-17%, I 2 : 82.8%). The most common ADs after PCD intervention were development of fistula (106, 42.6%), hemorrhage (44, 17.7%), sepsis (40, 16.1%)., Conclusion: A significant clinical success proportion with low AEs, surgery, and overall mortality proportion after PCD intervention was found, although the results should be interpreted with caution due to the high heterogeneity., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: The main purpose of this systematic review was to reflect on recent literature on bariatric LGA embolization for obesity treatment and to compare this new procedure in human and animal studies., Methods: A systematic search of Scopus, MEDLINE, Web of Science, Embase, and Google Scholar was performed to identify human and animal studies employing bariatric LGA embolization to treat obesity. As well, Cochrane's Q test and the I 2 statistic were utilized to determine heterogeneity., Results: Nine human and four animal studies recruiting a total of 118 cases (n = 78 patients and n = 40 animals) were included in analysis. All assessments on body mass index (BMI), weight, and ghrelin levels had been fulfilled based on before-after (human studies) and intervention-control designs (animal studies) using bariatric LGA embolization. The findings suggested that bariatric LGA embolization had significantly decreased BMI (mean difference (MD): - 2.66, 95% confidence interval [CI] - 3.74, - 1.58, P < 0.001) and weight (MD: - 8.69, 95% CI - 10.48, - 6.89, P < 0.001) in humans. Although overall pooled estimate showed no significant changes in ghrelin levels following this procedure (Hedges' g statistic: - 0.91, 95% CI - 1.83, 0.01, P = 0.05) in humans, a significant reduction was observed in animal studies (MD: - 756.56, 95% CI - 1098.79, - 414.33, P < 0.001) along with a significant drop in weight (MD: - 7.64, 95% CI - 13.73, - 1.54, P < 0.001)., Conclusion: The present study concluded that ghrelin levels in humans had not been affected, although bariatric LGA embolization might significantly improve BMI and weight., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Rationale and Objectives: Despite all the benefits and effectiveness of the coronavirus disease 2019 (COVID-19) vaccines mentioned in recent clinical trials, some post-vaccination side effects such as lymphadenopathy (LAP) were observed. The present study reviewed all studies with imaging findings presentation of LAP after COVID-19 vaccination., Materials and Methods: We conducted a literature search in online databases, including Scopus, Medline (PubMed), Web of Science, Embase (Elsevier), Cochrane library, and Google Scholar., Results: A total of 19 studies (68 cases), including 60 (88.2%) females and eight (11.8%) males with a presentation of LAP after COVID-19 vaccination, were reviewed. LAP was identified after first or second dosages of three types of COVID-19 vaccines, including Pfizer-BioNTech (n = 30, 44.1%), Moderna (n = 17, 25%), and Oxford-AstraZeneca (n = 1, 1.5%). In 20 (29.4%) cases, vaccine type was not reported or only reported as mRNA COVID-19 vaccine. The median days of LAP presentation after the first and second dosages of COVID-19 vaccination, were 12 and 5 days, respectively. Most of the LAP imaging findings related to COVID-19 vaccination (n = 66, 97%) were seen from first day to 4 weeks after vaccination. However, LAP remained after 5 and 6 weeks of the first and second dosages of COVID-19 vaccination with decreased lymph nodes' size and residual cortical thickening in two cases., Conclusion: This review study of cases with LAP-associated COVID-19 vaccination guides radiologists and physicians to rely on patient's clinical context and updated resources to prevent potential disease upstaging and change in therapy., (Copyright © 2021 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Purpose: To study the safety, efficacy, and long-term outcomes of percutaneous pancreatic duct drainage (PPDD) for treating pancreatic duct (PD) obstruction., Materials and Methods: This prospective observational cohort study included 73 patients with PD obstruction between December 2010 and June 2020. Patients underwent PPDD under ultrasound and fluoroscopy guidance, computed tomography (CT) and fluoroscopy guidance, or CT guidance only. They were categorized into 2 groups: nonmalignant (26 patients with PD obstruction due to acute and chronic pancreatitis or postoperative stricture) and malignant (47 patients with pancreatic head and ampullary tumors)., Results: The overall technical success rate was 98.6% (72/73). No major complications were encountered; however, severe weakness, lack of appetite, and tachycardia were observed in 4.1% (3/73) of patients, managed with intravenous resuscitation. Multivariate analysis demonstrated that diagnosis type (pancreatic head tumor: P = .049; odds ratio = 1.95 [1.11-2.25], and chronic pancreatitis: P = .048; odds ratio = 6.25 [1.74-22.22]) was associated with mortality. The median survival time was 16.3 months. Moreover, 15.1% (11/73) of the patients were alive 4 years after the PPDD procedure, and the mean overall survival time of nonmalignant and malignant patients was 35.1 and 21.4 months, respectively., Conclusions: Image-guided PPDD appears to be feasible and safe and provides a valuable therapeutic option for managing patients with PD obstruction., (Copyright © 2021 SIR. All rights reserved.)

Liver cancer is a highly lethal cancer, in which local tumor microenvironment and systemic immune suppression allow tumor to escape immune surveillance. Intervening in tumor microenvironment by locoregional treatment options can be beneficial for patients. We aimed to study changes in serum cytokines levels due to local disturbance of tumor microenvironment after radiofrequency thermal ablation procedure compare to liver resection in patients with primary and metastatic liver cancer. A total of 17 patients with primary (HCC and Cholangiocarcinoma) and secondary (metastatic) liver cancer were enrolled in this prospective study. Out of 17 patients, 7 were referred to RFA procedure and another 10 underwent surgical liver resection using non-RF based devices. Blood samples were collected from each patient before and after 1 and 3 months of treatment. The following serum cytokines: IL-10, IL-17, INF-γ, TGF-β were assayed by ELISA (ebiosciences, USA). RFA procedure unlike liver resection decreased serum level of IL-10 in patients with liver cancer. No significant changes in the level of the studied cytokines were revealed.

Many patients with hepatocellular carcinoma cannot be treated surgically because of the advanced stage of the tumor and/or coexisting cirrhosis. Transcatheter arterial embolization (TAE) represents an alternative therapeutic approach for some of these patients. However, it is not a curative measure, and an additional therapy is required to eradicate the residual disease. In this communication, we report a case of 55-year-old man with giant hepatocellular carcinoma located in the right lobe of the liver that was successfully treated with TAE. TAE completely devascularized the tumor in one session. Despite of postembolization antibiotic therapy, complete tumor necrosis led to abscess formation. After 57 days of abscess drainage, necrotic tumor tissue was completely evacuated from the drained cavity; no viable tumor tissue was identified by computed tomography/magnetic resonance imaging scan on a 5 year follow-up. TAE procedure can be suggested as a modulator of antitumor immune response, by exposing tumor antigens after necrosis leading to inflammation. In addition to necrosis caused by TAE, an antimicrobial acute inflammatory reaction in the treated area led to the complete destruction of the giant tumor., (© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Background: Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer-related deaths in developed countries. The liver is the most prevalent site of metastasis from CRC. Currently, the gold-standard treatment for colorectal liver metastases (CLMs) is surgical resection. However, depending on the pattern of the disease, a significant number of patients may require different approaches alone or in combination with surgery, including thermal ablation (radiofrequency (RFA) or microwave (MWA) ablation) or transarterial liver-directed therapies, although the latter is not yet part of the standard treatment for CRC liver metastases. Methods and Results: We present the case of a 63-yearold man with bilobar CLM who was treated with transarterial embolization (TAE) and RFA followed by chemotherapy. A post-RFA study of immune parameters revealed the downregulation of CD39 expression in the circulating CD4 + T cell population and a reduction of the serum levels of cytokines IL-10, TGF-β, IFN-gamma and IL-17, which positively correlated with the diminished serum level of gamma-glutamyl transferase (GGT) and the subdued inflammatory markers: the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). Later, the patient underwent chemotherapy. Liver failure developed within two years and nine months following tumour ablation, leading to the death of the patient. Conclusions: However, the denial of adjuvant chemotherapy by the patient gave us the opportunity to assess the immunomodulatory changes following RFA in the absence of any other therapeutic modalities.

Aim of investigation - the assessment of opportunities of ultrasound (US) imaging for visualization of the shoulder joint pathological changes. 100 patients with the pathologies of shoulder joint have been investigated, they included traumatic, degenerative -dystrophic and inflammatory pathologies (tendinitis, tendinosis, tendinopathy, subacromial-subdelatoid bursitis).Ultrasound study performed on ultrasound TOSHIBA xario XG by high linear probe (7,5-12.0 MHz) with dopplerography(color, energetic), transverse and sagittal planes. It has been evaluated the thickness(diffuse, local), echostructure, continuity of contours of main shoulder joint tendons in above mentioned pathologies, in order to study their diagnostic values. 23 patients have been investigated by MRI which was used as "gold standard". The thickness, structure and continuity of contours of tendons have been evaluated by MRI in following regimes: T1, T2 and PDFs. In the study group the comparative results of ultrasound and MRI research were compared to determine the high diagnostic reliability of US, which is important for timely and effective treatment. The evaluation of US diagnostic accuracy for tendon thickness showed that the sensitivity was 95.00%, specificity - 66.67%, and diagnostic accuracy - 91.30%. It should be noted that negative likelihood ratio (NLR) is significant and equals to 0.08 (95% CI - 0.01÷0.60). The assessment of US diagnostic accuracy for tendon echostructure showed that the sensitivity was 94.74%, specificity - 50.00%, and diagnostic accuracy - 86.96%. It should be noted that negative likelihood ratio (NLR) is significant and equals to 0.11 (95% CI - 0.01÷0.60). The sensitivity of the evaluation of continuity of contours by US was 95.00%, specificity - 66.67%, diagnostic accuracy - 91.30%. It should be noted that negative likelihood ratio (NLR) is significant and equals to 0.08 (95% CI - 0.01÷0.60). On the basis of obtained results we can conclude that US may be characterized by high sensitivity, moderate specificity and high diagnostic accuracy for diagnostics of shoulder joint pathologies. It should be noted that mainly NLR is significant features for this imaging technique. US can be used in primary outpatient diagnostics, MRI and MR-arthrography should be performed in the hospital, to reveal the accompanying anomalies when planning surgical and/or other interventions.

Aim: To evaluate the efficacy and feasibility of preoperative percutaneous pancreatic duct drainage (PPDD) and improve the safety of pancreatojejunal anastomosis, we refer to our experience from 2013 to 2017 that include the last series of 27 cases of PD for 14 pancreatic and 13 ampullary tumors. Apart from the standard "classic" Whipple procedure in 17 cases, and the "modified"pylorus-preserving variant (ppPD) in 10 cases, in 26 cases a pancreaticojejunostomy and in 1 case a pancreatico gastrostomy was performed. In last series the percutaneous biliary drainage procedure in 18 cases and dual biliary + pancreatic duct decompression in 4 casas was performed. In 21 cases the biliary drainage was used as transanastomotic stent during hepaticojejunostomy and in 3 cases the pancreatic duct drainage was also used as transanastomitic stent at our method of performing the double invaginated pancreatojejunostomy., Results: Without operative mortality in our series of PD, there were however some complications requiring in two patients interventional radiologic and intensive care management, and 5 patients died at follow up period (6 months - 3 years). There was no postoperative pancreatic fistula in our last series of PD, where preoperative biliary and pancreatic duct drainage and our modified double invaginated pancreatojejunostomy was performed., Conclusions: Despite our limited experience, we can conclude that preoperative percutaneous biliary and pancreatic drainage is feasible, safe, effective and a realistic mini invasive procedure. The preliminary results obtained with the described method of double invaginated pancreatojejunostomy with transanastomotic stent and external pancreatic duct drainage are very encouraging and indicate that this technique is less complicated and time consuming, very safe, simple, easy to perform and also applicable almost to all situations., Key Words: Invaginated Pancreatojejunostomy Pancreatoduodenectomy, Pancreatic Duct Drainage.

Introduction: Hepatic cancer is a highly lethal tumour with increasing worldwide incidence. These tumours are characterized by the proliferation of malignant cells, generalised immunosuppression and chronic inflammation marked with an increase in inflammatory markers as a neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR) and overexpression of CD4+CD39+ on T lymphocytes. The studies have outlined immunomodulatory changes in liver cancer patients as the plausible explanation for the better survival. The aim of this pilot study was understand the possible immunomodulatory effect of radiofrequency (RF) energy and liver resection (non-radiofrequency based devices; non-RF device) in relation to NLR, PLR and expression of CD4+CD39+ T lymphocytes and compare the magnitude of these changes. Material and Methods: In the present study, 17 patients with hepatic cancer were prospectively divided into treatment groups radiofrequency ablation (RFA group) and Liver resection using non-RF devices (LR group). A blood sample was collected from each patient, one month before and after the procedure and compared with the blood samples of age-matched healthy volunteers for group wise comparison. The Mann-Whitney U test, Mc Nemar test and Wilcoxon rank test were used for statistical comparisons as appropriate. Results: A decrease in NLR was reported after RFA from 4.7±3.3 to 3.8±1.8 ( P =0.283), in contrary to an increase from 3.5±2.8 to 4.5±3.2 ( P =0.183) in LR group. Likewise, a decrease was discerned in PLR following RFA from 140.5±79.5 to 137±69.2 respectively ( P =0.386) and increase in the LR group from 116±42.2 to 120.8±29 respectively ( P =0.391). A significant decrease in CD4+CD39+ lymphocytes from 55.8±13.8 to 24.6±21.1 ( P =0.03) was observed in RFA group whilst a significant increase was reported in LR group from 47.6±8.8 to 55.7±33.2 ( P =0.38). Conclusion: Studies have shown that decrease in the NLR, PLR and expression of CD4+CD39+ on T lymphocytes as the marker of better survival in hepatic cancer patients and our findings have confirmed that these changes can be induced following application of RF energy. Moreover, this could be the explanation of better survival observed in different studies using RFA or other RF-based devices in comparison to non-RF based liver resection techniques. However, further larger studies are needed to confirm these findings., Competing Interests: Competing Interests: Professor Nagy Habib is the inventor of the HabibTM 4X device, which is a radiofrequency based device. None of the other authors have a conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript to declare.

Case report presents the successful treatment of unresectable liver metastasis in a patient with colon cancer. A 44-year-old male underwent right hemicolectomy followed by capecitabine for a moderately differentiated adenocarcinoma of the colon. 2 years later, a liver metastatic lesion was detected and had increased in size despite chemotherapy with capecitabine plus oxaliplatin (XELOX). Curative liver resection was conducted after conversion of unresectable tumor to resectable by transarterial chemoembolization followed by chemotherapy - irinotecan with fluorouracil and folinic acid (FOLFIRI). No recurrence was observed during 22-month follow-up after hepatectomy.

Background: Endovascular management is the mainstay of therapy for most patients with primary and secondary liver tumors. Radiologist should understand the anatomy of the hepatic vasculature and tumor feeding vessels to ensure successful conduction of the embolization procedure. The aim of this study was to evaluate the accuracy of multidetector computed tomographic angiography (MDCTA) for the evaluation of hepatic arterial anatomy and tumor feeding vessels prior to embolization procedure., Methods: This study included 42 patients. They were 30 with hepatocellular carcinoma, 6 with colorectal cancer metastases, 3 with intrahepatic cholangiocellular carcinoma, 2 with giant focal nodular hyperplasia and 1 with gallbladder tumor. The findings of MDCTA were compared with the DSA findings, which served as the standard of reference. Sensitivity and specificity of the MDCTA were calculated., Results: MDCTA showed 100% coincidence with the DSA and 100% accuracy in the evaluation of gross hepatic arterial anatomy and its variations. 61 out of the 64 feeders were correctly identified with the MDCTA. False positives and false negatives were 3 each. Accordingly sensitivity and specificity were 95.31%, 97.95% respectively., Conclusions: MDCT angiography permits accurate assessment of the hepatic vascular anatomy. Although some pathways of tumor irrigation may not be well visible on the computed tomography. These require detailed reevaluation of suspected tumor feeders during embolization procedure.

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Portal vein tumor thrombosis (PVTT) is a frequent entity in HCC, which strictly limits the gold standard treatment options such as surgical resection and transarterial chemoembolization. Therefore, the prognosis of patients with PVTT is extremely poor and an emergence of seeking an alternative option for intervention is inevitable. We present a case of a 60-year-old male patient with HCC induced PVTT who was subjected to the intraportal RFA and stenting-VesOpen procedure. No additional medical intervention was performed. The repeated CT performed 5 months after the VesOpen procedure revealed significant decrease of the tumor size, patent right, and main portal vein and a recanalization of the left portal vein, which was not processed. At this time point, liver functional tests, appetite, and general condition of the patient were improved evidently. This report designates the RFA as an instrumental option of therapeutic intervention for HCC patients with PVTT.

Hepatocellular carcinoma (HCC) is a highly lethal and the most common primary liver cancer with increasing worldwide incidence. Pathogenesis of HCC is immune mediated, however, not completely understood. Chronic low-grade inflammation alters both innate and adaptive immune responses. As a result tolerogenic environment is established in damaged organ. Up to date, incomplete understanding of HCC pathogenesis and the extend of biomarker variability among patients represent the major obstacle for early diagnosis and for the choice of effective treatment. Among current treatment options for HCC, thermal ablation strategy, which in addition to cancer eradication provides adjuvant/"danger"signal to the patient's immune cells, has demonstrated its active immunotherapeutic effect. In ongoing phase I/II clinical trials, tumor antigen loaded dendritic cell (DC)-based vaccines as well as tumor-specific cytotoxic T cells are being tested. Genetically redirected T cell therapy and more refined autologous vaccines are still awaiting approaches in HCC. The topic of this review focuses on current and bench-to-bedside immunotherapeutic strategies for HCC and discusses their advantages and limitations in clinic. We also weight up several prospective immunotherapeutic approaches which in theory have the potential for further implication in HCC. Combination of the induction of effective antitumor immunity with the inhibition of the mechanisms of tumor-induced immunosuppression ought to be a key objective in these future developments.

Unlabelled: Hepatocellular carcinoma (HCC) occurs predominantly in patients with liver cirrhosis. Here we show an innovative RNA-based targeted approach to enhance endogenous albumin production while reducing liver tumor burden. We designed short-activating RNAs (saRNA) to enhance expression of C/EBPα (CCAAT/enhancer-binding protein-α), a transcriptional regulator and activator of albumin gene expression. Increased levels of both C/EBPα and albumin mRNA in addition to a 3-fold increase in albumin secretion and 50% decrease in cell proliferation was observed in C/EBPα-saRNA transfected HepG2 cells. Intravenous injection of C/EBPα-saRNA in a cirrhotic rat model with multifocal liver tumors increased circulating serum albumin by over 30%, showing evidence of improved liver function. Tumor burden decreased by 80% (P = 0.003) with a 40% reduction in a marker of preneoplastic transformation. Since C/EBPα has known antiproliferative activities by way of retinoblastoma, p21, and cyclins, we used messenger RNA (mRNA) expression liver cancer-specific microarray in C/EBPα-saRNA-transfected HepG2 cells to confirm down-regulation of genes strongly enriched for negative regulation of apoptosis, angiogenesis, and metastasis. Up-regulated genes were enriched for tumor suppressors and positive regulators of cell differentiation. A quantitative polymerase chain reaction (PCR) and western blot analysis of C/EBPα-saRNA-transfected cells suggested that in addition to the known antiproliferative targets of C/EBPα, we also observed suppression of interleukin (IL)6R, c-Myc, and reduced STAT3 phosphorylation., Conclusion: A novel injectable saRNA-oligonucleotide that enhances C/EBPα expression successfully reduces tumor burden and simultaneously improves liver function in a clinically relevant liver cirrhosis/HCC model., (© 2013 by the American Association for the Study of Liver Diseases.)

Purpose: Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction., Methods: Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted., Results: Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14-260) days and median stent patency of 84.5 (range 14-260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14-260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38-210) days., Conclusions: In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.

The aim of the research is to study sonosemiotics of ankle joint pathology by means of ultrasound in order to optimize the diagnostic process and improve the treatment. 130 patients (age ranges from 5 to 70 years) underwent the radiological study of ankle joint medial aspect. Pathology types: degenerative-dystrophic diseases - 39 (30%), inflammatory pathology - 21 (16.2%), traumatic injuries - 20 (15.2%), vascular pathologies - 26 (20%), neurogenic problems -7 (5.4%), soft tissue neoplasms - 5 (3.8%), congenital anomalies - 7 (5.4%) and vertebral pathology - 5 (4.0%). The diagnostic studies include: a) Ultrasound, performed on digital ultrasound system using high frequency (7.5-12.0 MHz) linear probe with Doppler capability (all patients); b) X-Ray filming in antero-posterior and lateral projections (6 patients- 4.5%); c) MRI - T1 and T2 weighted images in saggital and transverse planes 10 patients (10.0%) and d) CT - 2 patients (1.5%); To 2 (1.5%) patient biopsy has been performed. This study showed that ultrasound was successful in ankle joint medial aspect pathology diagnosis in 108 cases (84.0%); It was ineffective in osseous pathology definition. In final diagnosis of impingment syndrom MRI was required in 4 (3.6%) cases. It is concluded that ultrasound should be used as a Gold Standard in diagnosis of localized pain and swelling in the ankle joint.

Hepatocellular carcinoma (HCC) is the fifth most common neoplasm in the world, closely correlated with viral hepatitis and liver cirrhosis. The vast majority of HCC patients present at a late stage and are unsuitable for surgery due to limited liver functional reserve. Tumors can involve major vessels or hilar structures, necessitating major liver resection and/or rendering liver resection unfeasible. A series of new technologies have been developed to optimise HCC management. Stem cell therapy improves impaired liver functional reserve prior to liver resection. Intravascular radiofrequency ablation recanalises the portal vein invaded by tumour thrombus and endobiliary radiofrequency ablation restores and extends biliary patency of the bile duct invaded by malignancy. Laparoscopic radiofrequency assisted liver resection minimizes blood loss and avoids liver warm ischemia, while increasing parenchymal sparing. These benefits combined maximize the safety of liver resection.

The aim of the research was to outline the normal sonoanatomy and improve achilles tendon pathology ultrasound diagnosis (Refinement of sonosemiotics) in order to optimize the diagnostic process and improve the treatment, to avoid the possible complications. 135 patients (age ranges from 15 to 70 years) underwent the radiological study of ankle joint posterior aspect. Pathology types: traumatic injuries--45%, inflammatory pathology--30% and degenerative-dystrophic diseases--25%. Unilateral pathology was diagnosed in 85%, bilateral--in 15% of cases. The diagnostic studies include: a) ultrasound, performed on digital ultrasound system using high frequency (7.5-12.0 MHz) linear probe with Doppler capability (all patients) b) X-Ray filming in antero-posterior and lateral projections (32 patients) and c) MRI - T1 and T2 weighted images in sagittal and transverse planes (5 patients). Ultrasound was successful in ankle joint posterior compartment pathology diagnosis in 132 cases (97.8%). It was ineffective in osseous pathology definition. Ultrasound failed defining pathology (posterior impingement-syndrome, due to the presence of triangular bone) in 3 cases (2.2%). In this cases MRI was helpful; it was also critical in differential diagnosis of massive partial tear and complete tear of the tendon. Ultrasound should be used as a Gold Standard when the patient presents with localized clinical symptoms (pain and swelling). Critical is the possibility of dynamic and Doppler studies in real-time. X-Ray should be used when the bony pathology is suspected and MRI should be considered if the pain is not localized exactly.

This study was designed to clarify the long-term efficacy of percutaneous ethanol injection (PEI) therapy in benign nodular and cystic thyroid diseases. Solid nodule and complex cyst were classified into three groups in accordance with volume reduction. In solid nodule (n = 38) and complex cyst (n=8), initial volume was significantly reduced to final volumes, and volume reduction persisted during follow-up period. Complete response, partial response and no response were as follows: 21 %, 63 %, 15 % in solid nodule; 37,5 %, 50 %, 12,5 % in complex cyst, respectively. Differences of volume reduction according to initial volume (>10 mL vs <10 mL) were significant. Correlation between initial and final volumes, and between initial volume and volume reduction were also significant. Complications were developed in 10,5 % of patients but there were not permanent complications. In conclusion, our data suggest that PEI therapy could be an effective and safe therapeutic modality for benign nodular and cystic thyroid diseases especially when initial volume is more than 10 mL.

For objective assessment of an ultrasound picture of the kidneys in tumors the authors compared the results of USI, angiography of the kidneys and the removed operative material. In 32 cases kidney tumors were hyperechogeneous, in 13 cases--medium echogeneous, and in 8 cases--hypoechogeneous. The authors detected no relationship between a degree of vascularization of the tumor and its echogeneous type. By their results hypernephromas can have a different echographic picture which may be determined by tumor macromorphology (the presence of necrosis, cystic cavities, etc.). Sizes of kidney tumors by USI findings were 10-15% less than true tumor sizes, and the determination of tumor borders based on USI findings, was rather difficult.

The paper describes results of comparative assessment of morphometric and in vivo measurements of the intraorbital part of the optic nerve and the distance from the posterior pole of the eye ball to the muscular tendon ring. It is shown that the method of ultrasound scanning is accurate enough and may be used for measuring the length of the intraorbital part of the optic nerve and the distance from the posterior pole of the eye ball to the muscular tendon ring in each concrete case.

Roentgenological, radionuclide, ultrasound and thermographic methods were evaluated in 31 patients with acute and 85 with chronic cholecystitis. It was established that the succession of using of the above methods depends on the course of cholecystitis. In acute cholecystitis examination is begun with thermography and terminated by ultrasound. In chronic cholecystitis ultrasound is the first method to be followed by radionuclide methods. If necessary infusional cholegraphy and thermography are employed.