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Yin-Gen Luo,&ast; Xiao-Wu Zhang,&ast; He Zhao, Jin-Gui Li, Jiay-Wei Tsauo, Tao Gong, Ai-Xin Ou, Tian-Hao Cong, Wen-Di Kang, Xiao Li Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiao Li; He Zhao, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China, Tel/Fax +86 010 8778 8502, Email simonlixiao@gmail.com; hezhaoo@gmail.comObjective: This study aimed to establish a rat model that simulates benign esophageal strictures induced by endoscopic submucosal dissection (ESD).Materials and Methods: Sixteen male Sprague-Dawley rats were randomly divided into mucosal resection (n = 8) and sham-operated groups (n = 8). The rats in the mucosal resection group underwent a 5-mm three-fourths mucosal resection by way of a 3-mm incision in the distal esophagus under direct visualization via laparotomy. Rats in the sham-operated group underwent a 3-mm incision of the muscularis propria layer in the distal esophagus via laparotomy without mucosal resection. Dysphagia score, weight gain, mucosal constriction rate, and histology were evaluated 2 weeks after surgery.Results: Technical success was achieved in all the animals. One rat in the mucosal resection group died of infection, and no other complications were observed. Weight gain (P < 0.001) and luminal diameter derived from the esophagograms (P < 0.001) were significantly lower in the mucosal resection group than those in the sham-operated group. Dysphagia score (P < 0.001) and mucosal constriction rate (P < 0.001) were significantly higher in the mucosal resection group than those in the sham-operated group. The inflammation grade (P = 0.002), damage to the muscularis propria (P < 0.001), number of nascent microvessels (P = 0.006), and degree of α-SMA positive deposition (P = 0.006) were significantly higher in the mucosal resection group.Conclusion: A rat model of benign esophageal stricture induced by ESD was successfully and safely established by mucosal resection.Keywords: esophageal stenosis, endoscopic mucosal resection, models, animal

Yin-Gen Luo, Xiao-Wu Zhang, Jiay-Wei Tsauo, Ying Li, Jin-Gui Li, Qing Peng, Ya-Wei Li, Wei Sun, He Zhao, Xiao Li Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of ChinaCorrespondence: Xiao Li; He Zhao, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China, Tel/Fax +86 010 8778 8502, Email simonlixiao@gmail.com; hezhaoo@gmail.comObjective: This study aimed to investigate the shortest compression time to achieve hemostasis and the optimal hemostasis strategy in patients treated with transradial access chemoembolization (TRA-TACE).Methods: From October 2019 to October 2021, 119 consecutive patients with hepatocellular carcinoma (HCC) who underwent 134 sessions of TRA-TACE were included in this prospective single-center study. The compression time was measured by decompressing the device for 30 min, and thereafter, every 10 min after the procedure until complete hemostasis was achieved.Results: Technical success was achieved for all TRA procedures. None of the patients experienced major TRA-related adverse events. Minor adverse events occurred in 7.5% of the patients. The mean compression time was 31.8 ± 5.0 min. Factors that may impact hemostasis were analyzed by univariate and multivariate analyses, and a platelet count < 100× 109 /L (p = 0.016, odds ratio = 3.942) was found to be an independent factor that could predict the failure to achieve hemostasis within 30 min. For patients with a platelet count < 100× 109 /L, the compression time required to achieve hemostasis was 60 min. For patients with a platelet count ≥ 100× 109 /L, the compression time required to achieve hemostasis was 40 min.Conclusion: To achieve hemostasis in patients with HCC treated with TRA-TACE, compression for 60 min is sufficient for those with a platelet count < 100× 109 /L, and compression for 40 min is sufficient for those with a platelet count ≥ 100× 109 /L.Keywords: hepatocellular carcinoma, transarterial chemoembolization, transradial access, hemostasis

Effect of serum calcium levels on prognosis of patients with coronary artery disease (CAD) is not well evaluated. We aimed to assess the associations of baseline serum calcium levels with both short-term and long-term outcomes in CAD patients.

Introduction. To investigate the effect of an individualised functional training programme for patients with low back pain (LBP). Methods. A randomised, controlled trial with single-blind design was conducted. Patients with non-specific LBP for at least 3 months were recruited and randomised into training and control groups. Both groups maintained their current treatment, and the training group participated in an additional programme for 100 h. Measures were performed initially and after completing the programme, and included rating determining impairment associated with pain, Oswestry disability index (ODI) and functional capacity evaluation (FCE). Results. Thirteen in the training group completed the training and measurements, and 12 in the control group completed their measurements. Twelve items in FCE had significant improvement in training group, but only one in control group. Severity of pain (11.8 ± 3.6-5.6 ± 3.6), activity limitation from pain (3.2 ± 1.5-1.5 ± 1.1) and emotional disturbance by pain (4.3 ± 1.7-2.2 ± 1.4) significantly decreased in the training group, no significant change in the control group. The ODI demonstrated a significant reduction (p = 0.044) in the training group (22 ± 9-16 ± 9), but not in the control group. Conclusion. An individualised functional training programme benefits chronic LBP patients. [ABSTRACT FROM AUTHOR]

Purpose. The aims of this study were to evaluate outcomes of osteosarcoma patients who underwent wide resection and endoprosthetic knee reconstruction, to compare with their own sound sides and controls, and to assess the interrelationships among these parameters.Method. Twenty patients and 20 matched controls were recruited. Strength and range of motion (ROM) of the knee, gait and Enneking functional score were measured.Results. The results revealed the operated knees were significantly weaker than sound knees and controls (p < 0.05). The ROM of operated knees, sound knees and controls were 106.2 degrees +/- 13.0 degrees, 134.1 degrees +/- 7.5 degrees, and 137.7 degrees +/- 7.0 degrees respectively (p < 0.05). Patients' and controls' walking velocity were 54 +/- 12m/min, and 72 +/- 6m/min (p < 0.05). Their Enneking score was 21.6 +/- 2.8 (72% of total score, 30). The ratio of extensor strength of operated/sound knee and isometric hamstring/ quadriceps ratio of operated knee were significantly correlated to the difference of stance-phase duration of bilateral sides (p < 0.05). In addition, the ratio of isometric flexor strength was significantly correlated to Enneking score (p < 0.05).Conclusions. The patients achieved an acceptable recovery in strength and gait in spite of some functional limitation. [ABSTRACT FROM AUTHOR]

Background: Proprioception as an outcome for patients with osteosarcoma who have undergone modular endoprosthetic knee reconstruction has not been studied, as far as we know. The primary purpose of the present study was to understand the differences in knee proprioception between this patient population and control subjects. We also compared differences in proprioception between patients with tumors at different sites and between patients who had different proportions of bone length excised.Methods: We evaluated twenty patients who had undergone a wide resection of a tumor about the knee followed by reconstruction with a modular endoprosthesis. The mean age of the patients was 21.7 years. The patients were grouped according to tumor site, i.e., the distal part of the femur or the proximal part of the tibia; they were also grouped according to the length of resected bone (<40% or >or=40% of the length of the bone). Another twenty age-matched control subjects were recruited for this study. Knee proprioception was evaluated by comparing active and passive angular repositioning of the involved limb and the normal limb in the patients and the dominant limb in the central subjects.Results: The absolute matching error of active and passive repositioning was 2.7 degrees +/- 2.1 degrees and 2.9 degrees +/- 2.2 degrees , respectively, for knees treated operatively and 3.2 degrees +/- 2.1 degrees and 2.1 degrees +/- 1.3 degrees , respectively, for the dominant knees in the control subjects. The differences between the operatively treated knees and the control knees were not significant (p > 0.05). There was also no significant difference in proprioception between the patients with a distal femoral tumor and those with a proximal tibial tumor (p > 0.05). The proprioception of the patients with a greater length of bone resected was significantly worse in both lower extremities than that of patients with a shorter resected length (p = 0.016 for the normal side and p = 0.025 for the involved side).Conclusions: The proprioception of the involved knees in the patients with osteosarcoma who had modular endoprosthetic reconstruction was not found to be different from the normal knees or the knees in the control subjects. On the basis of our data, we found that proprioception is probably not influenced by the tumor site. Conversely, resection length appears to be an important factor. These study findings may be used as a reference for knee proprioception in patients with osteosarcoma who have a modular endoprosthetic knee reconstruction. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of 3 different health promotion exercise programs for work-related shoulder and neck pain.Design: Comparative study design.Subjects: A total of 178 employees were recruited and grouped.Methods: Those in the 'Self-exercise group' (n = 56) were given a lecture about the exercise program and then performed the program by themselves during their office break. 'Team-exercise group I' (n = 69) performed the program once under the supervision of a physiotherapist after the lecture. 'Team-exercise group II' (n = 14) performed the program twice; once under a physiotherapist's supervision. A modified Nordic questionnaire, pain threshold and cervical range of motion were used to evaluate the effect of intervention. There were 39 subjects in the reference group.Results: When daily change of pain threshold (post-work - pre-work) was treated as an improvement index, the odds ratios for the self-exercise group, team-exercise group I and team-exercise group II were 1.39, 4.63 (p < 0.05) and 7.06 (p < 0.05), respectively, compared with the reference group. A dose-response effect of intervention intensity was demonstrated.Conclusion: An intensive team-exercise program is beneficial in reducing neck and shoulder symptoms in sedentary workers. [ABSTRACT FROM AUTHOR]

Abstract Background Few randomized controlled trials (RCTs) report interventions targeting improvement of frailty status as an outcome. Methods This RCT enrolled 117 older adults (65-79 years of age) in Toufen, Taiwan who scored 3-6 on The Chinese Canadian Study of Health and Aging Clinical Frailty Scale Telephone Version and then score ≥1 on the Cardiovascular Health Study Phenotypic Classification of Frailty (CHS_PCF). With a two by two factorial design, subjects were randomly assigned to interventions (Exercise and nutrition, EN, n = 55 or problem solving therapy, PST, n = 57) or controls (non-EN, n = 62 or non-PST, n = 60). Educational booklets were provided to all. EN group subjects received nutrition consultation and a thrice-weekly exercise-training program while PST group subjects received 6 sessions in 3 month. Subjects were followed at 3, 6, and 12 months. Primary outcome was improvement of the CHS_PCF by at least one category (from pre-frail to robust, or from frail to pre-frail or robust) from baseline assessments. One hundred and one completed final assessments. Intention-to-treat analysis with the generalized estimating equation model was applied with adjustment for time and treatment-by-time interactions. Results Mean age was 71.4 ± 3.7 years, with 59% females. Baseline characteristic were generally comparable between groups. EN group subjects had a higher improvement rate on the primary outcome than non-EN group subjects (45% vs 27%, adjusted p = 0.008) at 3 months, but not 6 or 12 months. They also had more increase of serum 25(OH) vitamin D level (4.9 ± 7.7 vs 1.2 ± 5.4, p = 0.006) and lower percentage of osteopenia (74% vs 89% p = 0.042) at 12 months. PST group subjects had better improvement (2.7 ± 6.1 vs 0.2 ± 6.7, p = 0.035, 6-month) and less deterioration (−3.5 ± 9.7 vs −7.1 ± 8.7, p = 0.036, 12-month) of dominant leg extension power than non-PST subjects. Some secondary outcomes were also improved in control groups (non-EN or non-PST). No adverse effects were reported. Conclusions The three-month EN intervention resulted in short-term (3-month) frailty status improvement and long-term effect on bone mineral density and serum vitamin D (12-month) among Taiwanese community-dwelling elders. The effect of PST was less pronounce. Trial registration ClinicalTrials.gov: EC0970301

Abstract Background Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients’ functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. Methods Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. Results The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). Conclusions In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual rehabilitation needs of cancer patients remain unmet.

Background: The effectiveness of metallic stents in treating ureteral strictures following surgery and radiotherapy for gynecological tumors is currently uncertain. We aimed to investigate the efficacy and safety of thermo-expandable metallic stent (Memokath) in the treatment of ureteral stricture after radiotherapy for gynecological tumors., Methods: In this descriptive cross-sectional study, 27 patients with ureteral stricture were treated with Memokath stent after gynecological tumor radiotherapy with or without chemotherapy that was admitted to our hospital from August 2021 to August 2023. Clinical data on efficacy, safety, and complications during stent insertion and indwelling were analyzed., Results: The successful insertion of thirty-three stents in twenty-seven patients studied. The stenosis length was 10.14 ± 6.76 cm, and the hospitalization was 4.43 ± 1.83 days. One patient has died from the primary disease carrying a patency stent. The Kaplan-Meier graph showed that the cumilative patency rate of patients with thermo-expandable metallic stent were 92.4% (SD = 5.2%) in eight months, 77.4% (9.1%) in 12 months and 67.7% (SD = 12%) in 29 months, while the cumilative survival rate was 87.5% (SD = 11.5%) in 29 months. The stent patency was 81.48% and later complications of stent indwelling were 5/27, including refractory urinary tract infection (UTI) in three cases, stent migration, and stent intolerance respectively. The creatinine levels, hydronephrosis degree, and glomerular filtration rate improved after the operation, and the first two indicators were statistically significant., Conclusion: Memokath stent is a safe and effective treatment for ureteral stricture after surgery and radiotherapy with or without chemotherapy for gynecological tumors., (© 2024. The Author(s).)

Background: To assess the feasibility and tissue response of using a gold nanoparticle (AuNP)-integrated silicone-covered self-expandable metal stent (SEMS) for local hyperthermia in a rat esophageal model., Methods: The study involved 42 Sprague-Dawley rats. Initially, 6 animals were subjected to near-infrared (NIR) laser irradiation (power output from 0.2 to 2.4 W) to assess the in vitro heating characteristics of the AuNP-integrated SEMS immediately after its placement. The surface temperature of the stented esophagus was then measured using an infrared thermal camera before euthanizing the animals. Subsequently, the remaining 36 animals were randomly divided into 4 groups of 9 each. Groups A and B received AuNP-integrated SEMS, while groups C and D received conventional SEMS. On day 14, groups A and C underwent NIR laser irradiation at a power output of 1.6 W for 2 min. By days 15 (3 animals per group) or 28 (6 animals per group), all groups were euthanized for gross, histological, and immunohistochemical analysis., Results: Under NIR laser irradiation, the surface temperature of the stented esophagus quickly increased to a steady-state level. The surface temperature of the stented esophagus increased proportionally with power outputs, being 47.3 ± 1.4 °C (mean ± standard deviation) at 1.6 W. Only group A attained full circumferential heating through all layers, from the epithelium to the muscularis propria, demonstrating marked apoptosis in these layers without noticeable necroptosis., Conclusions: Local hyperthermia using the AuNP-integrated silicone-covered SEMS was feasible and induced cell death through apoptosis in a rat esophageal model., Relevance Statement: A gold nanoparticle-integrated silicone-covered self-expanding metal stent has been developed to mediate local hyperthermia. This approach holds potential for irreversibly damaging cancer cells, improving the sensitivity of cancer cells to therapies, and triggering systemic anticancer immune responses., Key Points: • A gold nanoparticle-integrated silicone-covered self-expanding metal stent was placed in the rat esophagus. • Upon near-infrared laser irradiation, this stent quickly increased the temperature of the stented esophagus. • Local hyperthermia using this stent was feasible and resulted in cell death through apoptosis., (© 2024. The Author(s).)

Background: Knowledge of the characteristics of self-expanding metal stents (SEMSs) is essential during selection process to ensure the best therapeutic outcomes for patients with malignant biliary obstruction. The aim of this study was to evaluate the characteristics of four commonly used SEMSs., Methods: This in vitro study analyzed the radial force (RF), crush resistance (CR), axial force (AF), conformability, surface quality, foreshortening, and radiopacity of the following SEMSs: uncovered Wallflex™, EGIS single bare, Zilver 635®, and E-Luminexx™. Two samples of each SEMS type were included in this study, all having identical specifications with a diameter of 10 mm and a length of 6 cm. One sample from each type was analyzed for surface quality, followed by CR, conformability, and foreshortening. The other sample was analyzed for radiopacity, followed by RF and AF., Results: The uncovered Wallflex™ exhibited low RF, high CR, high AF, good conformability, poor surface quality, high foreshortening, and good radiopacity. The EGIS single bare demonstrated high RF, high CR, low AF, moderate conformability, good surface quality, high foreshortening, and poor radiopacity. The Zilver 635® displayed moderate RF, low CR, low AF, moderate conformability, moderate surface quality, no foreshortening, and good radiopacity. The E-Luminexx™ showed high RF, moderate CR, high AF, poor conformability, poor surface quality, no foreshortening, and good radiopacity., Conclusions: There was considerable variation in the characteristics among the four evaluated SEMSs. These characteristics should be carefully considered during selection to ensure optimal therapeutic outcomes for patients., Relevance Statement: The selection of self-expanding metal stents for treating malignant biliary obstruction requires careful consideration of various characteristics, including their radial force, crush resistance, axial force, conformability, surface quality, foreshortening, and radiopacity., Key Points: • The characteristics of self-expanding metal stents (SEMSs) can vary considerably. • Specific situations may warrant the use of SEMSs with particular characteristics over others. • Characteristics of SEMSs must be considered during selection for optimal outcomes., (© 2024. The Author(s).)

Objective: To compare the efficacy and safety of preoperative localization of small pulmonary nodules (SPNs) with 4-hook anchor device and hook-wire before video-assisted thoracoscopic surgery., Methods: Patients with SPNs scheduled for computed tomography-guided nodule localization before video-assisted thoracoscopic surgery between May 2021 and June 2021 at our center were randomized to either 4-hook anchor group or hook-wire group. The primary end point was intraoperative localization success., Results: After randomization, 28 patients with 34 SPNs were assigned to the 4-hook anchor group and 28 patients with 34 SPNs to the hook-wire group. The operative localization success rate was significantly greater in the 4-hook anchor group than in the hook-wire group (94.1% [32/34] vs 64.7% [22/34]; P = .007). All lesions in the 2 groups were successfully resected under thoracoscopy, but 4 patients in the hook-wire group who required transition from wedge resection to segmentectomy or lobectomy because of unsuccessful localization. Total localization-related complication rate was significantly lower in the 4-hook anchor group than in the hook-wire group (10.3% [3/28] vs 50.0% [14/28]; P = .004). The rate of chest pain requiring analgesia after the localization procedure was significantly lower in the 4-hook anchor group than in the hook-wire group (0 vs 5/28, 17.9%; P = .026). There were no significant differences in localization technical success rate, operative blood loss, hospital stay length and hospital cost between the 2 groups (all P > .05)., Conclusions: The use of the 4-hook anchor device for SPN localization offers advantages over the traditional hook-wire technique., (Copyright © 2023. Published by Elsevier Inc.)

Purpose: The purpose of this study was to retrospectively evaluate the outcome of transcatheter arterial embolization (TAE) in the treatment of cancer-related non-variceal upper gastrointestinal bleeding (UGIB)., Materials and Methods: One-hundred and seven patients who underwent TAE for the treatment of cancer-related non-variceal UGIB at five institutions between June 2016 and May 2019 were retrospectively included. There were 78 men and 29 women, with a mean age of 60.6 ± 13.2 (SD) (age range: 31-87 years). Clinical success was defined as no rebleeding within 30 days after TAE. Rebleeding was defined as non-variceal UGIB resulting in a decrease in hemoglobin > 2 g/dL within 24 h. The Kaplan-Meier method was used to estimate actuarial probabilities of rebleeding and survival within 30 days after TAE. Univariable and multivariable analyses were performed to identify variables associated with clinical success and 30-day mortality., Results: Technical success was achieved in 106 out of 107 patients (99.1%). Positive angiographic findings (contrast extravasation and pseudoaneurysm) were observed in 30/107 patients (28.0%). Empiric embolization was performed in 77/107 patients (72.0%). Clinical success was achieved in 60/107 patients (56.1%). The 3-day, 7-day, and 30-day actuarial probabilities of rebleeding were 21.5%, 31.0%, and 44.6%, respectively. No variables were identified as predictors of clinical success. Nineteen patients (19/107; 17.8%) died within 30 days after TAE; of them, 14 (14/107; 13.1%) died due to bleeding-related causes. The 3-day, 7-day, and 30-day actuarial probabilities of survival were 91.6%, 88.8%, and 77.4%, respectively. A baseline hemoglobin level of ≤ 60 g/L (Odds ratio [OR]: 3.376; 95% confidence interval [CI]: 1.223-9.318; P = 0.019) and clinical failure (OR: 6.149; 95% CI: 2.113-17.893; P = 0.001) were identified as predictors of 30-day mortality. Major complications (gastrointestinal perforation) occurred in one patient (1/107; 0.9%). Minor complications (abdominal pain, fever, and vomiting) occurred in 19 patients (19/107; 17.8%)., Conclusion: TAE is a safe treatment option for patients with cancer-related non-variceal UGIB, and seems to be effective in more than half of these patients., Competing Interests: Conflict of Interest The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article., (Copyright © 2022 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: To compare patient satisfaction, procedural variables, and safety with transradial access (TRA) and transfemoral access (TFA) in patients undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC)., Materials and Methods: From February 2019 to August 2021, 130 patients undergoing TACE for HCC were randomly allocated to the TRA (n = 65) or TFA (n = 65) group. Vascular closure devices were not used after TFA-TACE. All patients completed the post-catheterization questionnaire and 8-item Short-Form Health Survey 1 day after TACE., Results: Technical success rate, crossover rate, contrast agent dose, fluoroscopy time, procedure time, air kerma, dose-area product, length of hospital stay, and total cost were similar between the two groups (all p > 0.05). The incidence and severity of adverse events were also similar between the two groups (all p > 0.05). However, overall discomfort, difficulty going to the bathroom, difficulty feeding or self-caring, difficulty walking, general health, physical function, role physical function, social function, mental health, and role emotional function were better in the TRA group than in the TFA group (all p < 0.001). Consequently, more patients preferred the current access for their next procedure in the TRA group than in the TFA group (90.8% vs. 24.6%; p < 0.001)., Conclusion: In patients undergoing TACE for HCC, using TRA instead of TFA can improve patient satisfaction without compromising procedural variables and safety., Key Points: • Transradial access (TRA) enabled early ambulation after transarterial chemoembolization (TACE), resulting in significant increase in activities of daily living and health-related quality of life (HRQoL) compared to transfemoral access (TFA) when vascular closure devices were not used. • Procedural variables (contrast agent dose, fluoroscopy time, procedure time, air kerma, dose-area product, length of hospital stay, and total cost) were not significantly different between patients who received TRA-TACE and TFA-TACE. • The incidence and severity of adverse events were similar between patients who received TRA-TACE and TFA-TACE., (© 2022. The Author(s), under exclusive licence to European Society of Radiology.)

Purpose: To evaluate the effectiveness and safety of the Urexel stent for treating malignant ureteral obstruction (MUO)., Materials and Methods: This retrospective study included 129 patients (mean age: 57.9 ± 11.8 years; men: n = 64, 49.6%; ureteral units [UUs]: N = 175) who underwent Urexel stent placement to treat MUO between March 2013 and April 2021. The Urexel stent is a fully covered self-expanding metal stent. To reduce stent migration, the proximal end of the stent has an additional layer of stent mesh and is flared mildly., Results: Eighty-three patients (64.3%) had unilateral MUO (right side: n = 47, 36.4%; left side: n = 36, 27.9%), and 46 patients (35.7%) had bilateral MUO. Successful Urexel stent placement after successful guidewire passage of the obstructed ureteral segment was achieved in 172 UUs, rendering a technical success rate of 98.3%. Stent malfunction occurred in 37 UUs (21.4%) during follow-up, including tumor overgrowth (n = 29), tumor ingrowth (n = 3), stent migration (n = 3), and stent collapse (n = 2). A total of 120 patients (93.0%) died during a median follow-up of 4.1 months (range: 0.2 - 33.5). The median survival of the patients was 4.4 months (interquartile range [IQR] 2.0 - 8.8). The median malfunction-free survival of the patients was 3.6 months (IQR: 1.6 - 7.9). Fifteen grade 3 or higher complications occurred in 14 patients (10.9%), including flank pain (n = 10), gross hematuria (n = 4), and dysuria (n = 1)., Conclusion: Urexel stent placement may be effective and safe for treating MUO., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Background: To determine the prevalence and prognostic impact of hepatopulmonary syndrome (HPS) in patients with unresectable hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE)., Methods: Fifty-four patients with unresectable HCC undergoing TACE between December 2014 and December 2015 were prospectively screened for HPS and were followed up for a maximum of 2 years or until the end of this prospective study., Results: Nineteen of the 54 (35.2%) patients were considered to have HPS, including one (5.3%) with severe HPS, nine (47.4%) with moderate HPS, and nine (47.4%) with mild HPS. The median overall survival (OS) was 10.1 (95% confidence interval [CI], 3.9-16.3) months for patients with HPS and 15.1 (95% CI, 7.3-22.9) months for patients without HPS, which is not a significant difference ( P  = 0.100). The median progression-free survival was also not significantly different between patients with and without HPS (5.2 [95% CI, 0-12.8] vs. 8.4 [95% CI, 3.6-13.1] months; P  = 0.537). In the multivariable Cox regression analyses, carbon monoxide diffusing capacity (hazard ratio [HR] = 1.033 [95% CI, 1.003-1.064]; P  = 0.028) and Child-Pugh class (HR = 1.815 [95% CI, 1.011-3.260]; P  = 0.046) were identified to be the independent prognostic factors of OS., Conclusion: Mild or moderate HPS is common in patients with unresectable HCC undergoing TACE, but it does not seem to have a significant prognostic impact., (Copyright © 2022 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)