氰基丙烯酸酯胶栓塞原发性肝细胞癌合并重度肝动脉门静脉瘘12例疗效分析

【摘要】 目的 评价采用α-氰基丙烯酸正丁酯（N?蛳 butyl 2?蛳 cyanoacrylate,NBCA）胶栓塞治疗肝癌伴重度肝动脉门静脉瘘（arterioportal shunt,APS）的临床疗效。方法 2006年1月至2010年1月,采用NBCA胶栓塞治疗12例原发性肝细胞癌合并有门静脉主干表现为离肝血流的重度APS患者。随访和分析12例重度APS患者的手术前后APS改善情况、肿瘤反应、生存期和手术相关并发症等。结果 接受NBCA胶栓塞的12例患者在术后即刻造影显示APS迅速改善。而在进行随访复查造影的10例中,有8例的APS得到持续改善。按mRECIST标准在首次栓塞术后第4个月肿瘤取得最大疗效;接受随访的病例中部分缓解为2/10,疾病进展为3/10,疾病稳定为5/10。患者的半年、1年和2年的生存率分别为67%,33%,8%;中位生存期为275 d,介入栓塞未出现严重并发症。结论 采用NBCA胶栓塞肝癌合并重度APS患者是一种安全有效的治疗方法。

     

化疗栓塞治疗肝癌合并肝动-静脉分流的生存预后因素分析

【摘要】 目的 探讨PVA联合碘油化疗药乳剂（或化疗药物）在肝癌合并肝动-静脉分流栓塞治疗的生存预后因素。方法 2013年1月—2014年6月,97例肝癌并肝动-静脉分流的患者（慢速型分流21例,中速型分流40例,快速型分流36例）,分别应用PVA-300、PVA-500及PVA-700行末梢性化疗栓塞,其中慢、中速型加用碘油化疗乳剂栓塞,快速型仅加用化疗药物。应用Kaplan-Meier法、Log-Rank检验进行生存分析,Cox比例风险模型进行多因素回归分析。结果 97例肝癌合并肝动-静脉分流的患者中位生存期为281 d,6、12、18个月生存率分别为67%、37.2%、14.2%。多因素分析结果显示:术前AFP≥400 ng/ml（HR=3.763,P=0.002）、门静脉癌栓形成（HR=2.669,P=0.021）及疾病进展（HR=2.55,P=0.039）为独立危险因素;而栓塞次数≥3次（HR=0.216,P=0.001）、分流完全及次全栓塞（HR=0.22,P=0.030）及采用综合治疗（HR=0.181,P＜0.001）为独立保护因素。结论 PVA联合碘油化疗药乳剂（或化疗药物）末梢性化疗栓塞肝癌合并肝动-静脉分流是一种可行、有效的方法。栓塞次数较多、分流完全及次全栓塞以及采用综合治疗的患者预后较好,而术前AFP高水平、门静脉癌栓形成及疾病进展为患者预后危险因素。

     

肝细胞癌患者伴发糖尿病行肝动脉化疗栓塞术的预后因素分析

【摘要】 目的 分析糖尿病（DM）对不可切除肝细胞癌（HCC）患者TACE术后预后的影响。方法 选取2010年1月-2015年6月就诊于上海交通大学医学院附属新华医院行TACE术的HCC患者 858例,其中合并 DM患者175例（DM组）,HCC未合并 DM患者683例（非DM组）,分析两组患者一般临床资料及总体生存的差异。生存率用Kaplan- Meier法计算,组间差异采用Log- Rank方法,采用 Cox比例风险回归分析不可切除 HCC患者TACE术预后的影响因素。结果 两组性别、年龄、血清总胆红素、白蛋白、凝血酶原时间、甲胎蛋白（AFP）、Child- Pugh分级、肿瘤最大直径和数目、肝硬化、TACE治疗次数以及BCLC分期比较,差异均无统计学意义（P＞0.05）;DM组空腹血糖（FPG）水平高于非DM组（P＜0.05）。DM组患者 1、3、5年生存率为 60.9％、27.5％和10.7%,非DM组为 70.9％、36.0％和17.6%,经 Log- rank检验,差异存在统计学意义（P＝0.008）。将上述变量进行多因素 Cox比例风险回归分析结果显示,肿瘤最大直径>5 cm、肿瘤数目多发、AFP>20 ng/ml、BCLC分期、以及合并DM是影响 HCC患者 TACE预后的独立危险因素。结论 DM是影响不可切除HCC患者 TACE后独立危险因素。
     

海藻酸钠微球栓塞治疗肝细胞癌合并动静脉分流22例近期疗效观察

【摘要】 目的 探讨海藻酸钠微球（KMG）经肝动脉栓塞治疗肝细胞癌（HCC）合并动静脉分流的安全性及近期临床疗效。方法 回顾性分析2009年9月—2012年10月应用KMG栓塞治疗的22例HCC合并动静脉分流患者的临床资料,分析其相关不良反应、并发症及肿瘤的近期疗效。结果 22例患者中肝动脉-门静脉分流（APS）18例,肝动-静脉分流（AVS）3例,APS合并AVS 1例;周围型20例,混合型2例;轻度分流5例,中度分流17例。所有患者均成功行瘘口封堵及肿瘤栓塞治疗;术后不良反应包括:发热59.1%（13/22）;肝区疼痛72.7%（16/22）;恶心呕吐 22.7%（5/22）,无严重并发症发生;术后1个月左右复查CT或MR见肿瘤活性灶较栓塞前缩小（t = 2.286,P = 0.033）;所有患者并再次行TACE/TAE治疗,术中示10例出现新发APS,2例新发AVS,再次以KMG成功栓塞。结论 KMG栓塞治疗HCC合并动静脉分流安全,近期疗效显著。

     

索拉非尼联合PVA微粒化疗栓塞治疗肝癌并肝动-静脉分流的疗效及预后分析

【摘要】 目的 评价索拉非尼联合PVA化疗栓塞（PVA- TACE）治疗肝癌合并肝动-静脉分流（HAVS）的疗效及预后因素。方法 110例肝癌合并HAVS患者,采用索拉非尼+PVA- TACE治疗（治疗组）17例,PVA- TACE治疗（对照组）93例。依据HAVS的分流速度,采用不同大小的PVA化疗栓塞分流道。随访并分析生存期、并发症等。采用Kaplan- Meier法计算累计生存率,预后因素采用Cox模型分析。结果 治疗组与对照组中位生存期（overall survival,OS）分别为12.8个月和7.7个月,两组有统计学意义（χ2=3.907,P=0.048）。两组6、12个月生存率分别为78.8%、45.5%,66.7%、23.6%。多因素分析结果显示:联合索拉非尼（HR=0.351,P=0.007）及多次栓塞（HR=0.498,P=0.018）为独立保护因素,术前AFP≥400 ng/ml（HR=1.984,P=0.018）为独立危险因素。结论 索拉非尼联合PVA- TACE治疗中晚期肝癌并HAVS安全、有效,疗效优于单纯PVA- TACE;术前AFP低表达及多次栓塞治疗患者的预后较好。
     

原发性肝癌合并下腔静脉及右心房癌栓的动脉内化疗栓塞治疗

【摘要】 目的 评价肝动脉化疗栓塞（TACE）治疗原发性肝癌合并下腔静脉及右心房癌栓的可行性。方法 回顾性分析经肝动脉化疗栓塞治疗16例原发性肝癌合并下腔静脉及右心房癌栓的患者。在行氟尿嘧啶、丝裂霉素、吡柔比星动脉灌注化疗后用与吡柔比星、碘油和PVA颗粒（直径300 μm）混合物进行肿瘤供血动脉栓塞治疗。结果 癌栓治疗有效患者11例（占68.7％,11/16）,其中位生存期为13.5个月（7.5 ~ 26个月）。整组的中位生存期为12个月（范围2.6 ~ 26个月）。5例癌栓无反应组（癌栓对治疗无反应）的中生存期为3.3个月（2.6 ~ 12.5个月）（P < 0.01）。所有患者无严重栓塞后并发症发生。结论 肝动脉化疗栓塞治疗原发性肝癌合并下腔静脉及右心房癌栓是安全,有效的方法。

     

选择性动脉栓塞治疗原发性肝癌自发破裂出血的疗效及预后分析

【摘要】 目的 探讨初诊行选择性动脉栓塞（TACE）治疗原发性肝癌自发破裂出血的疗效及预后相关因素。方法 回顾性分析2012年6月至2016年6月,初诊接受选择性TACE治疗的57例原发性肝癌自发破裂出血的患者。末次随访时间为2016年10月。采用Kaplan- Meier法计算累积生存率,Cox回归模型分析生存预后因素。结果 57例患者,中位生存期为208 d,6个月、1年、2年累积生存率分别为50.3%、35.9%、14.7%。多因素Cox回归分析显示:肿瘤直径、Child- Pugh分级、休克病史以及栓塞材料是患者预后的独立相关因素。结论 初诊行选择性TACE治疗肝癌自发破裂出血安全、有效。本研究显示,较大的肿瘤直径,Child- Pugh分级不佳,休克病史与患者预后不良有关。同时,碘油联合明胶海绵颗粒TACE治疗患者可以获得比单纯PVA颗粒栓塞更好的预后。
     

肝动脉化疗或栓塞治疗胰腺神经内分泌肿瘤肝转移的疗效分析

目的评价经肝动脉灌注化疗或栓塞治疗胰腺神经内分泌肿瘤肝转移的临床效果。方法对２１例胰腺神经内分泌肿瘤肝转移患者,共进行７７例次经动脉介入治疗,其中单纯经动脉灌注化疗５４例次,肝动脉化疗栓塞２３例次。分析临床疗效、影像学评价、无进展生存期（PFS）、总生存期（OS）和并发症。结果所有患者均顺利完成介入治疗,无严重并发症发生。临床反应为显效１０例、有效６例、无效５例,总有效率７６．２％（１６／２１）;影像学疗效评价有效１１例、稳定４例、疾病进展６例;PFS（１５．０±１０．９）个月,OS（３１．２±１７．４）个月。结论经肝动脉灌注化疗或栓塞治疗胰腺神经内分泌肿瘤肝转移安全有效,可作为不能手术切除患者的一线治疗方法。     

肝动脉化疗栓塞及射频消融治疗胰腺神经内分泌肿瘤肝转移的疗效和生存分析

【摘要】 目的 评价经肝动脉化疗栓塞（TACE）和射频消融（RFA）治疗胰腺神经内分泌肿瘤肝转移患者的疗效并进行生存分析。方法 回顾28例接受TACE或（和）RFA治疗的胰腺神经内分泌肿瘤伴肝转移患者,统计治疗后影像学改变、总生存期和疾病无进展生存期,对比分析可能影响患者预后的潜在影响因素。结果 24例患者进行了70例次TACE,6例进行了11例次RFA治疗。影像学评价有效率46.4%,总生存期为（24.6 ± 6.6）个月,疾病无进展生存期为（17.5 ± 6.0）个月。影响因素中,患者有和无在除肝脏以外的远处转移灶生存期分别为（15.8 ± 6.0）个月和（28.7 ± 8.4）个月（P = 0.041）。结论 TACE和RFA是胰腺神经内分泌肿瘤肝转移的有效疗法。肝脏外的远处转移灶的存在可能为影响该类患者预后的因素。

     

氩氦冷冻消融术前外周血中性粒细胞与淋巴细胞比值对原发性肝癌患者预后的影响

【摘要】 目的 探讨原发性肝癌（HCC）患者氩氦冷冻消融术前外周血中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）对患者预后的影响。方法 回顾性分析72例HCC患者行经皮穿刺氩氦冷冻消融术的相关临床病理资料。根据术前NLR，分为低NLR组（NLR＜3.5）和高NLR组（NLR≥3.5），统计分析两组患者术后的总生存期（overall survival，OS），并对其影响预后的危险因素进行单因素和多因素分析。结果 所有患者经氩氦冷冻消融治疗后，中位生存期为22.4个月，其中高NLR组的中位生存期为13.2个月，低NLR组的中位生存期为24.2个月，两组中位生存期差异有统计学意义（P=0.003）。单因素分析显示:原发灶大小、肝功能Child- Pugh分级、白蛋白、总胆红素、胆碱酯酶、NLR是影响HCC患者氩氦冷冻消融术后生存期的相关因素（P＜0.05）。多因素分析显示:原发灶大小和NLR是影响HCC患者氩氦冷冻消融术后生存的独立预后因素（P＜0.05）。结论 术前外周血中NLR可作为HCC患者行氩氦冷冻消融术的预后指标，肝内原发灶越大、NLR越高，患者预后越差。

     

Hydrogen absorption by metallic thin films detected by optical transmittance measurements

The hydrogen absorption by bilayers of Pd/Nb and Pd/Ti, grown on glass substrates, was studied by measuring changes in optical transmittance and reflectance in the visible range (wavelengths between 400 nm and 1000 nm) of the films at hydrogen pressures between 3.99 × 10² and 4.65 × 10⁴ Pa. The electrical resistance of the films was also measured during absorption to correlate with the optical data. All the films were grown by a controlled sputtering technique in high vacuum. Pd films ranging in thickness between 4 nm and 45 nm were also characterized when the films were exposed to a hydrogen pressure. The resistance and transmittance of all the Pd samples increased with the uptake of hydrogen until saturation occurred. For Pd/Ti bilayers, fast uptake of hydrogen was deduced from a transmittance increase, indicating hydrogen absorption in the Ti layer. In the case of the Pd/Nb bilayer, a decrease in transmittance was observed, indicating that hydrogen was not absorbed in the Nb layer. The transmittance decrease could be explained by a reduction of Nb native oxide by the hydrogen at the surface.     

Light-driven biological hydrogen production by Escherichia coli mediated by TiO2 nanoparticles

Photocatalytic hydrogen production using an inorganic bio-hybrid system can contribute to the proficient utilization of light energy, but it would necessitate the development of novel approaches for preparing a new hydrogen-producing biocatalyst. In this study, we developed a hybrid system to produce hydrogen, whereby the highly efficient light-harvesting inorganic semiconductor (TiO₂) was mixed with Escherichia coli to form a biocatalyst with the addition of an electron mediator (MV²⁺) under different visible light irradiation. Under this hybrid system, the hydrogen production by E. coli was light intensity-dependent showing maximum production at 2000 W m⁻², with a 2-fold increase in the hydrogen production compared to that without TiO₂. The experiments on the continued cycle of hydrogen production revealed that the production could be continued for at least 3 cycles of 5 h incubation for each. A possible pathway utilizing glucose for hydrogen production by the hybrid system was proposed based on the analysis of the levels of metabolites. A feasibility study was also conducted using natural sunlight for hydrogen production by the hybrid system. Overall results demonstrated that whole cells of E. coli could be employed for photocatalytic hydrogen production where the intactness of the E. coli was retained under experimental conditions.     

Hydrogen production by splitting water on solid acid materials by thermal dissociation

Conventionally, there have been three basic ways of research on H₂ production from H₂O-splitting with solar energy: photo-catalytic, photo-electrochemical and thermochemical. Among them the thermal dissociation of H₂O has been considered the most efficient, because it is a single step energy conversion process and gives much higher conversion efficiency than those resulted from other methods. However, the major stumbling block of thermal dissociation of H₂O has been the requirement of a high dissociation temperature which causes problems both with materials for the reactor and with energy conversion efficiency for the process. In this study, we show that the dissociation temperature can be drastically lowered when H₂O is thermally dissociated on solid acid materials. A probable mechanism of the thermal H₂O-splitting on solid acid materials is also presented, based on some experimental results of this study and reports in the literature.     

Electrowetting-on-Dielectric by Wireless Powering

Electrowetting-on-dielectric (EWOD), in which microdroplets are manipulated using electrical inputs, has drawn a great deal of attraction with applications of digital lab-on-a-chip and hot-spot cooling. In most EWOD actuations, the commonly used powering method is wired transmission, which may not be suitable for isolating and employing EWOD devices in hard-to-reach areas. In this study, we investigate wireless power transmission for EWOD utilizing inductive coupling. Since EWOD is typically operated by a high-input voltage although the current is minimal, wireless EWOD also requires a similarly high voltage at the receiver, unlike conventional inductive coupling. To meet this condition, the resonant inductive coupling method at a high resonant frequency is introduced and investigated. To optimize the transmission efficiency, we study the effects of many parameters, such as the frequency, inductance, and capacitance at the transmitter and receiver, the gap between the transmitter coil and receiver coil, and the droplet size, by measuring the voltage at the receiver and the contact angle of the droplet placed on a wirelessly operated EWOD chip. In addition, by applying amplitude modulation to the resonant inductive coupling, wireless AC-EWOD, which generates droplet oscillations and is a common mode for EWOD droplet handling, is also achieved. Finally, it is successfully demonstrated that a droplet is transported laterally by using an array of electrodes, which is also powered by an amplitude-modulated wireless signal.     

Hydrogen generation by aluminum corrosion in seawater promoted by suspensions of aluminum hydroxide

Nowadays, new processes of H₂ generation from water via Al corrosion are mainly limited by Al passivation. Here we report on the systematic assessment of H₂ production by corrosion of Al in seawater suspensions prepared with NaAlO₂. The reported results are encouraging, since it was observed that seawater suspensions tested can prevent Al passivation during H₂ evolution, reaching 100% yields at ca. 700 cm³ H₂ min⁻¹. XRD analysis revealed the formation of solid Al(OH)₃ (bayerite) in initial seawater suspensions. So, model suspensions were prepared using NaAlO₂ + Al(OH)₃ in distilled water, which even improved the results obtained in seawater. Suspended particles of Al(OH)₃ act as nuclei in a mechanism of seeded crystallization, which prevents Al surface passivation. Moreover, a synergistic effect of Al(OH)₃ suspensions in combination with NaAlO₂ solutions was key in promoting Al corrosion. The effect of NaCl in aqueous suspensions was also studied, but it was insignificant compared to this synergistic effect. The composition of suspensions was optimized and a 0.01 M NaAlO₂ solution with 20 g dm⁻³ Al(OH)₃ was selected as candidate to generate H₂ at pH ca. 12 with high efficiency. Consecutive runs of the selected composition were performed obtaining ca. 90% yields in all of them.     

Hydrogen production by steam-oxidative reforming of bio-ethanol assisted by Laval nozzle arc discharge

The hydrogen production from an easily transported liquid feedstock can be an efficient alternative for fuel cells application. The steam-oxidative reforming of bio-ethanol by a novel gliding arc discharge named Laval nozzle arc discharge (LNAD) was investigated in this paper at low temperature and atmospheric pressure. The conversion efficiency and product distributions, mainly of H₂ and CO, were studied as functions of O/C ratio, S/C ratio, the ethanol flow rate and input power. The voltage–ampere (V–I) characteristic is also discussed here concerning the non-thermal plasma effect on the bio-ethanol reforming. A high conversion rate and fair H₂ yield have been achieved, 90% and 40% respectively. When the ethanol flow rate (G_ethanol) was 0.15 g s⁻¹ and S/C = 2.0, the minimum specific energy requirement of H₂ and CO were achieved at O/C = 1.4 with the specific energy input of 55.44 kJ per ethanol mole, 72.92 kJ mol⁻¹ and 80.20 kJ mol⁻¹ respectively. The optimal conditions for ethanol reforming seem to be S/C = 2.0 and O/C = 1.4–1.6, which are higher than those of the reaction's stoichiometry. This paper shows interesting results in comparison with the ethanol reforming assisted by other discharges. Compared with others, it features good conversion rate, low energy consumption and significantly reduced nitrogen oxide emission.     

Exploitation of solar energy collected by solar stills for desalination by membrane distillation

The aim of this work was to evaluate the technical feasibility of producing potable water from simulated seawater by integrating a membrane distillation module with a solar still. The relatively hot brine in the solar still was used as a feed to the membrane module. The synergistic action of the solar still and the membrane module in the production of potable water was quantified. For this purpose, two types of experiment were conducted, indoor experiments and outdoor experiments. The sensitivity of the permeate flux to the brine temperature, flow rate, salt concentration and solar irradiation were all investigated. Overall, the flux of water from the solar still was no more than 20% of the total flux. The brine temperature significantly affected the flux of both the solar still and the membrane module, while the effect of salt concentration was marginal. The effect of these process parameters was more noticeable in the membrane module than in the solar still.     

Optimization of hydrogen production by filtration combustion of natural gas by water addition

The effect of adding steam during filtration combustion of natural gas–air mixtures was studied with the aim to evaluate the optimization of hydrogen production. Temperature, velocity, chemical products of combustion waves, and conversion from fuel to H₂ and CO were evaluated in the range of equivalence ratio (φ) from stoichiometric (φ = 1.0) to φ = 3.0 and steam content in the mixture from 0% to 39%, at filtration velocities from 12 to 25 cm/s. Numerical simulation was carried out using GRI-MECH 3.0. Results suggest that H₂ and CO concentrations, dominant for rich and ultrarich combustion, are products from partial oxidation and steam natural gas reforming processes. Experimental and numerical results show that hydrogen yield increase with an increase of steam content in the natural gas–air mixtures.