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Objective: To investigate the clinical efficacy of percutaneous vertebroplasty (PVP) combined with iodine-125 ((125)I) seed brachytherapy in the treatment of spinal metastatic epidural spinal cord compression (MESCC) and toassess the changes inthe grade of epidural spinal cord compression (ESCC) by magnetic resonance imaging (MRI). Methods: A total of 37 MESCC patients treated with PVP combined with (125)I seed brachytherapy in the interventional and vascular surgery department of Zhongda Hospital affiliated to Southeast University from January 2014 to June 2019 were retrospectively analyzed, including 23 cases of bilateral lower limbs paralysis. Total diseased vertebrae are 39 segments. Visual analogue scale (VAS) and paralysis of lower extremities were evaluated regularly before and after treatment, and VAS values at different follow-up time points were compared. At the same time, MRI was used to evaluate the changes of ESCC grade in the spinal canal and calculate the local lesion efficiency after operation. The postoperative local lesion efficiency at different follow-up times was compared. Results: PVP combined with (125)I seed implantation in all diseased vertebral bodies was successful. The average injection volume of polymethylmethacrylate (PMMA) was (3.2±1.3) ml/segment, the average number of (125)I seed implanted was (25.0±8.6) seeds/segment and the average radiation dose was (15.0±5.1) mCi/segment. The VAS before operation was 8.5, and postoperative VAS were respectively 3.6±1.3, 3.8±1.5, 3.4±1.4, 5.5±1.0, 5.9±1.4 at 5 days, 1 month, 3 months, 6 months, and 1 year after operation. The differences between all follow-up time points and preoperative VAS values were statistically significant (all P <0.001). Compared with 5 days, 1 month and 3 months after operation, VAS increased significantly at 6 months and 1 year after operation, and the difference was statistically significant (all P <0.001); there was no significant difference between the VAS value at 6 months after operation and 1 year after operation ( P =0.405). At a follow-up of 3 months, 22 of 23 patients with paralysis of bilateral lower limbs regained the functions of autonomous walking and voiding; the effective rates of MESCC local lesions evaluated by MRI at 1 month, 3 months, 6 months, and>1 year were 89.7%, 91.9%, 90.6%, and 94.7%, respectively, and there was no statistically significant differences among those follow-up time points (all P >0.05). Conclusions: PVP combined with (125)I seed brachytherapy in the treatment of MESCC has significant improvement in immediate pain relief and spinal cord function. After combined treatment, MRI showed that the tumors around the spinal cord regressed dramatically, which could considerably reduce the MESCC grade and remain stable for a long time.

Objective: To evaluate the effectiveness of cement augmentation on the osteolytic lesion in patients with vertebral metastasis. Methods: A total of consecutive 132 patients with 268 vertebral metastatic lesions treated with PVP from January 2008 to December 2016 in Zhongda Hospital were enrolled in this study. Retrospective analysis of preoperative, postoperative 3 days, 3 months, 6 months, 12 months and ≥ 18 months imaging data on CT, the local control and progression of the tumor were evaluated by MDA response criteria. The local control rates were compared between the groups with the different rate of cement filling by Chi 2 -test. Results: Vertebroplasty procedures were performed successfully in all 268 vertebrae under DSA guidance, and the mean volume of PMMA injected in each vertebra was 0.7-8.5(3.9±1.5)ml.The rate of local control at 3 months, 6 months, 12 months and ≥18 months after PVP was respectively 98.9%, 95.1%, 91.8%, and 85.2%, the difference was statistically significant(all P <0.05). The local control rate showed a statistically significant relationship to the groups with the rate of cement filling at 6 months, 12 months and ≥18 months after PVP, but there was no statistical difference at postoperative 3 months. The rate of local control was higher in 68 patients with lung or gastrointestinal cancer than in 17 patients with liver or kidney cancer at 3 months, 6 months and 12 months, the difference was statistically significant ( P <0.05). Conclusion: Cement augmentation has a local anti-tumor effect on vertebral osteolytic metastatic lesion, and the anti-tumor effect will decrease as the follow-up time extended.

Objective: To determine the anatomical relation between the carotid artery or laryngopharynx and the needle path via anterolateral oblique approach to C2 vertebral body, and whether the simulated path can direct the actual procedure. Methods: Contrast agent was injected into bilateral carotid arteries of 10 fresh cadavers (20 sides), and then CT scans were performed on each subject. Bilateral simulated puncture paths were simulated on the image of two-dimensional reconstruction CT. The distance between the puncture site and middle line(AC), the angle between the simulated puncture paths and the median sagittal plane (AOB), the distance between the simulated puncture paths and the side wall of hypopharynx, or the carotid artery was measured respectively. Under the guidance of fluoroscopy, oblique puncture via anterolateral to C2 was performed according to the simulated parameters, and then CT was done. The actual needle path was measured on the image of two-dimensional reconstruction CT. The outcomes were compared by using paired t test between groups. Results: Bilateral simulated puncture paths in all 10 cadavers were achieved on the image of CT. The bilateral punctures via anterolateral to C2 were successfully performed under fluoroscopic guidance in 10 cadavers, and the actual needle path could be showed on the image of two-dimensional reconstruction CT. The AC, angle AOB, the distance to carotid artery and side wall of laryngopharyngeal of the left simulated path was(4.7±1.0)cm, (33±8)°, (6.7±2.6)mm, (6.6±2.8)mm, respectively; and those in the right side was(5.2±1.3) cm, (36±8)°, (7.5±2.2) mm, (7.2±2.5) mm, respectively.The AC, angle AOB, the distance to carotid artery and side wall of laryngopharyngeal of the left actual needle was(4.5±1.1) cm, (33±9) °, (6.7±3.0) mm, (7.1±3.9) mm, respectively; and those in the right side was(5.1±1.5) cm, (35±10) °, (7.4±2.1) mm, (7.2±2.6) mm, respectively.And the actual and simulation data of both sides were compared and no significant differences was found by t test ( t =0.104-1.882, all P >0.05). Conclusion: The simulated approach via anterolateral to C2 can be achieved on the image of two-dimensional reconstruction CT, it is consistent with the real needle path and can be used to direct the actual practice to improve the accuracy and safety.

Objective: To analyze the clinical characteristics of IgG 4 -related disease (IgG 4 -RD)so as to improve the understanding of IgG 4 -RD in China. Methods: IgG 4 -RD patients were recruited from Peking Union Medical College Hospital between January 2011 and January 2016. All patients were followed-up for more than 6 months. The demographic characteristics, symptoms, organ involvements, laboratory examinations and treatment efficacy were evaluated and analyzed. Results: A total of 346 patients were finally enrolled, including 230 males (66.5%) and 116 females (33.5%). The mean age of disease onset was (53.8±14.2) years old. The mostly common involved organs were lymph nodes (56.4%) and submandibular glands (52.6%). Other affected organs and manifestations included: swelling of the lacrimal glands (46.5%), autoimmune pancreatitis (38.4%), pulmonary involvement (28.0%), sclerosing cholangitis (25.4%), naso-sinusitis (23.4%), parotid gland swelling (21.7%), retroperitoneal fibrosis (19.9%), large arteries involvement (9.5%), kidney involvement (obstructive nephropathy caused by retroperitoneal fibrosis was excluded) (6.9%), skin lesions (6.4%). Rare features consisted of thyroid glands, pituitary glands, gastrointestinal tract, pachymeningitis, pericardium, sclerosing mediastinitis and orchitis. The majority of patients had multi-organ involvement, such as 74.3% patients with 3 and more, 18.2% and 7.5% patients with 2 and single organ involvement respectively. The average IgG 4 -RD responder index (IgG 4 -RD RI) was 13.21±5.70. History of allergy was found in 172 (49.7%) patients. As to the laboratory tests, elevated serum IgG 4 levels were confirmed in 285 (94.1%) patients, which was positively correlated with IgG 4 -RD RI. There were 33.5% patients receiving monotherapy of glucocorticoid, 52.6% treated with glucocorticoids combined with immunosuppressive agents, 4.9% patients with immunosuppressant only, and 9.0% patients with mild disease not receiving medication. The majority (336, 97.1%) patients improved the above regimens. Conclusion: IgG 4 -RD is a systemic fibro-inflammatory disease with multiple organ involvement. The mostly common involved organs include lymph node, submandibular glands, and pancreas. Glucocorticoids and immunosuppressive agents were effective for IgG 4 -RD.

Objective: To study the perioperative management and surgical treatment of patients with neurosurgical critical diseases and thrombocytopenia., Methods: Eleven patients with the diagnosis of neurosurgical critical diseases and thrombocytopenia who received surgical treatment in Department of Neurosurgery, Peking Union Medical College Hospital from 2010 to 2015 were reviewed retrospectively. All eleven patients received platelet transfusions preoperatively. The safety and efficacy of surgical treatment were analyzed by GOS score at 6 months after operations., Results: Platelet counts of six patients who received minimally invasive surgery reached 80×10(9) /L by platelet transfusions preoperatively. Platelet counts of five patients who received Craniotomy and ventriculoperitoneal shunt reached 100×10(9) /L by platelet transfusions preoperatively. Eight patients received platelet transfusions postoperatively according to a low platelet count 24 hours after operations. Two patients died after surgery and one died after discharge. All other eight survival patients got well recovery with an average GOS score of 4.5 at six months after operations., Conclusions: Patients with neurosurgical critical diseases and thrombocytopenia could receive surgical treatment in collaboration with relative departments.

Objective: To explore the changes of magnetic resonance imaging (MRI) and computed tomography (CT) after transplantation of VX2 carcinoma into lumbar vertebrae of rabbits under CT guidance and examine its relationship with the onset of paralysis., Methods: A total of 52 rabbits were randomly divided into 4 groups. Under CT guidance, pieces of VX2 carcinoma were transplanted into the first or second lumbar vertebra in Groups A, B and C (n = 14 each) while sham operation was performed in Group D (n = 10). The anticipated endpoints of group A was natural death or Day 50 post-operation, group B Day 3 after onset of paralysis, group C Day 14 post-transplantation and group D natural death or Day 50 post-operation. CT and MR scans were performed at an interval of 7 days and hind limb functions monitored daily post-operation until endpoints. Pathohistological examinations of vertebrae were performed at endpoints., Results: All lumbar vertebrae were successfully transplanted under CT guidance. Thirty-two rabbits with spinal tumor and 9 surviving rabbits in the control group were monitored until endpoints. Abnormal signals on target vertebrae appeared on MRI in all 41 rabbits at Day 7 post-operation while positive CT findings were absent. No abnormal MRI/CT findings were found in 9 control rabbits from Day 14 post-operation to the end of study. Significant differences (P < 0.001) existed between the rates of tumor visualization with 65.6% (21/32) on MR and 3.1% (1/32) on CT at Day 14, 100% (21/21) on MR and 42.9% (9/21) on CT at Day 21. The rates of tumor visualization were 100% on both MR and CT from Day 28 to endpoints. The average survival time of Group A was significantly shorter than Group D (40 ± 4 vs 50 days, P < 0.01). The onset time of paralysis time in Group A (22 ± 5 days) had no significant difference with Group B (22 ± 5 days) (P = 0.952)., Conclusion: A rabbit model of spinal metastasis is established with high rates of success and reproducibility. Vertebral tumor may be located earlier on MR than CT after transplantation of VX2 carcinoma. The examinations of MRI and CT after Day 7 post-operation are controversial. The survival time of rabbits with paralysis caused by spinal tumor is significantly shortened.

Objective: To evaluate the feasibility, safety and efficiency of a new biliary intraluminal irradiation stent system loaded with (125)I seeds., Methods: The study was approved by the institutional ethics committee of our hospital, and informed consent was obtained from each patient. Patients with malignant biliary obstruction were treated with a new biliary irradiation stent system loaded with (125)I seeds according to a treatment plan system. All of the biliary seeds carrying devices combined with the matched biliary stents were placed by the procedures of percutaneous transhepatic biliary puncture. After stents implantation, all patients were followed-up., Results: The whole biliary stent systems loaded with (125)I seeds were successfully placed in 12 patients, no (125)I seeds exfoliation during the procedure and no radioactive leakage by general emission computed tomography reexamination during the follow-up were observed. The obstructive jaundice relived and the systemic conditions improved remarkably in all patients. There were no complications related to the stents, such as biliary perforation or hemobilia, were observed. And no significant change in the blood routine and immune parameters detected before and after operation during the follow-up were observed. The median survival period was 7.40 months (95%CI 6.204 - 8.596) and the mean survival period was 8.03 months (95%CI 6.142 - 9.909)., Conclusion: Development of a new biliary intraluminal irradiation stent system loaded with (125)I seeds is technically feasible and safe, treatment of this stent system has potential benefits of extending survival, however the long-term clinical efficacy needs to be certificated by further follow-up observation and control trials.