Currently， traditional chemotherapy， targeted therapy， and immunotherapy are the standard treatment options for inoperable advanced non-small cell lung cancer （NSCLC）. However， their efficacy has reached a plateau. Bronchial arterial chemoembolization （BACE） is considered a relatively mature palliative minimally invasive treatment modality， which has distinct advantages in increasing the local concentration of chemotherapy drugs and reducing systemic side effects. In recent years， with the development of embolic materials， drug-eluting beads （DEB）， also known as drug-loaded microspheres， have been used to load chemotherapy drugs， allowing for a prolonged and stable maintenance of high drug concentrations within the tumor. This further enhances the therapeutic effect of BACE. This article aims to review the drugs loaded onto drug-eluting beads BACE （D-BACE）， the endpoints of embolization， the beneficiary population， and the clinical research progress and explore the current issues and future directions of D-BACE therapy for NSCLC.
Identification of benign and malignant lung lesions has always been a difficult and hot issue in imaging and clinical diagnosis and treatment. Percutaneous lung puncture biopsy can efficiently obtain pathologic specimens， which is the key to accurate diagnosis and treatment of lung lesions， especially peripheral lung lesions， and has high clinical application value. To improve the precision and safety of puncture， researchers have explored a variety of image-guided modalities， including computed tomography，C-arm computed tomography， ultrasound， MRI， positron emission tomography /computed tomography， and robot-assisted navigation systems. These methods have their own advantages and disadvantages in different application scenarios. In this article， we review the clinical application of percutaneous lung puncture biopsy and the research progress of its image-guided modalities， aiming to provide practical guidance for the selection of image-guided methods for percutaneous lung biopsy.
To explore the clinical efficacy and safety of drug-eluting bead bronchial artery chemoembolization （D-BACE） in the treatment of rare non-small cell lung cancer （NSCLC）.
Methods
The clinical data of 8 patients with pathologically confirmed rare NSCLC who underwent D-BACE treatment were analyzed. The types of cancer included adenoid cystic carcinoma （3 cases），lymphoepithelioma-like carcinoma （2 cases）， SMACAR4-deficient lung cancer （2 cases）， and pulmonary sarcomatoid carcinoma （one case）. The clinical efficacy and safety of D-BACE were evaluated by observing objective response rate， disease control rate， progression-free survival （PFS）， and overall survival （OS）.Adverse reactions during the treatment process were also recorded and assessed.
Results
The average age of the patients was （51.0±3.4） years， with 5 males and 3 females. Among them， 1 patient underwent surgical resection in combination with D-BACE， 4 patients received chemotherapy and immunotherapy in combination with D-BACE， and 3 patients were treated with anlotinib in combination with D-BACE. After the first D-BACE treatment， the objective response rate was 25% （2/8）， and the disease control rate was 87.5% （7/8）. The median follow-up time was 18 months， with a median PFS of 6 months. The median OS has not yet been reached. Common adverse reactions included mild local pain （2 cases， 25%）， nausea and vomiting （2 cases， 25%）， fever （1 case， 12.5%）， and chest numbness （1 case， 12.5%）. All adverse reactions were mild and self-limited or relieved after symptomatic medication treatment. No serious complications were observed.
Conclusion
The combination of D-BACE and systemic treatment for rare non-small cell lung cancer is safe and feasible. However， further studies are needed to evaluate its long-term efficacy as the median overall survival has not yet been reached. The clinical value of D-BACE as a selective local treatment option warrants further exploration.
To investigate the clinical efficacy and safety of drug-loaded microspheres bronchial artery chemoembolization （D-BACE） in treating refractory non-small cell lung cancer （NSCLC）.
Methods
A retrospective analysis was conducted on 17 patients with stage Ⅲ～Ⅳ refractory NSCLC underwent D-BACE combined with systemic treatment （chemotherapy， targeted therapy， immunotherapy）from June 2018 to December 2022. The number of D-BACE treatments， median progression-free survival（PFS）， overall survival （OS）， disease control rate （DCR）， objective response rate （ORR）， and safety were recorded.
Results
The median number of D-BACE treatments was 1， ranging from 1 to 7 times. The ORR was 17.6%， and the DCR was 64.7%. The OS was 19.0 months， and the PFS was 9.5 months. No severe complications were observed； mild complications included chest numbness in 5 cases （29.4%）， pain in 8 cases （47.0%）， and nausea and vomiting in 5 cases （29.4%）.
Conclusion
D-BACE combined with systemic treatment can effectively control refractory NSCLC with minor adverse reactions， warranting further exploration and promotion.
To investigate the application value and safety analysis of bronchoscopy combined with digital subtraction angiography （DSA） under general anesthesia with transnasal tracheal tube intubation in the interventional diagnosis and treatment of airway stenosis.
Methods
We retrospectively analyzed the 90 cases of bronchoscopy combined with DSA under general anesthesia with transnasal tracheal intubation in the interventional diagnosis and treatment of airway stenosis in our hospital from January 2020 to December 2023.The clinical efficacy， and intraoperative and postoperative complications were evaluated.
Results
The success rate of metal tracheal stent placement in 90 patients was 100%. No serious adverse reactions such as massive hemorrhage and asphyxia occurred during the operation. The shortness of breath score and percutaneous arterial oxygen saturation （SpO2） before and after treatment were significantly different from those before stent placement （P＜0.000 1）. The patients with preoperative hemoptysis （7 cases） and intraoperative bleeding （35 cases） did not see any bleeding points after hemostasis under bronchoscope. The symptoms such as dyspnea were immediately relieved after stent implantation， and the clinical symptoms were relieved after surgery.
Conclusion
Bronchoscopy combined with DSA intervention under general anesthesia with transnasal tracheal intubation can effectively relieve airway stenosis and effectively stop bleeding，with feasible technology， safe operation and reliable recent efficacy， which is worthy of clinical promotion.
Preoperative embolization （PE） is an optional method to reduce intraoperative blood loss （IBL） during resection of metastatic vertebral tumors. This study aimed to investigate the efficacy and safety of PE for metastatic vertebral tumors.
Methods
The data for 14 patients with metastatic vertebral tumors who received PE from December 2021 to May 2024 were reviewed retrospectively. The rates of technical and clinical success， intraoperative blood loss， and complications were analysed.
Results
PE was successfully executed in all patients. Mean IBL was 350.0±284.1（50～1 000） mL during surgical resection of vertebral metastases. According to classification of intraoperative angiography findings， 12 cases were hypervascular tumors and 2 cases were nonhypervascular tumors. IBL in hypervascular tumors was 395.8 mL， and in nonhypervascular tumors was 75 mL. According to classification of the primary tumor histopathology， 2 cases were hypervascular tumors and 12 cases were nonhypervascular tumors. IBL in hypervascular tumors was 900 mL， and in nonhypervascular tumors was 258.3 mL. No serious complications， such as spinal cord infarction， pneumonia， bedsore or sudden death， were observed in these patients.
Conclusion
Nonhypervascular tumors classified by histopathology may still appear vascularly rich on angiography in the context of spinal metastases. The primary tumor histopathology and intraoperative angiography may impact the IBL. PE is an effective and safe treatment for metastatic vertebral tumors of reducing IBL during surgery.
To investigate the clinical efficiency of Glubran-2 in the selective arterial embolization treatment of refractory nasal bleeding in patients with nasopharyngeal carcinoma.
Methods
A retrospective analysis was conducted on the clinical data of 56 patients with refractory nasal bleeding due to nasopharyngeal carcinoma， who underwent Glubran-2 embolization in the neurosurgery department of the Third Affiliated Hospital of Southern Medical University from July 2018 to December 2023.Based on angiographic results. the patients were divided into a pseudoaneurysm group （29 cases） and a nonpseudoaneurysm group（27 cases）.The pseudoaneurysm group received super-selective embolization ， while the non-pseudoaneurysm group underwent empiric embolization of feeding arteries. Differences in clinical characteristics and prognosis between the two groups were analyzed.
Results
There was a statistically significant difference in the amount of bleeding between the two groups （P=0.029）. A total of 52 patients（92.9%） achieved completely hemostasis， 100% （29/29） in the pseudoaneurysm group and 85.2% （23/27） in the non-pseudoaneurysm group. Thirteen patients （23.2%） experienced complications， with 3 cases （10.3%）in the pseudoaneurysm group and 10 cases （37.0%） in the non-pseudoaneurysm group. The difference was statistically significant （P=0.018）.
Conclusion
In patients with nasopharyngeal carcinoma， rupture of pseudoaneurysms from the external carotid artery is more likely to result in severe bleeding. Both Glubran-2 super-selective embolization and empirical embolization are effective hemostatic methods. Super selective embolization of pseudoaneurysm is safer than empirical selective embolization.
To investigate the predictive value of preoperative CTA-based clot burden score for the first pass effect （FPE） of stent retrieve thrombectomy for acute anterior circulation large vessel occlusion.
Methods
The clinical data of 395 consecutive acute ischemic stroke （AIS） patients treated with first-line stent retrieve thrombectomy for large vessel occlusion in the anterior circulation at the First Affiliated Hospital of Nanjing Medical University from January 2021 to December 2023 were retrospectively included. Patients were divided into the FPE group （114 cases） and the non-FPE group （281 cases） according to angiography after the first thrombectomy attempt. Univariate and multivariate logistic regression analyses were used to identify predictors of FPE. The overall discriminative ability of clot burden score in predicting FPE was evaluated by receiver operating characteristic （ROC） curve.
Results
After adjustment for potential confounders， clot burden score （OR： 2.454， 95%CI： 1.753～3.429， P＜0.001） remained as an independent predictor for FPE. Based on the ROC， the clot burden score as a predictor for predicting FPE had an area under the curve of 0.820. The optimized cut-off of the clot burden score for predicting FPE was 6. When the score was ≥ 6， the sensitivity for predicting FPE was 87.3%， the specificity was 76.9%， the positive predictive value was 79.1%， and the negative predictive value was 91.4%.
Conclusion
The clot burden score had predictive value for FPE of stent retrieve thrombectomy for acute anterior circulation large vessel occlusion and may be used as an early independent predictor of FPE.
To analyze the growth rate and CT morphological features and enhancement characteristics of benign lung nodules with concomitant growth， and to apply the AI-assisted diagnostic tool for facilitating the differential diagnosis of benign and malignant lung nodules.
Methods
From January 2016 to October 2023， 22 benign pulmonary nodules in 20 cases in the Fifth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. The growth rate and volume doubling time （VDT） of nodules were calculated. The edge and internal imaging features and enhancement features of nodules on the initial CT and the last CT were recorded. The risk of nodules was judged by AI-assisted diagnostic tools for pulmonary nodules.
Results
Eighteen cases received surgical resection and two cases underwent percutaneous biopsy，which leading to the diagnosis of cryptococcosis in 1 case， tuberculous granuloma in 3 cases， inflammatory pseudotumor in 2 cases， nodular alveolar proteinosis in 1 case， chondromatous hamartoma in 1 case， fibrotic and necrotic nodule in 1 case and granuloma in 11 cases. The interval between the initial and last CT scans of 22 pulmonary nodules was 91～2 175 d， with a median of 419.50（298.25， 728.50） d， and the growth rate of pulmonary nodules was 16.67%～566.67%， with a median of 114.58%（26.07%， 217.13%）， and the VDT was 44.73～991.67 d， with an average of （279.55±236.06） d. At the last CT scan， there were 18 solid， 3 partially solid and 1 non-solid nodules， round and irregular lesions in 9， 13 nodules respectively， clear and blurred boundaries lesions in 18， 4 nodules respectively， spiculation， lobulation and pleural tag in 5， 7 and 10 nodules respectively， and bronchogram， bubble sign， cavity， and calcification in 2， 1， 1， and 6 nodules respectively，there are 2 nodules with satellite lesions. The mean net enhancement value of 7 nodules in the last enhanced CT scan was less than ＜20 HU. 12 nodules of the last CT scan were analyzed by AI， of which 3 were classified as high risk and 9 as low risk.
Conclusion
Some benign pulmonary nodules are similar to lung cancer in growth speed and morphology. CT enhancement and AI-assisted diagnostic tools for pulmonary nodules are helpful for the diagnosis of benign nodules， and CT-guided percutaneous biopsy may be helpful to avoid unnecessary surgery.
To evaluate the efficacy and safety of anchor positioning hook in preoperative localization of small pulmonary nodules under thoracoscopy.
Methods
A retrospective analysis was conducted on the clinical data of 107 patients （111 nodules） with pulmonary nodules or ground glass lesions that required localization before thoracoscopic surgery in our hospital from July 2021 to March 2023. All the lesions were located by anchor localization under the guidance of CT before operation. The effectiveness and complications of this localization method were comprehensively analyzed after operation.
Results
A total of 111 nodules were located， including 46 cases of pure ground glass lesions， 33 cases of partial ground glass nodules and 32 cases of solid nodules， with a localization success rate of 100%. Under video-assisted thoracoscopy， the lesions can be found quickly and accurately according to the location of the hook and resected， and there was no case of conversion to thoracotomy. No positioning hook shifted or fell off. Mild complications occurred in 16 cases （14.95%）， including 7 cases of pneumothorax （6.54%）， 3 case of hemoptysis（2.80%） and 6 cases of mild chest tightness and chest pain （5.60%）.
Conclusion
Anchor localization under the guidance of CT for preoperative localization of small pulmonary nodules or frosted glass lesions has the advantages of simple operation， high safety and good localization effect， and has a good application prospect.
To explore the correlation between imaging manifestations ，clinical symptoms and efficacy of Nocturnal enuresis （NE） in children with spina bifida occulta （SBO）.
Methods
From July 1， 2020 to June 30， 2023， 48 children diagnosed with NE combined with SBO in the Fifth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed in terms of imaging data，questionnaire survey and urinary diaries， and the clinical data of the included children were analyzed. Two radiologists independently evaluated the SBO classification， grading， and the number of vertebrae involved based on X-ray， and scored the SBO again after an interval of 1 month. The consistency between the two radiologists and within the radiologists was evaluated by Kappa consistency test. The Chi-square test or fisher's exact test was used to explore the correlation between different types， grades， the number of involved vertebrae and the general conditions of children with SBO enuresis， such as gender， age， severity of enuresis，presence or not of overactive bladder， single symptom nocturnal enuresis， and drug treatment response.
Results
1） Among the 48 children， SBO was divided into unilateral type （27 cases）， floating spine type（17 cases） and rostral spine type （4 cases）. In terms of the severity of enuresis， the unilateral type was mainly light and medium， while the floating spine and rostral spine types were predominantly severe， with statistical difference between them （P＜0.05）. In terms of treatment response， rostral spine type had the worst effect，with statistical difference （P＜0.05）. 2） Among the 48 children with SBO， 34 cases had grade Ⅰ， 8 cases had grade Ⅱ， and 6 cases had grade Ⅲ. There were no statistical differences in clinical symptoms and treatment of NE children with different grade SBO （P＞0.05）. 3） Among the 48 children with spina bifida， 27 cases had one vertebral body involvement， 18 cases had two vertebral bodies involvement， and 3 cases had three vertebral bodies involvement. In terms of age， the children with three vertebral bodies involvement were older than the other two groups， with statistical difference （P＜0.05）. In terms of treatment response， the effective rates of one vertebral involvement and two vertebral involvement were all above 85%， while the children with three vertebral involvement did not respond to treatment， and the difference was statistically significant（P＜0.05）.
Conclusion
The clinical manifestation and therapeutic effect of NE children with SBO are different. The floating spine type and rostral spine type are dominantly characterized by severe enuresis， and rostral spine type has the worst therapeutic effect. The more involved the vertebrae， the less effective the treatment. Therefore， holistic and individual evaluation and treatment should be carried out in the diagnosis and treatment of NE children with SBO.
To demonstrate the feasibility of multi-shell diffusion magnetic resonance imaging （MRI） techniques in characterizing microstructural changes in brain tissue during ischemic stroke.This study evaluates the differences， specificity and sensitivity of diffusion metrics.
Methods
We established a middle cerebral artery occlusion-reperfusion （MCAO/R） model in rats. Using a 9.4T small animal in vivo magnetic resonance imaging system， we collected multi-shell diffusion data， and analyzed a typical diffusion tensor imaging （DTI） model， and two advanced models diffusion kurtosis imaging （DKI）， and neurite orientation dispersion and density imaging （NODDI）， within the framework of multi-shell diffusion magnetic resonance imaging. Paired t-tests， receiver operating characteristic （ROC） curve and area under the curve（AUC） were employed to assess the specificity and sensitivity of diffusion metrics.
Results
Compared to the contralateral normal region， significant differences were observed in all NODDI indices： orientation dispersion index （ODI）， neurite density index （NDI）， and volume fraction of isotropic water （FISO） on the infarcted side（P＜0.001）， with NODDI metrics demonstrating high detection performance. Both NDI and the DKI index showed similar capabilities in detecting disease progression. NDI and DKI showed similar capabilities in detecting disease progression. Furthermore， NODDI-related metrics were consistent with histological analysis results.
Conclusion
Multi-shell diffusion magnetic resonance imaging exhibits high sensitivity in detecting and revealing microstructural changes in brain tissue during ischemic stroke， establishing a crucial foundation for the clinical translation of diagnostic and therapeutic strategies for ischemic stroke.
To explore a prevention and control technology for osteoporosis （OP） and concurrent vertebral compression fractures （OVCF） using a biodegradable polymer drug loaded alendronafe balloon （ALN balloon） combined with polymethylmethacrylate （PMMA）.
Methods
12-month-old female miniature Bama pigs were used to study， and the base-line of bone mineral density （BMD）， estradio （E2） and bone gla protein BGP （BGP） were measured. With bilateral ovariectomy， prednisolone-induced for 3 weeks，and sham operation， sham drug administration， the pigs are randomly divided into three groups： osteoporosis modeling group 1 （OM-1 group）， osteoporosis modeling group 2 （OM-2 group）， and sham osteoporosis modeling group （SOM group）. Based on percutanous vertebral augmentation （PVA）， OM-1 group with ALN balloon + PMMA， OM-2 group with non drug loaded balloon + PMMA， SOM group with ALN balloon +PMMA. BMD， E2， BGP are measured at the 0， 3rd， 6th months.
Results
Three months after PVA surgery，the BMD values of lumbar spine in the OM-1 group were higher than those of the OM-2 group， and the difference was statistically significant （P＜0.05）. With the increase of animal age， the BMD values of lumbar spine in the OM-1 group showed an increasing trend， while those in the OM-2 group showed a decreasing trend， and the difference between the two groups was statistically significant （P＜0.01）. After PVA surgery，with increasing age， E2 levels in the OM-1 and OM-2 groups significantly decreased， while BGP levels significantly increased， with statistically significant differences compared to baseline values （P＜0.01），and there was no statistically significant difference between the two groups （P＞0.05）.
Conclusion
ALN balloon+PMMA simultaneously has the effect of preventing and treating OVCF and OP.
Lymphatic malformation （LM） is a rare congenital anomaly of lymphatic vessel development. Based on its clinical and histologic features， it can be classified as macrocystic， microcystic，or mixed. Lymphatic malformation grows relatively slowly and almost never subsides naturally. Currently，the focus of research on lymphatic malformations has shifted to drug therapy， especially targeted drugs for their gene regulation. In recent years， several gene mutations， such as PIK3CA， TEK， GATA2， CCBE1，etc.， have been found to be closely associated with lymphatic malformations， which provides new ideas for molecular diagnosis and targeted therapy. The aim of this paper is to explore the pathogenesis of lymphatic malformations in depth and to combine it with the current research progress in drug therapy， in order to improve the understanding of the molecular mechanism of lymphatic malformations and to provide more targeted medication guidance for clinical treatment.
Sporadic Venous Malformations （SVMs） is the most common type of venous malformations. It mainly presents with isolated and sporadic abnormal dilatation and malformations，accounting for more than 90% of all venous malformations. In recent years， the molecular mechanism of the pathogenesis of vascular malformations and related signal transduction pathways have been studied more and more thoroughly. Multiple pathogenic genes and related pathogenic signal pathways of SVMs have been confirmed， such as TIE2 and PIK3CA. For SVMs that are ineffective to conventional treatment， a variety of targeted drugs， such as Sirolimus and Apelisib， can control the development of SVMs， significantly improve the clinical symptoms of patients， and improve the quality of life， showing a good application prospect in the treatment of SVMs.
To create a list of health problems covered in patient guidelines after percutaneous liver puncture biliary drainage based on Delphi method and analytic hierarchy process （AHP），and to provide reference for the formulation of relevant patient guidelines.
Methods
A list of health problems was developed through literature research and semi-structured interview， and the list items were scored by Delphi expert correspondence. The weight of each index was determined by analytic hierarchy process， and the list item of health problems in patients'guide after percutaneous liver puncture biliary drainage was determined.
Results
A total of 16 issues related to health management after percutaneous hepatic puncture biliary drainage were extracted from 6 literatures. After interviews with 11 patients， 14 family caregivers and 9 medical professionals， a list of 20 health problems was extracted.A total of 19 health problems were identified as priority issues for this patient guide by screening the questions based on the Delphi expert correspondence score and the weights obtained from AHP.
Conclusion
Through literature research， in-depth personal interviews and correspondence from Delphi experts， AHP was used to calculate the weight to determine the health problems to be included in the patient guidelines for percutaneous liver puncture biliary drainage， which can provide reference for the formulation of follow-up patient guidelines.
To explore the effect of narrative nursing training based on analysis -designdevelopment-implementation-evaluation（ADDIE） model in obstetric preventive interventional treatment of placental accretion disease.
Methods
From October 2022 to October 2023， 60 nurses in the Department of Obstetrics and Intervention of our hospital were selected as the research objects， and were divided into observation group and control group by random number table， with 30 nurses in each group. The control group received routine teaching training， and the observation group received narrative nursing training based on ADDIE model. After the training， the humanistic caring ability， empathy ability， nursing core ability score and training satisfaction of the two groups of nurses were compared.
Results
The scores of humanistic caring ability， empathy ability and core nursing ability in the observation group were higher than those in the control group （P＜0.05）， and the training satisfaction of nurses in the observation group was higher than that in the control group （P＜0.05）.
Conclusion
Narrative nursing training based on ADDIE model can improve the humanistic care ability， empathy ability and core nursing ability of obstetric and interventional nurses in the preventive interventional treatment of placental accretion.
To analyze the application of cluster nursing in the treatment of lumbar disc herniation with ozone ablation.
Methods
A total of 68 patients with lumbar disc herniation admitted to Nanfang Hospital， Southern Medical University from January 2022 to June 2023 were selected. All of the patients were divided into control group （34 cases， routine nursing） and observation group （34 cases， cluster nursing） according to the random number table method. The clinical effects of the two groups were evaluated and compared.
Results
After 3 months of intervention， compared with the control group， The total effective rate， Japanese Orthopaedic Association （JOA） score， general quality of life inventory 74 （GQOLI-74）score and nursing satisfaction in the observation group were significantly improved， while visual analogue scale （VAS） score was significantly decreased， and the differences were statistically significant （P＜0.05）.
Conclusion
Cluster nursing for lumbar disc herniation with ozone ablation can improve clinical symptoms，relieve pain and promote functional recovery.
