Clinical characteristics of children with lobar pneumonia and the distribution of pathogens in bronchoalveolar lavage fluid / 中国热带医学

@#Abstract: Objective　To analyze the clinical characteristics of children with lobar pneumonia and the distribution of pathogens in bronchoalveolar lavage fluid (BALF) collected from these patients, hence providing a scientific basis for their precise diagnosis and treatment. Methods　A total of 115 children diagnosed with lobar pneumonia from August 2019 to August 2022 at Suining Central Hospital were screened as the research subjects. The clinical manifestations and occurrence of complications in the patients were investigated. All the children underwent bronchoalveolar lavage after admission, and BALF samples were collected. Fluorescence quantitative PCR was adopted to detect and analyze the distribution and clinical characteristics of Streptococcus pneumoniae (SP) and other related pathogenic microorganisms in BALF specimens. Results Among the 115 pediatric patients with lobar pneumonia, the occurrence of manifestations or complications including involvement of ≥2 lung lobes, myocardial damage, pleural effusion, abnormal liver function, digestive system involvement, nervous system involvement, rash, renal function impairment, and lung atelectasis were observed in 46, 46, 39, 33, 18, 17, 11, 5, and 4 cases, respectively. The pathogen positivity rate in the BALF samples of the 115 patients was 87.0% (100/115), with 81 cases of single infection and 19 cases of mixed infection. A total of 121 strains of pathogens were isolated, including 83 strains of Mycoplasmal pneumonia (MP) (accounting for 68.6%) and SP(13.2%). The differences in the detection rates of HI, MP, RSV strains among different age groups were statistically significant (χ2=8.834, 19.454, 10.284, P<0.05), while the differences in the infection rates of SP, KP, CP, and ADV were not statistically significant (χ2=3.393, 2.67, 0.565, 0.097, P>0.05). The MP pneumonia group showed significantly higher incidence of complications such as pleural effusion, nervous system involvement, and abnormal liver function than the non-MP pneumonia group (χ2=3.925, 4.195, and 4.513, P<0.05). The highest pathogen detection rate was in winter, accounting for 33.91%. Conclusions MP is the most common pathogen in BALF of children with lobar pneumonia. There is variation in the pathogen detection rate among different age groups and seasons. Those with combined infections were more prone to complications, which is worthy of attention by clinicians.

Comparison of Ultrasound Features of Primary Metastatic Papillary Thyroid Carcinoma and Recurrent/Persistent Metastatic Cervical Lymph Nodes / 中国医学科学院学报

Objective To explore the ultrasound features and levels of cervical lymph node metastases in primary and recurrent/persistent papillary thyroid cancer (PTC).Methods We retrospectively analyzed the clinical data of 2181 patients who underwent cervical lymph nodes dissection for PTC from January 12015 to January 12016.Totally 418 PTC patients (with 622 lymph nodes) who met the inclusion criteria entered the final analysis.Patients who had not received any prior thyroid treatment (surgery with or without radioactive iodine) were categorized as the primary group (352 patients with 527 metastatic lymph nodes),and patients who had received prior treatment (thyroidectomy with or without radioactive iodine) for PTC were categorized as recurrent/persistent group (66 patients with 95 metastatic lymph nodes).Pathological results from lymph node dissections were used as the gold standards by means of level-to-level analysis.Results The mean of the minimum axis diameter of the lymph nodes in the primary group was (6.7±3.6)mm,and that of the recurrent/persistent group was (6.6±3.1)mm (U=0.180,P=0.857).The proportion of metastasis in the central area of primary group was 40.0%,which was significantly higher than that in the recurrent/persistent group (12.6%);the proportion of metastasis in the lateral area was 60.6% in the primary group,which was significantly lower than that in the recurrent/persistent group (87.4%)(χ=26.288,P<0.001).In lateral metastatic lymph nodes,Ⅲ level was the most common place in both groups.Level Ⅴ metastatic lymph was rare in both primary group and recurrent/persistent group.Calcifications (63.1% vs. 48.2%;χ=7.207,P=0.007) and peripheral vascularity (81.1% vs. 59.4%;χ= 16.147, P<0.001) were more common in the recurrent/persistent group.The round shape,absence of an echogenic hilum,hyperechogenicity,and cystic aspects were not significantly different between these two groups (all P>0.05).Conclusions Primary metastatic lymph nodes often occur in the central area of lymph nodes,while lateral metastatic lymph nodes are more common in recurrent/persistent PTC.For metastatic lymph nodes,calcifications and peripheral vascularity are more common in recurrent/persistent PTC.

"Onion Skin-liked Sign" in Thyroid Ultrasonography: A Characteristic Feature of Benign Thyroid Nodules / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Some ultrasonographic (US) signs overlap between benign and malignant nodules. The purpose of this study was to raise a special US sign of benign thyroid nodules, termed the "onion skin-liked sign."</p><p><b>METHODS</b>Twenty-seven patients with 27 nodules who shrank naturally and the "onion skin-liked sign" appeared on the final US images were enrolled in the study. The ultrasound characters and risk stratifications at the start and end of observation were compared. Then, thirty goiters with fibrosis and thirty papillary thyroid carcinomas (PTC) were randomly selected from the database of our hospital, matched the sizes of 27 nodules at the end point of observation. The differences of "onion skin-liked sign" between the two groups were analyzed.</p><p><b>RESULTS</b>The average duration of follow-up of 27 nodules was 24.0 ± 12.2 months (range, 12-65 months). At the end of the follow-up, the size of the nodules decreased on average by 1.26 ± 0.82 cm (range, 0.3-3.4 cm) and calcification was found in 21 nodules, compared with only 2 nodules with calcification at the start of the follow-up. In addition, only negligible or no blood flow signal could be detected at the periphery of all the nodules and 100% (27/27) were high suspicion at the end of observation. In matched groups, all PTC showed high suspicion of malignancy, 18/30 (60%) goiters with fibrosis were high suspicion and 11/30 (37%) were intermediate suspicion. Twenty-two patients in the group of nodular fibrosis presented "onion skin-liked sign," which was not shown in any patient of PTC group. The sensitivity, specificity, positive predictive value, and negative predictive value of "onion skin-liked sign" in predicting nodular goiter with fibrosis were 73.3%, 100%, 100%, and 78.9%, respectively.</p><p><b>CONCLUSIONS</b>The "onion skin-liked sign" was a characteristic US feature of benign thyroid nodules detected in the follow-up of thyroid nodules. It is useful to differentiate PTCs and nodular goiters with fibrosis.</p>

Comparison of Clinical and Ultrasonographic Features of Poorly Differentiated Thyroid Carcinoma and Papillary Thyroid Carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The clinical behavior and management of poorly differentiated thyroid carcinoma (PDTC) are very different from papillary thyroid carcinoma (PTC). By comparing the clinical and ultrasonographic features between the two tumors, we proposed to provide more possibilities for recognizing PDTC before treatment.</p><p><b>METHODS</b>The data of 13 PDTCs and 39 age- and gender-matched PTCs in Peking Union Medical College Hospital between December 2003 and September 2013 were retrospectively reviewed. The clinical and ultrasonic features between the two groups were compared.</p><p><b>RESULTS</b>The frequencies of family history of carcinoma, complication with other thyroid lesions, lymph node metastases, recurrent laryngeal nerve injuries, and distant metastases were higher in PDTCs (30.8%, 61.6%, 69.2%, 23.1%, and 46.2%, respectively) than those in PTCs (2.6%, 23.1%, 25.6%, 2.6%, and 2.6%, respectively) (P < 0.05). The mortality rate of PDTCs was greatly higher than PTCs (P < 0.01). Conventional ultrasound showed that the size of PDTCs was larger than that of PTCs (3.1 ± 1.9 cm vs. 1.7 ± 1.0 cm). Clear margins and rich and/or irregular blood flow were found in 92.3% of PDTCs, which differed substantially from PTCs (51.7% and 53.8%, respectively) (P < 0.05).</p><p><b>CONCLUSIONS</b>PDTC is more aggressive and its mortality rate is higher than PTCs. Accordingly, more attention should be given to suspicious thyroid cancer nodules that show large size, regular shape, and rich blood flow signals on ultrasound to exclude the possibility of PDTCs.</p>

Diagnostic value of contrast-enhanced ultrasound of thyroid nodules coexisting with Hashimoto's thyroiditis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the value of contrast-enhanced ultrasound (CEUS) in diagnosing thyroid nodules coexisting with Hashimoto's thyroiditis (HT).</p><p><b>METHODS</b>Totally 62 thyroid nodules in 48 HT patients were retrospectively analyzed. The CEUS characteristics were reviewed, and diagnostic value of enhancement pattern and peak intensity were calculated.</p><p><b>RESULTS</b>Peak intensity (P=0.002) and enhancement pattern (P<0.001) differed significantly between malignant and benign thyroid nodules. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of heterogeneous enhancement were 97.6%, 85.7%, 93.0%, 94.7%, and 93.5%, respectively. Sensitivity, specificity, PPV, NPV and accuracy of low intensity at peak time were 85.4%, 52.4%, 77.8%, 64.7%, and 74.2%, respectively.</p><p><b>CONCLUSIONS</b>Heterogeneous enhancement is effective in the diagnosis of malignant thyroid nodules coexisting with HT. CEUS can improve the diagnostic accuracy in distinguishing thyroid nodules with unknown malignancy under the conventional ultrasound.</p>

Comparison of ultrasonic features between anaplastic thyroid carcinoma and papillary thyroid carcinoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the difference of the ultrasonic features between anaplastic thyroid carcinoma and papillary thyroid carcinoma.</p><p><b>METHODS</b>The ultrasound data of 7 patients with histopathologically confirmed anaplastic thyroid carcinomas who were treated in PUMC Hospital from April 2001 to June 2014 were retrospectively studied. In addition, 21 sex-and age-matched patients with histopathologically confirmed papillary thyroid carcinomas during the same period were enrolled as the control group. The pathologic results were regarded as the gold standard. The ultrasonic features of anaplastic thyroid carcinoma and papillary thyroid carcinoma were analyzed and compared.</p><p><b>RESULTS</b>Patients with anaplastic thyroid carcinoma were predominantly females (5/7,71.4%), with an average age of (64.9 ± 11.3) years. Large mass [(5.17 ± 1.26) cm vs. (1.85 ± 1.89)cm, P<0.001], anteroposterior-to-transverse diameter ratio less than 1(100.0% vs. 47.6%, P ＝ 0.03), and punctuate calcification (100.0% vs. 52.4%, P ＝ 0.03) were more frequently associated with anaplastic thyroid carcinoma than with papillary thyroid carcinoma. No significant difference was observed between the two groups in the shape, margin, cystic change, echogenicity, echotexture,vascularity,and envelope (all P>0.05).</p><p><b>CONCLUSION</b>In elderly women with common malignant features on ultrasound, the thyroid nodules with a maximum diameter greater than 5 cm,anteroposterior-to-transverse diameter ratio less than 1,and microcalcifications are highly likely to be anaplastic thyroid carcinoma.</p>

Discrepancy of Papillary Thyroid Carcinoma Sizes Measured by Ultrasonography and Pathology / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the size of papillary thyroid carcinoma on ultrasonography(US)and the actual size measured during histological examination and to discuss the potential causes of such discrepancy.</p><p><b>METHODS</b>A total of 148 patients with histologically confirmed papillary thyroid carcinoma underwent thyroid surgery in our center from December 2012 to May 2013. Patients were stratified based on the size,morphology,margin,cystic component,and presence of Hashimoto's disease to compare the discrepancy of the US and pathalogical measurements.</p><p><b>RESULTS</b>The mean sizes of the nodules measured by US and pathology were(1.58±0.94)cm and(1.33±0.84)cm,respectively(P=0.000). In 70.9%(105/148)of the nodules,the sizes measured by US were larger than those measured by pathology. In 17.6%(26/148)of the nodules,the sizes measured by US were smaller than those measured by pathology. In 1.1-1.4 cm size subgroup,the difference between mean ultrasound diameter and pathologic diameter was not significant [(1.21±0.11)cm vs.(1.11±0.32)cm,P=0.062]. In 0.1-1.0 cm size subgroup,the mean sizes of the nodules measured by US and pathology were(0.75±0.19)cm and(0.62±0.23)cm,respectively(P=0.000). In ≥1.5 cm size subgroup,the mean sizes of the nodules measured by US and pathology were(2.48±0.70)cm and(2.03±0.81)cm(P=0.000).</p><p><b>CONCLUSIONS</b>There is a significant discrepancy between US and pathologic size measurements for papillary thyroid carcinoma. However,for nodules sized 1.1-1.4 cm,the ultrasound and pathologic measurements are more likely to be consistent.</p>

Clinical research on nasal endoscopic surgery for rhinogenous optic function damage / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the surgical treatment of rhinogenous optic function damage (ROFD) through transnasal endoscopic approach.</p><p><b>METHODS</b>Twenty-three patients (25 eyes) with ROFD were retrospectively reviewed. All patients were operated on through transnasal endoscopic approach, and 9 patients underwent endoscopic optic nerve decompression.</p><p><b>RESULTS</b>Four patients had bilateral pansinusitis, 6 patients had unilateral posterior ethmoidal sinusitis and sphenoiditis. One patient had frontal and ethmoidal sinusitis. Five patients had fungal sinusitis occurred in the sphenoid sinus and unilateral posterior ethmoid sinus. Two patients had unilateral pyocyst and cyst of the sphenoid and ethmoid sinus. The preoperative visual acuity preoperative were as follows: 2 patients (2 eyes) no light perception (NLP), 6 patients (7 eyes) hand movement (HM), 7 patients (7 eyes) fingers counting (FC) less than 20 cm and 8 patients (9 eyes) were vision impaired in different degree. One patient (1 eye) was ophthalmoptosis, direct and indirect light reflex vanished. Three patients (3 eyes) diplopia, 2 patients (2 eyes) abduction paralysis, 3 patients (3 eyes) defect of visual field. One patient ptosis of upper lid. The visual acuity postoperative: 2 eyes failed, 10 eyes cured;13 eyes improved from HM or FC to FC (30-60 cm).</p><p><b>CONCLUSIONS</b>The endoscopic sinus surgery combined with appropriate medical therapy are effective to ROFD. Patients who suffered from severe visual damage and either unresponsive or intolerant to medical treatment should be administrated endoscopic sinus surgery including endoscopic optic nerve decompression.</p>

Phase I study of docetaxel combined with carboplatin in patients with non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To determine the maximum tolerated dose (MTU) and dose-limiting toxicity (DLT) of Docetaxel and Carboplatin in patients with non-small cell lung cancer.</p><p><b>METHODS</b>Docetaxel was given at escalating doses until MTD was determined from the initial dose of 65 mg/m2 to 75 mg/m2, 85 mg/ m2 on dl. Carboplatin was targeted to an area under the plasma concentration curve of 5 using Calver's equation on dl. The treatment cycle was repeated every 3 weeks.</p><p><b>RESULTS</b>16 patients received TXT and CBP for total of 54 courses (median four courses). Neutropenia was the dose-limiting toxicity. The MTD of TXT is 85 mg/m2.</p><p><b>CONCLUSION</b>We recommend TXT 75 mg/m2 on d1 and CBP with a target AUC of 5 on d1, 3weeks repeated for chemotherapy in naïve patients with NSCLC.</p>