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@#Objective To analyze the pathological manifestations and imaging characteristics of bronchiolar adenoma (BA). Methods The clinical data of 11 patients with BA who received surgeries in our hospital from January 2019 to September 2020 were retrospectively analyzed, including 5 males and 6 females aged 40-73 (62.40±10.50) years. The intraoperative rapid freezing pathological diagnosis, postoperative pathological classification, cell growth pattern, nuclear proliferation index Ki-67 and other immunohistochemical staining combined with preoperative chest CT imaging characteristics were analyzed. Results The average preoperative observation time was 381.10±278.28 d. The maximum diameter of imaging lesions was 5-27 (10.27±6.34) mm. Eight (72.7%) patients presented with irregular morphology of heterogeneous ground-glass lesions, and 3 (27.3%) patients presented with pure ground-glass lesions. There were 10 (90.9%) patients with vascular signs, 8 (72.7%) patients with vacuolar signs, 1 (9.1%) patient with bronchus sign, 3 (27.3%) patients with pleural traction and 9 (81.8%) patients with burr/lobular sign. The surgical methods included sub-lobectomy in 10 patients and lobectomy in 1 patient. Five (45.5%) patients were reported BA by intraoperative frozen pathology. The postoperative pathological classification included 8 patients with distal-type and 3 patients with proximal-type, and the maximum diameter of the lesions was 4-20 (8.18±5.06) mm. Eight (72.7%) patients showed characteristic bilayer cell structure under microscope, and 10 (90.9%) patients showed thyroid transcription factor 1 expression in pathological tissues. The expression of NapsinA in intracavity cells was found in 9 (81.8%) patients. The Ki-67 index of the lesion tissue was 1%-5% (3.22%±1.72%). Conclusion The pathological features and imaging findings of BA confirm the premise that BA is a neoplastic lesion. However, to identify BA as a benign or inert tumor needs more clinical data and evidence of molecular pathological studies.
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BACKGROUND@#With the extensive application of segmental lung resection in the treatment of early-stage lung cancer, how to complete segmentectomy more accurately and minimally invasively has become a research hotspot. The aim of this study is to explore the application of three-dimensional computed tomography bronchography and angiography (3D-CTBA) combined with perfusion area recognition technique in single-hole thoracoscopic complex segmentectomy.@*METHODS@#From January 2021 to January 2022, the clinical data of 112 consecutive patients undergoing single-port thoracoscopic complex segmentectomy in the Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The three-dimensional reconstruction combined with perfusion area identification technique was used to perform the operation and the clinical data were analyzed.@*RESULTS@#The average operation time was (141.1±35.4) min; the initial time of intersegmental plane display was (12.5±1.7) s; the maintenance time of intersegmental plane was (114.3±10.9) s; the intersegmental plane was clearly displayed (100%); the amount of bleeding was [10 (10, 20)] mL; the total postoperative drainage volume was (380.5±139.7) mL; the postoperative extubation time was (3.9±1.2) d; and the postoperative hospitalization time was (5.2±1.6) d. Postoperative complications occurred in 8 cases.@*CONCLUSIONS@#The advantages of 3D-CTBA combined with perfusion area recognition technique are fast, accurate and safe in identifying intersegmental boundary in single-port thoracoscopic complex segmentectomy, which could provide guidances for accuratding resection of tumors, shortening operation time and reducing surgical complications.
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Humans , Lung Neoplasms/pathology , Bronchography , Pneumonectomy/methods , Retrospective Studies , Thoracic Surgery, Video-Assisted/methods , Tomography, X-Ray Computed , Angiography/methods , PerfusionABSTRACT
@#Objective To assess the clinical value of preoperative localization coupled with computed tomography (CT) three-dimensional reconstruction in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection. Methods The clinical data of 30 patients of combined subsegmental/segmental resection in our hospital from December 2019 to October 2021 were retrospectively collected. There were 19 males and 11 females with the mean age of 56.4 (32.0-71.0) years. The pulmonary nodules were located by CT-guided injection of glue before operation. The three-dimensional reconstruction image and operation planning were carried out by Mimics 21.0 software. Results The operations were all successfully performed, and there was no conversion to open thoracotomy or lobectomy. The mean tumor diameter was 11.6±3.5 mm, the mean distance between the nodule and the visceral pleura was 13.6±5.6 mm, the mean width of the actual cutting edge was 25.0±6.5 mm, the mean operation time was 110.2±23.8 min, the mean number of lymph node dissection stations was 6.5±2.4, the mean amount of intraoperative bleeding was 50.8±20.3 mL, the mean retention time of thoracic catheter was 3.2±1.1 d, and the mean postoperative hospital stay was 4.5± 1.7 d. There was 1 patient of subcutaneous emphysema, 1 patient of atrial fibrillation and 1 patient of blood in sputum. Conclusion Preoperative CT-guided injection of medical glue combined with CT three-dimensional reconstruction of pulmonary bronchus and blood vessels is safe and feasible in pulmonary nodule-centered uniportal thoracoscopic combined subsegmental/segmental resection, which ensures the surgical margin and reserves lung tissues.
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【Objective】 The purpose of this study was to perform bioinformatics analysis of infliximab （IFX） treatment of rheumatoid arthritis （RA） non-responders and responders gene data chip based on autophagy， and to screen out the characteristic autophagy-related genes， carry out a preliminary experiment on the role of characteristic genes， and explore the possible mechanism of IFX treatment of RA non-response. 【Methods】 R language was used to analyze the differential expressions of autophagy-related genes on the selected gene expression omnibus database （GEO） data set. Univariate logistic regression， least absolute shrinkage and selection operator （Lasso） regression， and multiple logistic regression analyses were made to screen out the characteristic autophagy-related genes； receiver operating characteristic curve （ROC） was used to assess the diagnostic value of the characteristic autophagy-related genes. Real-time PCR was used to detect the expressions of characteristic autophagy-related genes in RA clinical samples， and Western blot was used to detect the role of characteristic autophagy-related genes in autophagy in RA synovial cell line MH7A cells. 【Results】 Part of autophagy-related genes were differentially expressed between non-responders and responders to IFX treatment of RA （P<0.05）， and autophagy-related gene sets were mainly expressed in non-responders. Hepatocyte growth factor-regulated tyrosine kinase substrate （HGS） and autophagy related 4 homolog B （ATG4B） were screened out as characteristic genes of non-response to IFX treatment of RA. The ROC showed that the predictive model constructed using the selected markers had good discrimination ability in the internal validation data set GSE78068 （AUC=0.708， P<0.05） and the external validation data set GSE58795 （AUC=0.719， P<0.05）. The Real-time PCR results showed that the expression of HGS was increased in peripheral blood leukocytes in the non-responders. After overexpression of HGS in MH7A cells， the ratio of LC3BⅡ/LC3BⅠ was increased while the expression of P62 was decreased， indicating that autophagy increased. 【Conclusion】 The autophagy-related gene expression profiles were different between IFX-treated RA non-responders and responders， suggesting that the non-response of IFX treatment of RA may be related to autophagy. The prediction model constructed with HGS and ATG4B had a certain ability to predict IFX-treated RA non-response， and HGS promoted autophagy in MH7A cells， which provides a new idea for future research on the molecular mechanism of IFX in treating RA non-response.
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BACKGROUND@#When lung cancer screening work extensively developed in recent years, more and more small lung lesions were found in clinic. The aim of this study is to analysis computed tomography (CT) guided percutaneous biopsy for lung small lesions (diameter<2 cm) on results, complications and prognosis.@*METHODS@#Choose CT guided percutaneous lung biopsy were performed in 41 cases of pulmonary peripheral lesions, single lesion in 39 cases, multiple lesions in 2 cases, 5-20 (13.1±5.2) mm in maximum diameter, depth from lung surface 1-45 (16.5±13.7) mm, ground-glass opacity (GGO) components 0%-100% (66.8%±35.2%).@*RESULTS@#41 patients and 43 biopsies successfully obtained pathological tissue. Atypical adenomatous hyperplasia in 3 cases, squamous carcinoma in 1 case, adenocarcinoma in 37 cases( carcinoma in situ in 7 cases, micro-invasive carcinoma in 5 cases, invasive adenocarcinoma in 25 cases, double primary lung cancer in 2 cases), inflammatory lesions in 2 cases. Except 2 cases of inflammatory lesions are in follow-up, biopsy and surgical pathology alignment (specificity) was 100%. 41 patients occurred complications related to percutaneous biopsy. Pneumothorax were in 22 cases, drainage required in 2 cases. There were 17 cases with hemoptysis, accounting for 39.5% incidence are self-limited. Intracranial air embolism occurred in 2 cases by 4.6% incidence. They were fully recovered.@*CONCLUSIONS@#For small lung lesions, CT guided percutaneous biopsy is technically feasible. However, for small lung lesions especially pure GGO biopsy, it is still need to be cautious.
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Adult , Aged , Female , Humans , Male , Middle Aged , Biopsy , Lung Neoplasms , Pathology , Tumor BurdenABSTRACT
The loss of dopaminergic neurons and the decreased release of dopamine neurotransmitters in the substantia nigra pars compacta are the main pathological mechanisms leading to Parkinson 's disease (PD) in clinical research. Under the combined influence of genes and environment, there are many death mechanisms of dopaminergic neurons. Current research suggests that apoptosis, necrosis and autophagic death all participate in the death of dopaminergic neurons, but these deaths are not sufficient to explain their pathological processes and mechanisms. Ferroptosis is a newly discovered iron-dependent cell death pathway characterized by increased iron load and accumulation of large amounts of lipid peroxides. These characteristics are highly consistent with the clinical molecular characteristics of the brain in PD patients. In addition, there is evidence that ferroptosis and oxytosis (observed in nerve cells 30 years ago) have a high degree of similarity in signal regulation, and they may represent the same form of programmed cell death. This review discusses the current advances of ferroptosis death pathway in PD, and briefly discusses the possibilities for ferroptosis and oxytosis as the same type of cell death. The elucidation of the death pathway and mechanism of dopaminergic neurons can provide a fundamental theoretical basis for the development of anti-PD drugs.
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OBJECTIVE@#To explore the high risk factors of adult complex appendicitis, and to provide a reference for the development of a reasonable treatment strategy for acute appendicitis.@*METHODS@#A retrospective case-control study was conducted to collect clinical data of 312 adult patients with acute appendicitis confirmed by pathology undergoing appendectomy, including open and laparoscopic surgery, from May 2011 to August 2016 at Affiliated Hospital of Qingdao University. Age <14 years old, pregnant women, complicating abscess around the appendix, AIDS, blood system diseases, autoimmune diseases, inflammatory bowel disease or progressive cancer patients were excluded. According to the intra-operative findings and pathological types, patients were divided into complex appendicitis(112 cases, including gangrene and perforation) and non-complex appendicitis (200 cases, including simple and non-perforated appendicitis, ie suppurative appendicitis). After comparing the clinical data of these two groups, statistically significant variables were induded for multivariate logistic regression analysis to identify risk factors of complex appendicitis, and to establish a regression model. Enter method was applied to establish the regression equation: P=ExpiΣBiXi/1+ExpΣBiXi, and to calculate the relative risk of each variable. Meanwhile, retrospective and prospective verification was performed on this predictive model (cases of acute appendicitis from September 2016 to December 2017 were further collected). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of complex appendicitis were calculated with the regression model.@*RESULTS@#Comparison of the clinical data between the complex appendicitis group and the non-complex appendicitis group showed that differences of 10 preoperative indexes were statistically significant, including period from abdominal pain to admission [(59.1±42.6) hours vs. (47.5±34.4) hours, t=3.051, P=0.002], white blood cell count [(12.9±3.7)×10/L vs. (9.2±4.0)×10/L, t=9.755, P<0.001], neutrophil count [(9.8±4.0)× 10/L vs.(7.1±3.9)×10/L, t=6.020, P<0.001], neutrophil percentage[(84.5±8.7)% vs.(68.2±16.0)%, t=12.754, P<0.001], C-reactive protein levels [(86.0±45.4) μg/L vs. (55.9±35.8) μg/L, t=7.614, P<0.001], serum albumin levels [(334.0±4.8) g/L vs. ( 41.0±4.3) g/L, t=16.055, P<0.001], vomiting ratio [44.6%(50/112) vs. 23.5%(47/200), χ²=14.980, P<0.001], high fever(≥39°C) ratio [16.1%(18/112) vs. 7.5%(15/200), χ²=5.577, P=0.022], the proportion of patients ≥60 years old [22.3%(25/112) vs. 13.0%(26/200), χ²=4.562, P=0.038] and previous history of appendicitis [16.1%(18/112) vs. 7.5%(15/200), χ²=5.577, P=0.022]. The above 10 variables were included in the logistic regression model for multivariate analysis. The results showed that six variables were associated with complex appendicitis. According to their strength, they were old age (≥60 years old) X1(OR=5.094), high fever (≥39°C) X2(OR=4.464), neutrophil count X6 (OR=1.269), neutrophil percentage X4 (OR=1.077), C-reactive protein level X5 (OR=1.027), and serum albumin level X3 (OR=0.763). A predictive regression model was established: P=1/[1+e], whose sensitivity and specificity of judging complex appendicitis were 76.8%(86/112) and 90.0%(180/200),respectively. Sensitivity and specificity for predictive value of complex appendicitis in further prospective validation of the model were 76.2%(48/63) and 81.1% (30/37), respectively.@*CONCLUSIONS@#Age ≥ 60 years old, body temperature ≥39°C, increased neutrophil count, neutrophil percentage and C-reactive protein levels, and hypoalbuminemia are risk factors for complex appendicitis. The establishment of predictive model may help determine complex appendicitis.
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Adolescent , Adult , Female , Humans , Middle Aged , Pregnancy , Acute Disease , Age Factors , Appendicitis , Diagnosis , Epidemiology , Pathology , Case-Control Studies , Leukocyte Count , Models, Statistical , Retrospective Studies , Risk FactorsABSTRACT
Objective The aim of the present study was to evaluate the clinical application of 2 μm thulium laser in pulmonary nodules resection under VATS.Methods 61 patients,undergoing thoracoscopic resection of pulmonary nodules in thoracic department of Xuanwu Hospital,were identified between January and December of 2016.Of those,30 underwent 2μm thulium laser dissection and 31 were treated with standard technique by using staplers.In terms of clinical characteristics,including gender,age and smoking history,there is no significant difference between the laser group and the stapler group,but the lesion size was slightly larger in the stapler group compared with the laser group.The lesions of the two groups were almost evenly distributed on the five lobes.Results All the procedures were performed successfully under VATS.The intraoperative evaluation of air leaks demonstrated that less than or equal to 2 grade air leaks were observed in 28 cases in the laser group and in 30 cases in the stapler group.Grade 3 air leaks requiring a rescue treatment were observed in 2 cases in the laser group and in 1 case in the stapler group.There were no significant differences in the postoperative hospital stay and total hospital stay between two groups.Chest tube duration was lower in the laser group compared with the stapler group even if it was not statistically significant (2.71 vs 3.55 days).Hospitalization costs was significantly lower for the laser group.Conclusion The use of 2um thulium laser to prevent intra-and postoperative air leaks and bleeding is effective and makes patients recover quickly,which allows a minimally invasive,accurate and safe application during thoracoscopic resection of pulmonary nodules.
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Objective The purpose of this study is to evaluate Surgical Procedure and Prognosis for elderly stage 1NSCLC patients above 70 years old.Methods The patients who were stage Ⅰ non-small cell lung cancer from 2003 to 2007were enrolled ( n =71 ).The median age was 74 years ( ranged from 70 to 84 years).The median follow-up of patients was 30months( ranged from 2 to 81 months).Results The percentages of postoperative complications after sublobar resection and lobectomy patients were 36.4％ and 46.9％,respectively.The period in hospital were 11.36 days and 12.24 days.The 3 year survival was 85.9％ for patients undergoing sublobar resection and 78.8％ for lobectomy.The 5 year survival was 56.4％ and 56.9％ respectively.No significant difference was observed between two types of surgical procedure in the elderly.Staging is the independent factor of prognosis.Conclusion Lobectomy is still the main therapy method for elderly stage Ⅰ NSCLC patients.Especially,for those who can undergo radical resection.But sublobar resection also appears to be a viable surgical treatment for patients with cardiopulmonary physiologic impairment.
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<p><b>OBJECTIVE</b>To prepare pulsed-release tablet (PTS) according to the rhythm of coronary heart disease based on efficacy material and the mechanism of compound Danshen.</p><p><b>METHOD</b>PTS were achieved by coating the core which contains drugs, CMS-Na, lactose, succinic acid and MCC with separation layer (Eudragit RL), swelling layer (HPMC E5), and controlled-release membrane (Eudragit RS-RL-EC).</p><p><b>RESULT</b>The results of in vitro experiments showed that no difference was observed among the profiles of Danshensu, protocatechuic aldehyde, ginsenoside Rg1, Rb1, notoginsenoside R1 release from the two-step release system. And it indicated that swelling was the basis and prerequisite for drug release from PTS, and the diffusion, organic acid-induced, and osmotic pumping mechanism were involved in drug release, but the latter they were the dominant factors.</p><p><b>CONCLUSION</b>Successfully obtained the PTS of a certain lag-time behind the rapid release which indicate that after bed time administration of such device, the drug plasma concentration-time curve CAN meet the requirements of chronotherapy of cardiovascular disease.</p>
Subject(s)
Benzaldehydes , Metabolism , Catechols , Metabolism , Chromatography, High Pressure Liquid , Coronary Disease , Drug Therapy , Diffusion , Drug Compounding , Methods , Drug Delivery Systems , Drugs, Chinese Herbal , Chemistry , Metabolism , Therapeutic Uses , Ginsenosides , Metabolism , Osmosis , Salvia miltiorrhiza , Chemistry , Tablets , Time FactorsABSTRACT
<p><b>OBJECTIVE</b>To prepare effervescent osmotic pump tablet (EOPTs) according to the rhythm of coronary heart disease based on efficacy material and the mechanism of compound Danshen and to study the mechanism of drug released of that tablets.</p><p><b>METHOD</b>Since compound Danshen consist of compounds with polyphenolic groups or carboxyl groups, such as phenolic acids, flavonoids, and triterpenoids that they were acidic. EOPTs were prepared from tablet cores which containing NaHCO3 as effervescent, NaCL and manitol as osmotic agents, HPMC as retarding agents coating with CA membrane. And study the mechanism of drug released according to the change of tablet osmotic pressure.</p><p><b>RESULT</b>The results of in vitro experiments showed that no difference was observed among the profiles of Danshensu, protocatechuic aldehyde, ginsenoside Rg1, Rb1, notoginsenoside R1 release EOPTs. The drug was completely released from the device with a zero-order release rate over 12 h.</p><p><b>CONCLUSION</b>EOPTs are Successfully obtained EOPT which the drug is released from the device over 12 h and the release mechanism of EOPTs is explained.</p>
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Coronary Disease , Drug Compounding , Drugs, Chinese Herbal , Metabolism , Infusion Pumps , Osmosis , Salvia miltiorrhiza , Metabolism , Tablets , Time FactorsABSTRACT
Objective To observe the improvement of Guangdong Liangcha Granules (GLG) on restraint-stress-induced peroxidation in genital organs of mice. Meth ods Mice models of peroxidation injury in genital organs were induced by 18-hou r restraint stress. Testicular and ovarian malondialdehyde (MDA) level was detec ted by thiobarbituric acid method,glutathione (GSH) content by HPLC,xanthine o xidase (XOD) and GSH-PX activities by colorimetric method,nitric oxide (NO) co ntent by Griess chemical method and oxygen radical absorbance capacity (ORAC) by enzyme-linked fluorescent immunoassay. Results Compared with model group,GLG can markedly reduce MDA level,XOD acitivity and NO contents,in addition,GLG c an effectively increase the ORAC value,GSH content,GSH-PX activity in testis and ovaries. Conclusion Oral treatment of Guangdong Liangcha Granules was found to reduce the status of peroxidation in testis and ovaries,and the improvement may be related to the increase of its free radical scavenging activity and lipid peroxidation.