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"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions. .
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Objective To detect the expression of matrix metalloproteinase-9 (MMP-9) gene in peripheral blood of patients with oral paraquat (PQ) poisoning and evaluate its predictive value for their prognosis.Methods Thirty-seven cases of oral PQ poisoning admitted to Linyi People's Hospital from January 2013 to June 2014 were enrolled,and they were divided into survival group (26 cases) and death group (11 cases) according to the survival sitnation in 28 days after poisoning;a healthy control group included 10 healthy people selected in the same period.The peripheral blood 3 mL was collected from each PQ patient on the 1st and 3rd day after admission,and in the healthy control group,3 mL peripheral venous blood was obtained under fast on the day for physical examination.The MMP-9 gene expression of peripheral blood mononuclear cells (PBMCs) was detected by reverse transcription-polymerase chain reaction (RT-PCR) methods;the serum MMP-9 concentration was determined by using enzyme-linked immunosorbent assay (ELISA);the serum PQ level was detected by high performance liquid chromatography (HPLC),and the amount of poison orally taken was recorded.The correlations between PQ amount orally taken,serum PQ level and MMP-9 expression were analyzed by Spearman correlation analysis.A receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of peripheral blood MMP-9 level for the 28-day prognosis of PQ poisoning patients.Results After admission the 1 day serum PQ level was (2.60 ± 1.29) mg/L,and the amount of poison taken was 50.0 (7.5,60.0) mL in the 37 patients with oral PQ poisoning.The MMP-9 gene expression level in PBMCs and serum MMP-9 protein level of both PQ poisoning groups were significantly higher than those of healthy control group,and the levels were gradually increased with the extension of poisoning time;the degrees of elevation in death group were more significant [the PBMCs' MMP-9 gene expression (A value):2.84± 1.16 vs.0.95 ± 0.23 on the 1st poisoning day,4.22± 1.75 vs.1.29 ±0.30 on the 3rd poisoning day;serum MMP-9 concentration (μg/L):2791.48± 1 230.88 vs.807.81±279.86 on the 1st poisoning day,4384.21 ± 1 781.97 vs.1 131.14±291.76 on the 3rd poisoning day,all P ＜ 0.05].Correlation analysis showed:there were significant positive correlations of oral PQ amount,serum PQ concentration to the MMP-9 gene expression in PBMCs and serum MMP-9 protein concentration in patients with oral PQ poisoning (all P =0.000).ROC curve analysis showed:the MMP-9 gene expression in PBMCs on the 1st day and the serum MMP-9 content on the 3rd day after admission had predictive value for 28-day prognosis in patients with oral PQ poisoning,and the ROC areas under the curve (AUC) was 0.820 and 0.776 respectively.When the cutoff value of MMP-9 gene expression level on the 1st day after admission was 0.90,the predictive sensitivity and specificity were 80.00％ and 63.64％ respectively;when the cutoff value of serum MMP-9 protein content on the 3rd day after admission was 904.36 μg/L,the predictive sensitivity and specificity were 80.00％ and 72.73％ respectively.Conclusion Oral PQ poisoning can lead to the MMP-9 gene expression in PBMCs and elevation of serum MMP-9 protein level in the body,and the MMP-9 gene expression has predictive value for the prognosis of patients with oral PQ poisoning.
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<p><b>BACKGROUND</b>The plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level is frequently elevated in dyspnoeic patients and increasingly used in emergency departments to assess the cause of acute dyspnea. In this study we prospectively tested NT-proBNP levels in patients with congestive heart failure (CHF) and/or acute pulmonary embolism (APE) and determined the utility of NT-proBNP for discriminating APE from CHF.</p><p><b>METHODS</b>A cohort of 177 dyspnoeic patients with a diagnosis of APE and/or CHF was prospectively studied between June 2010 and March 2013. NT-proBNP was measured by the electrochemiluminescence immunoassay (ECLIA). All patients were evaluated with transthoracic echocardiography (TTE). APE was diagnosed in the presence of thrombi signs in the pulmonary arteries with computed tomographic pulmonary angiography (CTPA) or a high-probability lung ventilation/perfusion scan. Risk stratification was based on the evaluation on admission according to the ESC guidelines from 2008. The diagnosis of CHF was based on the guidelines of the American College of Cardiology/American Heart Association and the European Society of Cardiology. Two physicians independently reviewed the records to determine the final diagnosis.</p><p><b>RESULTS</b>Fifty-nine patients met the criteria for dyspnea caused by APE, and 113 patients were diagnosed with CHF. Most of the APE patients (41, 69.5%) were intermediate-risk. The symptoms and signs, such as orthopnea, paroxysmal nocturnal dyspnea and rales in the lungs, were more common in patients with CHF than in patients with APE (P < 0.01). Median NT-proBNP was significantly lower in patients with APE compared to those in patients with CHF (2 855.9 pg/ml vs. 6 911.4 pg/ml, P < 0.01). We constructed the receiver operating characteristics (ROC) curve in predicting the diagnosis of APE. At a cut point = 1 582.750 pg/ml, NT-proBNP provided a specificity of 93% and a true positive rate (sensitivity) of 17% for the diagnosis. At a cut point = 3 390.000 pg/ml, NT-proBNP had a specificity of 83% and a sensitivity of 84% for the diagnosis of APE. At a cut point = 6 486.500 pg/ml, they were 54% and 93% respectively.</p><p><b>CONCLUSIONS</b>NT-proBNP can assist in excluding CHF patients from those admitted to the emergency department with acute dyspnea and identifying patients with a high probability of APE, which would reduce the missed diagnosis of APE. Larger studies are necessary to validate these findings.</p>
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Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Acute Disease , Biomarkers , Blood , Dyspnea , Blood , Heart Failure , Blood , Diagnosis , Natriuretic Peptide, Brain , Blood , Peptide Fragments , Blood , Prospective Studies , Pulmonary Embolism , Blood , DiagnosisABSTRACT
BACKGROUND:Idiopathic interstitial pneumonia is of poor response to treatment. Glucocorticoids are the first medicine for the treatment, however there is only 30% of the patients who are responded. Traditional Chinese drugs (TCD) have been researched hot point for prevention and treatment of pulmonary fibrosis. Many TCD have been used clinically, and with a certain therapeutic effect. Transforming growth factor-β1 and tumor necrosis factor-α are the considerable cytokines to cause pulmonary fibrosis, inhibition of their expression, therefore, may be effective to pulmonary fibrosis.OBJECTIVE: To investigate the interventional effect of qidan granule on pulmonary fibrosis in rats induced by bleomycin A5 and the influence on the expressions of transforming growth factor-β1 and tumor necrosis factorα, and also to compare with those of hydrocortisone.DESIGN:A randomized and interval grouping design.SETTING:Department of Respiratory Medicine, Shandong Provincial Hospital, Shandong University.MATERIALS:The experiment was conducted from May 2003 to March 2004 at Pathological Laboratory of Shandong Provincial Academy of Medical Science. Totally 105 SD male rats, were at random divided into 4groups: normal control group (n= 15 ), model group, qidan group and hydrocortisone group, with 30 rats in each group. Each group was subdivided as7-day, 14-day and 28-day group, with 5 rats in each normal group, and 10in each other groups.METHODS: [1] Model establishment: A perfusion was intrabronchially performed, of 0.25 mL normal saline for rats in normal control group, and of bleomycin A5 0.25 mL ( 5 mg/kg,4 g/L) for rats in other 3 groups, to set up the models of pulmonary fibrosis. [2]Administration: Next day to the beginning of modeling qidan granule (consisting of Radix Astragali seu Hedysari, Radix Salviae Miltiorrhizae, Rhizoma Ligustici Chuanxiong and so on, 3 125 mg/kg) was intragastrically given per day for rats in qidan group, hydrocortisone (25 mg/kg) was intraperitoneally given per day for rats in hydrocortisone group, and normal saline (2 mL/rat) was intragastrically given per day for rats in normal and model groups.[3] Observation indexes: The rats in each group were on the day 7, day 14 and day 28 put to death under the anesthesia, then the lung tissue was taken, stained with hematoxyline-eosin stain for pathological observation of lung tissue. The expressions of transforming growth factor-β1 and tumor necrosis factor-α were detected by immunohistochemistry.MAIN OUTCOME MEASURES:Pathological observation of lung tissue,and the expressions of transforming growth factor-β1 and tumor necrosis factor-α at different time points of rats in each group.RESULTS:Totally 100 rats entered the final result analysis.[1]Pathological observation of lung tissue: In the normal group the structure was normal, in the model group there were alveolitis on the day 7, deterioration of alveolitis on the day 14, and extensive fibrosis on the day 28; the degrees of alveolitis and fibrosis in the qidan group were slighter than those in the model group, and there was normal structure of alveoli; and in the hydrocortisone group the alveolitis on the day 7 and 14 was slighter than that in the model group, but there was no significant difference of fibrosis compared with the model group.[2] Expression of transforming growth factor-β1:In the model group the expression was highest on the day 28 and obviously higher than that in the normal group (3.6±0.4,1.2±0.4,P ＜ 0.01 ); the expression in the qidan group and hydrocortisone group was obviously lower than that in the model group(1.7±0.5,2.5±0.4,P ＜ 0.01), and the expression in the qidan group was lower than that in the hydrocortisone group (P＜ 0.01 ). [3]Expression of tumor necrosis factor-α: In the model group at different time points the expression was continuously increased, the expression in the qidan group and hydrocortisone group was obviously lower than that in the model group(P ＜ 0.05 or P ＜ 0.01), and the expression in the qidan group was lower than that in the hydrocortisone group ( P ＜ 0.01).CONCLUSION: Qidan granule can obviously reduce the extent of pulmonary fibrosis in rats induced by bleomycin A5, lower the expressions of transforming growth factor-β1 and tumor necrosis factor-α, and the effect was better than that of hydrocortisone.
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Objective:To investigate clinical therapeutic effect of Qidan Granule on pulmonary interstitial fibrosis(PIF).Methods:The treatment group(105 cases)were treated by Qidan Granule,3 times a day,and the control group(60 cases)were treated by prednisone,0.5mg/kg,for 3～6 months.The patients were followed up once every 1～3 months.Changes of symptoms,signs and high-resolution computed tomogram(HRCT)and pulmonary function were investigated after treatment.Results:After treatment of 6 months,the improvement rate of symptoms and signs in the treatment group was superior to that in the control group(P