Esophageal Angiolipoma:Report of One Case and Literature Review / 中国医学科学院学报

Esophageal angiolipoma is a rare disease with unspecific clinical manifestations.This paper reported a case of esophageal angiolipoma confirmed by upper gastrointestinal endoscopy and summarized the clinical manifestations,endoscopic and pathological features,treatment and prognosis of the patients by reviewing the relevant literature,aiming to provide references for clinical diagnosis and treatment of this disease in the future.

Retrograde thoracic duct approach via left venous angle in the treatment of chylothorax / 中华放射学杂志

Objective:To investigate the feasibility and effect of retrograde thoracic duct approach via left venous angle in the treatment of chylothorax.Methods:From July 2019 to April 2021, the clinical data of 16 patients with chylothorax in Shanghai Pulmonary Hospital Tongji University were retrospectively collected. All patients underwent percutaneous inguinal lymphography, super selective retrograde thoracic duct catheterization was attempted via the left venous angle. Successful patients underwent direct thoracic ductography. After the position of the rupture was shown, the thoracic duct was embolized with microcoils and glue.Results:The inguinal lymphography of 16 patients was successful, and the end of thoracic ducts was identified. Retrograde thoracic duct catheterizations were successful in 10 patients, 6 cases showed contrast agent overflow in thoracic ductography, and the thoracic ducts were embolized using microcoils combined with glue. Chylothorax was improved in 16 patients, and 6 cases were completely cured. All patients had no serious complications.Conclusion:It is an effective and feasible method to treat chylothorax by retrograde thoracic ductography and embolization approach via left venous angle.

The predictive value of the expression of EZH2 on B lymphocyte subsets on the prognosis of septic patients / 中华急诊医学杂志

Objective:To investigate the dynamic expression of histone methyltransferase (enhance of zeste homolog 2, EZH2) in peripheral blood B lymphocytes (CD19 +B) and memory B lymphocytes (CD19 +CD27 +B) of septic patients and its value in predicting prognosis in sepsis. Methods:From June 2018 to January 2020, 48 septic patients in the Intensive Care Unit of Shanghai East Hospital were enrolled, and 40 healthy adult volunteers were recruited as healthy controls. Septic patients were divided into the non-survivors (18 cases) and the survivors (30 cases) according to whether the patients survived at 28 days. Blood samples were collected at day 1, 3 and 7, blood routine, IL-6 and blood gas analysis were collected, and SOFA and APACHE Ⅱ scores were counted. Flow cytometry was used to detect the positive rate and the mean fluorescence intensity of EZH2 on CD19 +B lymphocytes, and the positive rate of EZH2 on CD19 +CD27 +B lymphocytes at different time points. In the healthy controls, fasting was taken only once in the morning. ROC curve was drawn and the area under the curve (AUC) was calculated to evaluate the value of expression of EZH2 on CD19 +B lymphocytes and CD19 +CD27 +B lymphocytes in predicting the prognosis of septic patients. Results:(1) Compared with the healthy controls, the positive rate and average fluorescence intensity of EZH2 on CD19 +B lymphocytes and the positive rate of EZH2 expression on CD19 +CD27 +B lymphocytes were significantly increased at day 1, 2 and 3 in septic patients ( P<0.05). Over time, the expression of EZH2 in CD19 +B lymphocytes and CD19 +CD27 +B lymphocytes increased gradually ( P<0.05). (2) Compared with the survivors, the positive rate of EZH2 on CD19 +B lymphocytes of the non-survivors was increased at day 1, but the positive rate of EZH2 on CD19 +CD27 +B lymphocytes of the non-survivors was decreased at day 3 and 7 ( P<0.05). (3) The positive rate of EZH2 on CD19 +B lymphocytes, APACHE Ⅱ score, SOFA score and IL-6 level in septic patients at day 1 were independently associated with 28-day mortality. (4) The AUC of APACHEⅡ score was 0.907 (95% CI: 0.825-0.990), and the sensitivity and the specificity were 88.89% and 76.67%. The AUC of SOFA score was 0.831 (95% CI: 0.706-0.955), and the sensitivity and the specificity was 66.67% and 86.67%; The AUC of EZH2 positive rate on CD19 +B lymphocytes were 0.799 (95% CI: 0.657-0.941), and the sensitivity and specificity were 88.89% and 80.77%, respectively, the sensitivity was better than SOFA score, and the specificity was higher than APACHEⅡ score. Conclusions:The high expression of EZH2 on B lymphocytes in septic patients is associated with poor prognosis. Dynamic monitoring of EZH2 expression on B lymphocytes has certain predictive value for sepsis.

Correlation between CT-feature of lobulation and epidermal growth factor receptor gene mutations in advanced pulmonary adenocarcinoma / 中华放射学杂志

Objective@#To investigate the correlation between the feature of lobulation, degree of lobulation on CT images and epidermal growth factor receptor gene (EGFR) mutations in advanced pulmonary adenocarcinoma.@*Methods@#Two hundred and one patients who were diagnosed with advanced pulmonary adenocarcinoma between January and December 2017 and had undergone a chest CT and EGFR mutation testing at Shanghai Pulmonary Hospital were enrolled in this retrospective study. The clinical and imaging data of the patients were analyzed. The patients were classified into EGFR mutations group (107 cases) and wild type group (94 cases) according to whether EGFR gene mutation occurred. The feature of lobulation (described as presence of lobulation, absence of lobulation, or obscured margin), degree of lobulation (including deep lobulation, shallow lobulation, no lobulation, and obscured) on CT images were statistically compared between the two groups.@*Results@#Based on the presence or absence of lobulation sign, there were 99, 0, 8 cases with lobulation, no lobulation, obscured margin in the EGFR mutations group and 80, 1, 13 cases in the wild type group, respectively. There was no significant difference in lobulation sign between the EGFR mutations group and wild type group (P=0.152). According to the degree of lobulation, there were 32, 67, 0, 8 cases of deep lobulation, shallow lobulation, no lobulation, obscured margin in EGFR mutations group and 60, 20, 1, 13 cases in wild type group. Significant differences of frequency were found regarding deep lobulation and shallow lobulation between the two groups (P<0.001). However, there was no significant difference between the two groups in the presence of no lobulation, and obscured margin (P>0.05).@*Conclusions@#EGFR mutations are significantly associated with shallow lobulation in advanced pulmonary adenocarcinoma. Conversely, deep lobulation is more likely to appear in advanced pulmonary adenocarcinoma with wild-type EGFR. However, there is no association between EGFR mutation status and the presence of lobulation.

Correlation between CT?feature of lobulation and epidermal growth factor receptor gene mutations in advanced pulmonary adenocarcinoma / 中华放射学杂志

Objective To investigate the correlation between the feature of lobulation, degree of lobulation on CT images and epidermal growth factor receptor gene (EGFR) mutations in advanced pulmonary adenocarcinoma. Methods Two hundred and one patients who were diagnosed with advanced pulmonary adenocarcinoma between January and December 2017 and had undergone a chest CT and EGFR mutation testing at Shanghai Pulmonary Hospital were enrolled in this retrospective study. The clinical and imaging data of the patients were analyzed. The patients were classified into EGFR mutations group (107 cases) and wild type group (94 cases) according to whether EGFR gene mutation occurred. The feature of lobulation (described as presence of lobulation, absence of lobulation, or obscured margin), degree of lobulation (including deep lobulation, shallow lobulation, no lobulation, and obscured) on CT images were statistically compared between the two groups. Results Based on the presence or absence of lobulation sign, there were 99, 0, 8 cases with lobulation, no lobulation, obscured margin in the EGFR mutations group and 80, 1, 13 cases in the wild type group, respectively. There was no significant difference in lobulation sign between the EGFR mutations group and wild type group (P=0.152). According to the degree of lobulation, there were 32, 67, 0, 8 cases of deep lobulation, shallow lobulation, no lobulation, obscured margin in EGFR mutations group and 60, 20, 1, 13 cases in wild type group. Significant differences of frequency were found regarding deep lobulation and shallow lobulation between the two groups (P<0.001). However, there was no significant difference between the two groups in the presence of no lobulation, and obscured margin (P>0.05). Conclusions EGFR mutations are significantly associated with shallow lobulation in advanced pulmonary adenocarcinoma. Conversely, deep lobulation is more likely to appear in advanced pulmonary adenocarcinoma with wild?type EGFR. However, there is no association between EGFR mutation status and the presence of lobulation.

Enzymology of snails under treatment of molluscicides / 中国血吸虫病防治杂志

Studies on the enzymology of snails are important in the study of molluscicidal mechanism.The alteration of activi-ties of enzymes after molluscicidal treatment was reported in large numbers of papers.This paper reviews the progress of studies on the enzymology of snails under the treatment of molluscicides.

3.0T MRI in predicting triple negative breast cancer / 中国医学影像技术

Objective To evaluate the related factors in 3.0T MR imaging features for predicting triple negative breast cancer (TNBC).Methods Totally 191 patients with breast cancer confirmed by histopathology were enrolled,among them 25 were TNBC (TNBC group),while the other 166 were non-TNBC (non-TNBC group).All patients underwent 3.0T MR examination.Patient age,tumor size,shape,margin,enhancement pattern,signal intensity on T2WI,time-intensity curve (TIC),ADC value,and peritumoral vessel between the two groups were compared.Univariate and multivariate Logistic regression analyses were used to predict the related factors.Results Compared with non-TNBC group,smooth margin (P=0.023),round mass (P=0.001),rim enhancement (P＜0.001),high signal intensity on T2WI (P=0.003),higher ADC value (P=0.022) and increased peritumoral vessel (P=0.046) were significantly associated with TNBC.Further multivariate Logistic regression analysis identified four independent risk factors of TNBC (all P＜0.05),including enhancement pattern,signal intensity on T2WI,ADC value and increased peritumoral vessel.The area under ROC curve of combination of the 4 factors was 0.840.Conclusion Rim enhancement of mass,high signal intensity on T2WI,higher ADC value,and increased peritumoral vessels are independent risk factors in predicting TNBC.

Window Settings in the Diagnosis of Invasiveness of Lung Adenocarcinoma with Ground Glass Opacities / 中国医学影像学杂志

Purpose To explore the value of window width adjustment in diagnosing the invasiveness of lung adenocarcinoma manifested as ground glass opacities on high-resolution CT, and to provide guidance for the diagnosis of lung adenocarcinoma in different types. Materials and Methods The preoperative CT data of 102 preinvasive lesions and 107 invasive lesions of lung adenocarcinoma were analyzed retrospectively. Among 102 cases of preinvasive lesions, 25 were atypical adenomatous hyperplasia (AAH), 77 were adenocarcinoma in situ (AIS). Among 107 cases of invasive lesions, 78 were minimally invasive adenocarcinoma (MIA), and 29 were invasive adenocarcinoma. The lesions were ground glass opacity (GGO) on lung window while were invisible on mediastinal window. The window width was adjusted constantly until the lesions were invisible with the fixed mediastinal window level (40 HU). When the lesions became invisible, the window width was compared and the best cut-off was found on ROC curve in the two groups. Results The window width of lesions between preinvasive lesions and invasive lesions was different (Z= - 6.203, P<0.05). Window width was a good indicator for the invasiveness of pulmonary adenocarcinoma (area under the ROC was 0.748, P<0.05), and the window width of 1303 HU was the best cut-off for preinvasive lesions and invasive lesions (sensitivity was 56.9%, specificity was 86.0%. Conclusion Window width may be useful for the diagnosis of the invasiveness of the GGO of lung adenocarcinoma on HRCT. The lesion disappearing when the window width is larger than 1303 HU is more likely to be preinvasive; while the lesion disappearing when the window width is smaller than 1303 HU is more likely to be an invasive one.

Study on Compatibility of TCM Prescriptions for Treating Alzheimer Disease Based on Data ;Mining / 中国中医药信息杂志

Objective To study the compatibility of TCM prescriptions of TCM practitioners of all dynasties of Alzheimer disease (AD). Methods Amnesia, forgetting, dementia, and idiot were set as search words to retrieve relevant literature in Encyclopadia of Traditional Chinese Medicine. Prescription information was screened and standardized to build database. Frequency analysis and association rules were used to mine TCM prescriptions and compatibility rules. Results Totally 449 AD related prescriptions were selected, involving 682 Chinese medicinal herbs. The individual herb with the highest frequency was Ginseng Radix Rhizoma (192);the herbal pair with the highest frequency was Ginseng Radix Rhizoma-Polyhalae Radix (182);the herbal combination with 3 Chinese medicinal herbs with the highest frequency was Poria with Hostwood-Ginseng Radix Rhizoma-Polyhalae Radix (79);the herbal combination with 4 Chinese medicinal herbs with the highest frequency was Polyhalae Radix-Ginseng Radix Rhizoma-Poria with Hostwood-Glycyrrhizae Radix et Rhizoma (37). The results of association rules showed that Ginseng Radix Rhizoma-Polyhalae Radix, Ginseng Radix Rhizoma-Glycyrrhizae Radix et Rhizoma, and Ginseng Radix Rhizoma-Poria with Hostwood were commonly used compatibilities in AD related prescriptions. Conclusion Treatment of TCM practitioners in all dynasties for AD mainly chooses Chinese medicinal herbs with the efficacy of tonifying qi and soothing nerves. The compatibilities and combinations are reasonable and with certain representativeness.

Observation of endovascular stent insertion for non-small cell lung cancer patients with superior vena cava syndrome / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness and safety of endovascular stent insertion for non-small cell lung cancer patients with superior vena cava syndrome.</p><p><b>METHODS</b>We retrospectively studied 123 patients referred to our hospital for the treatment of non-small cell lung cancer presenting with superior vena cava syndrome. Patients were devided in two groups according to the use of endovascular stent insertion in superior vena cava syndrome or not. 64 patients underwent endovascular stent insertion was designed as the stenting group and 59 without stenting as control group. The differences between the two groups in complete response, complication and survival were analyzed.</p><p><b>RESULTS</b>The complete response rate of superior vena cava obstruction was 92.0% for the stenting group, and 42.0% for the control group, showing a significant difference between the two groups (P < 0.001). The median time to complete response was (3.76 ± 2.83) days in the stenting group, significantly shorter than that of the control group (28.08 ± 16.06) days (P < 0.001). The relapse rate after complete response was 12.0% in the stenting group and 16.0% in the control group, showing a non-significant difference between the two groups (P = 0.607). The median time to relapse was 2.7 months in the stenting group and 1.1 months in the control group (P = 0.533). In the stenting group, stent stenosis occurred in 1 case and thrombosis was observed in 3 cases. The incidence rate of complications was 6.3%. Thrombosis occurred in 1 case of the control group, with an incidence rate of complications of 1.7%, showing a non-significant difference between the two groups (P = 0.201). Seven among the 123 patients were still alive at the endpoint of following up. The median survival time was 8.0 months (stenting group) and 5.5 months (control group) (P = 0.382).</p><p><b>CONCLUSIONS</b>Endovascular stent insertion is effective and safe for non-small lung cell cancer patients with superior vena cava syndrome, and it may be recommended as the first choice for palliative treatment of superior vena cava obstruction.</p>

Interventional therapy for lung cancer patients with superior vena cava syndrome / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the method, therapeutic effect and safety of interventional therapy for lung cancer patients with superior vena cava syndrome (SVCS).</p><p><b>METHODS</b>Fifty-two cases of lung cancer with SVCS who received interventional therapy in our hospital between Jan to Dec 2011 were included in this study. Of the 52 cases, 50 cases had successfully carried out superior vena cava stent implantation. The distal venous pressure was measured before and after angioplasty, and the results were assessed by Wilcoxon matched-pairs test. In addition, the 50 patients were followed up and the therapeutic effect and postoperative survival rate were evaluated.</p><p><b>RESULTS</b>The mean distal venous pressure in the 50 patients was significantly decreased from preoperative (28.2 ± 1.9)cm H2O to postoperative (8.7 ± 0.5)cm H2O (P = 0.0085). The efficacy of the treatment was as follows: complete remission (20/52, 38.5%), partial remission (28/52, 53.8%), ineffective 4 (4/52, 7.7%), and total effective rate 92.3%. The complications after angioplasty and stent implantation included chest pain (12 cases, 23.1%), hematoma at the puncture site (5 cases, 9.6%), and fever (2 cases, 3.8%). No serious complications such as massive hemorrhage, pulmonary embolism and stent migration into the cardiac atrium were observed. The rate of postoperative restenosis was low (2/52, 3.8%). For the SCLC group, the objective effective rate was 74.1% and 1-year survival rate was 21.0%. For the NSCLC group, the objective effective rate was 21.7% and 1-year survival rate was 35.0%.</p><p><b>CONCLUSIONS</b>For lung cancer patients with SVCS, interventional therapy may relief obstruction effectively, promote blood flow recovery, and relieve clinical symptoms. Interventional therapy with endovascular angioplasty and stenting may be highly recommended as the first choice for palliative treatment of SVCS. It is an effective initial palliative treatment. However, subsequent comprehensive anti-tumor treatment is necessary.</p>

Study on the tumor growth and angiogenesis in the tumor of colon cancer xenografts in high fat diet induced metabolic syndrome model in nude mice / 中华消化杂志

Objective To investigate the characteristics of growth and angiogenesis of colon cancer xenograft in nude mice with metabolic syndrome induced by high fat diet.Methods Female BALB/C nude mice were fed with high fat diet (45.0％ from fat,HFD group) or common diet (13.8％ from fat,CD group) for 12 weeks (n=15,respectively).Colon cancer cell line SW480 was marked with green fluorescent protein (GFP) and subcutaneous xenograft model was established.The tumor growth was observed by the in vivo imaging system in small animal at the 4th week.By the end of the experiment,serum glucose and lipid level of the two groups were measured,visceral subcutaneous and visceral adipose tissue,liver and xenograft tumor were dissociated and weighted.The differences of proliferating cell nuclear antigen (PCNA) and CD31 expression in the tumors between groups were analyzed.The t-test or x2 test were performed for group comparison.Results Compared with CD group,the body weight,blood serum glucose level,triglyceride and cholesterol level,adipose content of subcutaneous and visceral of the HFD group significantly increased (t=2.91,4.12,4.43,3.92,3.77 and 4.02,all P＜0.05).Averagedaily energy intake of HFD group was significantly higher than that of CD group (t=2.34,P＜0.05).There was no significant difference between the two groups in liver weight (t=1.02,P＞0.05).However,by HE staining lipid vacuoles in the liver tissue was obvious in HFD group.Average bioluminescent index,tumor volume and weight of xenografts of HFD group were remarkably higher than those of CD group (t=8.84,2.48 and 2.86,all P＜0.05).The immunohistochemical staining results indicated that the strong positive rate of PCNA in xenografts of HFD group was 80.00％ and the microvessel density (MVD) was (25.75±0.96)/per high power field,both of which were higher than those of CD group (14.29％ and (13.33±1.53)/per high power field respectively,x2 =12.52,t=13.35,both P＜0.01).Conclusions The colon cancer xenograft in nude mice with metabolic syndrome induced by high fat diet had a high MVD and grew fast.

Pleiotrophin stimulates growth and albumin secretion of rat hepatocytes in culture / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the influence of pleiotrophin (PTN) on the growth of rat hepatocytes.</p><p><b>METHODS</b>Primary rat hepatocytes were isolated from male Sprague-Dawley rats and divided into three groups: group A (negative control), cultivated in normal culture medium; group B (positive control), cultivated with culture medium supplemented with supernatant from the embryonic fibroblast 3T3 cell line; group C (experimental), cultivated with culture medium supplemented with human recombinant (hr) PTN (100 ng/ml). The hepatocytes' growth rate and level of secreted albumin (ALB) were evaluated by microscopy and biochemical assay, respectively. Significance of between-group differences were assessed by one-way ANOVA, and pairwise comparisons were performed by the least significant difference test.</p><p><b>RESULTS</b>The growth rates of hepatocytes in groups A, B and C were 2.800+/-0.084%, 4.300+/-0.132% and 3.800+/-0.053%, respectively. The growth rate of group B was significantly higher than the other two groups (F = 333.735, P less than 0.05). For all groups, the highest levels of secreted ALB were detected between the second and sixth day of culture, with g/L concentrations at day 2, 4 and 6 of: group A, 0.550+/-0.010, 0.900+/-0.030 and 0.300+/-0.040; group B, 0.900+/-0.030, 1.300+/-0.020 and 1.400+/-0.030; group C, 0.900+/-0.010, 1.160+/-0.010 and 0.700+/-0.050. The secreted ALB of group B was significantly higher than that of the other two groups (F = 651.355, 338.831 and 863.205, P less than 0.05 ).</p><p><b>CONCLUSION</b>PTN can benefit in vitro culturing of rat hepatocytes by stimulating growth and enhancing their ability to secrete albumin.</p>

Pulmonary arterial dimensions and right ventricular function by cardiac MRI / 中华放射学杂志

Objective To evaluate the diagnostic value of cardiac magnetic resonance imaging (CMRI) for pulmonary arterial hypertension(PAH).MethodsOne hundred and thirty patients with PAH confirmed by right cardiac catheterization were examined by CMRI and the results were compared with that of 31 healthy control participants.The main pulmonary artery diameter( MPAD),aortic diameter( AOD),main pulnonary arterydiameter/aorticdiameter(MPAD/AOD), rightventricular end-diastolicvolume ( RVEDV ),right ventricular end-systolic volume ( RVESV),right ventricular ejection fraction (RVEF) and right ventricular mass (RVM) were measured.The independent samples t-test was used to compare the PAH group with the control group.The Pearson correlation analysis and linear regression analysis were used to evaluate the relationship between cardiac and arterial measurements and pulmonary arterial pressure (PAP).ResultsThe MPAD,MPAD/AOD,RVEDV,RVESV,RVM in PAH group[ (3.88 ±0.57) cm,1.36 ±0.17,(161.63 ±56.37) ml,( 112.61 ±41.46) ml,(82.70 ± 20.73) g,respectively ] were increased compared with those in normal control group[ (2.74 ±0.31 ) cm,0.90 ±0.07,( 131.31 ± 15.14) ml,(61.33±9.00) ml,(44.39±5.87) g,respectively].The RVSV and RVEF in PAH group[(49.02 ±19.20) ml,( 30.76 ± 5.85 ) ％,respectively ] were decreased compared with those in normal control group [ (69.95 ± 9.63 )ml,(53.28 ± 4.14 )％,respectively ].The MPAD,MPAD/AOD,RVEDV,RVESV,RVSV,RVEF,RVM were significantly different between PAH patients and control participants(tMPA =10.82,tMPAD/AOD=14.93,tRVEDV=2.96,tRVESV=6.83,tRVSV=-5.89,tRVEF=-20.22,tRVM=10.12,respectively,P＜0.01).There were no significant correlations between MPAD,RVEDV,RVESV,RVSV and PAP (r=0.299 for MPAD,r =0.127 for RVEDV,r=0.278 for RVESV,r =-0.229 for RVSV).Moderate positive correlations were found between MPAD/AOD, RVM and PAP (r =0.702 for MPAD/AOD,r =0.683 for RVM ).A moderate negative correlation was found between RVEF and PAP (r=-0.660).Conclusion CMRI is an excellent imaging modality for the diagnosis of PAH. The MPAD/AOD,RVM,and RVEF can be used to indicate the severity of PAH.

Prognostic analysis and establishment of a prognostic model for patients with liver failure with hepatorenal syndrome / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To identify the factors that may influence the prognosis of patients with hepatorenal syndrome and try to establish a prognostic model.</p><p><b>METHODS</b>Data of 126 patients with hepatorenal syndrome were analyzed and 56 indexes that might affect the prognosis were focused on, involving history, symptoms, signs and lab findings. Cox model and Kaplan-Meier survival analysis were used.</p><p><b>RESULTS</b>Many factors were found to affect the prognosis independently, including hepatic encephalopathy (HE) and its degree, gastrointestinal bleeding (GIB), blood neutrophil count (N1) and serum creatinine (Cr). The prognosis model was established as the following equation where PI represents prognosis index: PI = 0.711HE + 0.836GIB + 0.052N1 + 0.002Cr (GIB: no = 0, yes = 1; HE: no = 0, phase I = 1, phase II = 2, phase II = 3, phase IV = 4). When PI < 1, the average survival time was 42 days; when 1 < or = PI < or = 3, the average survival time was 15 days; when PI > 3, the average survival time was 2 days.</p><p><b>CONCLUSION</b>The results obtained from this study may help in estimation of diagnosis, analysis of illness state and evaluation of therapy in clinical work.</p>

Endovascular embolization for the management of cryptogenic massive hemoptysis in long-term smokers / 中华放射学杂志

ObjectiveTo determine the effectiveness of endovascular embolization in patients with cryptogenic massive hemoptysis who were all long-term smokers.Methods Aortography and subclavian artery angiography were performed in 21long-term smokers with cryptogenicmassive hemoptysis.Transarterial embolization (TAE) was performed in patients with detectable pathologic systemic arteries.The angiographic findings were reviewed and the clinical and follow-up CT results were observed.ResultsThe pathologic systemic arteries were all bronchial arteries (BAs) and thirty-five arteries were involved.The angiography demonstrated peripheral hyperplasia in all BAs,with 24 pathologic BAs supplying the right lung and 25 supplying the upper lobes.In thirty-five BAs,24 showed hypertrophy and 11 were normal.TAE of the pathologic BAs was successfully performed and cessation of bleeding was achieved in all patients.During follow-up,one patient had episodic bloody sputum after embolization and no recurrence in all patients.The follow-up CTdemonstratednoadditionalabnormalitybesidespre-existingpulmonaryemphysema.Conclusion Cryptogenic massive hemoptysis in long-term smokers efficiently treated by endovascular embolization of the responsible bronchial artery.

Prognosis and staging of superficial endobronchial lung cancer: the impact of invasion depth, tumor diameter, and coexistent pneumonitis or atelectasis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are few reports discussing the surgical pathological characteristics of superficial endobronchial lung cancer (SELC) defined as cancer growth limited to the bronchial wall. Its prognosis and corresponding TNM staging have not been fully clarified. Little is known as to whether T status is impacted by the existence of associated atelectasis or pneumonia (which might be controversial, indicating either T1 or T2), and circumstantial invasion depth.</p><p><b>METHODS</b>Between 1988 and 2007, 81 out of 8817 surgically treated patients met SELC criteria; there was no detectable invasion beyond the bronchial wall. A retrospective review was performed and follow-up information was collected.</p><p><b>RESULTS</b>The overall five-year survival rate of 81 patients was 85.6%; for N0M0 (n = 67), N1M0 (n = 7) and N2M0 (n = 7) patients, they were 89.3%, 75.0% and 60.0%, respectively. Intraluminal tumor size measured from 0.4 to 3.0 cm; obstructive atelectasis or pneumonia was noted in 14 patients. The presence of tumor-associated obstructive atelectasis or pneumonia did not have a significant impact upon prognosis (P = 0.96), nor did the greatest diameter of the tumor (P = 0.70). Histology showed carcinoma in situ (level one) in 13 cases; invasion of the submucosal layer (level two) in 12, involvement of the muscular layer (level three) in 20, invasion into the space between the muscular layer and cartilage (level four) in 21, and bronchial cartilage infiltration in 15 (level five). In cases without lymphnode metastases, five-year survival was 100% for the first three levels and 84.0% and 61.3% for the level four and level five.</p><p><b>CONCLUSIONS</b>Relative to TNM-based prognostic data, superficial endobronchial lung cancer exhibits increased five-year survival rates, and therefore should be placed at the forefront among tumors in the T1 class, regardless of tumor size or the presence of secondary obstructive atelectasis or pneumonia. Lymphnode metastasis is associated with a worse prognosis. Survival is negatively impacted by tumor infiltration depth into the bronchial wall.</p>

Mucoepidermoid carcinoma of the tracheobronchial tree: CT findings / 中华放射学杂志

Objective To explore the CT findings of mucoepidermoid carcinoma (MEC) of the tracheobronchial tree and improve the diagnostic accuracy. Methods The CT images, histopathological and clinical data in 24 patients with pathologically proved MEC of the tracheobroncbial tree were retrospectively analyzed. Results The clinical symptoms included cough, sputum, fever, wheezing, chest pain and hemoptysis. The patient was proved to be low-grade (n=19) and high-grade (n=5) MEC histopathologically. One lesion was located in trachea, 6 in main bronchus, 12 in lobar bronchus and 5 in segmental, subsegmental and distal bronchus. The tumor presented as no-invasive endotracheobronchial well-defined round-like nodule (n=13, locating in lobar and higher bronchus) and columnar sharp (n=3, locating in main bronchus), or intra-and-extraluminal well-defined round-like nodule or mass (n=6, locating in lobar and lower bronchus) and irregular mass with invasive pattern (n=2, high-grade type). The density of lesion was similar to the muscule and the calcification within lesion was showed in 4 patients on non-enhanced CT. The lesion had marked enhancement in 17 patients on enhanced CT. Obstructive changes were found in 20 patients. Conclusion MEC of the tracheobronchial tree is usually low-grade malignancy and locates in main and lobar bronchus with no-invasive well-defined airway mass, marked enhancement and calcification on CT.

Endovascular embolization through pulmonary artery access for refractory massive hemoptysis / 中华放射学杂志

Objective To determine the effectiveness of endovascular embolization through pulmonary artery access in patients with refractory massive hemoptysis in whom systemic artery (SA)embolization is ineffective or contraindicated. Methods A total of 102 patients were treated with SA embolization for hemoptysis. Of the 102 patients, 6 patients had severe persistent hemoptysis despite complete SA embolization and 1 patient had severe hemoptysis following complete bronchial artery embolization and other SA embolization was contraindicated. The underlying diseases were chronic cavitary pulmonary tuberculosis (n = 3), chronic cavitary pulmonary tuberculosis complicated with aspergilloma (n=1), tuberculous bronchiectasis (n=1), severe necrotizing pneumonia (n=1) and bronchiectasis complicated with pneumatocele (n=1). The findings of SA angiography, main pulmonary angiography and selective pulmonary angiography were analyzed. Endovascular embolization was performed in patients with the detectable pathology in PA and the clinical results were observed. Results The findings of SA angiography showed bronchopulmonary shunting in all cases, and pseudoaneurysm of PA in 2 cases and hypertrophy of peripheral PA in 2 cases. The main PA angiography demonstrated pseudoaneurysm of PA in 1 case and hypoperfusion of the diseased PA in other case. The selective PA angiography demonstrated pseudoaneurysm of PA in 4 cases (1 case with extravasation of constrast medium) and hypertrophy ofperipheral PA in 2 cases. Coil embolizations of the pathologic PA were successfully performed and bleeding ceased in all patients. During follow-up, 1 patient had episodic bloody sputum after embolization, and 2 died day 6 and 15 of severe infection and respiratory failure and the remaining patients were all stable.Conclusions In patients with refractory massive hemoptysis after systemic embolization, the possibility of PA pathology, especially pseudoaneurysm of PA should be considered. Selective pulmonary angiography is necessary to demonstrate the pathology in PA. Endovascular management of the pathologic PA appears to be a safe and effective treatment.