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Objective To examine the value of bronchoscopy in the diagnosis of sputum-negative pulmonary tuberculosis in a general hospital.Methods A retrospective study was conducted for the 459 patients treated in a general hospital from June 2010 to May 2015.All the patients had symptoms and radiographic changes suggestive of pulmonary tuberculosis but smearnegative.All patients were subjected to bronchoscopy,including brushing,bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB).The bronchoscopic specimens were submitted for direct smear and acid-fast stain,Mycobacterium tuberculosis culture or histopathological assay,respectively.Results The diagnosis was confirmed by bronchoscopy in 378 (82.4％) of the 459 patients.Of the 378 patients whose diagnosis was confirmed,pulmonary tuberculosis was identified in 238 patients (63.0％).Other diagnoses included bronchogenic carcinoma,non-specific inflammation,organizing pneumonia,pulmonary fungal infection,interstitial pneumonia,sarcoidosis,nontuberculous mycobacterial infection.Of the patients with confirmed diagnosis by bronchoscopy,the sensitivity for diagnosis was 57.95％ by direct smear and acid-fast stain of brushing or BALF,79.78％ by culture of BALF,and 56.93％ by histopathological assay of TBB specimens.The integrated method by combining smear and stain,culture and histopathological assay of TBB specimens could improve the sensitivity,specificity,positive predictive value,and negative predictive value to 91.01％,97.46％,97.98％ and 88.89％.Conclusions For the patients whose clinical manifestations and imaging changes are suggestive of pulmonary tuberculosis but smear-negative,bronchoscopy is a valuable method for the diagnosis,which should be adopted as a routine test in clinical practice.
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Objective To explore the serum expression of DKK1 protein, a Wnt signaling pathway inhibitor in patients with non-small cell lung cancer (NSCLC) and its relationship with osseous metastasis. Methods Serum DKK1 protein levels were assayed by enzyme-linked immunosorbent assay (ELISA) in NSCLC patients, including 33 NSCLC patients with osseous metastasis and 41 NSCLC patients without respectively, and 32 healthy volunteers were served as the control group. Furthermore, the differential expression of the serum DKK1 protein level between the patients and the volunteers was compared by using the variance analysis and the independent sample t test. The correlation between DKK1 expression and bone metastasis was detected by Pearson correlation analysis. Results Serum DKK1 protein level of NSCLC patients was (79.6±8.3) ng/ml, which was significantly higher than that in healthy volunteers [(21.5±6.4) ng/ml, t=13.17, P=0.001]. The serum DKK1 level in osseous metastasis group was (110.3±11.4) ng/ml, which was significantly higher than that in non-skeletal metastasis group [(60.7±10.5) ng/ml, t=14.128, P=0.003]. The positive association was observed between the DKK1 level in the peripheral blood and osseous metastasis in NSCLC patients (r=0.855, P<0.001). Conclusion The serum expression level of DKK1 protein in NSCLC patients is closely related to the osseous metastasis, which may be a predicting biomarker for the osseous metastasis.
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Objective To investigate the clinical characteristics of diffuse alveolar hemorrhage. Methods 12 patients with diffuse alveolar hemorrhage hospitalized in Guangzhou NO.1 Hospital were included in the research, whose clinical characteristics were analyzed. Results 7 cases of the 12 diffuse alveolar hemorrhage cases were male and 5 cases were female. 8 cases were caused by ANCA associated vasculitis , 1 cases by connective tissue disease, 1 cases by poisoning, and 2 cases of unknown etiology (medication could be considered). The clinical manifestations were fever (91.67%), hemoptysis (100%), anemia (100%), and dyspnea (3.33%). Conclusion Diffuse alveolar hemorrhage is a life-threatening clinical syndrome. It can be caused by many causes. It should be considered if there is the presence of hemoptysis, dyspnea, anemia, etc. Timely examination and early intervention can effectively improve the prognosis of the disease.
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Objective To evaluate the level changes of serum WASP-family verprolin homologous protein-1 (WAVE1) and vascular endothelial growth factor-C (VEGF-C) and their clinical significance in patients with advanced non-small lung cancer (NSCLC) before and after chemotherapy.Methods Serum WAVE1 and VEGF-C were measured in 43 patients with advanced NSCLC by ELISA,and the results were compared with 43 healthy volunteers.Results The levels of serum WAVE1 and VEGF-C before chemotherapy in patients group were (0.573±0.082) ng/ml and (947.3±125.4) pg/ml respectively,while in healthy volunteers group,they were (0.256±0.064) ng/ml and (425.5±110.1) pg/ml respectively,which suggested that before chemotherapy the levels of serum WAVE1 and VEGF-C in NSCLC group were significantly higher than those of in the control (P ＜ 0.05).The serum levels of WAVE1 and VEGF-C in advanced NSCLC patients were closely related to lymph node metastasis status and distant metastasis status (P ＜ 0.05),but not to the gender,age,tumor length,histology type,differentiation grade and C-TNM stage (P ＞ 0.05).The serum WAVE1 and VEGF-C levels of the effective treatment group was (0.290±0.037) ng/ml and (596.1±127.5) pg/ml after chemotherapy respectively,which decreased obviously compared with the group before chemotherapy which levels were (0.517±0.051) ng/ml and (964.6±100.3) pg/ml (both P ＜ 0.05).But the serum WAVE1 and VEGF-C levels of the ineffective treatment group were (0.547±0.065) ng/ml and (957.0±111.2) pg/ml after treatment,which had no difference compared with the group before chemotherapy which levels were (0.517±0.051) ng/ml and (964.6±100.3) pg/ml (both P ＞ 0.05).Furthermore,statistically significant relationship was found between the serum WAVE1 and the VEGF-C levels (r =0.331,r =0.540,both P ＜ 0.05).Conclusion Serum WAVE1 and VEGF-C may be used as indicators for prediction of the efficacy of chemotherapy in patients with advanced NSCLC.
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Objective To study the therapeutic effect and safety of pleurodesis with medical thoracoscopy by powdery talc on treatment of malignant pleural effusion.Methods Retrospective analysis were done in 74 cases of malignant pleural effusion accepted simple powdery talc pleurodesis under medical thoracoscopy.Results The doses of powdery talc were from 1g to 5g,average 2.18g in the course of the treatment.After operation,45 (60.8％) cases which were complete remission(CR) were full pleural adhesion and complete lung recruitment,14cases (18.9％),which were partial remission(PR),were less pleural adhesion and most lung recruitment,and 10cases(13.6％) were stable diseases(SD),while 5cases(6.7％),which were progressive diseases(PD),were without pleural reaction.The total effective rate,including CR,PR and SD,was 93.3 ％ (69/74).The complications of simple powdery talcage under medical thoracoscopy were included in:95.9％ (71/74) with chest pain,64.8％ (48/74) with fever,28.4％ (21/74) with shortness of breath,12.2 ％ (9/74) with mediastinal and subcutaneous emphysema,5.4％ (4/74) with nausea and vomiting,4.1％ (3/74) with abdominal distension,while the complications of acute pulmonary edema,massive hemorrhage,pulmonary embolism and wound infection were not observed.Conclusion Treatment of malignant pleural effusion by simple powdery talcage under medical thoracoscopy has definite clinic therapeutic effect,which is safe,cost-effective,less trauma and worthy of clinical application.
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OBJECTIVE:To evaluate the effects of propofol in relieving pain during fibrobronchoscopy when it is used in general intravenous anesthesia.METHODS:160patients undergoing fibrobronchoscopy were randomly divided into propofol group and control group.90patients in the propofol group were anesthetized intravenously by injection of propofol at the dosage of1.5mg/kg and speed of30mg/10s and then underwent fibrobronchoscopy;While70patients in the control group underwent regular fibrobronchoscopy.RESULTS:The lash reflex disappeared within(40.73?7.91)seconds after propofol injection,and patients became conscious within(5.39?1.85)minutes after stopping injection,full consciousness occurred at(10.82?2.73)minutes.Electrocardiogram did not show any signs of change in blood pressure,myocardial ischemia and cardiac dysrhythmia,the post-operative satisfaction rate was96%as compared with81%in the control group.The patients in the propofol group showed extensive willingness for second fibrobronchoscopy,while the patients in the control group presented cough,struggle,and20%of them refused the second fibrobronchoscopy.CONCLUSION:It is safe and effective to apply propofol in painless fibrobronchoscopy.