Diffuse lung involvement in rheumatoid arthritis: a respiratory physician's perspective / 中华医学杂志(英文版)

The lungs are one of the most common extra-articular organs involved in rheumatoid arthritis (RA), which is reported to occur in up to 60% to 80% of RA patients. Respiratory complications are the second leading cause of death due to RA. Although there is a wide spectrum of RA-associated respiratory diseases, interstitial lung disease is the most common manifestation and it impacts the prognosis of RA. There has been progress in understanding the management and progression of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and RA-associated respiratory diseases recently, for example, opportunistic pulmonary infectious diseases and toxicity from RA therapies. From a chest physicians' perspective, we will update the diagnosis and treatment of RA-associated ILD, methotrexate-associated lung disease, and the complication of Pneumocystis jiroveci pneumonia in RA in this review.

Next Steps after Negative Results Obtained by EBUS-TBNA from Patients Suspected Clinically Lung Cancer with Mediastinal Lymphnode Metastasis / 中国肺癌杂志

BACKGROUND@#Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is well known as an important technique for diagnosis and staging of lung cancer. But a standard protocol to deal with patients who have a negative pathology result still needs to be defined. Herein, we describe the subsequent procedures of these patients in a single center.@*METHODS@#A total of 1,412 patients with clinical suspected lung cancer and mediastinal metastasis who underwent EBUS-TBNA were collected between September 2010 and December 2016. Among them, 51 patients with nonspecific pathology result were included and retrospectively analyzed.@*RESULTS@#The 51 patients were stratified into five groups by clinical characterize and follow-up procedures: (1) Diagnosed by other bronchoscopy procedures group (9 cases). Abnormalities of tracheobronchial tree were found during visual examination in the majority of patients (8 cases). Biopsy, endobronchial brushing, bronchoalveolar lavage, and transbronchial lung biopsy (TBLB) were used to get a specific diagnosis. (2) EBUS-TBNA re-biopsy group (11 cases). Patients in this group had normal mucosal appearance and airway lumen. Re-biopsy were performed on patients in this group. (3) Surgery group (6 cases). Patients underwent surgery after negative result of EBUS-TBNA. Five of them were confirmed with non-nodal metastasis after surgery. (4) Underwent other pathology diagnosis group (15 cases). patients in this group had other metastasis sites besides midiastinal lymph node. Computed tomography (CT)-guided fine-needle aspiration and lymph node biopsy were performed. (5) Follow-up group (10 cases). None invasive procedure was used in this group. The median follow up time was 38 months. One patient was diagnosed lymphoma during the follow up.@*CONCLUSIONS@#Diagnostic procedures should be chosen based on the clinical character in EBUS-TBNA negative patients with suspected lung cancer. Long time follow-up is very important in patients whose diagnosis is apparently unknown.

Endobronchial Ultrasound Guided Transbronchial Needle Aspiration for The Diagnosis and Genotyping of Lung Cancer / 中国肺癌杂志

BACKGROUND@#Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has emerged as an innovative technique for diagnosis and staging of lung cancer. But whether the procedure can provide enough tissue for the detection of gene mutations is still to be defined. Here we evaluated the efficacy of lung cancer diagnosis and gene analysis using samples obtain via EBUS-TBNA.@*METHODS@#Patients with suspected lung cancer and mediastinal lesions were referred for EBUS-TBNA. Diagnosis and sub-classifications were made by pathologists. Samples with non-squamous non small cell lung cancer sub type were tested for the EGFR and/or ALK mutations.@*RESULTS@#A total of 377 patients were included in this study. The median needle passes were 2.07. Lung cancer was diagnosed in 213 patients. The diagnosis accuracy for malignancy was 92%. Epidermal growth factor receptor (EGFR) mutations, anaplasticlymphoma kinase (ALK) fusion genes and double genes analysis were successfully preformed in 84 (90%), 105 (95%) and 79 (90%) patients. The number of needle passes and the diameters of lymph node were not associated with the efficacy of gene testing in univariate analysis. However, samples of adenocarcinoma sub type showed a tendency associated with higher genotyping efficacy.@*CONCLUSIONS@#Tissue samples obtained through EBUS-TBNA are sufficient for pathological diagnosis and genetic analysis of lung cancer. The pathology type of sample affected genotyping efficacy.

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration versus Standard Bronchoscopic Modalities for Diagnosis of Sarcoidosis: A Meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective technique used to precisely detect enlarged mediastinal lymph nodes. The efficacy of EBUS-TBNA versus standard modalities for the diagnosis of sarcoidosis remains to be elucidated. In this meta-analysis, we compared the efficacies of these methods.</p><p><b>METHODS</b>We searched PubMed, Embase, The Cochrane Library, Wanfang, Cpvip, CNKI, and the bibliographies of the relevant references. We analyzed the data obtained with Revman 5.2 (Nordic Cochrane Center, Copenhagen, Denmark) and Stata 12.0 software (Stata Corporation, College Station, TX, USA). The Mantel-Haenszel method was used to calculate the pooled odds ratio (OR) and 95% confidence intervals (CIs).</p><p><b>RESULTS</b>Sixteen studies with a total of 1823 participants met the inclusion criteria, and data were extracted regarding the diagnostic yield of each approach. The ORs for EBUS-TBNA versus transbronchial lung biopsy (TBLB) for the diagnosis of sarcoidosis ranged from 0.26 to 126.58, and the pooled OR was 5.89 (95% CI, 2.20-15.79, P = 0.0004). These findings indicated that EBUS-TBNA provided a much higher diagnostic yield than TBLB. The pooled OR for EBUS-TBNA + TBLB + endobronchial biopsy (EBB) versus TBNA + TBLB + EBB was 1.54 (95% CI, 0.61-3.93, P = 0.36), implying that there was no significant difference between their diagnostic yields. However, clinical heterogeneity was reflected in the nature of the studies and in the operative variables.</p><p><b>CONCLUSIONS</b>The results of this meta-analysis suggest that EBUS-TBNA + TBLB + EBB could be used for the diagnosis of sarcoidosis, if available. At medical centers without EBUS-TBNA, TBNA + TBLB + EBB could be used instead.</p>

Initial study of stratifying management with objective structured clinical examination in resident standardized training / 基础医学与临床

Using objective structuned clinical exammation ,OSCE to access a new resident standardized training , analyze the result and perform stratifying management and teaching based on the result , which may improve the effi-ciency and effectiveness of resident standardized training .

Effect on therapeutic effect of inducing the formation of the post-moxibustion sore for bronchial asthma / 中国针灸

<p><b>OBJECTIVE</b>To observe the impact of inducing the formation of the post-moxibustion sore on the efficacy of bronchial asthma treated with scarring moxibustion.</p><p><b>METHODS</b>Three hundred and seventy-two cases diag nosed definitely as bronchial asthma at remission stage were randomly divided into a modified nursing group (248 cases) and a conventional nursing group (124 cases). The scarring moxibustion was applied at Dazhui (GV 14), Feishu (BL 13), Danzhong (CV 17) and Tiantu (CV 22) in either group. The direct moxibustion with moxa cone was adopted. In modified nursing group, 0.5% Iodine was used for the sterilization at moxa abscess. The herbal plaster was cut into an inverted triangle and compressed on the wound. After suppuration, the fester was not cleaned in each dressing change. Additionally, the patients were advised to have high-protein diets after moxibus tion till abscess dropped. In conventional nursing group, 0.5% Iodine was used for the sterilization at moxa abscess. The herbal plaster was cut into a round shape that could cover completely the moxa wound. After suppuration, in each dressing change, the wound was cleaned and sterilized. Additionally, the patients were advised to avoid any stimulating food after moxibustion till abscess dropped. The clinical efficacy, the change of C3 content in blood serum and the clinical symptom score were observed in two groups.</p><p><b>RESULTS</b>The total effective rate was 93.5% (232/248) in modified nursing group, which was better than 79.0% (98/124) in conventional nursing group (P < 0.01). C3 content increased apparently after treatment as compared with that before treatment in either group (both P < 0.01), but C3 level increased much more apparently in modified nursing group as compared with that in conventional nursing group (P < 0.01). The clinical symptom score reduced apparently after treatment in either group (both P < 0.01), but that reduced much more apparently in modified nursing group as compared with that in conventional nursing group (P < 0.01).</p><p><b>CONCLUSION</b>In the treatment of bronchial asthma with scarring moxibustion, to induce the formation of the post-moxibustion sore achieves the better clinical efficacy as compared with conventional nursing.</p>

Clinical analysis of pulmonary alveolar proteinosis and cases with combination of severe infection / 中国医师进修杂志

Objective To describe and analyze the misdiagnosis and mistreatment status of pulmonary alveolar proteinosis (PAP), especially cases with combination of severe infection. Method The misdiagnosis and mistreatment of 84 PAP patients and 6 cases with combination of severe infection before admitting to PUMCH was analyzed retrospectively. Results 66.7%(56/84) had experienced misdiagnosis before admission. 32.1% (27/84) were misdiagnosed with idiopathic interstitial pneumonia (IIP) and 14.3% (12/84) with pulmonary tuberculosis. 88.1%(74/84) had received anti-infection treatment, 33.3%(28/84) received eortieosteroids, and 19.0%(16/84) received anti-tuberculosis treatment. The percentage of the pa-tients who had taken the bronchoscopic examination outside the PUMCH was 53.6%(45/84). The PAP pa-tients diagnosis was established through bronchoscopic examination (including BAL and TBLB) in 86.9% (73/84) patients. There were 6 patients who had severe infection when PAP established. All of these 6 cases had been misdiagnosed with IIP and received corticosteroids treatment, 2 of whom died. Conclusions The misdiagnosis and mistreatment happens commonly in PAP patients. The misuse of corticosteroids makes some PAP cases get the severe infection. The image feature and the examination of bronchoscopy, BAL and TBLB are the key point in avoiding misdiagnosis. The administration of corticosteroids in uncertain patients should be avoided.

The guidance role of the CURB-65 criteria in the management of community-acquired pneumnia in adults / 中国医师进修杂志

Objective To evaluate the guidance role of the CURB-65 criteria in the management of community-acquired pneumonia(CAP) in adults. Methods The clinical date of 13 patients with CAP from January 2007 to January 2008 were analysed, the diagnosis and treatment of 3 patients were enumerated. Evaluated the effect of CURB-65 criteria on CAP. Results According to the CURB-65 criteria, the scores of 3 patients with CAP were 0, 2, 5 scores respectively.After the proper treatment based on CURB-65 criteria,each patient got a good prognosis. Conclusions The CURB-65 criteria plays an encouraging role in assessing the severity of CAP. But the veracity of identifying severe CAP is poor. In this situation the criteria for severe CAP is needed to make the decision.