Encapsulation and characterization of ω-3 medium- and long-chain triacylglycerols microencapsulated with different proteins as wall materials.

In this study, ω-3 medium- and long-chain triacylglycerols (MLCTs) microcapsules with excellent performance were obtained using soy protein as the wall component to address the oxidation-related problems of MLCTs. Additionally, the effect of soy, whey, or pea proteins on microcapsules in terms of the changes in their structure and physicochemical properties was investigated. The results showed that the small particle size, low PDI (polydispersity index) and zeta potential, fast adsorption rate, and low interfacial tension of these protein-based samples fabricated through the O/W template method were conducive to maintaining the integrity of microcapsules during spray-drying. The microcapsules, characterized by a spherical shape, exhibited superior encapsulation efficiency of 94.56%, surpassing the findings of previous investigations. Overall, these microcapsules exhibited long-term storage stability and low controllable release rates, which could be utilized as carriers for liposoluble actives.

Decreased Expression of a Novel lncRNA FAM181A-AS1 is Associated with Poor Prognosis and Immune Infiltration in Lung Adenocarcinoma.

Background: There is no clear information regarding the role of FAM181A antisense RNA 1 (FAM181A-AS1) in lung adenocarcinoma (LUAD). We explored the relationship between FAM181A-AS1 and LUAD using bioinformatics analysis and experimental validation in this study. Methods: Statistics and databases were used to evaluate the relationship between clinical features in LUAD patients and FAM181A-AS1 expression, prognostic factors, regulation network, and immune infiltration of FAM181A-AS1 in function. LUAD cell lines were tested for FAM181A-AS1 expression using qRT-PCR. Results: FAM181A-AS1 showed significantly low expression in LUAD patients. Low FAM181A-AS1 expression predicted a poorer overall survival (OS) (HR: 0.66; 95% CI: 0.49-0.88; P=0.005) and disease specific survival (DSS) (HR: 0.64; 95% CI: 0.44-0.92; P=0.017) of LUAD patients. There was also an independent correlation between low FAM181A-AS1 expression (HR: 0.547; 95% CI: 0.350-0.857; P=0.008) and OS in LUAD patients. The FAM181A-AS1 high-expression phenotype was differentially enriched for M phase, cellular senescence, cell cycle checkpoints, chromatin modifying enzymes, ESR-mediated signaling, DNA repair, G2/M checkpoints, HCMV infection, and DNA double-strand break repair. A correlation was found between the expression of FAM181A-AS1 and immune infiltrating cells. A significant decrease in FAM181A-AS1 expression was observed in LUAD cell lines compared to Beas-2B. Conclusion: There was a significant association between low FAM181A-AS1 expression in LUAD patients and poor survival and immune infiltration. The FAM181A-AS1 gene may provide a useful biomarker for LUAD prognosis and immunotherapy response.

Incidence, aetiology and clinical features of eosinophilic pleural effusion: a retrospective study.

BACKGROUND: Eosinophilic pleural effusion (EPE) is a distinct entity among pleural effusions, but its diagnostic and prognostic significance is still controversial. This study aimed to evaluate the incidence and aetiological distribution of EPE in our institution and to assess the relationship between EPE and malignancy and other underlying diseases and the relevance of the percentage of eosinophils and other laboratory parameters. METHODS: A retrospective study was conducted by reviewing the medical records of 252 patients with PE from September 2017 to January 2021. RESULTS: EPE was found in 34 (13.49%) out of 252 patients. There were 20 (58.82%) males and 14 (41.18%) females in the EPE group. The mean percentage of eosinophils in EPE (21.7%, range (10.0-67.5%)) was significantly higher than the percentage of eosinophils in peripheral blood (5.65%, range (0-34.60%); p < 0.05). The most common cause of EPE was malignant disease (52.94%), followed by idiopathy (14.71%), parasites (8.82%), pneumonia (8.82%) and others (14.71%). Comparative analysis of patients with malignant versus nonmalignant EPE showed that patients with malignant EPE were significantly older, and had a lower white blood cell (WBC) count in the pleural fluid (1.8 vs 4.7 cells × 109/L, p < 0.05). However, the percentage of eosinophils in PE was not significantly different between malignant EPE and nonmalignant EPE (p = 0.66). There was no correlation between the percentage of eosinophils in PE and peripheral blood (r = 0.29; p = 0.09). CONCLUSIONS: Malignant disease ranks as the leading cause of EPE. The presence of EPE should not be considered as a predictive factor of benign conditions. Pleural parasitic infestation (PPI) should be emphasized in areas with a high incidence of parasitic disease.

Translational Nanotherapeutics Reprograms Immune Microenvironment in Malignant Pleural Effusion of Lung Adenocarcinoma.

Malignant pleural effusion (MPE) remains a treatment bottleneck in advanced lung cancer, due to its complicated microenvironments and "cold" immunity. Therefore, the search for therapeutic drugs to transform MPE to functionally "hot" one could advance the development of effective immunotherapeutic strategy. Herein, translational selenium nanoparticles coated with immune-modulating macromolecule lentinan (SeNPs@LNT) are designed to restore the dysfunctional immune cells in patient-derived MPE microenvironment. Internalization of the SeNPs@LNT can effectively reduce the immunosuppressive status by enhancing the proliferation of CD4+ T cells and natural killer cells, and remodeling the tumor associated macrophages into tumoricidal M1 phenotype in MPE derived from patients presenting low Se levels in blood and pleural effusion. Th1, cytotoxic T cell, γδ T, and B cell functions are upregulated, and Th2, Th17, and Treg cells activity is downregulated. Furthermore, SeNPs@LNT can be gradually metabolized into SeCys2 to promote the production of metabolites associated with tumor growth inhibition and immune response activation in MPE microenvironment. In contrast, lung cancer markers and vitamin B6 metabolism are decreased. The translational SeNP-based nanotherapeutic strategy restores functional "cold" MPE to "hot" MPE to activate the immune responses of various immune cells in MPE of lung cancer patients.

A multidisciplinary approach for the diagnosis of benign asbestos pleural effusion: a single-center experience.

BACKGROUND: There is little detailed information regarding benign asbestos pleural effusion (BAPE). It is frequently misdiagnosed because of lack of a standardized diagnostic approach and criteria. The present study aimed to better characterize BAPE and outline a diagnostic approach for this disease. METHODS: Complete clinical data of 11 consecutive patients with BAPE were prospectively collected and analysed. A multidisciplinary team (MDT) was involved in discussing the suspected cases of BAPE. The team was comprised of thoracic physicians, radiologists and pathologists. A multidisciplinary practical diagnostic approach for BAPE was introduced. RESULTS: Six patients had respiratory symptoms, but another 5 were asymptomatic. All the patients had an asbestos exposure and the median duration was 23.9 years (rang, 12-36 years). The median level of lactate dehydrogenase (LDH), adenosine deaminase (ADA), proteins and carcinoembryonic antigen (CEA) in the pleural fluid (PF) were 221.4 U/L (range, 189.8-11,325 U/L), 21 U/L (rang, 14-247 U/L), 48.3 g/dL (range, 35.2-53.2 g/dL) and 3.46 mg/mL (range, 0.84-4.54 mg/mL), respectively. Five patients had pleural plaques, 2 had diffuse pleural thickening (DPT), 1 had asbestosis, and 1 had round atelectasis. The pleural biopsy specimens showed a benign fibrotic pleura in all case. The symptoms and pleural pulmonary radiologic findings remained stable during the follow-up. CONCLUSIONS: BAPE is diagnosed by exclusion. A suspected diagnosis of BAPE with an asbestos exposure should be considered, especially with the presence of pleural plaques, and/or DPT, and rounded atelectasis. The MDT-based diagnostic approach may reduce misdiagnosis.

Diagnostic procedure for idiopathic eosinophilic pleural effusion: a single-center experience.

BACKGROUND: Eosinophilic pleural effusion (EPE) is attributed to several well-recognised causes. However, some patients remain idiopathic, even after thorough clinical work-up. The present study aimed to better characterize idiopathic EPE (IEPE) and to outline the diagnostic procedure for this disease. METHODS: Complete clinical data of 11 consecutive patients with IEPE were prospectively collected and analysed. Preliminary diagnostic procedure of IEPE in our hospital was performed. RESULTS: All the 11 patients had respiratory symptoms and unilateral pleural effusion (PE) occurred in 4 patients. The mean percentage of eosinophils in PE was 22.4% (range, 12.4-50.5%). Lactate dehydrogenase, adenosine deaminase, proteins and carcinoembryonic antigen in PE were 246.0 U/L (range, 89.8-421.9 U/L), 13.8 U/L (range, 1.8-24.0 U/L), 42.6 g/dl (range, 32.8-52.6 g/dl) and 2.17 mg/mL (range, 0.46-4.31 mg/mL), respectively. Parasite-specific IgG antibody in blood and parasite eggs in stool were both negative. No evidence of tuberculosis or malignancy was observed in pleural biopsy. Symptoms and abnormal pulmonary imaging were eliminated after glucocorticoid use. CONCLUSIONS: IEPE is a diagnosis of exclusion. Patients with EPE without a clear cause should be asked to provided complete medical, surgical and drug-related histories. A thorough work-up is essential. Moreover, we recommend follow-up after the use of glucocorticoid until effusion resolves. TRIAL REGISTRATION: GYFYY. Registration No: GYFYY20150901221. Registered time: 1 September 2015. Date of enrolment of the first participant to the trial: 22 January 2016.

Is 18F-FDG PET/CT useful for diagnosing relapsing polychondritis with airway involvement and monitoring response to steroid-based therapy?

BACKGROUND: 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a promising tool for diagnosing relapsing polychondritis (RP). However, its usefulness in assessing RP with airway involvement is unknown. OBJECTIVE: This study aimed to further evaluate and confirm the potency of 18F-FDG PET/CT in diagnosing RP with airway involvement and monitoring response to steroid-based therapy. METHODS: A total of 30 patients from a dedicated respiratory centre, diagnosed with RP in accordance with McAdam, Damiani or Levine criteria, were included in this study. All patients underwent baseline 18F-FDG PET/CT, and 10 patients underwent second scans after 2.5-15 months of steroid-based therapy. Visual scores (VS) and maximal standard uptake values (SUVmax) were analysed. RESULTS: In the initial scan, 83.3% (25/30) of patients were found to have FDG uptake in more than one cartilage. The median VS and SUVmax in the cartilages were 3 (range, 1-3) and 3.8 (range, 1.9-17.9), respectively. Positive rates for PET/CT-guided biopsy in nasal, auricular, and tracheal/bronchial cartilages were 100% (5/5), 88.9% (8/9), and 10.5% (2/19), respectively, but the positive biopsy rate in the auricular cartilage was 92.3% (12/13) even without PET/CT assessment. Based on biopsy-proven sites, the sensitivity of PET/CT was 55.6%, and the specificity was 5.3%. Compared with the baseline scan, the second scan showed much lower median VS (2 vs 3, respectively; p < 0.0001) and SUVmax (2.9 vs 3.8, respectively; p < 0.001). Of 10 patients who underwent second PET/CT, 8 had complete therapeutic response, while 2 had partial response. CONCLUSION: 18F-FDG PET/CT assists in identifying multiple cartilage involvement in RP, but it seems neither a sensitive nor specific modality in diagnosing RP with airway involvement. Moreover, PET/CT has limited utility in locating biopsy sites and monitoring therapeutic response to corticosteroids.

Retrospective study of pleural parasitic infestations: a practical diagnostic approach.

BACKGROUND: Pleural parasitic infestation (PPI) is a disease prevalent in certain parts of the world. It is frequently misdiagnosed due to its lack of standardized diagnostic criteria. The purpose of this study was to evaluate the clinical characteristics of PPI patients and develop a practical diagnostic approach for PPI. METHODS: A retrospective study was conducted by reviewing the medical records of 11 patients with PPI. A practical diagnostic approach was proposed based on the unique laboratory findings. RESULTS: All patients demonstrated respiratory symptoms, including shortness of breath, cough, fever, chest pain, excessive sputum and hemoptysis. Leukocytosis (> 10,000/µL) and eosinophilia (> 500/µL) of peripheral blood were present in 45.5 and 36.4% patients, respectively. The mean concentrations of pleural effusion lactate dehydrogenase (LDH), adenosine deaminase (ADA), protein and carcinoembryonic antigen (CEA) were 338.2 U/L (range, 61-667 U/L), 11.6 U/L (range, 0.1-28.2 U/L), 43.7 g/dL (range, 21.9-88.1 g/dL), and 1.84 mg/mL (range, 0.28-4.8 mg/mL), respectively. The mean percentage of eosinophils in the pleural effusion was 19.5% (10.5-41%). Blood test was positive for parasite-specific IgG antibody in 9 patients, including 4 for Paragonimus westermani, 3 for Taenia solium, 1 for Clonorchis sinensis and 1 for Echinococcus granulosus. Eggs of Clonorchis sinensis were detected in the stool of two patients. Sparganum was found in the pleural effusion of one patient. Respiratory symptoms and abnormal appearances in pulmonary radiographic examination were disappeared in all patients who received anti-parasitic treatment. CONCLUSIONS: In patients with unexplained pleural effusion, parasite-specific IgG antibody tests should be performed when pleural fluid testing shows eosinophilic pleural effusion. It is preferable to consider the diagnosis of PPI in clinical practice when serum parasite-specific IgG antibody test is positive.

The pleural fluid lactate dehydrogenase/adenosine deaminase ratio differentiates between tuberculous and parapneumonic pleural effusions.

BACKGROUND: Although pleural fluid lactate dehydrogenase (LDH) and adenosine deaminase (ADA) levels are often used to distinguish between tuberculous pleural effusion (TPE) and parapneumonic pleural effusion (PPE), this can be challenging as the LDH level may vary from normal to severely increased in PPE and a significantly elevated ADA is frequently measured in both conditions. In this study, we evaluated use of the pleural fluid LDH/ADA ratio as a new parameter to discriminate TPE from PPE. METHODS: A retrospective study was conducted in patients with pathologically-confirmed TPE (n = 72) and PPE (n = 47) to compare pleural fluid LDH and ADA levels and LDH/ADA ratios between the 2 groups. A receiver operating characteristic (ROC) curve was constructed for identifying TPE. RESULTS: The median pleural fluid LDH and ADA levels and LDH/ADA ratios in the TPE and PPE groups were: 364.5 U/L vs 4037 U/L (P < .001), 33.5 U/L vs 43.3 U/L (P = .249), and 10.88 vs 66.91 (P < .0001), respectively. An area under the ROC curve of 0.9663 was obtained using the LDH/ADA ratio as the indicator for TPE identification, and the sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were, respectively, 93.62%, 93.06%, 13.48, and 0.068 at a cut-off level of 16.20. CONCLUSIONS: The pleural fluid LDH/ADA ratio, which can be determined from routine biochemical analysis, is highly predictive of TPE at a cut-off level of 16.20. Measurement of this parameter may be helpful for clinicians in distinguishing between TPE and PPE.

Combined ultrasound-guided cutting-needle biopsy and standard pleural biopsy for diagnosis of malignant pleural effusions.

BACKGROUND: The most efficient approach to diagnose malignant pleural effusions (MPEs) is still controversial and uncertain. This study aimed to evaluate the utility of a combined approach using ultrasound (US)-guided cutting-needle biopsy (CNB) and standard pleural biopsy (SPB) for diagnosing MPE. METHODS: Pleural effusions were collected from 172 patients for biochemical and microbiological analyses. US-guided CNB and SPB were performed in the same operation sequentially to obtain specimens for histological analysis. RESULTS: US-guided CNB and SPB procedures provided adequate material for histological analysis in 90.7 and 93.0% of cases, respectively, while a combination of the 2 techniques was in 96.5% of cases. The sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV) and diagnostic accuracy of US-guided CNB versus SPB were: 51.2 vs 63.4%, 100 vs 100%, 100 vs 100%, 64.9 vs 72.2% and 74.4 vs 81.3%, respectively. When CNB was combined with SPB, the corresponding values were 88.6, 100, 100, 88.6 and 93.9%, respectively. Whereas sensitivity, NPV and diagnostic accuracy were not significantly different between CNB and SPB, the combination of CNB and SPB significantly improved the sensitivity, NPV and diagnostic accuracy versus each technique alone (p < 0.05). Significant pain (eight patients), moderate haemoptysis (two patients) and chest wall haematomas (two patients) were observed following CNB, while syncope (four patients) and a slight pneumothorax (four patients) were observed following SPB. CONCLUSIONS: Use of a combination of US-guided CNB and SPB afforded a high sensitivity to diagnose MPEs, it is a convenient and safe approach.

The efficacy and safety of airway foreign body removal by balloon catheter via flexible bronchoscope in children - A retrospective analysis.

OBJECTIVES: To investigate the efficacy and safety of the airway foreign body removal by balloon catheter via flexible bronchoscope in children. METHODS: Retrospective analysis was performed of 26 cases of airway foreign body removal in children by balloon catheter via flexible bronchoscope in the First Affiliated Hospital of Guangzhou Medical University between December 2006 and December 2014. RESULTS: There were 14 males and 12 females, aging between 1 and 12 years (median age: 25 months). The clinical course ranged from 0.5h to 60 days (median: 3 days). The foreign bodies consisted of peanuts (16 cases), soybeans (3 cases), pumpkin seeds (3 cases), porcine bone (1 case), olive nut (1 case), and a plant-based object (1 case). All foreign bodies were successfully removed. The operation duration ranged from 3 to 15 (5.3±2.9)min. No complication was observed such as hemorrhage, pneumothorax, or airway laceration. CONCLUSIONS: Balloon catheter via flexible bronchoscope is a safe, effective, and easily performed method of removing airway non-sharp foreign bodies in children.

The Role of Cryptococcus in the Immune System of Pulmonary Cryptococcosis Patients.

OBJECTIVES: To investigate the role of Cryptococcus in the immune system of immunocompetent patients with pulmonary cryptococcosis (PC) by analysing the dynamic changes of patients' immune status before and after antifungal therapy. METHODS: The level of the serum interferon-γ (IFN-γ) and interleukin (IL)-2, -4, -10 and -12 was measured before and after 6-months of treatment. Peripheral blood samples were obtained from 30 immunocompetent PC patients and 30 age- and gender-matched healthy controls. Peripheral blood mononuclear cells (PBMCs) were isolated and incubated with recombinant human IL-12 (rhIL-12) for 48 h. Then the concentrations of IFN-γ and IL-4 in the supernatant were analysed. RESULTS: Baseline serum IFN-γ level was significantly lower in the PC patients as compared with the control group (P < 0.001). The serum IL-2 and IFN-γ of PC patients were significantly increased after appropriate treatments (P < 0.05 and P < 0.001 when compared to their baseline levels). The productions of IFN-γ in the culture supernatant of PBMCs showed no significant difference between the control and PC patients both before and after antifungal treatments. RhIL-12 is a potent stimulus for IFN-γ production. Culture PBMCs collected from PC patients before treatments had a smaller increase of IFN-γ production in the present of rhIL-12 than the control (P < 0.01); PBMCs from PC patients completing 6-months of treatment showed a comparable increase of IFN-γ production by rhIL-12 stimulation to the control group. CONCLUSIONS: In apparently immunocompetent patients with PC, a normalization of serum IFN-γ was achieved after recovery from infection. This suggests that Cryptococcus infection per se can suppress the immune system and its elimination contributes to the reestablishment of an immune equilibrium.

[Refractory pulmonary alveolar proteinosis treated with inhaled granulocyte macrophage colony stimulating factor: a case report and review of the literatures].

OBJECTIVE: To observe the efficacy of granulocyte macrophage colony stimulating factor inhalation therapy for pulmonary alveolar proteinosis (PAP) patients and to improve the understanding of the therapy. METHODS: The clinical data of a patient with autoimmune PAP treated with inhaled granulocyte macrophage colony stimulating factor were described and the literatures were reviewed. RESULTS: This 70-year-old female patient was diagnosed with autoimmune PAP and had been treated with whole lung lavage for 10 times, but only achieved short-term symptomatic relief after each operation. Inhalation of granulocyte macrophage colony stimulating factor was then used after the recurrence of PAP, and a significant improvement in oxygenation and clinical symptoms were abserved. The patient remained stable 4 month after the therapy. CONCLUSION: Treatment with inhalation of granulocyte macrophage colony stimulating factor is safe, effective and economic for patients with PAP, and would be the first choice for the recurrence of autoimmune PAP after whole lung lavage.

Utility of contrast-enhanced ultrasound with SonoVue in biopsy of small subpleural nodules.

OBJECTIVES: This study aimed to evaluate the diagnostic accuracy and complication rates of contrast-enhanced ultrasound (CEUS)-guided biopsy of small subpleural nodules with SonoVue. METHODS: CEUS-guided biopsies with SonoVue and conventional ultrasound were performed to determine nodule size, texture and biopsy route. After baseline ultrasonography, all patients received an intravenous injection of 4 mL of SonoVue, followed by 5 mL of saline flush. CEUS was obtained using a convex probe and contrast-specific imaging software. The lesion was observed using a contrast agent. Biopsies were performed during real-time visualisation of the target lesion. RESULTS: A total of 51 patients (34 males and 17 females; average age, 54.8 ± 5.8 years) with subpleural nodules were enrolled. The median nodule size was 1.92 ± 0.75 cm (0.9-2.5 cm). Forty-eight of 51 procedures (94.1%) provided adequate material for histological analysis. Thirty patients (62.5%) were malignant and 18 patients (37.5%) were benign at the definitive diagnosis. The true positive and true negative result were 28 (58.3%) and 18 (37.5%), no false positive result was seen and two (4.2%) provided a false negative result. The sensitivity, specificity, positive and negative predictive values for the malignant diagnosis were 93.3, 100, 100 and 90%, respectively. The diagnostic accuracy was 95.8% (46/48), the standard error and the 95% CI were 2.8% and 86%-99%. An asymptomatic pneumothorax was present in one patient with no chest tube placement required. A small amount of hemoptysis was observed in another patient, which stopped spontaneously without treatment. CONCLUSIONS: CEUS-guided biopsy with SonoVue exhibits high diagnostic accuracy and low complication rates. It is especially advantageous for biopsies of small subpleural nodules.

IgG4-related lung disease manifested as pneumonia in puerperium: a case report.

IgG4-related lung disease (IgG4-RLD) is recently emerging entity. Several reports concerned with the clinicopathologic feature have been described, but this disease in puerperium has not been reported previously. Here, we report a 24-year-old woman diagnosed as IgG4-RLD in puerperium, who developed dry cough, low fever and exertional dyspnea following the delivery. The inflammatory markers and pulmonary lesions of the patient suggested pneumonia. However, there was no improvement after antibiotic treatment. The infiltration of IgG4-positive lymphoplasmacytes was found in lung biopsy by video-assisted thoracic surgery (VATS). And the serum IgG4 level was high. The patient was effectively treated with corticosteroids. This unique case highlights the occurrence of IgG4-RLD in puerperium and underscores it should be taken into consideration as a possible differential diagnosis when dense lymphoplasmacytic infiltration was found in pulmonary consolidation in complex puerperal respiratory cases.

¹8F-FDG PET/CT is a valuable tool for relapsing polychondritis diagnose and therapeutic response monitoring.

OBJECTIVES: To retrospectively investigate the role of (18) F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) for the diagnosis and therapeutic response in relapsing polychondritis (RP) patients. METHODS: (18)F-FDG PET/CT findings were reviewed in six RP patients. The initial scans were performed for all patients, follow-up scans were performed during steroid therapy for five patients. Changes in the abnormal lesions and the maximal standard uptake value (SUVmax) were analyzed. RESULTS: The initial PET/CT scans revealed intense FDG uptake in the cartilages for all six patients. The lesions of abnormal FDG uptake were tracheal/bronchial cartilage (n = 4), costicartilage (n = 4), nasal cartilage (n = 3), cricoid cartilage (n = 3), auricular cartilage (n = 3), arytenoid cartilage (n = 3), thyroid cartilage (n = 2), hyoid cartilage (n = 1) and mediastinum lymph node (n = 1). The mean visual score and the mean SUVmax were 2.96 ± 0.20 and 4.10 ± 0.6. The intense uptake reduced or disappeared during steroid therapy for five patients, the mean visual score and the mean SUVmax were 1.58 ± 1.4 and 1.51 ± 1.4. CONCLUSIONS: (18)F-FDG PET/CT enables the acquisition of both morphologic and glucose metabolic of the related cartilage structures. It plays a valuable role in assessing almost all cartilage and detecting RP, which is a better selection of a biopsy site as well as therapeutic response monitoring.

[The predictive value of gray scale sonographic features in malignant hilar and mediastinal lymph node].

OBJECTIVE: To explore the sonographic features of malignant hilar and mediastinal lymph nodes and the predictive value. METHODS: We performed retrospective analysis of 390 lymph nodes under the endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis in the bronchoscope center of the First Affiliated Hospital of Guangzhou Medical University from November 1st, 2012 to November 31st, 2013. They were divided into malignant and benign groups, and sonographic features of lymph nodes were analyzed, including the length of short axis, shape, margin, echogenicity, homogenicity, coagulation necrosis, calcification, coalesence and posterior acoustic enhancement. RESULTS: A total of 390 lymph nodes were evaluated, including 207 malignant and 183 benign lymph nodes, respectively. The accuracy based on the length of short axis, shape, margin, echogenicity, homogenicity, coagulation necrosis, calcification, coalesence and posterior acoustic enhancement to predict the malignancy were 61.0% (238/390), 75.4% (294/390), 75.6% (295/390), 73.8% (288/390), 65.9% (257/390), 68.2% (266/390), 51.8% (202/390), 55.1% (215/390), 67.4% (263/390), respectively. Binary multivariable logistic regression analysis revealed that 5 parameters, including round, distinct margin and heterogeneous, hypoechoic, and posterior acoustic enhancement possessed a significant predictive value(P < 0.05).We found that only 35.3% (73/207) malignant lymph nodes possessed these 5 ultrasonographic characteristics, and the diagnosis rate was 93.6% (73/78).72.46% (150/207) malignant lymph nodes possessed any 4 or more positive sonographic features, and the diagnosis rate was 85.2% (150/176).85.0% (176/207) malignant lymph nodes had any 3 or more positive sonographic features, and the diagnosis rate was 84.6% (176/208). CONCLUSION: The combination of gray scale sonographic features has a predictive value in the diagnosis of malignant hilar and mediastinal lymph nodes.

[Diagnostic values of the clinical characteristics of chronic cough].

OBJECTIVE: To evaluate whether the clinical characteristics of chronic cough were helpful in determining its specific causes. METHODS: Patients with chronic cough were evaluated by a validated systematic diagnostic protocol. The patients with identified single cause were divided into 4 groups accordingly: cough-variant asthma (CVA), upper airway cough syndrome (UACS) or post-nasal drip syndrome (PNDS), eosinophilic bronchitis (EB), gastroesophageal reflux related cough (GERC), and the characteristics of the timing, character, onset and associated manifestations of chronic cough in different causes were compared. RESULTS: A total of 196 patients met the inclusion criteria, including 55 with EB, 45 with UACS, 50 with CVA and 46 with GERC. No significant difference was found in age, gender and course among EB, UACS, CVA and GERC. The incidence of nocturnal cough in CVA was 26.0% (13/44), significantly higher than in EB (9.1% (5/55), chi2 = 5.272, P<0.05), UACS (2.2% (1/45), chi2 = 10.657, P<0.01) and GERC (0% (0/46), chi2 = 13.833, P<0.01). The specificity of nocturnal cough for CVA was 95.9%. The sensitivity and specificity of cough associated with meals in GERC was 52.2% (24/46) and 83.3%, and regurgitation associated symptom in GERC were 69.6% (32/46) and 80.0%, which were significantly higher than other groups. The incidence of postnasal drip, rhinitis associated symptom and case history of nasal diseases in UACS were 66.7% (30/45), 88.9% (40/45) and 82.2% (37/45), and the specificity of them were 89.4%, 65.6% and 63.6% respectively. CONCLUSION: The timing character and some associated symptoms of chronic cough are useful in predicting a single cause.

Fibrobronchoscopic evidence of endobronchial hairs in intrapulmonary teratoma with hemoptysis but without trichoptysis.

Intrapulmonary teratoma (IPT) is exceedingly rare, hence preoperative diagnose is usually inaccurate. A 21-year-old man was presented with a 5-year history of recurrent hemoptysis and left upper lung mass with heterogeneous opacity on chest x-ray. Diagnostic fibrobronchoscopy detected tuft of brownish hairs in the left upper anterior segmental bronchus, achieving the diagnosis of IPT preoperatively, which was further confirmed by lobectomy. The case report is noteworthy with fibrobronchoscopic finding of endobronchial hairs in a heterogeneous lesion, which underscores the important role of fibrobronchoscopy in the differential diagnoses of chronic cavitary lesions such as IPT without trichoptysis.