ObjectiveTo explore the CT imaging features and independent risk factors for cystic pulmonary nodules and establish a malignant probability prediction model. Methods The patients with cystic pulmonary nodules admitted to the Department of Thoracic Surgery of the First People's Hospital of Neijiang from January 2017 to February 2022 were retrospectively enrolled. They were divided into a malignant group and a benign group according to the pathological results. The clinical data and preoperative chest CT imaging features of the two groups were collected, and the independent risk factors for malignant cystic pulmonary nodules were screened out by logistic regression analysis, so as to establish a prediction model for benign and malignant cystic pulmonary nodules. ResultsA total of 107 patients were enrolled. There were 76 patients in the malignant group, including 36 males and 40 females, with an average age of 59.65±11.74 years. There were 31 patients in the benign group, including 16 males and 15 females, with an average age of 58.96±13.91 years. Multivariate logistic analysis showed that the special CT imaging features such as cystic wall nodules [OR=3.538, 95%CI (1.231, 10.164), P=0.019], short burrs [OR=4.106, 95%CI (1.454, 11.598), P=0.008], cystic wall morphology [OR=6.978, 95%CI (2.374, 20.505), P<0.001], and the number of cysts [OR=4.179, 95%CI (1.438, 12.146), P=0.009] were independent risk factors for cystic lung cancer. A prediction model was established: P=ex/(1+ex), X=–2.453+1.264×cystic wall nodules+1.412×short burrs+1.943×cystic wall morphology+1.430×the number of cysts. The area under the receiver operating charateristic curve was 0.830, the sensitivity was 82.9%, and the specificity was 74.2%. ConclusionCystic wall nodules, short burrs, cystic wall morphology, and the number of cysts are the independent risk factors for cystic lung cancer, and the established prediction model can be used as a screening method for cystic pulmonary nodules.
Objectives To investigate the diagnosis and laparoscopic surgical treatment methods of calculus of cystic duct. MethodsThe clinical data of 147 patients with calculus of cystic duct underwent laparoscopic cholecystectomy (LC) in the Second Affiliated Hospital of Wenzhou Medical College from June 2008 to June 2013 were analyzed retrospectively. ResultsAmong the 147 patients with calculus of cystic duct, 19 cases were given preoperative diagnosis by B-ultrasound and CT scanning, 128 cases were found by exploration in operation; 146 cases underwent LC successfully and 1 case was converted to laparotomy.The 147 cases were followed-up for 3 months to 2 years with an average of 7 months and all cases were out of bile duct injury, hemorrhage, bile leakage, residual calculi or other complications. ConclusionsPreoperative diagnosis of calculus of cystic duct is difficult, meanwhile, routine intraoperative probe is very necessary for the diagnosis of calculus of cystic duct.Proficiency in surgical technique with laparoscopic treatment of calculus of cystic duct is the key to the success of LC.
ObjectiveTo investigate the expression and significance of cysteine-rich protein 61 (Cyr61) in patients with chronic obstructive pulmonary disease (COPD).MethodsBetween September 2017 and September 2018, 27 patients with benign tumor needing to surgical therapy, were divided into COPD group (15 patients) and non-COPD group (12 patients), according to lung function. Lung tissues were selected at the distance at least 5 cm from the tumor. The levels of Cyr61, interleukin-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) in serum were determined by enzyme-linked immunosorbent assay. Meanwhile, the expressions of Cyr61 in lung tissues were measured by immunohistochemistry technology between two groups. Furthermore, correlations among Cyr61, IL-8, MCP-1, smoking index, forced expiratory volume in the 1st second as percentage of predicted values (FEV1%pred), scores of COPD Assessment Test (CAT) were analyzed.ResultsSerum Cyr61, IL-8, MCP-1 levels were significantly higher in patients with COPD than in the non-COPD group (P<0.05), (2409.80±893.87)pg/mL, (76.27±10.53)pg/mL, (173.67±42.64)pg/mL vs. (1065.42±158.83)pg/mL, (57.33±8.29)pg/mL, (138.42±27.62)pg/mL, respectively. By immunohistochemistry technology, the expression levels of Cyr61 in lung epithelial cells and in lung macrophage cells of COPD patients were higher than in the non-COPD group (P<0.01). Positive correlations were found between serum IL-8, serum MCP-1, CAT scores, smoking index and serum Cyr61 (r=0.674, 0.566, 0.602, and 0.755, P=0.006, 0.028, 0.018, and 0.003, respectively) in COPD group. Furthermore, in COPD group, there were also positive correlations between serum IL-8, serum MCP-1, CAT scores, smoking index and intrapulmonary Cyr61 (r=0.542, 0.635, 0.809, and 0.580, P=0.037, 0.011, 0.001, and 0.038 respectively). Inverse correlation was found between serum Cyr61 and FEV1%pred (r=–0.772, P<0.01), and the same as between intrapulmonary Cyr61 and FEV1%pred (r=–0.683, P<0.01).ConclusionsCyr61 highly expresses in serum and in lung tissues of patients with COPD, and its expression is correlated with lung function of patients. The results indicate that Cyr61 may interact with IL-8 and MCP-1 in the pathogenesis of chronic obstructive pulmonary disease.
Objective To observe the efficiency and safety of a single intravi treal injection of Bevacizumab (Avastin) in patients with diabetic macular edema. Methods Prospective, open label study of 18 eyes of 18 patients with diabetic macular edema which was diagnosed by examination of regular inspection, fundus fluorescein angiography(FFA) and optic coherence tomography(OCT). The patients without general or partial surgery contraindications, aged from 34-75 years with a mean age of 54plusmn;11 years. The best corrected visual acuity of logMAR was 1.023plusmn;0.45 and the retinal thickness of macular foveal was 486 mu;m before the treatment. The eyes have intravitreal injection with Bevacizumab at dose 1.5 mg (0. 06 ml). After the treatment, the follow-up period ranging from 12 to 20 weeks (m e an 16plusmn;4 weeks). The changes of visual acuity, intraocular pressure, OCT and FFA before and after the treatment were observed and analyzed. Results All 18 patients had a mean logMAR BCVA of 1.023plusmn;0.45 at baseline and at the follow-up weeks 1, 4, 12, the mean logMAR BCVA was significantly improved as 0.864plusmn;0.48 （P=0.001）, 0.739plusmn;0.51 (P=0.003), 0.792plusmn;0.50 (P=0.015) respectively, and the differences are statistically significant compared with before. Sixteen eyes (88.9%) had a improved or stable visual acuity, the BCVA increased 2 lines (0.2 logMAR vision) or better in 10 eyes (55.6%) and decreased in 2 eyes at 12 weeks after injection. OCT demonstrated that retinal thickness of macular foveal decreased from 486 mu;m to 413 mu;m at 4 weeks, decreased to 383mu;m at 12 weeks（P=0.002， P=0.001）, and the differences are statistically significant compared with before. There are remarkable resolution of central retinal edema in 13 eyes (72.2%) at 12 weeks after the injection. No local or systemic adverse events were observed in any patients. Conclusions The preliminary result in our observati on showed that int ravitreal injection of Bevacizumab therapy was well tolerated with a significant improvement in BCVA and decrease in macular edema for patients with diabetic macular edema. A randomly controlled multicenter clinical trial is necessary. (Chin J Ocul Fundus Dis,2008,24:172-175)
Objective To investigate the clinicopathologic features of congenital cystic adenomatoid malformation (CCAM) of lung in adults. Methods The clinical and pathological characteristics of two cases of CCAM of lung in adults from November 19, 2012 to February 12, 2014 were analyzed, and relevant literatures were reviewed. Results Both of the two patients were males who were 59 years and 60 years old respectively. Both of them presented with respiratory symptoms such as productive cough, hemoptysis and fever. The lesions in the two cases were about 4.0 cm×3.0 cm×1.5 cm and 5.0 cm×5.0 cm×3.0 cm in size respectively. Both had a cystic appearance and involved unilateral lobes of the lung. Histologically, normal pulmonary alveoli were replaced by different size of cysts composed of adenomatoid hyperplastic bronchioles. The inner cystic wall was lined by pseudostratified ciliated columnar epithelium, and the cystic wall contained smooth muscle and elastic tissue, but no cartilage. In one of our cases, mucous cells could be seen in part of the inner cystic wall, with focal atypical hyperplasia. Conclusions CCAM of the lung is a rare congenital developmental anomaly, which typically manifests in neonates and infants, but extremely rare in adults. The diagnosis of CCAM in adults depends on clinical features, imaging changes and histopathological characteristics.
Objective To explore the value for localization of cystic lymph node in laparoscopic cholecystectomy. Methods Clinical data of 100 cases who underwent laparoscopic cholecystectomy in Affiliated Hospital of Southern Medical University and The Third Division Hospital of Xinjiang Production and Construction Corps were collected to analyze retrospectively, for exploring the relationship of localization of cystic lymph node, cystic artery, cystic duct, and liver door. Results Of the 100 cases, 81 cases (81.0%) were found lymph node, in which 76 cases (76.0%) were found 1 lymph node and 5 cases(5.0%) were found lymph node more than 1, the other 19 cases(19.0%) were not found lymph node. Of the 76 cases who were found only 1 lymph node, lymph nodes were located above the anterior branch of cystic artery in 48 cases, below the anterior branch of cystic artery in 21 cases, and adjacent to the posterior branch of cystic artery in 7 cases. The operation was successful in all patients without death, of which 3 cases were transferred to laparotomy. The operation time were (43.0±6.5) min (25-116 min), and hospital stay after operation were (3.0±0.6) days (2-6 days). No serious complications of bile leakage, bile duct injury, and death happened after operation, and all cases were cured and discharged. Conclusion Cystic lymph node in the calot triangle is in relatively fixed position of laparoscopic cholecystectomy, it can help to guide judging anatomical hepatic portal region of each organization structure, and can to confirm the location of cystic artery and cystic duct, which is helpful to prevent injury during the operation of laparoscopic cholecystectomy.
Objective To investigate the temporal and spatial expression pattern of Caspase3、Bax and Bclxl in NmethylNnitrosourea (MNU) damaged rat retina. Methods Twenty-four 50 dayold female Sprague-Dawley rats (n=24) received single intraperitoneal injection of MNU 40 mg/kg and were examined at 1, 3, 7 and 10 days after MNU treatment (6 rats sacrificed at each timepoint). As control, six rats were injected with saline (5 ml/kg) and sacrificed 3d after injection. Expressions of Caspase-3 and bax and bcl-xl were detected by RTPCR and immunofluorescence assays, photoreceptor cell apoptosis was measured by terminal deoxynucleotidyl transferasemediated deoxyuridine triphosphatedigoxigenin nick-end labeling (TUNEL). Results Animal models were successful established and confirmed by pathological studies. RTPCR results indicated that caspase3 and bax upregulated at 1 d (caspase-3 RA =83.23plusmn;8.11，P= 0.009; bax-RA=72.73plusmn;9.46，P=0.004) and peaked at 3 d （caspase-3 RA=140.48plusmn;18.40，P=0.000；bax-RA=102.36plusmn;13.97，P=0.001）compared with control (caspase-3 RA=62.45plusmn;7.65; bax-RA =46.53plusmn;4.41). Bcl-xl expression increased and peaked at 3d (3d RA=79.83plusmn;5.58, P=0.000 vs control 45.98plusmn;3.06). It was noted that the ratios of bax / bclxl expression at 1 d, 3 d and 7 d after MNU injection were enhanced (1 d 1.15plusmn;0.14, P= 0.143; 3 d 1.28plusmn;0.16, P=0.001; 7 d 1.17plusmn;0.08, P= 0.079, vs control 1.01plusmn;0.09), and at 3 d the ratio reached the peak, whereas at10 d bax / bcl-xl ratio (0.73plusmn;0.07, P= 0.001) was decreased compared with the control. Immunofluorescence assays demonstrated that the changes of bax, bclxl and caspases3 protein expressions coincided with their RTPCR results respectively. The Bax positive cells were detected in the outer nuclear layer; while caspase3 and bclxl positive cells emerged in several layers of retina included the pigment epithelium layer, the photoreceptor cell inner segments, the outer nuclear layer, the outer plexiform layer, the inner plexiform layer and the ganglion cell layer. Photoreceptor cell apoptosis was only detected in the outer nuclear layer and peaked at 3 d in MNU treated rats (AI= 76.97plusmn;5.83, P= 0.000 vs control 0.00 plusmn; 0.00). Conclusions These data suggest that bax and bcl-xl and caspases3 may involve in the MNUinduced rat photoreceptor cell apoptosis.
Objective To explore the frequency, clinical features, and characteristics of results of fundus fluorescein angiography (FFA) of uveitis related cystoid macular edema (CME). Methods The clinical data and FFA results of 67 patients (106 eyes) with posterior uveitis examined in our hospital from July 2002 to June 2005 were collected. The clinical features and characteristics of FFA images of CME were observed and analyzed. Results Among the106 eyes of 67 patients with uveitis,the CME was observed in 28 eyes (26.4%) of 18 patients, including 7 males and 11 females with the average age of (42.5plusmn;10.8) years. The dark area due to the choroidal fluorescence blocked by the macular edema was found at the early FFA phase, and th en followed by the punctate and sheetlike leakage of fluorescein; the capillar y was dilated at the venous phase, and the typical petaloid appearance was seen at the late phase because the fluorescein cumulated in several small vesicles in the macular area. After treated by corticosteroids and topical non-steroidal anti-inflammatory medicine and carbonic anhydrase inhibitors, the extent of CME diminished, and the visual acuity improved in varying degrees. Conclusi ons Uveitis may seriously harm the visual function, in which CME induces the damage of visual acuity. Early detection and timely treatment may prevent thepermanent visual damage. (Chin J Ocul Fundus Dis, 2006, 22: 394-396)
Objective To discuss the surgical indication of mammotome （MMT） operation and its auxiliary diagnosis value on breast cysts. Methods Seventy-eight patients with breast cysts from May 2010 to November 2011 in this hospital were enrolled. Excision and biopsy were performed according to the following guidelines：Single cyst with inhomogeneous interna echoes and diameter at least 1 cm；Multiple cysts associated with irregular megalgia， localized thickening of breast or ineffective drug treatment after three months；High risk of breast cancer；Hypoechoic nodules and laticifers exaggerated cysts；Ultrasonography showed disorderly echo and abundant blood supply in glandular tissues around the lesions. The result of preoperative ultrasound was compared with that of postoperative pathology diagnosis. Results In these 78 breast cysts patients with preoperative ultrasound diagnosis， 40 cases were breast multiple cysts， 38 cases were multiple cysts plus untouchable hypoecho nodules；42 cases were high risk lesions， and the other 36 cases were low risk lesions. Postoperative pathology diagnosis revealed 27 cases of cystic hyperplasia， 2 cases of atypical hyperplasia， and 1 case of breast cancer in the ultrasonic high risk lesions， and 19 cases of cystic hyperplasia in the ultrasonic low risk lesions. Ultrasound diagnostic accuracy rate was 60.26%（47/78）， sensitivity was 61.22%（30/49）， and specificity was 58.62%（17/29）. The number of resection lesions was 13.00±8.16， the time of operation was （74.25±22.68） min. The average hospital stay was 1 d after surgery. The local hematoma occurred in 2 cases and no other complications occurred during one month of follow-up. Conclusions The guidelines of MMT protocoled according to clinical manifestation of breast cyst patients and imaging of high-frequency ultrasound in author’s department are simple and utility. Minimal excision and biopsy via MMT can confirm the histological type and help for early diagnosis of breast cancer and precancerous lesion. It is important and necessary to standardize the surgical indications of MMT in the clinical work.
Objective To evaluate the diagnostic value of ELISA using AgB in cystic echinococcosis (CE). Methods Such databases as PubMed, EMbase, The Cochrane Library, EBSCO, CBM, CNKI, WanFang Data and MedaLink were retrieved on computer, and the relevant journals were also manually searched to collect the trials on ELISA using AgB in diagnosis of CE. The retrieval time was from inception to July 5th, 2012. Two reviewers independently screened the literature, extracted the data and assessed the quality according to QUADAS. Then the meta-analysis was conducted by using Meta-Disc 1.4 software. Results A total of 8 studies were included, and there were 562 CE patients diagnosed by gold standard, 434 suspected cases and 303 healthy people. There were no threshold effects among those 8 studies (the spearman’s correlation coefficient of log sensitivity to log 1-specificity was 0.527, P=0.400 1). The meta-analysis of DerSimonia-Laird showed that, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio was 0.76 (95%CI 0.73 to 0.79), 0.84 (95%CI 0.82 to 0.86), 5.20 (95%CI 3.59 to 7.55), 0.26 (95%CI 0.18 to 0.35), 23.93 (95%CI 12.35 to 46.39), respectively. And the AUC of SROC was 0.889 7 (Q=0.820 4). Conclusion ELISA using natural AgB and rAgB has greater diagnostic value in detecting CE.