Objective To investigate the risk factors，clinical features and outcome of invasive aspergillosis（IA） in nonneutropenic patients.Methods Fifty-four patients with IA at the First Affiliated Hospital of Zhengzhou University from Jan 2001 to Dec 2006 were analyzed retrospectively.According to the definitions of EORTC/MSG，proven diagnosis was made in 9 cases，probable diagnosis in 30 cases and possible diagnosis in 15 cases.Results In the neutropenic group（n=24），hematological malignancies were the major underlying conditions（n=20）.In nonneutropenic group（n=30），the main underlying condition was steroid-treated COPD（n=11）.Fever，dyspnea，cough，chest pain and haemoptysis were commonly symptoms.Thoracic computed tomography showed that segmental consolidation occurred more frequently in neutropenic patients，whereas diffuse nodules more frequently in nonneutropenic patients.Nodules or consolidation with evidence of cavity lesion had a higher sensitivity than the halo sign or air crescent sign in both groups.The total mortality of IA was 72.2%.The mortality of nonneutropenic group was higher than that of neutropenic group（83.3% vs 58.3%，P=0.042）.Multivariate analysis showed that secondary central nerves system IA and delayed diagnosis were associated with poor outcome of IA.Conclusion There were high incidence and mortality of IA among nonneutropenic patients，especially those with COPD treated with long-term corticosteroids.
Objective To investigate the influence of different pressures and duration of CO2 pneumoperitoneum on the adhesive and invasive ability of gastric cancer cells based on the expressions of adhesive and invasive molecules. Methods With an artificial CO2 pneumoperitoneum model in vitro, human gastric cancer cell lines including MKN-45, SGC-7901, and MKN-28 were exposed to CO2 in different environments: 0 mm Hg （1 mm Hg=0.133 kPa）, 9 mm Hg （2 h, 4 h）, and 15 mm Hg （2 h, 4 h）. The expressions of mRNA of E-cadherin, intercellular adhesion molecule-1 (ICAM-1), matrix metalloproteinase-2 (MMP-2), and vascular endothelial growth factor-A (VEGF-A) in the different environments were measured by RT-PCR. The expressions of protein of E-cadherin and ICAM-1 in the environments of 0 mm Hg and 15 mm Hg （4 h） were measured by FCM. Results With the increase of duration or pressure, RT-PCR showed that there was a downward trend in the expression of E-cadherin mRNA as well as there were upward trends in the expressions of ICAM-1, MMP-2, and VEGF-A mRNA; FCM showed that there was a downward trend in the expression of E-cadherin protein while the expression of ICAM-1 protein showed the opposite change. But there were no obvious differences under different environment (P＞0.05). Conclusions Under low pressure (≤15 mm Hg) and short time (≤4 h) of CO2 pneumoperitoneum, the adhesive and invasive ability of gastric cancer cells could not be affected, which means that under this environment, CO2 pneumoperitoneum will not increase the possibility of neoplasm metastasis.
Objective To comprehend the concept， pathology， molecular mechanisms， diagnosis， and treatmentof aggressive fibromatosis （AF）， and to find a novel way to cure aggressive fibromatosis. Method The literatures about the definition， molecular mechanisms， and clinical research of AF were reviewed and analized. Results AF is rare and benign fibromatous lesion that is the result of abnormal proliferation of myofibroblasts. The pathologic features of AF isa benign disease， but it has “malignant” biological behavior. The tumor often involved the surrounding organs and bloodvessels， and caused death of patients. For patients with clinical symptoms or complications， complete excision of thetumor is the treatment of choice. Even if the operation to ensure the negative margin also has a higher recurrence rate， soits treatment requires multidisciplinary treatment. Conclusions The mechanism of AF is very complex， and it’s mecha-nism is still unclear. Clinical management of patients with AF is difficult and controversial， at present， the most effective treatment for AF is operation resection. The effects of adjuvant radiotherapy， chemotherapy， and other treatment after operation for AF still need further study.
ObjectiveTo investigate the clinical features of patients who went through Nocardia co-infection with Aspergillus in lung.MethodsClinical data of 3 pulmonary nocardiosis patients complicated with aspergillosis from China-Japan Hospital during June 2015 and May 2016 were retrospectively analyzed. Nine related literatures found at PubMed were reviewed and they all were case report. No Chinese literature was found at Wanfang data and Chinese Journal Fulltext Database.ResultsAll of the 3 patients were diagnosed as pulmonary nocardiosis by etiological detection, at the same time meeting the diagnostic criteria of invasive pulmonary aspergillosis. Two cases were infected with Aspergillus fumigatus. Aspergillus was not detected in the third case, but the galactomannan of serum and bronchoalveolar lavage fluid significantly increased.ConclusionPulmonary nocardiosis complicated with aspergillosis trends to occur in immunocompromised patients, and pathogen detection is important for diagnosis.
ObjectiveTo investigate the relationship of dynamic contrast enhanced(DCE) MRI scan of the mass type of invasive ductal breast cancer to histological grade. MethodThe imagings of DCEMRI of 92 patients confirmed with operation or biopsy pathology and its correlation with WHO histological grade were analyzed. ResultsThere were 29(31.52%) patients with the tumor long diameter≤2 cm, 53(57.61%) 2-5 cm, 10(10.87%)≥5 cm. There were 3(3.26%) patients with round of the morphological lesions, 7(7.61%) oval, 33(35.87%) lobulated shape, 49(53.26%) irregular shape. There were 11 (11.96%) patients with smooth margin of the periphery of the lesions, 47 (51.09%) irregular shape, 34(36.96%) spiculate margin. There were 15(16.30%) patients with homogeneous enhancement, 40(43.48%) heterogeneous enhancement, 37(40.22%) ring-like enhancement. WHO pathological grade:grade 1 was in 5 cases(5.43%), grade 2 in 30 cases(32.61%), grade 3 in 57 cases(61.96%). The statistical results showed that MRI dynamic enhancement characteristics of lesions in size, shape, and enhanced features were correlated with WHO pathological grade (P < 0.05), there was no correlation between the edge features of the tumor and WHO histological grade(P > 0.05). ConclusionThere is a certain correlation between the breast cancer enhanced MRI features and WHO histological grade, which can be evaluated biological behavior and prognosis according to MRI signs of lesions.
Objective To summarize the research progress of CO2 pneumoperitoneum impacts on invasiveness of cancer cells. Methods Currently published experimental and clinical researches related to the effect of CO2 pneumoperitoneum on invasiveness of cancer cells were reviewed. Results CO2 pneumoperitoneum may affect the invasiveness of cancer cell through several ways， such as changing the structure and function of mesothelial cell， changing microenvironment of peritoneum， influencing the expression of oncogen， affecting the secretion of cell factor， and changing the adhesion of cancer cell. Conclusions The consequences of these alterations to cancer cell and the microenvironment are not well understood， but they may facilitate tumor invasion and implantation. Further investigations in this area are very urgent.
ObjectiveTo study the expressions of cyclooxygenase-2(COX-2) and Ki-67 in the invasive ductal carcinoma (IDC) of breast and to analyze its clinical significance. MethodsImmunohistochemical SP method was performed to detect the expressions of COX-2 and Ki-67 in 82 cases of IDC of breast and corresponding tumor-adjacent normal breast tissues, and the relationship of these expressions to clinicopathologic characteristics was analyzed. Results①The positive rates of COX-2 and Ki-67 protein expressions in the IDC of breast tissues were significantly higher than those in the corresponding tumor-adjacent normal breast tissue [COX-2:71.95%(59/82) versus 8.54%(7/82), χ2=68.56, P < 0.001;Ki-67:64.63%(53/82) versus 13.42%(11/82), χ2=45.20, P < 0.001].②The positive rates of COX-2 and Ki-67 protein expressions were positively correlated with TNM staging (COX-2:rs=0.349, P < 0.05;Ki-67:rs=0.305, P < 0.05), lymph node metastasis (COX-2:rs=0.336, P < 0.05;Ki-67:rs=0.419, P < 0.01), vascular invasion (COX-2:rs=0.235, P < 0.05;Ki-67:rs=0.461, P < 0.01), and histological grade (COX-2:rs=0.434, P < 0.01;Ki-67:rs=0.378, P < 0.05).The positive rate of Ki-67 protein expression was positively correlated with tumor diameter (rs=0.365, P < 0.01), but the positive rate of COX-2 protein expression wasn't correlated with it (rs=0.135, P > 0.05).The positive rates of COX-2 and Ki-67 protein expressions weren't correlated with menstrual status (COX-2:rs=0.172, P > 0.05;Ki-67:rs=0.163, P > 0.05).③The positive rate of COX expression was positively correlated with the positive rate of ki-67 expression (rs=0.475, P < 0.01). ConclusionsThere are high-expressions of COX-2 and Ki-67 in IDC of breast.COX-2 and Ki-67 are significantly correlated with the clinicopathologic characteristics in IDC of breast.Combined detection of COX-2 and Ki-67 might calculate the biological behaviors of IDC of breast.COX-2 might be a target of molecular targeted therapy to breast cancer.
Objective To evaluate the effectiveness and safety of preoperative feeding artery occlusion on vertebral resection of invasive vertebral hemangioma. Methods The clinical data of 20 patients with invasive vertebral hemangioma who received posterior lumbar vertebral body resection, bone grafting, fusion and internal fixation between March 2010 and March 2017 were retrospectively analyzed. According to whether feeding artery occlusion was performed before operation, the patients were divided into group A (11 cases, tumor feeding artery occlusion before operation) and group B (9 cases, no tumor feeding artery occlusion before operation). There was no significant difference in gender, age, lesion segment, and disease duration between the two groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, blood transfusion volume, and ambulant time after surgery, hospitalization time, and deep venous thrombosis of lower extremities were recorded and compared between the two groups. Pain improvement was evaluated by visual analogue scale (VAS) score. Results The operation time, intraoperative blood loss, blood transfusion volume, and ambulant time after surgery were significantly less in group A than those in group B (P<0.05). There was no significant difference in postoperative drainage volume and hospitalization time between the two groups (P>0.05). Five patients (3 in group A and 2 in group B) suffered from pleural tear due to intraoperative pleural adhesions. Closed thoracic drainage tubes were placed immediately after suture and extubated on 3-5 days. Both groups were followed up 1-1.5 years, with an average of 1.35 years. In group B, 1 patient died of pulmonary embolism at 7 days after operation; and 2 patients developed deep venous thrombosis of lower extremity after operation, who were treated with inferior vena cava filter and thrombolytic therapy, and recovered well after operation. The local pain of the other patients was significantly relieved after operation, and the pain disappeared at 1 month after operation. The VAS scores of the two groups at 3 days after operation were significantly improved when compared with those before operation (P<0.05). There was no significant difference in VAS scores between the two groups before operation and at 3 days after operation (P>0.05). Three patients (2 in group A and 1 in group B) who had neurological symptoms were significantly relieved after surgery. Bone healing was achieved in both groups at 1 year after operation. No fracture or loosening of internal fixator occurred during follow-up. Conclusion Nutritional artery occlusion before vertebrectomy for invasive vertebral hemangioma can effectively reduce intraoperative blood loss, operation time, perioperative blood transfusion, and other perioperative complications.
Objective To retrospectively analyze the clinical features of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU), so as to improve the level of clinical diagnosis and treatment. Methods A total of 81 patients diagnosed as IPA from March, 2017 to March, 2022 in the ICU of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China were selected as infection group. A total of 81 non-IPA patients with pulmonary infection and Aspergillus negative sputum culture were selected as the control group. The host factors, Acute Physiology and Chronic Health Assessment Ⅱ score at admission, underlying diseases, clinical symptoms and signs, relevant laboratory test results, and lung CT findings were compared between the two groups. Univariate analysis and multivariate conditional logistic regression analysis were used to identify the risk factors for the occurrence of pulmonary aspergillosis in IPA patients in ICU. At the same time, the types of aspergillus in the IPA group and the outcomes of the two groups at 28 days after ICU admission were analyzed. Results Of the 81 IPA patients, 4 were proven diagnosed and 77 were putative diagnosed. IPA patients were mainly infected with Aspergillus fumigatus and Aspergillus flavus. Symptoms and signs such as fever, cough and expectoration, dyspnea and pulmonary rales occurred in both groups. The level of procalcitonin in IPA group was higher than that in non-IPA group, and the difference was statistically significant (P=0.016). The positive rate of serum galactomannan antigen test (GM test) in the IPA group was higher than that in the non-IPA group, and the differences was statistically significant (P=0.000). The incidence of pulmonary imaging cavities in IPA group was higher than that in non-IPA group, and the difference was statistically significant (P=0.022). Univariate analysis showed that central venous catheterization, septic shock, complete parenteral nutrition, chronic obstructive pulmonary disease, and immunosuppression were risk factors for IPA (P<0.05); Multivariate conditional logistic regression analysis showed that complete parenteral nutrition, chronic obstructive pulmonary disease, and immunosuppression were independent risk factors for IPA (P<0.05). The 28-day fatality rate in IPA group was higher than that in non-IPA group (55.6% vs. 34.6%, P=0.007). Conclusions IPA patients have no specific clinical symptoms and signs, and are mainly infected with Aspergillus fumigatus and Aspergillus flavus; GM test has guiding significance for the diagnosis of IPA. Serum GM test and pulmonary imaging have cavity findings that are helpful for the diagnosis of IPA. Patients with a history of chronic obstructive pulmonary disease, immunosuppression, or complete parenteral nutrition need to be on high alert for the possibility of IPA during ICU stay.