Objective To evaluate the efficacy and safety of computed tomography (CT)-guided percutaneous and cone beam CT-guided transbronchial ablation in the treatment of early multiple primary lung cancer (MPLC). Methods Retrospective analysis was performed on patients who met inclusion criteria in Shanghai Chest Hospital between May 2020 to June 2022. According to ablation pathway, lesions were divided into two groups: percutaneous ablation group and transbronchial ablation group. Results A total of 13 MPLC patients with 26 lesions were included (14 percutaneous ablation and 12 transbronchial ablation). There were no statistically significant differences in solid component, lesion location, lung field and lesion size between the two groups. The distance from the parietal pleura in the transbronchial ablation group was longer than that in percutaneous ablation group (P=0.03). The median follow-up period time were 13 months and 12 months for group percutaneous ablation and transbronchial ablation. No significant differences were found in 3-month complete ablation rate (100.0% vs. 83.3%), 1-year local control rate (100.0% vs. 91.7%) and severe complication rate (7.1% vs. 16.7%). The minor complication rate in percutaneous ablation group was higher than that in transbronchial ablation group (50.0% vs 0.0%, P=0.02). Conclusions Percutaneous ablation and transbronchial ablation have high efficacy and safety, and the latter involves lower minor complication rate. They complement each other, which provide the individualized treatments for early MPLC patients who are not suitable for or refuse surgery.
Objective To evaluate the safety and diagnostic yield of transbronchial lung biopsy ( TBLB) performed in mechanically ventilated patients. Methods TBLB was performed in 19 mechanically ventilated patients form January 2001 to September 2007 in the ICU of Guangzhou Institute of Respiratory Diseases. The results of clinical data were retrospectively analyzed. Results A total of 19 patients were analyzed[ 9 female, 10 male, with amean age of ( 57. 94 ±15. 00) years] . Specific diagnoses were made in 9 cases ( 47. 4% ) by TBLB. The diseases included pulmonary aspergillus pneumonia in 4 cases ( 21. 0% ) ,lung cancer in 2 cases ( 10. 5% ) , radioactive pneumonia in 1 case( 5. 3% ) , Goodpasture’s syndrome in1case( 5. 3% ) , pulmonary tuberculosis in 1 case ( 5. 3% ) . Ten cases ( 52. 6% ) were not able to establish confirmed diagnoses including pulmonary interstitial fibrosis in 6 cases( 31. 6% ) and lung tissue nonspecific changes in 4 cases( 21. 0% ) . The treatment was adjusted according to the results of TBLB in 10 patients( 52. 6% ) . Complications associated with this procedure included episodes of bronchial hemorrhage of ≥30 mL in 4 cases ( 21. 0% ) , transient oxygen desaturation in 11 cases ( 57. 9% ) , hypotension in 5 cases ( 26. 3% ) , and transient tachycardia in 1 case ( 5. 3% ) without death and pneumothorax. Conclusions TBLB can be performed safely and has a diagnostic value in mechanically ventilated patients. TBLB should be considered as a diagnostic procedure before open lung biopsy.
ObjectiveTo explore the diagnostic value of endobronchial ultrasonography with a guide sheath (EBUS-GS) for pulmonary fungal disease.MethodsAll patients were collected from January 2015 to December 2018. They were diagnosed with pulmonary fungal disease by tissue biopsy, body fluid or blood test, and without other diseases such as pneumonia, lung cancer, lung abscess, tuberculosis, or organizing pneumonia, etc. After clinical anti-fungal treatment, clinical symptoms were relieved, chest CT lesions were absorbed, laboratory-related checks were turned negative in these patients. All patients underwent bronchoscopy, bronchoalveolar lavage fluid/brush examination, and blood galactomannan antigen test/latex agglutination test. They were divided into an EBUS-GS group and a non-EBUS-GS group according to whether EBUS-GS check was performed. Non-parametric test was used to analyze the diagnostic value of EBUS-GS in pulmonary fungal diseases.ResultsFifty-one patients were included and 20 patients in the EBUS-GS group and 31 patients in the non-EBUS-GS group. The EBUS-GS group had a higher positive rate of pulmonary fungal disease. The diagnostic rates of the EBUS-GS group and the non-EBUS-GS group were statistically different (90.0% vs. 48.4%, P<0.05).ConclusionEBUS-GS can improve the diagnosis rate of pulmonary fungal disease and provides further evidence for a clear diagnosis.
This study is aimed to investigate the effects of mechanical stretch on the expression of transforming growth factor-β1 (TGF-β1) and fibroblast growth factor-2 (FGF-2), and the signaling pathway in human bronchial epithelioid (16HBE) cells under mechanical stretch. Using loading device with flexible substrate (FX-4000T) to stretch 16HBE cells, we found that the stretching elongation was 15%, at frequency of 1 Hz, stretching for 0.5 h, 1 h, 1.5 h and 2 h. Choosing the higher expression of TGF-β1, FGF-2 and Ca2+ group to carry out intervention experiments, we used the cells pretreated with canonical transient receptor potential 1 (TRPC1) channel antagonist SKF96365, protein kinase C (PKC) inhibitor HA-100, and thereafter mechanical stretch to interpose. Compared with those in the blank control group, TGF-β1 and FGF-2' protein and mRNA, intracellular Ca2+ fluorescence intensity were higher, and the differences were statistically significant (P < 0.05) at the 4 time points, 0.5 h, 1 h, 1.5 h and 2 h. At 0.5 h, the increasing rate was the highest. TGF-β1 protein and mRNA, FGF-2 protein and mRNA, intracellular Ca2+ luorescence intensity in the stretch+SKF96365 and stretch+HA-100 intervented group were decreased, the differences were statistically significant than those in 0.5 h stretch group (P < 0.05) without intervention. The expression of TGF-β1, FGF-2 was up-regulated in 16HBE cells under mechanical stretch, PKC, TRPC1, and Ca2+ may participate in the signal path.
Acute respiratory distress syndrome is a clinical syndrome caused by many reasons, which is characterized by intractable hypoxemia. Its etiology is complex and its mortality is high. Lung biopsy techniques can give accurate histopathological diagnosis to such patients to guide treatment and improve prognosis. At present, lung biopsy techniques include surgical lung biopsy, transbronchial lung cryobiopsy, transbronchial lung biopsy and percutaneous lung biopsy. The diagnostic rate of surgical lung biopsy is high, but it is traumatic and difficult to implement. The diagnostic rate of transbronchial cryobiopsy is relatively high, and the complications are acceptable. Transbronchial lung biopsy is minimally invasive but the diagnostic rate is low. The diagnostic rate of percutaneous lung biopsy is relatively high, and the complications are relatively few. For patients with acute respiratory distress syndrome who need lung biopsy, it is very important to choose different surgical procedures according to their effectiveness, safety and applicability.
ObjectiveTo investigate the effects of ezrin on transforming growth factor beta (TGF-β) mediated epithelial mesenchymal transition (EMT). MethodsHuman bronchial epithelial 16HBE cells were stimulated by TGF-β to induce EMT. The mRNA and protein levels were analyzed by RT-PCR and Western blot. Lentivirus (LV)-Ezrin-shRNA was employed to investigate the effects of ezrin deficiency on cell morphology and expressions of EMT associated biomarkers including E-cadherin, vimentin, and alpha smooth muscle actin (α-SMA). The effects of recombinant ezrin protein on 16HBE were also examined. ResultsThe expression of ezrin was down-regulated in 16HBE activated by TGF-β. Due to ezrin depletion, the cell morphology changed from a typical multilateral paving stone-like appearance to a mesenchymal-like fusiform appearance along with the decreased expression of epithelium biomarker E-cadherin and the increased mesenchymal cell markers, vimentin and α-SMA. Recombination protein ezrin increased the expression of E-cadherin whilst reducing vimentin and α-SMA. ConclusionTGF-β promotes EMT of 16HBE cells at least partly via inhibiting the expression of ezrin.
ObjectiveTo evaluate the difference between the tracheal intubation connected to conventional ventilation (TI-CV) and rigid bronchoscopy connected to high frequency ventilation (RB-HFV) under general anesthesia on patients with transbronchial cryobiopsy (TBCB).MethodA prospective, randomized, controlled trial was conducted in interstitial lung disease patients with TBCB from August 2018 to February 2019 in the First Affiliated Hospital of Guangzhou Medical University. According to the different methods of intubation, the patients were divided to a TI-CV group and a RB-HFV group randomly. The operating duration, extubation duration, total anesthesia time, heart rate, blood pressure and arterial blood gas analysis were collected and analyzed.ResultsSixty-five patients were enrolled. There were 33 patients with an average age of (48.0±15.0) years in TI-CV group and 32 patients with an average age of (48.8±10.8) years in RB-HFV group. The basic line of body mass index, pulmonary function (FEV1, FVC and DLCO), arterial blood gas (pH, PaO2 and PaCO2) and heart rate (HR), mean arterial pressure (MAP) had no significant differences between two groups. At the first 5 minutes of operation, the pH was (7.34±0.06) and (7.26±0.06), and the PaCO2 was (48.82±9.53) and (62.76±9.80) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P=0.000). At the end of operation, the pH was (7.33±0.06) and (7.21±0.08), the PaCO2 was (48.91±10.49) and (70.93±14.83) mm Hg, the HR were (79.6±21.1) and (93.8±18.7) bpm, the MAP were (72.15±13.03) and (82.63±15.65) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P<0.05). There were no differences in the operating duration and extubation duration between two groups. The total anesthesia time was (47.4±8.8) and (53.3±11.6) min with significant difference (P=0.017). Five minutes after the extubation, there were no significant difference in the pH, PaO2, PaCO2, HR and MAP between two groups. No serious complications occurred in either group.ConclusionsCompared with rigid bronchoscopy, TI-CV under general anesthesia is more conducive to maintain effective ventilation, and maintain the HR and MAP stable during the TBCB procedure. TBCB procedure should be performed by TI-CV under general anesthesia in patients with poor cardiopulmonary function.
Objective To study the surgical treatment of tracheal and main bronchial tumors. Methods We retrospectively analyzed the clinical data of 30 patients with tracheal and main bronchial tumors treated in Shengjing Hospital of China Medical University from January 2000 to December 2015. There were 12 males and 18 females with the age ranging from 22 to 80 years. Results Ten patients were treated with enucleation, 12 patients tracheal tumor resection and end-to-end anastomosis, 1 patient window resection, 1 patient wedge resection, 5 patients tumor resection and tracheal reconstruction by using pulmonary tissue flap with alloy stent and 1 patient left pneumonectomy. One patient died of sudden massive hemoptysis 26 d after operation. Intraoperative complications were found in 2 patients. Others had a good recovery after operation. Patients were followed up for 11 months to 14 years. Eight patients were followed up less than 5 years postoperatively, one patient died of sudden massive hemoptysis 14 months after operation, while others survived; 21 patients were followed up more than 5 years and 5 patients were lost to follow-up. Conclusion Surgical resection is recommended for tracheal and main bronchial tumors. Patients with small benign tumor may choose local tracheal resection; tracheal segmental resection and end-to-end anastomosis is the most common surgical treatment. Patients with more than half of the whole length of tracheal defects or in the risk of anastomotic ischemic necrosis may be suggested to receive tracheal reconstruction.
ObjectiveTo investigate the clinical characteristics of tracheobronchial stenosis due to tracheobronchial tuberculosis (TBTB).MethodsWe recruited all patients diagnosed as TBTB within one year from four centers of Guangdong province, southern China. The prevalence, risk factors and bronchoscopy characteristics of tracheobronchial stenosis were analyzed. The location and pathological type of stenosis were also compared between different genders.ResultsA total of 345 patients were diagnosed with TBTB, 206 cases (59.7%) of which were concomitant with varying degrees of tracheobronchial stenosis. The stenosis was mainly located at upper lobe (50.0%) and gave priority to unilateral infiltration. The proportion of left and right-side stenosis were 53.9% and 44.2%, respectively. Forty-nine cases (23.8%) with tracheobronchia stenosis developed severe airway narrowing, the proportion of which was similar between left and right-side lung (49% vs. 51%). Severe stenosis in the left-side lung mainly involved in upper lobe (37.5%), main bronchus (37.5%) and the right-side mainly involved in upper lobe (44.0%), middle lobe or intermediate bronchus (40.0%). Among the TBTB patients, females, those with age ≥18 years, non-smokers, and those with symptom duration ≥4 weeks were more likely to be with tracheobronchial stenosis (P<0.05). The differences in gender between the patients with airway stenosis were as follows: the median age of female tracheobronchial stenosis patients was smaller than that of male patients (31 years vs. 43 years, P<0.05); stenosis were more likely involved in left side and main bronchus in female patients; ulceration necrosis of stenosis was more frequently seen in the female patients (P<0.05).ConclusionsTracheobronchial stenosis due to tracheobronchial tuberculosis is more frequently seen in young and middle-aged female patients. There are different stenosis location and lesion types between different genders.
Objective To systematically review the value of rapid on-site evaluation (ROSE) for diagnosing pulmonary and mediastinal lesions with endobronchial ultrasound (EBUS). MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were searched by computer to collect the studies of ROSE and EBUS in the diagnosis of pulmonary and mediastinal lesions from inception to August 2022. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. Meta-analysis was implemented by RevMan 5.4 and Stata 12.0 software. ResultsA total of 15 studies (9 retrospective studies and 6 prospective studies) with 3 577 patients were included. The meta-analysis results of main outcomes showed that the adequacy of the sample (RD=0.10, 95%CI 0.05 to 0.15, P<0.000 1), overall diagnosis rate (RD=0.07, 95%CI 0.04 to 0.10, P<0.000 1) and the diagnosis rate of the malignant lesion (RD=0.06, 95%CI 0.02 to 0.09, P=0.004) of the ROSE combined with EBUS group were significantly higher than those of the EBUS group. Subgroup analysis showed that the diagnosis rates of pulmonary lesions (RD=0.12, 95%CI 0.08 to 0.17, P<0.000 01) and mediastinal lesions (RD=0.06, 95%CI 0.01 to 0.12, P=0.02) in the ROSE group was significantly higher than those in the EBUS group. The overall diagnosis rate and malignant diagnosis rate of ROSE combined with EBUS were 90% and 92%. The meta-analysis results of secondary outcomes showed that the number of lesions punctures (MD=–1.16, 95%CI –1.89 to –0.43, P=0.002) in the ROSE combined with EBUS group were significantly less than that in the EBUS group; there was no statistical difference in operation time (MD=0.09, 95%CI –5.22 to 5.39, P=0.97) or incidence of complications (RD=–0.06, 95%CI –0.13 to 0.01, P=0.1) between the two groups. Conclusion ROSE can improve the diagnostic efficiency of EBUS in pulmonary and mediastinal lesions, and has the value of the clinical application.