目的:探讨电子支气管镜在肺癌诊断中的价值。方法:对233例支气管镜下诊断肺癌的患者进行分析。结果:电子支气管镜下肺癌的诊断率为63.49%,其中中央型肺癌的诊断率为72.85%,周围型肺癌的诊断率为27.63%,该组病例以老年人多见, 肿瘤多位于叶支气管,右肺57.51%, 左肺42.49%,病理类型为鳞癌45.92%, 小细胞癌22.75%, 腺癌24.03%。电子支气管镜下主要特征:鳞癌以管内增殖型改变为主,表现为新生物形成,阻塞管腔,伴有糜烂、充血、水肿,小细胞癌以增殖型和浸润型为主,可见气管内新生物形成及节结样改变。腺癌以管内增殖型和肿块压迫管腔为主,可见管内新生物形成或支气管呈缝隙样狭窄,甚至闭塞。结论:与周围型肺癌相比电子支气管镜检查对中心型肺癌诊断的准确率较高, 其检查方法简单, 创伤性小, 是正确指导临床医生选择合理治疗方法的一种较好的辅助检查技术。
ObjectiveTo investigate the application value of fibrinogen and other serological indicators in the management of patients with bronchiectasis. Methods Basic information, serological indicators such as blood routine items, biochemical, blood coagulation, and inflammation index of 121 patients with bronchiectasis in Nanjing Jinling Hospital and Nanjing Drum Tower Hospital from July 2021 to June 2023 were collected. The value of fibrinogen and other serological indicators in identifying patients with acute exacerbation and severely impaired lung function (FEV1%pred<60%) was evaluated. Results The levels of leukocytes, neutrophils, platelets, C-reactive protein and fibrinogen were higher in the patients with acute exacerbation and in the FEV1%pred<60% group, negatively correlated with FEV1%pred. While the level of albumin was higher in the patients of the stable group and FEV1%pred≥60% group, and positively correlated with FEV1%pred. Compared with leukocytes, neutrophils, platelets, C-reactive protein and albumin, fibrinogen demonstrated the best recognition ability for the patients with FEV1%pred<60% (AUC=0.839). The sensitivity of identifying patients with FEV1%pred<60% was 91.18% and the specificity was 71.26% when the level of fibrinogen was over 3.35 g/L. Conclusions Leukocytes, neutrophils, platelets, C-reactive protein, albumin and fibrinogen have shown certain application value in recognition of patients with bronchiectasis in acute exacerbation stage and FEV1%pred<60%. These serological indicators may be helpful in precision treatment and individual management of patients with bronchiectasis.
Abstract: ObjectiveTo explore the surgical characteristics of primary tracheal tumors treatment and its prognosis. Methods [WTBZ]We retrospectively investigated the clinical records of 38 patients with primary tracheal tumors in both Xiangya Hospital of Central South University and Hunan Provincial Tumor Hospital from Febuary 1982 to August 2009. There were 24 males and 14 females aged from 7 to 65 years. There were 2 benign lesions, 13 adenoid cystic carcinomas, 11 squamous cell carcinomas, 5 mucoepidermoid carcinomas, 4 adenocarcinomas and 3 other cell types. One patient with adenocarcinoma underwent exploratory thoracotomy only; 33 patients underwent tracheal resection and airway reconstruction, and according to the tumor growth characteristics, the surgeon applied circumferential tracheal resection with endtoend anostomosis or wedge resection; One patient had papilloma resected under fiber bronchoscopy; and three patients with locally advanced lesions underwent radiotherapy without surgery. The overall survival rate was calculated by the KaplanMeier method. The logrank method was used for comparing survival rates among different groups, characterized by cell types or surgical procedures. Results [WTBZ]The patient with exploratory thoracotomy died 3 days after surgery from respiratory failure. The perioperative mortality was 2.94% (1/34), and all the remaining 33 patients recovered and were discharged from hospital. Minor complications happened to 12 patients (35.29%), including 6 patients with pulmonary infection, 4 with atelectasis, and 2 with hoarseness. The followup time ranged from 6 months to 15 years. The followup rate was 97.29% (36/37). The threeunresected patients died within 6 months after hospital discharge. The 1, 5, and 10year survival rate for resected patients was88% （95%CI 0.77 to 0.99), 47%(95%CI 0.29 to 0.66), and 41% (95%CI 0.21 to 0.61), respectively. The survival rate of adenoid cystic carcinoma or mucoepidermoid carcinoma was significantly higher than that of squamous cell carcinoma or other tissue types (χ2=17.581, P=0.001). There was no statistical difference (χ2=0.021, P=0.886) in 5 year survival rate between wedge resection group at 63%(95%CI 0.34 to 0.91) and the segmental resection group at 77%(95%CI 0.44 to 0.99). Conclusions [WTBZ]Surgical treatment is safe and beneficial for primary tracheal tumors, and the pathological type is a significant prognostic factor after complete resection.
OBJECTIVE: To compare the effect of several types of rib rings with intercostal muscles for the replacement of trachea in thorax. METHODS: The surface layer of the third rib of dogs were ripped off and curved into triangular, quadrilateral and polygonal form. These three types of rib rings with intercostal muscles were used to replace a segment of trachea in thorax. RESULTS: The stability of triangular rib ring was very well, but stricture of ring were often happened because of its smaller internal diameter. These stability of quadrilateral rib ring was the worst. The polygonal rib ring presented the biggest diameter and good stability compared to the other two kinds of rings. If silicone tube was supplemented in the polygonal rib ring, the quality of artificial trachea was excellent. CONCLUSION: The rib rings with intercostal muscles are successfully used for replacing the defect of trachea in canine thorax. The polygonal rib rings have the best quality in the three types of rib ring for tracheal replacement.
ObjectiveTo investigate the clinical risk factors of preterm infants and its severity in premature infants with bronchopulmonary dysplasia (BPD) with retinopathy of prematurity (ROP).MethodsRetrospective clinical study was performed. A total of 126 preterm infants with BPD in the Neonatal Department of the Affiliated Hospital of Qingdao University from January 2016 to December 2018 were enrolled in the study. Among them, 69 were males and 57 were females, whose gestational age＜32 weeks and birth weight＜1500 g. BPD grades Ⅰ, Ⅱ, and Ⅲ were 63, 40, and 23 cases respectively. According to the presence or absence of ROP, children were divided into ROP group and non-ROP group, with 48 (38.1%) and 78 (61.9%) cases respectively. The differences of clinical data between the two groups were compared and analyzed. Quantitative data comparison between groups was performed by t test, and count data comparison was performed by χ2 test. The risk factors of ROP in BPD premature infants were analyzed by multi-factor logistics regression. The correlation between BPD severity and ROP severity was tested by Spearman rank correlation test.ResultsCompared with the non-ROP group, the ROP group had a smaller gestational age (t=5.988), lower birth weight (t=7.371), higher the application rate of oxygen concentration＞30% (duration of service＞24 h), high rate (χ2=17.244) and longer noninvasive ventilation time (t=－7.139), the differences were statistically significant (P＜0.05). In the logistic regression model, the noninvasive ventilation time was the risk factor for ROP in preterm infants with BPD (OR≈1.054, P＜0.05), while gestational age and birth weight were importantly protective factors for ROP in preterm infants with BPD (OR≈0.938, 0.996; P＜0.05). The results of the correlation analysis found that the severity of BPD was significantly positively correlated with the severity of ROP. As the severity of BPD increased, the severity of ROP increased, and the difference was statistically significant (rs=0.306, P＜0.035).ConclusionsFetal gestational age, low birth weight, hyperoxia, and long-term non-invasive mechanical ventilation are the main risk factors for ROP in preterm infants with BPD. The severity of BPD is positively correlated with the incidence and severity of ROP.
ObjectiveTo investigate the expression of histone deacetylase 2 (HDAC2) in animal model of benign tracheal stenosis, and explore the mechanism of HDAC2 in development of tracheal stenosis.MethodsEighteen rabbits were randomly divided into a blank control group, a model group, and an erythromycin group, with 6 rats in each group. The model group and the erythromycin group underwent tracheostomy, the inner wall of trachea was brushed back and forth with a nylon brush for more than 20 times to induce benign tracheal stenosis. From 7 days before surgery to 9 days after surgery, the model group received gavage with saline, the erythromycin group received gavage with low-dose erythromycin in dose of 15 mg·kg–1·d–1, and the control group did not receive any treatment. On the 10th day after operation, all the rabbits were sacrificed and the trachea was cut to measure the tracheal stenosis. RNA and protein were extracted from the granulation tissue in the stenosis and the relative mRNA expressions of HDAC2, interleukin (IL)-6 and IL-8 in the granulation tissue were detected by real-time fluorescence quantitative PCR. The relative expression of HDAC2 protein was detected by Western blot.ResultsCompared with the blank control group, the tracheal stenosis in the model group was more obvious [(84.60±1.14)% vs.(27.00±6.44)%], the mRNA and protein expressions of HDAC2 were decreased (0.29±0.07 vs. 1.00±0.00, 0.20±0.02 vs. 0.49±0.04), the mRNA expressions of IL-6 and IL-8 were up-regulated (4.22±0.67 vs. 1.00±0.00, 162.72±23.23 vs.1.00±0.00). Compared with the model group, tracheal stenosis in the erythromycin group was relieved [(64.00±12.25)% vs. (84.60±1.14)%], the mRNA and protein expressions of HDAC2 were increased (0.42±0.14 vs. 0.29±0.07, 0.43±0.01 vs. 0.20±0.02), the mRNA expressions of IL-6 and IL-8 were decreased (0.72±0.24 vs. 4.22±0.67, 130.22±7.93 vs. 162.72±23.23). All the differences were statistically significant (all P<0.05). The Pearson correlation coefficient between tracheal stenosis and HDAC2 mRNA relative expression was –0.96 (P<0.05).ConclusionsThe down-regulation of HDAC2 expression in model of benign tracheal stenosis is related to the occurrence and development of tracheal stenosis. The low dose of erythromycin may be used to treat benign tracheal stenosis by up-regulating expression of HDAC2 and thus inhibiting the inflammatory disorder during tracheal injury repair.