The Different Evaluative Significance of Enlarged Lymph Nodes on Preoperative CT in the N Stage for Patients with Suspected Subsolid and Solid Lung Cancers.

RATIONALE AND OBJECTIVES: To investigate the clinical value of enlarged mediastinal and/or hilar lymph nodes on CT for patients with lung subsolid and solid nodules. MATERIALS AND METHODS: The study was performed on patients who underwent surgical treatment for suspected lung cancer. One hundred seventeen subsolid nodules and 101 solid nodules with enlarged lymph nodes (LNs) were included in the study group. The same number of cases with normal LNs with a balanced distribution of the clinical T stage were randomly selected as the control group for each study group. The pathological statuses of the lymph nodes of these patients proven by histopathology after surgery were collected. RESULTS: Lung solid lesions with enlarged LNs were more prone to lymph node metastasis (37.6% vs. 13.9%, p <0.001). However, there were only two and one metastatic lesions in the subsolid group with and without enlarged LNs, respectively. (2/117 vs. 1/117, p = 1.000). No pathological lymph node metastasis was observed in subsolid lesions under clinical stage T1b (cT1b), even though some of them (117/234) with enlarged LNs. CONCLUSION: The evaluative significance of enlarged LNs on CT is different for subsolid and solid lesions. CT is useful for lymph node evaluation and N staging of solid lesions but may has little value for subsolid lesions. There is a very low possibility of lymph node metastasis occurring in patients with subsolid lesions under cT1b. Enlarged LNs on CT may not be critical in subsequent management and treatment for subsolid nodules.

Clinical Value and Pathologic Basis of Cystic Airspace Within Subsolid Nodules Confirmed as Lung Adenocarcinomas by Surgery.

PURPOSE: To investigate the clinical value and pathologic basis of cystic airspace within lung adenocarcinomas manifesting as subsolid nodules. PATIENTS AND METHODS: A retrospective study was conducted on a total of 541 surgically confirmed lung adenocarcinomas manifesting as subsolid nodules in computed tomography images, including 87 cases with cystic airspace and 454 cases without cystic airspace. The pathologic characteristics of the cases with and without cystic airspace were compared. The investigation of the pathologic structure of cystic airspace was attempted on the postoperative paraffin sections. RESULTS: There was a significant difference in the containing of cystic airspace between preinvasive and invasive adenocarcinomas (10.5 vs 26.6%; P < .001). Multivariate analysis indicated that cystic airspace is an independent predictor of invasive adenocarcinomas (odds ratio, 3.220; 95% confidence interval, 1.822-5.687). Nodules containing multiple cystic airspaces are more likely to be invasive adenocarcinomas than nodules with a single cystic airspace (47.1 vs 72.2%; P < .05). On paraffin sections, the walls of the cystic airspace seemed to be mainly composed of atypical hyperplasia and/or tumor cells on the surface and the remaining smooth muscle cells and stroma below, which is similar to the structure of bronchi. CONCLUSIONS: Cystic airspace may be a reliable predictor of invasive adenocarcinomas, the classification method based on the number of cystic airspaces might be suitable for the computed tomography-based typing of cystic airspace within subsolid nodules. Cystic airspace may derive from the destroyed and enlarged bronchi owing to the growth or infiltration of atypical hyperplasia and/or tumor cells.

Efficacy and safety of anti-viral therapy for Hepatitis B virus-associated glomerulonephritis: A meta-analysis.

OBJECTIVES: To assess the potency of anti-viral treatment for hepatitis B virus-associated glomerulonephritis (HBV-GN). Method: We searched for controlled clinical trials on anti-viral therapy for HBV-GN in MEDLINE, Embase, the Cochrane Library, and PubMed from inception to March 11th 2019. Seven trials, including 182 patients met the criteria for evaluating. The primary outcome measures were proteinuria and changes in the estimated glomerular filtration rate, and the secondary outcome measure was hepatitis B e-antigen clearance. A fixed or random effect model was established to analyze the data. Subgroup analyses were performed to explore the effects of clinical trial type, anti-viral drug type, age, and follow-up duration. RESULTS: The total remission rate of proteinuria (OR = 10.48, 95% CI: 4.60-23.89, I2 = 0%), complete remission rate of proteinuria (OR = 11.64, 95% CI: 5.17-26.21, I2 = 23%) and clearance rate of Hepatitis Be Antigen (HBeAg) were significantly higher in the anti-viral treatment group than in the control group (OR = 27.08, 95% CI: 3.71-197.88, I2 = 63%). However, antiviral therapy was not as effective regarding the eGFR (MD = 5.74, 95% CI: -4.24-15.73). In the subgroup analysis, age and drug type had significant impacts on proteinuria remission, and study type and follow-up duration only slightly affected the heterogeneity. CONCLUSION: Antiviral therapy induced remission of proteinuria and increased HBeAg clearance but failed to improve the eGFR. Pediatric patients were more sensitive to antiviral therapy than adults. IFNs seem more effective but are accompanied by more adverse reactions than NAs.

Joint use of the radiomics method and frozen sections should be considered in the prediction of the final classification of peripheral lung adenocarcinoma manifesting as ground-glass nodules.

OBJECTIVES: To evaluate the diagnostic accuracy of radiomics method and frozen sections (FS) for the pathological classification of peripheral lung adenocarcinoma manifesting as ground-glass nodules (GGNs) in computer tomography (CT). MATERIALS AND METHODS: A dataset of 831 peripheral lung adenocarcinoma manifesting as GGNs in CT were divided into two cohorts: training cohort (n = 581) and validation cohort (n = 250). Combined with clinical features, the radiomics classifier was trained and validated to distinguish the pathological classification of these nodules. FS diagnoses in the validation cohort were collected. Diagnostic performance of the FS and radiomics methods was compared in the validation cohort. The predictive factors for the misdiagnosis of FS were determined via univariate and multivariate analyses. RESULTS: The accuracy of radiomics method in the training and validation cohorts was 72.5 % and 68.8 % respectively. The overall accuracy of FS in the validation cohort was 70.0 %. The concordance rate between FS and final pathology when FS had a different diagnosis from radiomics classifier was significantly lower than when FS had the same diagnosis as radiomics classifier (46 vs. 87 %, P < 0.001). Univariate and Multivariate analyses showed that different diagnosis between FS and radiomics classifier was the independent predictive factor for the misdiagnosis of FS (OR: 7.46; 95%CI: 4.00-13.91; P < 0.001). CONCLUSIONS: Radiomics classifier predictions may be a reliable reference for the classification of peripheral lung adenocarcinoma manifesting as GGNs when FS cannot provide a timely diagnosis. Intraoperative diagnoses of the cases where FS had a different diagnosis from radiomics method should be considered cautiously due to the higher misdiagnosis rate.

Efficacy and safety of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker therapy for IgA nephropathy: A meta-analysis of randomized controlled trials.

BACKGROUND: Published reports evaluating whether angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ACEI/ARB) therapy could bring improvements to the prognosis of immunoglobulin A nephropathy (IgAN) have yielded confusing results, which entails a systematic review of those reports. In this study, we summarized currently available evidence from randomized controlled trials (RCTs) that evaluated the effect of ACEI/ARB therapy of IgAN. METHODS: PubMed, International comprehensive biomedical information bibliographic database produced by the National Library of Medicine (MEDLINE), Excerpt Medica Database (EMBASE), and Cochrane Library and article reference lists were searched for RCTs that compared ACEI/ARB with placebo and any other nonimmunosuppressive agents except RAAS agents for treating IgAN. The quality of the studies was evaluated with the performance of explicit eligibility criteria and the revised Jadad scale. Meta-analyses were completed on the outcomes of proteinuria, serum creatinine (SCr), blood pressure and glomerular filtration rate (GFR) in patients with IgAN. RESULTS: Five RCTs involving 295 patients were included in this review. ACEI/ARB agents had statistically significant effects on reduction proteinuria (standardized mean differences [SMD], -0.46; 95% confidence interval [CI], -0.64 to -0.27; P < 0.00001; heterogeneity I 2 = 35%; P = 0.20) and blood pressure, but no significant difference was found on SCr (SMD, -3.51; 95% CI, -16.55 to 9.54; P = 0.60; heterogeneity I 2 = 0%; P = 0.74) and GFR (SMD, 2.59; 95% CI, -7.14 to 12.33; P = 0.60; heterogeneity I 2 = 57%; P = 0.10). CONCLUSION: ACEI/ARB agents had statistically significant effects on reducing proteinuria. As proteinuria is a major pathology of IgAN, which was significantly improved by ACEI/ARB, we proposed that ACEI/ARB agents were a promising therapy. Because the studies under review did not perform blind method, used a variety of doses and types of ACEI/ARB agents and lacked follow-up to evaluate the long-term effect of the agents on IgAN patients.