Massive secretions in paragonimiasis pleural effusion: a new finding concerning clinical recognition and treatment.

Some paragonimiasis patients in Chongqing, southwest China, have recently exhibited pleural effusions (PEs) with massive viscous secretions. This study aimed to investigate their clinical characteristics, thereby promoting effective treatments. A 3-year retrospective review of paragonimiasis patients who were admitted for nonhomogeneous PEs at Chongqing University Three Gorges Hospital was conducted. Epidemiological data, symptoms, laboratory and imaging findings, treatments, and outcomes were analyzed. Twenty-eight patients were identified, of which 22 (78.6%) were males and 22 (78.6%) were rural residents. Respiratory (85.7%) and constitutional (57.1%) symptoms were common. Paragonimus-specific ELISA was positive in all patients. Eosinophilia was detected in all patients in peripheral blood and PEs. Irregular hyperdense signals were observed in PEs by chest CT scans (96.4%) and ultrasonography (100.0%). Thoracic closed drainage failed in 10 patients (conservative group) because of tube blockage and was eventually replaced by video-assisted thoracoscopic surgery (VATS). Eighteen patients (surgery group) initially underwent VATS, or thoracotomy surgery, without complications. Massive secretions, described as "bean-dregs" or "egg-floccule," were detected intraoperatively, which explained the imaging findings and tube blockage. All patients recovered well after 2-3 courses of postoperative praziquantel treatment. Viscous secretions in paragonimiasis patients warrant great concern. Irregular hyperdense signals in effusions are important characteristics in CT scans and ultrasonography. Treatments such as thoracic closed drainage may fail due to viscous secretions blocking the tube; therefore, surgeries should be considered. In-depth multidisciplinary research may help determine the optimal treatment strategy and reveal the origin of these secretions.

Exosomes-a potential indicator and mediator of cleft lip and palate: a narrative review.

OBJECTIVE: This article summarizes the recent literature on noncoding ribonucleic acids (ncRNAs) in relation to cleft lip with or without palate and exosomes and their usage in craniofacial diseases. BACKGROUND: Cleft lip with or without cleft palate (CL/P) is a common congenital malformation with genetic and environmental risk factors that affects numerous children and families. Surgical procedures can correct deformations; however, residual sequelae remain after surgery. Studies exploring the pathogenesis of CL/P are crucial for its early diagnosis and treatment and can inform treatment strategy decisions, etiology searches, and treatment during pregnancy. Recently, research has shown that most disease-related genes are ncRNAs, which are important transcripts in the human transcriptome. ncRNAs include microRNAs, long noncoding RNAs, and circular RNAs. These ncRNAs play essential roles in various pathophysiological processes, including cell proliferation, migration, apoptosis, and epithelial-mesenchymal transition. Previous studies on protein-coding genes have identified a number of genes related to CL/P; however, the pathogenesis of CL/P has not yet been thoroughly explained. Exosomes are vehicles that transfer various bioactive molecules between cells and represent a new method of intercellular communication. Research has shown that exosomes are related to some craniofacial diseases. METHODS: We searched the PubMed database for recently published English-language articles using the following keywords: "cleft lip with or without palate," "noncoding RNA," "exosomes," and "craniofacial diseases". We then reviewed the retrieved articles. CONCLUSIONS: As exosomes serve as cellular communicators and the palate consists of epithelial and mesenchymal cells, communication between the two cell types may affect its formation. Thus, exosomes could represent a new indicator and mediator of CL/P.

Wire fracture in postoperative Nuss procedure: a problem that cannot be ignored.

BACKGROUND: Surgical stainless wire has been widely used to stabilize pectus bar and ribs in Nuss procedure for pectus excavatum correction. However, wire fracture and its secondary complications are problems easily to be ignored but very important. The purpose of this article was to describe a series of cases with wire breakage, hoping to arouse the attention of worldwide thoracic surgeons to this potential threat, and to share our modifications on the fixation patterns and materials in Nuss procedure. METHODS: From September 2011 to January 2020, 44 patients underwent Nuss procedure at Chongqing University Three Gorges Hospital. In the initial 25 patients (Group A), each bar was secured by stainless wires, and the latter 19 patients (Group B) received stainless wires and polyblend polyethylene sutures (PDS) in the bar fixation. Patient demographics, Haller index (HI), wire fracture rate, characteristics of the broken wires, and operation time were recorded. RESULTS: The mean operation age was 8.1±4.3 years in group A and 10.4±2.9 years in group B. There was no statistical difference in HIs between the two groups (P>0.05). The wire fracture occurred in 88.0% of the patients in Group A, while the wires in Group B were all intact. There was no bar displacement or other serious complication requiring surgical intervention in the two groups. The mean operation time of bar removal when encountering wire fracture was 104.6±42.8 minutes, which was significantly higher than that in Group B (P≤0.001). CONCLUSIONS: The wire fracture in the bar fixation could pose potential hazards to patients deserving special attention from thoracic surgeons. Cancel the wire fixation in the non-stabilizer side while simultaneously using wires and PDS in the pectus bar fixation may achieve the pectus bar stability while overcoming the problem of wire fracture.

Pleural lump after paragonimiasis treated by thoracoscopy: A case report.

BACKGROUND: Paragonimiasis is a parasitic disease that has multiple symptoms, with pulmonary types being common. According to our clinical practices, the pleural effusion of our patients is full of fibrous contents. Drainage, praziquantel, and triclabendazole are recommended for the treatment, but when fibrous contents are contained in pleural effusion, surgical interventions are necessary. However, no related reports have been noted. Herein, we present a case of pulmonary paragonimiasis treated by thoracoscopy. CASE SUMMARY: A 12-year-old girl presented to our outpatient clinic complaining of shortness of breath after exercise for several days. Enzyme-linked immunosorbent assay revealed positivity for antibodies against Paragonimus westermani, serological test showed eosinophilia, and moderate left pleural effusion and calcification were detected on computed tomography (CT). She was diagnosed with paragonimiasis, and praziquantel was prescribed. However, radiography showed an egg-sized nodule in the left pleural cavity during follow-up. She was then admitted to our hospital again. The serological results were normal except slight eosinophilia. CT scan displayed a cystic-like node in the lower left pleural cavity. The patient underwent a thoracoscopic mass resection. A mass with a size of 6 cm × 4 cm × 3 cm adhered to the pleura was resected. The pathological examination showed that the mass was composed of non-structured necrotic tissue, indicating a granuloma. The patient remainded asymptomatic and follow-up X-ray showed complete removal of the mass. CONCLUSION: This case highlights that thoracoscopic intervention is necessary when fibrous contents are present on CT scan or chest roentgenogram to avoid later fibrous lump formation in patients with pulmonary paragonimiasis.

Epidemiological and clinical characteristics analysis of 11 children with 2019 novel coronavirus infection in Chongqing: a single-center retrospective study.

BACKGROUND: The global epidemic of the 2019 novel coronavirus (2019-nCoV) is still going on. This article shares information about the infected children from a treatment center in Chongqing, China. METHODS: A retrospective analysis of the epidemiology, clinical symptoms, signs, laboratory examinations, chest computed tomography results, treatment effect of 11 children infected by 2019-nCoV was performed. Children were diagnosed from January 25 to February 29, 2020 in Chongqing University Three Gorges Hospital. RESULTS: The mean age of the 11 children with 2019-nCoV infection was 11 years and 5 months. Two cases (18%) were imported cases from Wuhan. The 9 cases (82%) were family cluster cases. There were 5 asymptomatic type cases (45%), 2 mild cases (18%), and 4 common type cases (37%). The most common symptom was fever (5 cases), cough (3 cases), sore throat (1 case) and diarrhea (1 case). There were abnormal chest CT changes in 6 cases, including 4 cases with patchy ground-glass opacities and 2 cases with thickened lung texture. Laboratory tests showed that procalcitonin increased in 4 cases (36%), and C-reactive protein (CRP) increased in 1 case (9%). In lymphocyte subgroup examination, lymphocyte count increased in 2 cases (18%) and decreased in 1 case (9%); T%, cluster of differentiation 8 (CD8)+ T%, and natural killer (NK) cell% were normal in 11 cases; CD4+ T% was increased in 2 cases (18%), and CD4+ T%/CD8+ T% was decreased in 1 case (9%); B% was increased in 1 case (9%). The interleukin 4 (IL-4), IL-10, and IL-17 in 11 cases were normal; IL-6 was increased in 7 cases (64%); tumor necrosis factor-alpha (TNF-α) was increased in 1 case (9%); and interferon gamma (IFN-γ) was increased in 6 cases (55%). All patients had been discharged from the hospital. CONCLUSIONS: Children are generally susceptible to 2019-nCoV, and the main way of infection is close contact with an infected person in the family. Clinical symptoms are mild. Laboratory and chest CT examinations are not as typical as those of adults. The prognosis is generally good. The unique immune function of children may help fight the new coronavirus.