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Adenoid cystic carcinoma (ACC) is a malignant tumor that originates from the ductal epithelium of the secretory glands and has a tendency for perineural invasion. Primary tracheal ACC is a clinically rare subtype, with an annual incidence rate of 0.04-0.2%, accounting for <1% of all tracheal malignant tumors. Surgery and radiotherapy remain the standard treatments, but there are clinical challenges with the high recurrence rate. The present article reports the case of a patient who relapsed after partial tracheal resection and was considered inoperable. Bronchoscopy was used for airway assessment and interventional treatment, including submucosal injection and photodynamic therapy. After this intervention, the overall survival of the patient exceeded 12 years.
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Hypopharyngeal squamous cell carcinoma (HPSCC) continues to have the bleakest prognosis among head and neck cancers. Managing inoperable HPSCC, particularly in elderly patients, presents a complex therapeutic challenge. This case details an 84-year-old female with advanced recurrent HPSCC and a complex medical history was treated using photodynamic therapy (PDT) combined with Chinese herbal medicine (CHM). She was presented with a hemorrhagic mandibular mass. PDT was administered due to her inability to undergo surgery. Despite significant side effects such as erythema and swelling from PDT, these were effectively managed with the external application of the CHM formula Jiedu Zhitong Powder, which alleviated pain and inflammation. The treatment led to a decrease in tumor size, resolution of ulceration and hemorrhage, and improved hemoglobin levels, allowing the patient to be discharged. Regular follow-ups showed no recurrent bleeding, although she eventually succumbed to complications related to tumor progression 7 months post-treatment. This case highlights the potential benefits of integrating PDT with CHM in treating unresectable HPSCC. The successful management of PDT side effects with CHM could represent a promising avenue for enhancing patient tolerance and adherence to treatment in HPSCC cases.
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BACKGROUND: Tracheobronchial adenoid cystic carcinoma (TACC) is an uncommon gland-type tumor. While prior studies have addressed its clinical features and prognosis, evidence from larger cohorts remains scarce. METHODS: TACC patients treated at Dongzhimen Hospital (DZM) and Emergency General Hospital (EG) between 2010 and 2023 were enrolled. Survival curves were plotted using the Kaplan-Meier method before and after propensity score matching (PSM). The key variables were screened by LASSO regression, and predictive and interaction analysis was done by multifactor Cox regression and accelerated failure time (AFT) models. Overall survival (OS) was the study endpoint. RESULTS: The median age of 169 TACC patients (EG 144, DZM 25) was 47.8 ± 13.2 years, 50.9% were female, and 79.9% of patients had not undergone surgery. The median follow-up was 67.5 months (interquartile range [IQR] 42.2-105.8). Survival at 5, 10, and 15 years was 68.0%, 32.4%, and 17.1%, respectively. The median survival time was 88 months. Multifactorial Cox regression analysis found initial tumor extension (ITE) (HR: 1.28, 95% CI 1.12-1.47; P = 0.000), surgery (HR: 0.36, 95% CI 0.20-0.64; P = 0.000), and photodynamic therapy (PDT) (HR: 0.46, 95% CI 0.22-0.97; P = 0.042) to be independent prognostic factors; this was re-affirmed by AFT model. Survival was extended by surgery combined with PDT, but the interaction was nonsignificant. CONCLUSION: This study identified ITE as the independent prognostic factor. Surgery is the key to the prognosis, and PDT and its combination with surgery may enhance patient survival.
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Neoplasias Brônquicas , Carcinoma Adenoide Cístico , Neoplasias da Traqueia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Brônquicas/mortalidade , Neoplasias Brônquicas/terapia , Neoplasias Brônquicas/patologia , Neoplasias Brônquicas/diagnóstico , Carcinoma Adenoide Cístico/mortalidade , Carcinoma Adenoide Cístico/terapia , Carcinoma Adenoide Cístico/patologia , Carcinoma Adenoide Cístico/diagnóstico , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Traqueia/mortalidade , Neoplasias da Traqueia/terapia , Neoplasias da Traqueia/patologiaRESUMO
Background: Microwave ablation (MWA) and argon-helium cryoablation (AHC) have emerged as widely utilized therapeutic modalities for non-small cell lung cancer (NSCLC) globally, prompting increasing research focus on the comparative clinical characteristics and prognostic outcomes associated with these two ablation techniques. This study aimed to explore the clinical characteristics and prognosis of MWA and AHC in the treatment of NSCLC. Methods: A total of 125 cases of NSCLC treated in the Beijing University of Chinese Medicine Dongzhimen Hospital were retrospectively analysed. To reduce retrospective confounding bias, propensity score matching was performed. We compared the changes in laboratory examination index before and after treatment between the two groups and the occurrence of adverse events after treatment and graded the adverse events. Kaplan-Meier analysis was employed to assess survival rates. Cox regression analysis was employed to ascertain the factors that influence the prognosis of patients. Results: After treatment, the level of systemic inflammatory response in the MWA group exhibited a statistically significant increase (P<0.01), while there was no significant change in the AHC group (P>0.05). The red blood cells and haemoglobin in both groups exhibited a statistically significant decrease (P<0.05). The incidence of bleeding events after treatment in AHC group was higher than that in the MWA group (P<0.05). There was no statistical difference in the grade of adverse events and the overall survival (OS) rate between the two groups (P>0.05). Smoking [hazard ratio (HR), 0.29; 95% confidence interval (CI): 0.09-0.93; P=0.04], chronic obstructive pulmonary disease (COPD) (HR, 0.33; 95% CI: 0.14-0.76; P=0.009) and radiotherapy (HR, 0.11; 95% CI: 0.03-0.34; P=0.001) were independent prognostic factors impacting OS. Conclusions: MWA and AHC are both minimally invasive procedures with proven efficacy in the treatment of NSCLC with a favorable safety profile. However, AHC carries a higher risk of bleeding than MWA. It is recommended that the postoperative management of patients with smoke and COPD should be strengthened to improve their prognosis.
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OBJECTIVE: Many systematic reviews (SRs) and meta-analyses (MAs) have recently assessed the short-term outcomes of the transoral thyroidectomy vestibular approach (TOTVA) compared with conventional open thyroidectomy (COT) and non-transoral endoscopic thyroidectomy (NTET). However, their conclusions remain controversial. This overview aimed to evaluate the safety and feasibility of TOTVA by appraising the quality of existing SRs/MAs. METHODS: Seven Chinese and English databases were systematically searched from their inception to December 10, 2023. Eligible SRs/MAs, published between 2020 and 2023, compared the safety and efficacy of TOTVA with COT or NTET. The PRISMA, AMSTAR-2, and ROBIS tools were used to assess reporting quality, methodological quality, and risk of bias, respectively. RESULT: Eleven SRs/MAs were finally included. According AMSTAR-2, one study was assessed as high-quality, with the remainder as very low-quality. Using PRISMA 2020, the "Yes" response rate for Q5, Q8, and Q15 was below 55 percent. Per ROBIS, all SRs/MAs exhibited low risk in phase 1 and domain 1 but high risk in domain 2. Efficacy was assessed through intraoperative outcomes, primary postoperative outcomes, and statistically significant postoperative outcomes. Patients with thyroid disorders undergoing TOTVA experienced longer overall operative time and hospital stays, reduced intraoperative blood loss, increased lymph node retrieval, higher incidence of infection, lower postoperative pain scores, reduced incidence of hypocalcemia, larger drainage volumes, and higher cosmetic effect scores compared with those undergoing. CONCLUSION: The TOTVA may enhance cosmetic satisfaction, improve lymph node retrieval, and decreased postoperative complications. Nevertheless, these findings warrant cautious interpretation due to low methodological quality, high risk of bias, and limited evidence quality. More rigorous and standardized SRs/MAs are required to provide robust scientific evidence for definitive conclusions.
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Cirurgia Endoscópica por Orifício Natural , Doenças da Glândula Tireoide , Tireoidectomia , Humanos , Tireoidectomia/métodos , Tireoidectomia/efeitos adversos , Doenças da Glândula Tireoide/cirurgia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Estudos de Viabilidade , Revisões Sistemáticas como Assunto , Cirurgia Endoscópica por Orifício Natural/métodos , Cirurgia Endoscópica por Orifício Natural/efeitos adversosRESUMO
China has the largest number of hepatitis B patients globally, making early detection, intervention, and treatment crucial. This study assessed the knowledge, attitude, and practice (KAP) toward antiviral treatment among chronic hepatitis B (CHB) patients. A web-based cross-sectional study was conducted among hepatitis B patients at the author's Hospital, Tianjin, China, between October 2022 and January 2023. Primary outcomes were KAP scores (knowledge: 0-18, attitude: 0-35, practice: 0-50). Secondary outcomes included factors associated with KAP. A total of 457 hepatitis B patients participated. The Mean KAP scores were 9.70 ± 4.64 (knowledge), 24.00 ± 3.28 (attitude), and 38.85 ± 6.56 (practice). Factors independently associated with adequate knowledge included household income 5,000-10,000 CNY (OR = 1.81, 95%CI: 1.05-3.12; positive factor), > 10,000 CNY (OR = 2.05, 95%CI: 1.01-4.17; positive factor), rural cooperative medical insurance (OR = 0.5, 95%CI: 0.27-0.94; negative factor), carrier-stage hepatitis B (OR = 0.34, 95%CI: 0.13-0.91; negative factor), and treatment > 10 years (OR = 2.74, 95%CI: 1.09-6.88; positive factor). Positive attitude was associated with income > 10,000 CNY (OR = 2.77, 95%CI: 1.41-5.44; positive factor) but negatively with cirrhosis (OR = 0.43, 95%CI: 0.24-0.76; negative factor) and liver cancer (OR = 0.19, 95%CI: 0.05-0.71; negative factor). Knowledge (OR = 1.20, 95%CI: 1.13-1.27) was independently associated with a proactive practice, while female sex (OR = 0.58, 95%CI: 0.35-0.95) and use to drink (OR = 0.43, 95% CI: 0.22-0.82) were independently associated with worse practice. CHB patients demonstrated suboptimal KAP levels regarding antiviral therapy. Policy support should prioritize low-income populations to improve treatment adherence and outcomes.
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Antivirais , Conhecimentos, Atitudes e Prática em Saúde , Hepatite B Crônica , Humanos , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/epidemiologia , Hepatite B Crônica/psicologia , Feminino , Masculino , Antivirais/uso terapêutico , Adulto , Pessoa de Meia-Idade , Estudos Transversais , China/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
Background: Tracheal adenoid cystic carcinoma (TACC) is a rare malignant tumor with limited treatment options for unresectable cases. Although case reports have indicated the value of photodynamic therapy (PDT), its efficacy, survival outcomes, and prognostic factors remain poorly characterized. This two-center retrospective study aimed to evaluate the long-term outcomes of patients with TACC treated with PDT and to identify predictors of treatment response. Methods: A retrospective analysis was conducted on 39 patients with TACC who received continuous PDT treatment in two hospitals from August 2011 to September 2023. All patients were intravenously injected with hematoporphyrin derivative (HpD) at a dose of 2 mg/kg and treated 48 hours later. The therapeutic effect was evaluated according the 2019 efficacy evaluation standard for PDT for respiratory tumors. The primary endpoints were overall survival (OS) and progression-free survival (PFS), while the secondary endpoints included objective response rate (ORR) and safety. The prognostic factors were analyzed via a Cox regression model. Results: The study included 39 patients, with a mean age of 47.51±14 years (range, 19-79 years). The most recent efficacy evaluation of 39 patients, conducted 1 month after PDT treatment, showed complete response (CR) in 5 patients, partial response (PR) in 25 patients, and progressive disease (PD) in 9 patients. Both OS and PFS were significantly longer in the PR group than in the PD group (OS: P=0.008; PFS: P=0.005). The 5-, 10-, and 15-year survival rates for patients were 73.2%, 64.1%, and 42.7%, respectively. Only 7 patients experienced complications. Univariate Cox regression analysis indicated that the age and treatment interval were significant risk factors for the emergence of TACC (P=0.03). Conclusions: We found that PDT for patients with TACC achieved satisfactory clinical efficacy and safety, resulting in longer survival and fewer complications. Moreover, treatment interval and age were risk factors for the development of TACC.
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Introduction: More than half of patients with tracheal carcinoma (TC) do not receive radical treatment, but the clinical characteristics, palliative treatment options, and prognosis of this group remain unclear. Methods: This retrospective study analyzed 94 single primary TC patients (42 with tracheal squamous cell carcinoma [TSCC] and 52 with tracheal adenoid cystic carcinoma [TACC]) admitted to the Emergency General Hospital and Dongzhimen Hospital, Beijing University of Chinese Medicine. Kaplan-Meier survival curves, Log-rank tests, univariate and multivariate Cox and AFT models were used to assess overall survival (OS). Results: Among 89 patients without radical treatment, the median survival was 57 months, with 5-year and 10-year survival rates of 46.33% and 13.43%, respectively. Univariate analysis identified pathological type, smoking history, initial tumor extension (ITE), and targeted therapy as significant prognostic factors. The AFT model revealed that the median OS for TSCC patients was significantly shorter than for TACC patients, with a time ratio (TR) of 0.243 (95% CI: 0.153-0.386; P < 0.01), while targeted therapy was associated with a 1.790-fold increase in OS (TR: 1.790, 95% CI: 1.061-3.020; P = 0.029). Patients with extensive ITE had worse outcomes, with a TR of 0.628 (95% CI: 0.406-0.971; P = 0.037). Smokers had a TR of 0.601 (95% CI: 0.397-0.912; P = 0.017) compared with non-smokers. Subgroup analysis showed that smoking history was strongly associated with shorter OS in TSCC but not in TACC. Conclusions: Pathological type, ITE, targeted therapy and smoking history are important factors for evaluating the prognosis of TC patients receiving palliative treatment.
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BACKGROUND: Tracheal adenoid cystic carcinoma (TACC) is a rare salivary gland malignant tumor. Previous studies mainly focused on surgery, radiation, and chemotherapy. The purpose of this study is to describe more clinical characteristics, treatments, and overall survival (OS) of TACC. METHODS: Retrospectively analyzed TACC patients from two medical institutions and the SEER database from January 2010 to December 2021. Survival curves were drawn using the Kaplan-Meier method, and the effects of prognosis were analyzed by multivariate COX regression and AFT. The endpoint of the study was overall survival (OS). RESULTS: One hundred fifty TACC patients were enrolled (DZM 11, EG 64, SEER 75), and the 5- and 10-year survival rate was 70.62% and 35.80%, with a median survival time of 98 months. Lymph node status (yes) is an independent risk factor for TACC (HR = 3.020, 95% CI = 1.419-6.426, p = 0.004), and surgery is an independent protective factor (HR = 0.293, 95% CI = 0.146-0.587, p = 0.001). The AFT yielded similar results. In subgroup analysis of 63 non-surgical patients, lymph node status (Yes) (HR = 3.511, 95% CI = 1.498-8.229, p = 0.004), and tumor longitudinal diameter range (TLDR) > 1 (HR = 2.975, 95% CI = 1.360-6.506, p = 0.006) are independent risk factors, while Targeted Therapy (HR = 0.248, 95% CI = 0.096-0.637, p = 0.004) is an independent protective factor. CONCLUSION: Lymph node status and TLDR are prognostic factors of TACC. Surgery is associated with prolonged survival of TACC. Targeted therapy may be associated with improved survival among non-surgical TACC patients. TRIAL REGISTRATION: ChiCTR2400083551.
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Carcinoma Adenoide Cístico , Neoplasias da Traqueia , Humanos , Carcinoma Adenoide Cístico/terapia , Carcinoma Adenoide Cístico/mortalidade , Carcinoma Adenoide Cístico/patologia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Neoplasias da Traqueia/terapia , Neoplasias da Traqueia/mortalidade , Neoplasias da Traqueia/patologia , Neoplasias da Traqueia/diagnóstico , Prognóstico , Idoso , Adulto , Taxa de Sobrevida , Programa de SEER , Adulto JovemRESUMO
BACKGROUND: Ultrathin bronchoscopy (UTB) is commonly used to diagnose peripheral pulmonary lesions due to its small diameter. However, there is no consensus on its comparison with conventional bronchoscopy (CB) combined with various guiding modalities. METHODS: A comprehensive literature search was performed to identify studies comparing UTB and CB, extracting data on diagnostic yield, operating time, complications, pathological diagnoses, and lesion size. Protocol registration: identifier CRD42024554649. PRISMA guidelines were followed. RESULTS: This meta-analysis included 11 studies with 2,640 patients. UTB demonstrated a significantly higher diagnostic yield (70.5% vs. 57.6%, p = 0.005), particularly with rEBUS and fluoroscopy (p = 0.02). UTB had a higher complication rate, but the difference was not significant (p = 0.37). It also had a shorter operative time than CB-GS (p = 0.007). UTB showed a significant advantage in diagnosing malignant tumors, especially adenocarcinoma and metastatic cancer (p = 0.02, p = 0.03). Both techniques were comparable in diagnosing benign conditions, but UTB outperformed CB in all lesion size categories (p < 0.01). CONCLUSIONS: UTB's smaller diameter likely provides a diagnostic advantage over CB and CB-GS by enabling deeper and more accurate access to peripheral lung regions.
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Broncoscopia , Pneumopatias , Neoplasias Pulmonares , Pulmão , Humanos , Broncoscopia/métodos , Broncoscopia/efeitos adversos , Broncoscopia/instrumentação , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/diagnóstico , Valor Preditivo dos Testes , Pneumopatias/patologia , Pneumopatias/diagnóstico , Pulmão/patologia , Pulmão/diagnóstico por imagemRESUMO
Trachea squamous cell carcinoma (TSCC) is a subtype of lung cancer. A thorough investigation of the tumor microenvironment of TSCC is crucial for the development of cancer therapeutics and predicting clinical responses. In this study, we utilized single-cell RNA sequencing to analyze seven TSCC samples (including five malignant and two non-malignant samples) and obtained 70,682 high-quality cells. Based on the expression levels of marker genes, we identified 7 major cell types within the samples. By comparing malignant samples that received chemotherapy with those that did not, we identified critical transcriptional regulators responsible for T cell state transition in response to chemotherapy. Additionally, we found specific transcriptional regulators and differentially expressed genes between malignant and non-malignant groups. We identified more particularly abundant specifical intercellular communication in the malignant sample group and that may significantly influence the progression and spread of cancerous cells. Overall, our study provides the first single-cell atlas that comprehensively explains TSCC development and chemotherapy effects, thereby laying a new molecular foundation for therapeutic research in TSCC.
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AIMS: Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus. Early identification of individuals at high risk of DPN is essential for successful early intervention. Traditional Chinese medicine (TCM) tongue diagnosis, one of the four diagnostic methods, lacks specific algorithms for TCM symptoms and tongue features. This study aims to develop machine learning (ML) models based on TCM to predict the risk of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 4723 patients were included in the analysis (4430 with T2DM and 293 with DPN). TFDA-1 was used to obtain tongue images during a questionnaire survey. LASSO (least absolute shrinkage and selection operator) logistic regression model with fivefold cross-validation was used to select imaging features, which were then screened using best subset selection. The synthetic minority oversampling technique (SMOTE) algorithm was applied to address the class imbalance and eliminate possible bias. The area under the receiver operating characteristic curve (AUC) was used to evaluate the model's performance. Four ML algorithms, namely logistic regression (LR), random forest (RF), support vector classifier (SVC), and light gradient boosting machine (LGBM), were used to build predictive models for DPN. The importance of covariates in DPN was ranked using classifiers with better performance. RESULTS: The RF model performed the best, with an accuracy of 0.767, precision of 0.718, recall of 0.874, F-1 score of 0.789, and AUC of 0.77. With a value of 0.879, the LGBM model appeared to be the best regarding recall Age, sweating, dark red tongue, insomnia, and smoking were the five most significant RF features. Age, yellow coating, loose teeth, smoking, and insomnia were the five most significant features of the LGBM model. CONCLUSIONS: This cross-sectional study demonstrates that the RF and LGBM models can screen for high-risk DPN in T2DM patients using TCM symptoms and tongue features. The identified key TCM-related features, such as age, tongue coating, and other symptoms, may be advantageous in developing preventative measures for T2DM patients.
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Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Interpretação de Imagem Assistida por Computador , Aprendizado de Máquina , Doenças do Sistema Nervoso Periférico , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/etiologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Diabetes Mellitus Tipo 2/complicações , Medicina Tradicional Chinesa/métodos , Língua/diagnóstico por imagem , Estudos Transversais , Área Sob a Curva , Curva ROC , Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou maisRESUMO
Background: With the rapid development of critical care medicine, tracheal intubation and tracheotomy are increasingly used. Meanwhile, the number of tracheal stenosis cases, as one of the complications, is gradually rising. Bronchoscopic interventional treatment is quite effective for tracheal stenosis. However, the differences in treatment effects between post-intubation tracheal stenosis (PITS) and post-tracheostomy tracheal stenosis (PTTS) remain unclear. Also, there is a lack of in-depth and systematic exploration on the distinctions between these two types of tracheal stenosis with different causes. Thus, this article will describe and compare PITS and PTTS in detail, explore their differences and differences in treatment effects, aiming to provide a basis and guidance with certain reference value for clinical medical practice. Methods: In this cross-sectional observational study, the data of PITS and PTTS patients undergoing bronchoscopic interventional therapy in the Department of Respiratory and Critical Care Medicine II, and Oncology Department of Emergency General Hospital and the Department of Respiratory Medicine in Dongzhimen Hospital of Beijing University of Chinese Medicine were retrospectively analyzed. Results: The PTTS group had a higher prevalence of neurological diseases and burns, with more common dynamic stenosis; the PITS group was more commonly associated with drug poisoning respiratory, digestive, and circulatory system diseases, with scar tissue being more prevalent (P<0.05). Stenosis length was significantly longer in the PTTS than in the PITS. In terms of treatment modalities balloon dilatation and scleroscopic laser were more frequently used in the PITS group than in the PTTS group (P<0.05). After treatment, both groups showed significant reductions in the degree of stenosis and modified Medical Research Council (mMRC) scores, with a significant increase in Karnofsky Performance Status (KPS) scores (P<0.05), and a significant improvement in the degree of endoscopic stenosis (P<0.05). The PTTS group had fewer average hospitalizations and longer intervals between the two hospitalizations (P<0.05). Conclusions: The clinical characteristics of the two patient groups are different. Bronchoscopic intervention showed significant efficacy on PITS and PTTS, with a more pronounced improvement in KPS scores in PTTS patients.
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Pulmonary mixed squamous cell and glandular papilloma (MSCGP) is a subtype of pulmonary papilloma, which can be classified as central type and peripheral type based on its site of development. The central type is the most common. The clinical manifestations of pulmonary MSCGP are mainly related to the location of the tumor. Surgery is the main treatment for this disease. Bronchoscopic interventional treatment for the MSCGP in the central trachea could receive satisfactory effect. We reported a patient suffered from diffuse tracheal MSCGP who was treated by bronchoscopic interventional treatment in Respiratory Disease Center, Dongzhimen Hospital of Beijing University of Chinese Medicine, aiming to enhance the recognition of the clinical features and provide clinical references for the diagnosis and treatment of such disease.â©.
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Broncoscopia , Papiloma , Neoplasias da Traqueia , Humanos , Papiloma/cirurgia , Papiloma/patologia , Neoplasias da Traqueia/cirurgia , Neoplasias da Traqueia/diagnóstico , Masculino , Pessoa de Meia-Idade , FemininoRESUMO
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a severe autoimmune disease that often involves the upper and lower respiratory tracts. In recent years, numerous studies have found a significant increase in the incidence of cancer among AAV patients, but the association between lung cancer and AAV remains inconclusive, with relatively low clinical attention. This review summarizes the current literature on the risk of lung cancer in patients with ANCA-associated vasculitis (AAV), detailing the potential mechanisms by which AAV may contribute to lung cancer, and further elucidates the inherent carcinogenic risks of immunosuppressants.There is a correlation between AAV and lung cancer, which is related to T cell senescence and damage, as well as the abnormal expression of cytokines such as IL-6 and IL-10. In AAV patients, the use of cyclophosphamide and azathioprine (AZA) alone has a clear carcinogenic risk, with frequent use of CYC potentially posing a high risk for lung cancer. Although TNF inhibitors (TNFi) combined with CYC have carcinogenic risks, there is insufficient evidence to link them directly to an increased risk of lung cancer. For patients at high risk for lung cancer, the judicious use of immunosuppressants, timely computed tomography (CT), and lung cancer screening can reduce the risk of lung cancer in AAV patients.
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Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Imunossupressores , Neoplasias Pulmonares , Humanos , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia , Imunossupressores/uso terapêutico , Imunossupressores/efeitos adversos , Ciclofosfamida/uso terapêutico , Ciclofosfamida/efeitos adversos , Azatioprina/uso terapêutico , Azatioprina/efeitos adversosRESUMO
ABSTRACT: This expert consensus reviews current literature and provides clinical practice guidelines for the diagnosis and treatment of multiple ground glass nodule-like lung cancer. The main contents of this review include the following: â follow-up strategies, â¡ differential diagnosis, ⢠diagnosis and staging, ⣠treatment methods, and ⤠post-treatment follow-up.
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Consenso , Neoplasias Pulmonares , Humanos , Diagnóstico Diferencial , Gerenciamento Clínico , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/patologia , Nódulos Pulmonares Múltiplos/diagnóstico , Nódulos Pulmonares Múltiplos/patologia , Nódulos Pulmonares Múltiplos/terapia , Estadiamento de Neoplasias/normas , Guias de Prática Clínica como AssuntoRESUMO
Iron (Fe0, Fe (II), and Fe (III)) has been previously documented to upregulate the expression of key genes, enhancing the production of volatile fatty acids (VFAs) to achieve waste/wastewater resource recovery. However, the precise mechanism by why iron influences gene expression remains unclear. This study applied iron-assisted fermentation systems to explore the behind enhancing mechanism by constructing regulon networks among genes, microbes, and transcription factors. In iron-conditioned systems, a significant enhancement in VFAs production and upregulation of genes expression (1.19-3.92 folds) related to organic conversion and the electron transfer chain was observed. Besides, gene co-expression network and Procrustes analysis identified ten hub transcription factors (e.g., arsR, crp, iscR, perR) and their major contributors (genus) (e.g., Paludibacter, Acinetobacter, Tolumonas). Further analysis suggested that most of hub transcription factors were implicated in iron homeostasis regulation, which speculated that the induced iron homeostasis transcription factors probably effectively regulated the expression of genes encoding enzymes involving in VFAs production and electron transfer of functional microbes, in the case of Paludibacter, Acinetobacter, and Tolumonas while regulating the iron homeostasis, resulting in the efficient production of VFAs in iron-conditioned systems. This study might contribute to an enhanced understanding of the underlying genetic mechanisms by why iron influences gene expression regulation of microbes, which also provides a genetic theoretical basis for improving system VFAs production and resource recovery.
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Ácidos Graxos Voláteis , Fermentação , Ferro , Fatores de Transcrição , Ferro/metabolismo , Fatores de Transcrição/metabolismo , Fatores de Transcrição/genética , Ácidos Graxos Voláteis/metabolismo , Homeostase , Regulação Bacteriana da Expressão Gênica , Bactérias/metabolismo , Bactérias/genéticaRESUMO
BACKGROUND: Previous studies have validated the efficacy of both magnetic compression and surgical techniques in creating rabbit tracheoesophageal fistula (TEF) models. Magnetic compression achieves a 100% success rate but requires more time, while surgery, though less frequently successful, offers rapid model establishment and technical maturity in larger animal models. AIM: To determine the optimal approach for rabbit disease modeling and refine the process. METHODS: TEF models were created in 12 rabbits using both the modified magnetic compression technique and surgery. Comparisons of the time to model establishment, success rate, food and water intake, weight changes, activity levels, bronchoscopy findings, white blood cell counts, and biopsies were performed. In response to the failures encountered during modified magnetic compression modeling, we increased the sample size to 15 rabbit models and assessed the repeatability and stability of the models, comparing them with the original magnetic compression technique. RESULTS: The modified magnetic compression technique achieved a 66.7% success rate, whereas the success rate of the surgery technique was 33.3%. Surviving surgical rabbits might not meet subsequent experimental requirements due to TEF-related inflammation. In the modified magnetic compression group, one rabbit died, possibly due to magnet corrosion, and another died from tracheal magnet obstruction. Similar events occurred during the second round of modified magnetic compression modeling, with one rabbit possibly succumbing to aggravated lung infection. The operation time of the first round of modified magnetic compression was 3.2 ± 0.6 min, which was significantly reduced to 2.1 ± 0.4 min in the second round, compared to both the first round and that of the original technique. CONCLUSION: The modified magnetic compression technique exhibits lower stress responses, a simple procedure, a high success rate, and lower modeling costs, making it a more appropriate choice for constructing TEF models in rabbits.