Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition).

Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.

Change in left ventricular velocity time integral during Trendelenburg maneuver predicts fluid responsiveness in cardiac surgical patients in the operating room.

BACKGROUND: Fluid responsiveness is an important topic for clinicians. We investigated whether changes in left ventricular outflow tract (LVOT) velocity time integral (VTI) during a Trendelenburg position (TP) maneuver can predict fluid responsiveness as a non-invasive marker in coronary artery bypass graft (CABG) surgery patients in the operating room. METHODS: This prospective, single-center observational study, performed in the operating room, enrolled 65 elective CABG patients. Hemodynamic data coupled with transesophageal echocardiography monitoring of the LVOT VTI and the peak velocity were collected at each step [baseline 1, TP, baseline 2 and fluid challenge (FC)]. Patients whose VTI increased ≥15% after FC (500 mL of Gelofusine infusion within 30 min) were considered responders. RESULTS: Twenty-eight (43.1%) patients were responders to fluid administration. VTI changes during the TP maneuver predicted fluid responsiveness with an area under the receiver operating characteristic curve (AUC) of 0.90 (95% CI, 0.79-0.96), with a sensitivity of 100%, and a specificity of 70% at a threshold of 10% (gray zone, 8-15%). The increase in VTI during the TP was correlated with the VTI changes induced by FC (r=0.61, P<0.0001). Changes in peak velocity and pulse pressure during the TP were poorly predictive of fluid responsiveness, with an AUC of 0.72 (95% CI: 0.60-0.82) and 0.66 (95% CI: 0.53-0.77), respectively. CONCLUSIONS: An increase in VTI induced by the TP could predict fluid responsiveness in CABG patients in the operating room. However, changes in peak velocity and pulse pressure stimulated by the TP could not reliably predict fluid responsiveness.

May Measurement Month 2019: an analysis of blood pressure screening results from China.

To report the blood pressure (BP) data obtained in the May Measurement Month (MMM) 2019 in China. Study participants were recruited if ≥18 years of age and had ideally not had their BP measured for ≥1 year. BP was measured three times consecutively with a 1-min interval in the sitting position, using a validated electronic BP monitor. Trained volunteer investigators administered a questionnaire to collect information on lifestyle, medical history, and use of medications. The measurement was performed in 238 387 participants in 250 sites across 31 China provinces. The majority of screening took place in hospitals or clinics (78.7%), with 17.1% in outdoor public areas and 4.2% in other settings. The study participants included 127 853 women (53.6%) and had a mean (±SD) age of 48.9 ± 16.2 years. The mean (of readings two and three) systolic/diastolic BP was 121.8/73.8 mmHg. In all hypertensive patients (n = 66 181, 27.8%), the awareness, treatment, and control rates of hypertension were 51.5%, 48.4%, and 29.1%, respectively. Linear regression models showed differences in systolic and diastolic BP according to sex and age and several other major characteristics, such as previous stroke, myocardial infarction, and diabetes mellitus, antihypertensive medication use and known hypertension, previous hypertension in pregnancy and current pregnancy, alcohol intake and current smoking, and body mass index. The MMM 2019 campaign has been successful in measuring BP in a large member of participants in China.

May Measurement Month 2018: an analysis of blood pressure screening results from China.

To further improve awareness, treatment, and control of hypertension, the May Measurement Month (MMM) campaign continued in 2018 in China. Study subjects were adults aged 18 years or more, ideally those who had not their blood pressure (BP) measured for at least a year. Blood pressure was measured three times consecutively with a 1-min interval in the sitting position, using automated BP monitors in 288 342 participants and transmitted to a central database by a smartphone app. Questionnaire data were collected with the same app. After imputation, the overall proportion of hypertension was 29.8%. Of those with hypertension, the rates of awareness, treatment, and control were 62.3%, 57.3%, and 35.9%, respectively. In analysis based on linear regression models, both systolic and diastolic BP were higher with cigarette smoking, alcohol intake, and overweight and obesity. Our study results suggest that hypertension management is improving in comparison with the data in MMM 2017 and the nationwide survey in 2012-15, and several known lifestyle factors are key to hypertension management.

End-expiratory occlusion test predicts fluid responsiveness in cardiac surgical patients in the operating theatre.

BACKGROUND: The aim of this study was to evaluate whether a 20-second end-expiratory occlusion (EEO) test can predict fluid responsiveness in cardiac surgery patients in the operating theatre. METHODS: This prospective study enrolled 75 mechanically ventilated patients undergoing elective coronary artery bypass grafting surgery. Hemodynamic data coupled with transesophageal echocardiography monitoring of the velocity time integral (VTI) and the peak velocity (Vmax) at the left ventricular outflow tract were collected at each step (baseline 1, EEO, baseline 2 and fluid challenge). Patients were divided into fluid responders (increase in VTI ≥15%) and non-responders (increase in VTI <15%) after a fluid challenge (6 mL 0.9% saline per kg, given in 10 minutes). RESULTS: Fluid challenge significantly increased the VTI by more than 15% in 36 (48%) patients (responders). An increase in VTI greater than 5% during the EEO test predicted fluid responsiveness with a sensitivity of 81% and a specificity of 93%. The area under the receiver-operating characteristic curve (AUROC) of ΔVTI-EEO was 0.90 [95% confidence interval (CI): 0.83-0.97]. ΔVmax-EEO was poorly predictive of fluid responsiveness, with an AUC of 0.75 (95% CI: 0.63-0.86). CONCLUSIONS: Changes in VTI induced by a 20-second EEO can reliably predict fluid responsiveness in cardiac surgical patients in the operating theatre, whereas the changes in Vmax cannot.

Qi-Dong-Huo-Xue-Yin Inhibits Inflammation in Acute Lung Injury in Mice via Toll-Like Receptor 4/Caveolin-1 Signaling.

Acute lung injury (ALI) is a critical illness with no current effective treatment. Caveolin-1 indirectly activates inflammation-associated signaling pathways by inhibiting endothelial nitric oxide synthase (eNOS). This induces an imbalance between pro- and anti-inflammatory cytokine levels, which are involved in the pathogenesis of ALI. The compound Chinese prescription Qi-Dong-Huo-Xue-Yin (QDHXY) is efficacious for ALI treatment via an anti-inflammatory effect; however, the exact underlying mechanism is unknown. Therefore, we explored the protective effect of QDHXY against lipopolysaccharide- (LPS-) induced ALI in mice. Histopathological changes in mouse lung tissues were studied. Furthermore, alterations in the serum levels of pro- and anti-inflammatory cytokines were investigated. The levels of tumor necrosis factor- (TNF-)α, interleukin- (IL-) 6, IL-1ß, and interferon-γ-induced protein 10 in bronchoalveolar lavage fluid were measured. Additionally, the expression levels of myeloid differentiation factor 88 (MyD88), caveolin-1, and eNOS were assessed. QDHXY significantly reduced lung infiltration with inflammatory cells and the production of serum pro- and anti-inflammatory cytokines and inhibited the expression of TNF-α, IL-1ß, caveolin-1, and MyD88 but not eNOS. These indicate that QDHXY significantly improved the balance between pro- and anti-inflammatory cytokine levels, possibly by inhibiting the caveolin-1 signaling pathway. Therefore, QDHXY may be a potential treatment for ALI.

Extrapleural locating method in computed tomography-guided needle biopsies of 1,106 lung lesions.

Transthoracic needle biopsy is considered to be safe and effective for the diagnosis of focal lung lesions. The aim of the present study was to evaluate factors affecting the accuracy and safety of automated cutting needle lung biopsy (ACNB) using a new extrapleural locating (EPL) method. Computed tomography (CT)-guided needle biopsies were performed on 1,065 patients between March 2005 and May 2012 using the EPL method. The locating needle remained in the chest following extrapleural positioning, while the radiologist confirmed the puncture angle and distance between the locating needle and lesion. The biopsy instrument was advanced into the lung, and the core needle was subsequently fired into the lesion based on the direction indicated by the locating needle. Univariate and multivariate regression analyses were used to evaluate the diagnostic accuracy and safety of the procedure. The sensitivity, specificity, positive predictive value and negative predictive value of the extrapleural method were 91.9, 100, 100 and 82.9%, respectively, and the overall diagnostic accuracy was 94.2%. Significant risk factors affecting accuracy were younger age, atelectasis, hemoptysis and lesion depth (P<0.03). Multivariate logistic regression analysis revealed that the risk of malignant lesions receiving a false-negative diagnosis decreased for each additional year of subject age [odds ratio (OR), 0.97; P=0.027] and increased with each millimeter increase in lesion depth (OR, 1.03; P=0.008). Among the 1,106 lesions biopsied, 207 were associated with pneumothorax, 251 with hemorrhage and 58 with hemoptysis. Multivariate analysis revealed that lesion size and emphysema affected pneumothorax incidence, while age, lesion location and depth and emphysema significantly affected hemorrhage incidence (P<0.05). In conclusion, low-dose, CT-guided ACNB with the EPL method provides a safe and accurate diagnosis.

Computed tomography-guided cutting needle pleural biopsy: Accuracy and complications.

In cases of pleural lesion, tissue samples can be obtained through thoracoscopy or closed needle biopsy for histopathological analysis. Cutting needle biopsy is a relatively recent addition to these techniques. The aim of this study was to evaluate the diagnostic accuracy and safety of computed tomography-guided cutting needle pleural biopsy (CT-CNPB), as well as the associated complications, in patients with pleural lesion. This study was a retrospective analysis of 92 percutaneous CT-CNPBs on 90 patients between March 2008 and May 2013. For group comparisons, χ2 tests were used to detect the risk factors for diagnostic accuracy (false-negative rate). Of the 92 CT-CNPBs, malignant lesions were diagnosed in 55 cases (mesothelioma in 12, metastatic pleural disease in 36, synoviosarcoma in one, indeterminate-origin disease in one and false-negative lesion in five) and benign pleural disease was diagnosed in 37 cases (inflammation in 15, tuberculosis in 10, granuloma in three, solitary fibrous tumor in two, hematoma in one, fungus in one and indeterminate-origin disease in five). The sensitivity of diagnostic malignant lesion was 90.9%, and the specificity and positive and negative predictive values were 100, 100 and 88.1%, respectively. The overall diagnostic accuracy was 94.6%. A specific diagnosis was achieved in 89.1% of malignant lesions and 86.4% of benign lesions. Univariate analysis of the risk factors affecting accuracy (false-negative rate) did not reveal any significant differences (all P>0.05). The complication rates were 6.5% for pneumothorax, 8.7% for hemorrhage and 1.1% for hemothorax. In conclusion, CT-CNPB is a safe and accurate diagnostic technique that can be recommended as the primary method of diagnosis in patients with pleural thickening or lesions observed by CT scan.

Imaging appearance of a singular metastatic adenoid cystic carcinoma of the right kidney: A case report and literature review.

Renal metastasis of a submandibular gland adenoid cystic carcinoma is clinically rare when it presents with an atypical imaging appearance of singular renal metastases. Whole-body positron emission tomography (PET)/computed tomography (CT) can determine whether the singular renal mass is benign or malignant and identify metastases in other parts of the body, particularly in uncommon sites. In the present case, the patient developed a rare partial metastasis to the right kidney three years after undergoing a surgery for submandibular gland adenoid cystic carcinoma. Based on the present case, whole-body PET/CT examination could provide an important basis for making treatment plans for singular renal metastases.

The value of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in the detection and characterization of soft tissue metastasis.

Metastatic tumours presenting as soft tissue metastasis (STM) are relatively rare. STM represents metastasis to the muscle and subcutaneous tissues. The majority of the currently available clinical or radiological data on STM consist of isolated case reports or reviews. The aim of this study was to report the manifestations, origin and distribution of STM detected by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and to assess the value of 18F-FDG PET/CT in the characterisation of STM. We reviewed 17 cases of patients with STM who underwent 18F-FDG PET/CT scanning. The imaging and clinical data of these patients were retrospectively analysed. This method is very sensitive in the detection of STM and provides ample information for clinical tumour staging. PET is more sensitive compared to CT in detecting lesions in muscle, before the density and morphology of the soft tissues are altered, providing a clear view within the soft tissue. Due to the limitations in resolution, PET is less sensitive compared to CT in detecting lesions in the subcutaneous tissues. The aim of this study was to improve our knowledge of 18F-FDG PET/CT findings in the diagnosis of STM and determine its value in the staging of malignant tumours.

Primary retroperitoneal extraskeletal mesenchymal chondrosarcoma involving the vena cava: A case report.

The current study presents a case of extraskeletal mesenchymal chondrosarcoma (ESMC) involving the vena cava that originally occurred in the retroperitoneum of a 61-year-old female. Following excision of the masses, pathological examination confirmed a diagnosis of primary ESMC. Mesenchymal chondrosarcomas are extremely rare in comparison to conventional chondrosarcomas and even more so when arising in an extraskeletal location. In the current report, the major characteristics of ESMC are discussed and a review of the current knowledge regarding this rare disease entity is presented.

13,14-bis(cis-3,5-dimethyl-1-piperazinyl)-ß-elemene, a novel ß-elemene derivative, shows potent antitumor activities via inhibition of mTOR in human breast cancer cells.

Elemene has been approved for the treatment of advanced cancer in China, however, it inhibits cell growth only at high concentrations and is an essential oil with poor water solubility and stability. The discovery of new ß-elemene derivatives is of increasing interest. We recently reported that the compound 13,14-bis(cis-3,5-dimethyl-1-piperazinyl)-ß-elemene (IIi), a novel ß-elemene derivative with a cis-2,6-dimethylpiperazine substitution, is a potent agent for inhibiting the proliferation of SGC-7901 and HeLa cells. In the present study, we further verified that IIi is cytotoxic to a wide spectrum of human cancer cells in culture, including those of breast, ovarian, lung, gastric, hepatocellular and colon cancer, as well as leukemia cell lines, with an average IC50 of 3.44 µmol/l. Notably, IIi showed significant cytotoxicity in two multidrug-resistant (MDR) cell lines, with an average resistance factor (RF) of 1.66. Moreover, in mice with S-180 sarcoma xenografts, the intraperitoneal administration of IIi inhibited tumor growth. The immunoblotting study showed that treatment with IIi decreases phosphorylated p70S6K1 and 4EBP1 levels in the human breast cancer MCF-7 and MDA-MB-468 cells. In the MCF-7 cells, IIi also significantly increased the expression of cleaved LC3. This indicated that IIi inhibits mTOR activity and induces autophagy. The mTOR inhibitory function and the potent antitumor activity, taken together with the appreciable anti-multidrug resistance action, shows IIi to be a novel potential antitumor agent, which merits further research and development.

[The factor analysis of the incidence of complication in CT-guided lung automated cutting needle biopsy with extrapleural locating method].

OBJECTIVE: To evaluate the complication rate and analyze its impact of multiple facts of CT-guided percutaneous lung automated cutting needle biopsies (ACNB) with extrapleural locating method (EPL). METHODS: Retrospective study where information was obtained from the department of medical imaging, the sign of complication after 480 cases CT-guided ACNB with EPL was observed and its relationship with multiple factors were analyzed by multiple logistic regression model. RESULTS: The diagnostic accuracy was made in 456 cases (95.0%). The length of the biopsy procedures was 16 ± 2 min and the time of the biopsy needle in pulmonary parenchyma was < 20 s. Seventy-one (14.8%) cases presented pneumothorax which include 7 (1.5%) cases later pneumothorax, and 2 (0.4%) required chest tube insertions. The multivariate logistic regression analysis showed that emphysema, depth of intrapulmonal biopsy path and lesion size were sole effective factors of pneumothorax (OR = 7.991, 1.083, and 0.945 respectively). Lesions with emphysema, depth of intrapulmonal biopsy path and lesion size ≤ 10 mm had higher pneumothorax rates. Eight-seven (18.1%) cases presented pulmonary hemorrhage and twenty-six (5.4%) presented hemoptysis. The multivariate logistic regression analysis showed that depth of intrapulmonal biopsy path, emphysema, and number of pleural needle passes were sole effective factors (OR = 1.143, 0.712, and 0.521, respectively) of pulmonary hemorrhage. In patients with depth > 10 mm or 20 mm, emphysema and number of pleural needle passes had higher hemorrhage rates. The multivariate logistic regression analysis showed that depth of intrapulmonal biopsy path and emphysema were sole effective factors (OR = 1.077, and 0.578, respectively) of hemoptysis. Lesions with depth > 20 mm had higher hemoptysis rate. One case with pulmonary Cryptococcus presented pleural reaction, and three cases had the insistent pain. The total number of severe complications was 15 (3.1%) cases. CONCLUSION: ACNB with EPL was an accurate method for diagnosing pulmonary lesions. ACNB can be safely performed, which reduces the rate of pneumothorax and hemorrhage. Pneumothorax rate was influenced by emphysema, depth of intrapulmonal biopsy path and lesion size ≤ 10 mm. Hemorrhage was related with depth >10 mm or 20 mm, emphysema and number of pleural needle passes. Hemoptysis was related with depth of intrapulmonal biopsy path >20 mm. Later and severe complications should be considered in procedure.

[Microbial reduction and mobilization of adsorbed arsenate on ferric/aluminum hydroxides].

Although the mechanisms of arsenic release into groundwater remain poorly characterized, microbial reduction of As (V) adsorbed on the surface of iron oxides and the reductive dissolution of iron oxides are generally considered to play a key role in the mobilization of arsenic. We investigated the impact of bacterial reduction of adsorbed As (V) on a Al:Fe (1:0, 1:1, 0:1) hydroxides on arsenic mobilization using the mixed bacterial culture. After inoculation, the increase of dissolved As (III) concentration was observed, whereas As (V) was negligible in aqueous phase. Arenic release for the Al:Fe (1:0, 1:1, 0:1) hydroxides systems was 60 microg/L, 1.3 mg/L and 7.8 mg/L respectively. On the contrary, neither reduction nor release of arsenic was observed in the uninoculated groups. Furthermore, the introduction of aluminium may be responsible for the release of arsenic owing to its weaker affinity to As (III). In addition, our results showed that Fe reduction occurred far later than arsenic reduction and mobilization and obvious increase was not observed even after Fe reduction occurred. It suggested that in natural systems, the biotic reduction of As (V) adsorbed on ferric oxides or Fe (III) may not the major cause of arsenic release in sediment or groundwater system as previous works proposed. The reduction of As (V) bound to aluminum oxides or other minerals may play a key role.

[Preliminary outcome of large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty for whole cornea destruction].

OBJECTIVE: To understand the indication, surgical principle, outcome and complications of large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty for whole cornea destruction. METHODS: Eleven hospitalized patients with whole cornea destruction in Zhongshan Ophthalmic Center, Sun Yat-Sen University from May, 2005 to March, 2006 were involved in this study. Five left eyes and six right eyes underwent large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty. The patients were followed up for 12 to 18 months and their pinhole postoperative visual acuity, intraocular pressure, pachymetry of the central cornea and corneal endothelial cell density was recorded. RESULTS: The pinhole postoperative visual acuity of all patients improved and averaged separately 4.4 +/- 0.3, 4.5 +/- 0.3 and 4.5 +/- 0.3 at the 3rd, 6th and 12th postoperative month. There was a temporary increase of the postoperative intraocular pressure within one postoperative week which can be controlled by medication and released soon. And the postoperative intraocular pressure averaged (19.8 +/- 2.7), (19.2 +/- 1.7) and (19.5 +/- 2.0) mm Hg respectively at the 3rd, 6th and 12th month postoperatively. At the same following up times, the pachymetry of the central cornea averaged (538.9 +/- 8.9), (536.3 +/- 6.3) and (537.2 +/- 6.9) microm respectively and the corneal endothelial cell density averaged (2519.8 +/- 110.7), (2244.4 +/- 137.9) and (2093.3 +/- 141.9) cells/mm2 respectively. The main complication was the interspace between the two lamellar grafts and it would disappear automatically within one postoperative month. CONCLUSIONS: Large-diameter lamellar keratoplasty combined with deep lamellar endothelial keratoplasty can avoid postoperative glaucoma. It may offer further advantages over traditional surgery to treat whole cornea destruction.

[Applications of magnetic resonance imaging in diagnosis of the complications after breast augmentation with polyacrylamide hydrogel injection].

OBJECTIVE: To explore the clinical value of magnetic resonance (MR) imaging in the diagnosis of the complications after breast augmentation with polyacrylamide hydrogel injection. METHODS: MRI was performed in 16 patients who had breast augmentation with polyacrylamide hydrogel injection. The results of magnetic resonance imaging were compared with the clinical symptoms. RESULTS: MRI examinations of the 16 patients showed that (1) 4 breasts in 2 patients were comparatively natural; (2) a large lacteal cyst was detected in one patients in lactation; (3) breast asymmetry occurred in 3 patients (6 sides); (4) in 10 patients (20 sides), the injected gel was in irregular form. The results of MRI were in accord with the clinical symptoms. CONCLUSION: MRI is of great diagnostic value for the complications after breast augmentation with polyacrylamide hydrogel injection.

Human papillomavirus type 16 intratypic variant infection and risk for cervical neoplasia in southern China.

A case-control study was conducted on 1986 Hong Kong women to assess the risk of human papillomavirus (HPV) type 16 variants for cervical neoplasia. In total, 255 women were HPV-16 positive and were analyzed for E6 and E7 sequence variation. Two novel substitutions at E6 (T86I and Q116E) and 1 at E7 (R66W) were found. Most HPV-16 variants were of Asian (50.6%) or European (44.3%) lineage, and both lineages showed similar risk associations for high-grade and invasive cervical neoplasia. No increased risk was observed for the subclasses European variant and European 350G, which carry a higher risk for invasive cancer in some Western populations. The E7 N29S substitution, reported to have a higher risk in Korean women, was found equally distributed among normal and various degrees of neoplasia. The epidemiology and risk implication of HPV-16 variant infection in Hong Kong differ markedly from other parts of the world.