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Objective:To investigate the effect of early interventional therapy with fiberoptic bronchoscope in patients with inflammatory infiltrating type (Ⅰ type) tracheobronchial tuberculosis (TBTB).Methods:Using prospective research methods, 306 patients with Ⅰ type TBTB diagnosed by fiberoptic bronchoscopy in the Third People′s Hospital of Kunming City from January 2019 to April 2022 were selected. The patients were divided into observation group and control group according to the random number table method with 153 cases each. The patients in control group were given routine anti-tuberculosis chemotherapy, and the patients in observation group were given routine anti-tuberculosis chemotherapy combined with early interventional therapy with fiberoptic bronchoscope. Sputum smear examination and tuberculosis culture were performed at the end of 1, 3 and 6 months of treatment, and the negative conversion of sputum culture was recorded. Chest X-ray, pulmonary function and fiberoptic bronchoscope were performed at the end of 1, 3 and 6 months of treatment to evaluate the improvement rate of clinical symptoms, effective absorption rate of lesions and effective absorption rate of obstructive pneumonia. The CD 4+, CD 8+, CD 4+/CD 8+, interferon γ (IFN-γ), interleukin-6 (IL-6) and C reactive protein (CRP) before and after treatment were detected. The random walking model of immune inflammation was evaluated. Results:The sputum negative conversion rates at the end of 1, 3 and 6 months of treatment in observation group were significantly higher than those in control group: 64.71%(99/153) vs. 52.29%(80/153), 80.39%(123/153) vs. 62.09%(95/153) and 91.50%(140/153) vs. 73.86%(113/153), and there were statistical differences ( P<0.05 or <0.01). The improvement rate of clinical symptoms at the end of 1 month of treatment in observation group was significantly higher than that in control group: 94.77%(145/153) vs. 66.67%(102/153), and there was statistical difference ( P<0.01); the clinical symptoms disappeared in both groups at the end of 3 and 6 months of treatment. The effective absorption rates of lesions at the end of 1 and 3 months of treatment in observation group were significantly higher than those in control group: 73.20%(112/153) vs. 51.63%(79/153) and 96.73%(148/153) vs. 85.62%(131/153), and there were statistical differences ( P<0.01); all the lesions were absorbed at the end of 6 months of treatment in both groups. The effective absorption rates of obstructive pneumonia at the end of 1 and 3 months of treatment in observation group were significantly higher than those in control group: 78.43% (120/153) vs. 39.87%(61/153) and 89.54%(137/153) vs. 79.08%(121/153), and there were statistical differences ( P<0.01 or <0.05); all obstructive pneumonia were absorbed at the end of 6 months of treatment in both groups. There were no statistical differences in CD 4+, CD 8+, CD 4+/CD 8+, IL-6, IFN-γ and CRP before treatment between the two groups ( P>0.05); the CD 4+, CD 4+/CD 8+ and IFN-γ after treatment in observation group were significantly higher than those in control group: 0.343 ± 0.032 vs. 0.311 ± 0.023, 1.37 ± 0.18 vs. 1.12 ± 0.16 and (38.47 ± 3.50) ng/L vs. (20.52 ± 2.96) ng/L, the CD 8+, IL-6 and CRP were significantly lower than those in control group: 0.251 ± 0.020 vs. 0.268 ± 0.021, (19.40 ± 3.31) ng/L vs. (34.58 ± 5.82) ng/L and (10.41 ± 2.87) mg/L vs. (17.47 ± 3.14) mg/L, and there were statistical differences ( P<0.01). The evaluation results of random walking model showed that CD 4+, CD 8+, CD 4+/CD 8+, IFN-γ, IL-6 and CRP in the observation group were better than those in the control group in the maximum random fluctuation, number of walking steps, positive walking growth rate, random fluctuation power law value, comprehensive improvement rate, recording times of comprehensive evaluation index and expected improvement value. Conclusions:Early interventional therapy with fiberoptic bronchoscope can effectively assist systemic drug therapy in patients with Ⅰ type TBTB, which can accelerate focus absorption, promote sputum negative conversion, enhance cellular immunity and effectively inhibit inflammatory reaction.
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OBJECTIVE@#To investigate accuracy of the currently used strategies for intraocular pressure measurements for reflecting actual 24-hour intraocular pressure fluctuations.@*METHODS@#From September, 2018 to January, 2019, the patients with a suspected diagnosis of primary open angle glaucoma at our hospital were prospectively enrolled to receive 24-hour intraocular pressure monitoring using a Goldmann tonometer. With the intraocular pressure measurements at 0:00, 2:00, 5:00, 7:00, 8:00, 10:00, 11:00, 14:00, 16:00, 18:00, 20:00, and 22:00 as the gold standard (strategy 1), we compared the measurements taken at 5:00, 7:00, 10:00, 14:00, 18:00, and 22:00 (strategy 2) and at 8:00, 11:00, 14:00, and 16:00 (strategy 3) for their accuracy in reflecting 24-h intraocular pressure fluctuations.@*RESULTS@#A total of 41 patients (82 eyes) were enrolled in this study. The peak intraocular pressures measured using the 3 strategies were 21.09±4.15 mmHg, 20.54±4.10 mmHg, and 19.91±4.38 mmHg, respectively, showing significant differences among them (@*CONCLUSIONS@#For suspected cases of glaucoma, intraocular pressure measurements at 4 and 6 time points of a day can not precisely reflect the actual range of intraocular pressure fluctuations, and may lead to a missed diagnosis of glaucoma.
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Humans , Glaucoma/diagnosis , Glaucoma, Open-Angle , Intraocular Pressure , Prospective Studies , Tonometry, OcularABSTRACT
Background Using tablet computer at a short distance is one of the risk factors resulting to pathogenesis and progression of myopia.Studying the effect of such device on accommodative system of human eyes can provide further insights into myopia control.Objective This study was to explore the influences of playing iPAD game for a short duration on accommodative response,accommodative microfluctuation and pupil diameter in adolescent myopia patients.Methods Sixty adolescent myopic patients were included in Peking University People 's Hospital from August 2014 to April 2015,with the mean age (11.6±2.6) years and mean spherical equivalent refraction (SER) (-2.38±1.08)D.The patients were randomly divided into 3 groups according to different playing duration of iPAD game,including 3-minute group,5-minute group and 10-minute group.An open-field infrared refractometer was used to record pupil diameter and accommodation-associated data before and after playing iPAD game.Accommodative response was defined as the difference between the recorded value and theoretical accommodative response,and root mean square (RMS) was used to describe the amplitude of accommodative microfluctuation.One-dimension discrete Fourier transformation was used to analyze spectral characteristic of accommodative response curve.Paired t tests were used to compare these accommodative parameters before and after playing game,while Wilcoxon signed-rank tests were applied for analyzing high frequency component of accommodative microfluctuation.This research conforms to the declaration of Helsinki,and was approved by Peking University People's Hospital Ethics Committee,all the subjects and their guardian signed informed consent.Results The accommodative response values before and after playing iPAD game in 10-minute group were (0.81 ±0.29)D and (0.74 ± 0.27) D,respectively,with significant difference between them (t =2.263,P =0.036),and no significant differences were found in the accommodative response values before and after playing iPAD game in the 3-minute group and 5-minute group (both at P＞0.05).The RMS after playing iPAD game was (0.31 ±0.08) D in the 10-minute group,which was significantly higher than (0.27 ± 0.09) D before playing iPAD game (t =-2.259,P =0.036).The high-frequency spectral power of accommodative response curves in all the three groups were increased after playing iPAD game in comparison with before playing iPAD game,with significant differences in the 5-minute group and 10-minute group (Z =-2.213,-2.016;both at P ＜ 0.05),and the pupil diameters were significantly decreased after playing iPAD game in comparison with before playing iPAD game,with significant differences in the 5-minute group and 10-minute group (t =2.428,P =0.026;t =2.515,P =0.021).Conclusions Short-term exposure to iPAD does not deteriorate accommodative lag in adolescent myopic patients.However,the increase of amplitude and high-frequency spectral power of accommodative microfluctuation,together with accommodation lag will result in blurred images and may bring adverse effects on myopic eyes.
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Objective To evaluate CT and MRI findings of portal vein aneurysm(PVA)in order to improve its diagnostic accuracy.Methods CT and MRI findings of 9 patients with PVA proved by pathology and direct angiography were reviewed retrospectively.CT scanning was performed in 7 patients,including plain scan (n=2),both plain and enhanced scan (n=5),CT angiography (CTA)(n=3).Plain and enhanced MRI scan were performed in 3 patients.Results (1 )PVA showed a high predilection for old adults.(2 )Of the 9 tumors,4 located in portal vein trunk,2 located in junction of superior mesenteric vein and portal vein trunk,1 located in intrahepat-ic-extrahepatic portal vein,2 located in intra-hepatic portal vein.(3)8 tumors were characterized as well-defined and quasi-circular mass.1 patient occurred portal hypertension,thrombus as the portal vein trunk was oppressed by the tumor.(4)Plain CT showed the mass was slightly higher than pancreas parenchyma density,and uniform with the density of the liver parenchyma.Enhancement scanning showed 4 tumors represented mild or moderate enhancement in portal venous phase except for 1 patient accompany with portal vein thrombus.CTA showed clearly the relationship mass with portal vein,and classified the type of PVA .The 3 lesions represented hypo-intensity on T1 WI and even hyper-intensity on T2 WI.Enhancement scanning showed the tumor was significantly enhancement in portal venous phase on T1 WI.Conclusion CT and MRI have their own advantages in the diagnosis of portal vein aneurysm.Com-bination of CT and MRI could improve the diagnostic accuracy of portal vein aneurysm.
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<p><b>OBJECTIVE</b>To assess the efficacy and safety of bilateral versus unilateral biliary drainage in malignant hilar obstruction.</p><p><b>METHODS</b>Topically relevant studies,regardless of randomized or observational design, were searched for in PubMed, EmBase and the Cochrane Library database. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to compare the effect of the two treatments.</p><p><b>RESULTS</b>Three randomized trials and 7 observational studies were included, involving 894 patients with malignant hilar obstruction. The meta-analysis assessment of primary outcomes showed that the stent patency rate was better in bilateral drainage than in unilateral drainage (Rr=2.03,95% CI [1.16-3.56], P=0.01), but there were no significant differences in successful drainage rate (Rr=1.07,95% CI [0.97-1.18], P=0.20) and patient survival rate (Rr=-0.16,95% CI [-0.40-0.08], P=0.20). In the analysis of secondary outcomes,there were also no significant differences in the technical success rate (Rr=1.05,95% CI [0.98-1.17], P=0.34),the early complication rate (Rr=1.15, 95% CI [0.75-1.76], P=0.52), late complication rate (Rr=1.09,95% CI [0.75-1.60], P=0.60) and 30-day mortality rate (Rr=0.68,95% CI [0.38-1.23], P=0.20).</p><p><b>CONCLUSION</b>Although the cumulative stent patency was better for the bilateral than the unilateral drainage approach, based on the available data, there is not enough data to support bilateral drainage for malignant hilar obstruction. Well-designed randomized controlled trials are necessary to confirm it.</p>
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Humans , Biliary Tract Neoplasms , Pathology , Cholestasis , Therapeutics , Drainage , MethodsABSTRACT
Objective To summarize and investigate the lethal factor of acute obstructive suppurative cholangitis (AOSC).Methods The clinical data of 56 patients with AOSC were retrospectively analyzed.Results Six cases died,5 cases with acidosis,5 cases with thrombocytopenia and 5 cases with temperature change obviously,4 cases with heart,lung and kidney disease or diabetes,5 cases with operation and operation time ≥ 150 min,5 cases with from onset to treatment time ≥72 h.Eighteen cases of elderly patients ≥70 years old,4 cases died.The patients whose age≥70 years,temperature ≥39 ℃ or ＜ 36 ℃,combined with acidosis,platelet counts ≤6.0 × 1012/L,with heart,lung,kidney diease or diabetes,time of anesthesia and operation ≥ 150 min and from onset to treatment time ≥72 h had higher death rate (P ＜ 0.05).Conclusion Age,obvious temperature abnormalities,significantly platelet decrease,with heart,lung,kidney diease or diabetes,acidosis,long time of anesthesia and operation and from onset to treatment time ≥ 72 h are the lethal factor of AOSC.
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Since intra-arterial chemotherapy with the help of implantation of port-catheter system (PCS) was first used in the surgical field in 1981, PCS has been widely employed in the field of interventional radiology. Intra-arterial chemotherapy by implantation of PCS has some certain advantages such as minimal invasion, no need of general anesthesia, etc. Ten randomized clinic trails have been already reported, which indicate that intra- arterial chemotherapy with PCS is obviously superior to systemic chemotherapy in treating hepatic metastasis form colorectal cancer. As for the treatment of advanced biliary tract cancer, pancreatic carcinoma and hepatocellular carcinoma, the relevant reports can be found only in several phaseⅠ/Ⅱclinical trials or in some retrospective cohort studies. This paper aims to make a comprehensive review about the indications, clinical applications and complications of PCS in treating abdominal tumors in order to improve the clinical practice.
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Objective To analyze the risk factors of 30-day mortality in patients with malignant hilar obstruction (MHO) after percutaneous transhepatic biliary metal stent deployment. Methods One hundred and fifty-nine consecutive patients with MHO caused by cholangiocarcinoma or gallbladder carcinoma were enrolled in this study. Percutaneous transhepatic biliary stent (PTBS) implantation was carried out in all the patients. Independent predictors for 30-day mortality were evaluated by logistic regression analysis. Covariates that were incorporated into the multivariate analysis were the variables that reached statistical significance (P < 0.1) in univariate analysis. Two-tailed, P value of less than 0.05 was considered to be statistically significant. Results The 30-day mortality of patient with MHO after metal stent deployment was 9.4%. Univariate analysis indicated that the differences in WBC (OR = 1.224.95%CI [1.07 - 1.44], P < 0.01), INR (OR=78.75, 95%CI [5.02-1 235.70], P<0.01), PT(OR=1.55, 95%CI [1.18-2.04], P<0.01), BUN (OR=1.19, 95%CI [1.02- 1.38], P < 0.05), CRE(OR = 1.02, 95%CI [1.000 - 1.041], P < 0.1) and lymph nodes metastasis(OR = 0.334. 95%CI[0.105 - 1.131], P < 0.1) were statistically significantly between 30-day mortality group and non-30-day mortality group. Multivariate analysis showed that statistically significant differences in WBC (OR = 1.19, 95%CI[1.026 - 1.380], P < 0.05), INR(OR = 151.5, 95%CI [3.13 - 5 440.7], P < 0.05) and CRE (OR = 1.025, 95%CI [1.002 - 1.048], P < 0.05) also existed palliative treatment for patients with malignant hilar obstruction. Active preoperative measures to improve hepatic and renal functions as well as to control infection are necessary in order to reduce 30-day mortality.
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Molecular targeted therapy has become a new hot spot with the in -depth basic research on advanced biliary tract cancer (ABTC).Phase ⅡandⅢtrials of the molecular targeted therapies for ABTC are summarized to provide new insights into clinical practice. Phase II trials have shown that vascular endothelial growth factor receptor inhibitor and mitogen-activated protein kinase inhibitor do not ex-hibit good anti-tumor activity,but epidermal growth factor receptor (EGFR)inhibitor has proven to be safe and effective in the treatment of ABTC.The only multicenter,open-label,randomized,controlled phase Ⅲ trial has shown that nilotinib combined with gemcitabine and oxaliplatin,as the first-line chemotherapy for ABTC,cannot significantly increase the overall survival in patients.Subgroup analysis has shown that standard chemotherapy combined with nilotinib can significantly increase the progression-free survival in patients.These results indicate that EGFR inhibitor is effective to control the progression of ABTC,suggesting that EGFR might be a novel therapeutic target.
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<p><b>BACKGROUND</b>Neoadjuvant chemotherapy is one of the hot points of lung cancer therapy,which has been proven to be able to improve resection rate and 5-year survival of patients.But its effect on operation safety is not clear yet.The aim of this study is to confirm the effect of neoadjuvant chemotherapy on pulmonary arterial wall so as to assess its safety for operation in patients with lung cancer.</p><p><b>METHODS</b>Thirty-two patients underwent lobectomy or pneumonectomy with mediastinal lymphadenectomy after a neoadjuvant chemotherapy,compared with 36 patients surgically treated only.During the operation,the changes of thoracic structure were observed.After the operation,the pulmonary artery specimens were detected pathologically.</p><p><b>RESULTS</b>The incidence of pleural fibrosis and thickening of pulmonary arterial tunica adventitia in neoadjuvant chemotherapy group was significantly higher than those of control group(59.38% vs 22.22%,P < 0.01;68.75% vs 19.44%,P < 0.01).The incidence of tunica intima,internal elastic membrane and tunica media damage in neoadjuvant chemotherapy group was also markedly higher than those of control group(65.62% vs 33.33%,P < 0.01;59.38% vs 19.44%,P < 0.01;71.88% vs 22.22%,P < 0.01).</p><p><b>CONCLUSIONS</b>Neoadjuvant chemotherapy may lead to pleural fibrosis and thickening of pulmonary arterial tunica adventitia and increase crispness of pulmonary arterial wall,which may increase difficulty and risk of operation.</p>
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<p><b>BACKGROUND</b>How to improve the postoperative 5-year survival rate for lung cancer and to give more patients a chance of surgery have become research hot spots. The aim of this research is to evaluate the clinical and pathohistological responses and effects of preoperative bronchial artery infusion (BAI) chemotherapy in patients with locally advanced (stage III) non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>A total of 92 patients with locally advanced NSCLC were randomly divided into two groups. BAI group received BAI chemotherapy for 2 cycles before surgical resection. Surgery group received operation only. The complete resection rate and clinical response were compared between the two groups.</p><p><b>RESULTS</b>In the BAI group, the clinical response rate and the pathohistological response rate were 68.3% and 51.3% respectively. The complete resection rate in the BAI group was 89.7%, which was significantly higher than that in the surgery group (72.5%) (P < 0.05). The 1- and 2-year survival rate was 100.0% and 80.6% in the BAI group, and 94.1% and 60.0% in the surgery group.</p><p><b>CONCLUSIONS</b>BAI neoadjuvant chemotherapy is safe and effective, which has a good clinical and pathohistological response. It might increase the complete resection rate of the tumor and improve the long-term survival rate of stage III NSCLC patients.</p>