Acute respiratory distress syndrome is a clinical syndrome caused by many reasons, which is characterized by intractable hypoxemia. Its etiology is complex and its mortality is high. Lung biopsy techniques can give accurate histopathological diagnosis to such patients to guide treatment and improve prognosis. At present, lung biopsy techniques include surgical lung biopsy, transbronchial lung cryobiopsy, transbronchial lung biopsy and percutaneous lung biopsy. The diagnostic rate of surgical lung biopsy is high, but it is traumatic and difficult to implement. The diagnostic rate of transbronchial cryobiopsy is relatively high, and the complications are acceptable. Transbronchial lung biopsy is minimally invasive but the diagnostic rate is low. The diagnostic rate of percutaneous lung biopsy is relatively high, and the complications are relatively few. For patients with acute respiratory distress syndrome who need lung biopsy, it is very important to choose different surgical procedures according to their effectiveness, safety and applicability.
目的 分析多層螺旋CT在評價上腔靜脈綜合征側支循環中的作用。 方法 報道2012年2月收治的1例上腔靜脈綜合征患者，并以多層螺旋CT評價側支循環建立情況。 結果 通過多層螺旋CT的多維成像技術，可清楚發現患者典型的以及2支少見的側支循環。 結論 多層螺旋CT在評價上腔靜脈綜合征側支循環中有其重要意義。
Hemoptysis is a common respiratory emergency, and severe cases can lead to death. Patients with massive hemoptysis need emergency management at the bedside, and fully evaluation for indications and timing of tracheal intubation and transtracheal intervention. When a relatively stable state is achieved, emergency vascular intervention is performed to stop bleeding. CT plays an important role in the risk assessment and interventional treatment of hemoptysis, and it is worthy of clinical promotion and more exploratory research. This article introduces the emergency treatment for massive hemoptysis, the vascular interventional procedure, the exploration of clinical application of preoperative CT, and the clinical application value of CT for hemoptysis risk assessment. It aims to provide a better way to deal with massive hemoptysis and to apply CT to the interventional treatment of hemoptysis more reasonably for clinicians.
目的 探討慢性阻塞性肺疾病（COPD）患者中微量元素銅和鋅與炎癥介質的關系。 方法 2010年11月－2011年3月間測量15例COPD急性加重期患者入院時及治療后和13例健康者為對照組的血清銅、鋅、C反應蛋白（CRP）、白介素-6（IL-6），血漿中金屬硫蛋白，以及氧化應激產物丙二醛的濃度變化。并對銅、鋅濃度變化與CRP、IL-6進行相關分析。 結果 COPD組血清中銅濃度、CRP、IL-6水平高于對照組（P＜0.05），同時急性加重期患者血清中銅的濃度、CRP、IL-6水平以及丙二醛值高于緩解期患者（P＜0.05）。而急性加重期患者血清中鋅濃度低于緩解期組和對照組（P＜0.05）。血漿中抗氧化物質金屬硫蛋白在三組間差異無統計學意義（P＞0.05）。在微量元素與炎癥因子的相關分析中發現，銅與CRP（r=0.602，P＜0.001）、IL-6（r=0.533，P＜0.001）呈正相關，鋅與IL-6呈負相關（r=?0.336，P＜0.05）。 結論 在COPD氧化應激發病機制中，銅可能發揮促氧化應激的作用，而鋅可能發揮抗氧化應激的作用。微量元素穩態的紊亂有可能是COPD急性加重的危險因素。
目的 探討急性百草枯(PQ)中毒鼠肺組織病理損傷和肺組織血紅素氧合酶-1（HO-1）的表達及三七總皂甙（PNS）的保護作用。 方法 150只SD雄性鼠分為正常對照組（C組）30只、PQ中毒組（PQ組）60只及PNS組60只。PQ組和PNS組一次性灌胃PQ 25 mg/kg染毒，C組給予等體積生理鹽水灌胃。其中PNS組于染毒前15 min以PNS 50 mg/kg陰莖靜脈注射保護，以后1次/d給藥直至處死前；PQ組、C組分別在同時間點給予等體積生理鹽水。觀察各組大鼠在中毒后6、12 h，1、3、5、7 d肺組織病理改變，采用蛋白質印跡法分析肺組織HO-1蛋白表達和反轉錄-聚合酶鏈反應方法測定鼠肺組織HO-1 mRNA的表達。 結果 C組HO-1蛋白和HO-1 mRNA絕大多數標本有弱表達，個別標本不表達；與C組相比PQ組及PNS組HO-1蛋白和HO-1 mRNA表達增強，差異有統計學意義（P＜0.05）；PQ組HO-1蛋白和HO-1 mRNA的表達在1 d達高峰之后下降，第3天基本恢復到C組水平；PNS組與PQ組相似，但在6 h、12 h、1 d及3 d高于PQ組，差異有統計學意義（P＜0.05），至第5天和第7天二者相比差異無統計學意義（P＜0.05）。PQ組肺組織病理損傷評分在6、12 h，1、3 、5、7 d各亞組均高于PNS相應組，差異有統計學意義（P＜0.05），C組肺組織病理大致正常，與PQ組及PNS組相比，差異有統計學意義（P＜0.001）。 結論 HO-1參與PQ中毒所致急性肺損傷，PNS對PQ中毒所致急性肺損傷有保護作用。
ObjectiveTo examine the effect of preoperative adverse emotion on rehabilitation outcomes in lung cancer patients undergoing thoracoscopic major pulmonary resection.MethodsWe retrospectively analyzed the clinical data of 1 438 patients with lung cancer who underwent thoracoscopic lobectomy and segmentectomy in West China Hospital of Sichuan University from February 2017 to July 2018 including 555 males and 883 females. All patients were assessed by Huaxi emotional-distress index scoring, and were divided into three groups including a non-negative emotion group, a mild negative emotion group, and a moderate-severe negative emotion group. All patients underwent thoracoscopic lobectomy or segmentectomy plus systematic lymph node dissection or sampling. The volume of postoperative chest drainage, postoperative lung infection rate, time of chest tube intubation and postoperative duration of hospitalization were compared among these three groups.ResultsThere were different morbidities of adverse emotion in age, sex, education level and smoking among patients before operation (P<0.05). Univariate analysis showed that there was no statistical difference in the duration of indwelling drainage tube, drainage volume, postoperative pulmonary infection rate or the incidence of other complications among these three groups, but the duration of hospitalization in the latter two groups was less than that in the first group with a statistical difference (P<0.05). After correction of confounding factors by multiple regression analysis, there was no statistical difference among the three groups.ConclusionYoung patients are more likely to develop bad emotions, women are more likely to develop serious bad emotions, highly educated patients tend to develop bad emotions, and non-smoking patients tend to develop bad emotions. There is no effect of preoperative adverse emotions on the rapid recovery of lung cancer patients after minimally invasive thoracoscopic surgery.
ObjectiveTo explore the clinical characteristics and improve the knowledge of diagnosis and treatment of complex pulmonary arteriovenous fistula (PAVF) as well as enrich the experience of diagnosis and treatment of the disease.MethodsA retrospective analysis of pathogenetic process clinical manifestations, imaging features and diagnosis and treatment was conducted on one case of complex PAVF. The literature review was carried out with " complex pulmonary arteryovenous fistula (malformation)” as the research terms in English and Chinese respectively in CNKI, WanFang and PubMed database. Search time ranged from January 1997 to April 2018, and the literature was screened and reviewed.ResultsThe patient was a 47-year-old female complained of recurrent epistaxis for 40 years, intermittent hemoptysis for 20 years, headache, dizziness, chest pain, chest tightness for 4 years and the symptoms were aggravated by 3 months, visiting this hospital on January 23, 2018. Pulmonary CT angiography revealed multiple nodules in internal and external segment and outer basal segment of right lung, anterior basal segment and outer basal segment of left lung. CT enhanced scan showed that the thickened pulmonary artery was connected with the above lesion, and the edge was accompanied by large draining veins. Pulmonary artery revascularization showed complex PAVF abnormal branches. The diagnosis was complex PAVF, and interventional embolization therapy was carried out and curative effect was satisfactory during the follow-up. A total of 6 literatures were reviewed in above-mentioned databases, including 4 Chinese literatures and 2 English literatures, containing 10 patients, including 8 males and 2 females, with an average age of (9.7±7.0) years. Most of the clinical manifestations were shortness of breath after exercise, cyanosis and hemoptysis and all patients were cured and discharged after interventional embolization treatment except for 1 patient refused treatment.ConclusionsComplex PAVF is a very rare pulmonary vascular malformation. The clinical manifestations mainly include hypoxemia, dyspnea, hemoptysis, and the preferred treatment is interventional embolization, which has a satisfactory clinical effect at a short-term follow-up.
ObjectiveTo investigate the effect of small interfering RNA (siRNA) lentivirus-mediated silencing of P75 neurotrophin receptor (P75NTR) gene on osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) in rats.MethodsThree lentivirus-mediated P75NTR gene siRNA sequences (P75NTR-siRNA-1, 2, 3) and negative control (NC)-siRNA were designed and transfected into the 3rd generation Sprague Dawley (SD) rat BMSCs. The cells morphological changes were observed under an inverted microscope, and the expressions of P75NTR gene and protein in cells were detected by real-time fluorescence quantitative PCR and Western blot. Then the best silencing P75NTR-siRNA for subsequent osteogenic differentiation experiments was screened out. The 3rd generation SD rat BMSCs were randomly divided into experimental group, negative control group, and blank control group (normal BMSCs). The BMSCs of negative control group and experimental group were transfected with NC-siRNA and the selected P75NTR-siRNA lentiviral vector, respectively. The cells of each group were cultured by osteogenic induction. The expressions of osteogenic related proteins [osteocalcin (OCN) and Runx related transcription factor 2 (Runx2)] were detected by Western blot; the collagen type Ⅰ expression was observed by immunohistochemical staining; the osteogenesis of BMSCs was observed by alkaline phosphatase (ALP) detection and alizarin red staining.ResultsAfter lentivirus-mediated P75NTR transfected into BMSCs, the expressions of P75NTR mRNA and protein significantly reduced (P<0.05), and the best silencing P75NTR-siRNA was P75NTR-siRNA-3. After P75NTR gene was silenced, MTT test showed that the cell proliferation in the experimental group was significantly faster than those in the two control groups (P<0.05). After osteogenic induction, the relative expressions of OCN and Runx2 proteins, collagen type Ⅰ expression, and ALP activity were significantly higher in the experimental group than in the two control groups, the differences were significant (P<0.05). With the prolongation of osteogenic induction, the mineralized nodules in the experimental group gradually increased.ConclusionSilencing the P75NTR gene with siRNA lentivirus can promote the osteogenic differentiation of rat BMSCs and provide a new idea for the treatment of bone defects.
目的 研究同型半胱氨酸轉硫途徑、維生素B6及內源性硫化氫在慢性阻塞性肺疾病急性加重期（AECOPD）中的作用。 方法 2010年2月－4月間篩選AECOPD患者16例和健康志愿者（對照組）13例，測定AECOPD患者加重期、緩解期及對照組的肺功能、血清硫化氫（H2S）、丙二醛（MDA）、葉酸、維生素B12、C反應蛋白、白介素6、血漿同型半胱氨酸、胱硫醚、半胱氨酸和維生素B6的濃度。計算半胱氨酸轉化率（半胱氨酸濃度/胱硫醚濃度）與胱硫醚轉化率（胱硫醚濃度/同型半胱氨酸濃度）參與分析。 結果 ① 加重期血清MDA水平[（7.3 ± 5.1）nmol/L ]比緩解期[（3.0 ± 1.4）nmol/L ]和對照組[（3.0 ± 2.2）nmol/L ]均升高（P＜0.01）；血清MDA水平與第1秒用力呼氣容積/用力肺活量（FEV1/FVC）、第1秒用力呼氣容積占預計值百分比（FEV1%預計值）呈負相關。② 加重期血清H2S水平與血漿維生素B6水平較緩解期與對照組降低（P＜0.01）；緩解期血清H2S水平[（47.2 ±5.1） μmol/L ]高于對照組[（38.8 ± 2.1） μmol/L ]，P＜0.01；血清H2S水平、血漿維生素B6水平均與FEV1%預計值呈正相關（r=0.651、0.680，P＜0.01），均與血清MDA水平呈負相關（r=-0.334、-0.448，P＜0.05）。③ 加重期半胱氨酸轉化率（3.97 ± 2.41）低于緩解期（5.92 ± 2.18）與對照組（6.14 ± 3.15）差異有統計學意義（P＜0.05）；而胱硫醚轉化率則相反。④ 葉酸與維生素B12水平各組間均無差異。 結論 提高AECOPD患者維生素B6及H2S濃度可能能促使AECOPD患者向穩定狀態轉歸，減輕氧化應激損傷。維生素B6與H2S可能成為AECOPD患者的一個新的治療點。Objective To study the roles of homocysteine (Hcy) transsulfuration pathway, Vitamin B6 and endogenous hydrogen sulfide in treating patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Sixteen AECOPD patients and 13 healthy controls (Control group) from February to April 2010 were recruited in this study. Lung function, serum hydrogen sulfide (H2S), malondialdehyde (MDA), folate, vitamin B12, C-reactive protein (CRP), interleukin-6 (IL-6), Hcy, cystathionine, cystein (Cys) and vitamin B6 were all measured for all the patients in the acute exacerbation period and alleviation period and healthy controls. The conversion rate of Cys (expressed as Cys/cystathionine) and the conversion rate of cystathionine (expressed as cystathionine/Hcy) were calculated for analysis. Results Serum MDA level for patients in the acute exacerbation period (AE period) [(7.3 ± 5.1) nmol/L] was significantly higher than that in the alleviation period [(3.0 ± 1.4) nmol/L] and in the healthy controls [(3.0 ± 2.2) nmol/L] (P ＜ 0.01). Serum MDA level was negatively correlated with percentage of FEV1 in predicted FEV1 (FEV1% pred) and FEV1/FVC. Serum H2S level and plasma vitamin B6 level for patients in the AE period were significantly lower than those in the alleviation period and in the healthy controls (P ＜ 0.01), and serum H2S level was significantly higher in the alleviation period [(47.2 ± 5.1) μmol/L] than in the controls [(38.8 ± 2.1) μmol/L] (P ＜ 0.01). Both serum H2S and plasma vitamin B6 levels were correlated positively with FEV1% pred for patients in the AE period and healthy controls (r=0.651, 0.680; P ＜ 0.01), but negatively correlated with serum MDA level (r=-0.334, -0.448; P ＜ 0.05). The conversion rate of Cys for patients in the AE period (3.97 ± 2.41) was significantly lower than that in the alleviation period (5.92 ± 2.18) and the control group (6.14 ± 3.15) (P ＜ 0.05), but the conversion rate of cystathionine was just the opposite (P ＜ 0.05). There were no significant differences in the levels of serum folate and vitamin B12 among the three groups. Conclusion Raising the Vitamin B6 and H2S level may facilitate stabilizing of conditions in patients with AECOPD and reduce oxidative stress. Therefore, it may become a new treatment method for AECOPD.
ObjectiveTo evaluate the feasibility and accuracy of a novel three dimensional (3D) preoperative simulation software in a clinical setting for patients undergoing precise hepatectomy. MethodsThe clinical data of 85 patients with hepatocellular carcinoma underwent precise hepatectomy were retrospectively studied. All the patients received CT screening and subsequent evaluation on the liver resection volume and margin and the percentage of resected tumor by 3D preoperative simulation software, which compared with the actual resection liver values. The operation plan was optimized by virtual hepatectomy. ResultsThe liver, tumor as well as blood vessel could be clearly showed and reconstructed by 3D preoperative simulation software. All the patients underwent precise hepatectomy. After operation ascites occurred in 3 patients on 2 d, moderate pleural effusion occurred in 2 patients on 2 d, and bile leakage appeared in 4 patients on 5 d, which were improved by conservative treatment. The length of stay in all patients ranged from 6 to 88 d (mean 23 d), and no recurrence and death occurred within 30 d of operation. The predicted resection liver volume was significantly correlated with the actual resection volume (r=0.960, Plt;0.001), and the difference between the mean volume of predicted and actual resection liver was not significant (896.7 ml vs. 819.1 ml， t=1.851, P=0.068). In addition, the predicted resection margin was also correlated with the actual resection margin (r=0.972, Plt;0.001), with the difference in the mean resection margin was not significant too (12.2 mm vs. 11.9 mm， t=1.143, P=0.256). No patients suffered from severe postoperative complications. ConclusionsThe 3D preoperative simulation software is able to evaluate and simulate liver resection accurately, which may contribute to a safe precise hepatectomy plan.