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 探讨慢性阻塞性肺疾病（COPD）患者中微量元素铜和锌与炎症介质的关系。 方法 2010年11月－2011年3月间测量15例COPD急性加重期患者入院时及治疗后和13例健康者为对照组的血清铜、锌、C反应蛋白（CRP）、白介素-6（IL-6），血浆中金属硫蛋白，以及氧化应激产物丙二醛的浓度变化。并对铜、锌浓度变化与CRP、IL-6进行相关分析。 结果 COPD组血清中铜浓度、CRP、IL-6水平高于对照组（P＜0.05），同时急性加重期患者血清中铜的浓度、CRP、IL-6水平以及丙二醛值高于缓解期患者（P＜0.05）。而急性加重期患者血清中锌浓度低于缓解期组和对照组（P＜0.05）。血浆中抗氧化物质金属硫蛋白在三组间差异无统计学意义（P＞0.05）。在微量元素与炎症因子的相关分析中发现，铜与CRP（r=0.602，P＜0.001）、IL-6（r=0.533，P＜0.001）呈正相关，锌与IL-6呈负相关（r=?0.336，P＜0.05）。 结论 在COPD氧化应激发病机制中，铜可能发挥促氧化应激的作用，而锌可能发挥抗氧化应激的作用。微量元素稳态的紊乱有可能是COPD急性加重的危险因素。
目的 分析多层螺旋CT在评价上腔静脉综合征侧支循环中的作用。 方法 报道2012年2月收治的1例上腔静脉综合征患者，并以多层螺旋CT评价侧支循环建立情况。 结果 通过多层螺旋CT的多维成像技术，可清楚发现患者典型的以及2支少见的侧支循环。 结论 多层螺旋CT在评价上腔静脉综合征侧支循环中有其重要意义。
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 探讨急性百草枯(PQ)中毒鼠肺组织病理损伤和肺组织血红素氧合酶-1（HO-1）的表达及三七总皂甙（PNS）的保护作用。 方法 150只SD雄性鼠分为正常对照组（C组）30只、PQ中毒组（PQ组）60只及PNS组60只。PQ组和PNS组一次性灌胃PQ 25 mg/kg染毒，C组给予等体积生理盐水灌胃。其中PNS组于染毒前15 min以PNS 50 mg/kg阴茎静脉注射保护，以后1次/d给药直至处死前；PQ组、C组分别在同时间点给予等体积生理盐水。观察各组大鼠在中毒后6、12 h，1、3、5、7 d肺组织病理改变，采用蛋白质印迹法分析肺组织HO-1蛋白表达和反转录-聚合酶链反应方法测定鼠肺组织HO-1 mRNA的表达。 结果 C组HO-1蛋白和HO-1 mRNA绝大多数标本有弱表达，个别标本不表达；与C组相比PQ组及PNS组HO-1蛋白和HO-1 mRNA表达增强，差异有统计学意义（P＜0.05）；PQ组HO-1蛋白和HO-1 mRNA的表达在1 d达高峰之后下降，第3天基本恢复到C组水平；PNS组与PQ组相似，但在6 h、12 h、1 d及3 d高于PQ组，差异有统计学意义（P＜0.05），至第5天和第7天二者相比差异无统计学意义（P＜0.05）。PQ组肺组织病理损伤评分在6、12 h，1、3 、5、7 d各亚组均高于PNS相应组，差异有统计学意义（P＜0.05），C组肺组织病理大致正常，与PQ组及PNS组相比，差异有统计学意义（P＜0.001）。 结论 HO-1参与PQ中毒所致急性肺损伤，PNS对PQ中毒所致急性肺损伤有保护作用。
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 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.
目的 研究同型半胱氨酸转硫途径、维生素B6及内源性硫化氢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月间筛选AECOPD患者16例和健康志愿者（对照组）13例，测定AECOPD患者加重期、缓解期及对照组的肺功能、血清硫化氢（H2S）、丙二醛（MDA）、叶酸、维生素B12、C反应蛋白、白介素6、血浆同型半胱氨酸、胱硫醚、半胱氨酸和维生素B6的浓度。计算半胱氨酸转化率（半胱氨酸浓度/胱硫醚浓度）与胱硫醚转化率（胱硫醚浓度/同型半胱氨酸浓度）参与分析。 结果 ① 加重期血清MDA水平[（7.3 ± 5.1）nmol/L ]比缓解期[（3.0 ± 1.4）nmol/L ]和对照组[（3.0 ± 2.2）nmol/L ]均升高（P＜0.01）；血清MDA水平与第1秒用力呼气容积/用力肺活量（FEV1/FVC）、第1秒用力呼气容积占预计值百分比（FEV1%预计值）呈负相关。② 加重期血清H2S水平与血浆维生素B6水平较缓解期与对照组降低（P＜0.01）；缓解期血清H2S水平[（47.2 ±5.1） μmol/L ]高于对照组[（38.8 ± 2.1） μmol/L ]，P＜0.01；血清H2S水平、血浆维生素B6水平均与FEV1%预计值呈正相关（r=0.651、0.680，P＜0.01），均与血清MDA水平呈负相关（r=-0.334、-0.448，P＜0.05）。③ 加重期半胱氨酸转化率（3.97 ± 2.41）低于缓解期（5.92 ± 2.18）与对照组（6.14 ± 3.15）差异有统计学意义（P＜0.05）；而胱硫醚转化率则相反。④ 叶酸与维生素B12水平各组间均无差异。 结论 提高AECOPD患者维生素B6及H2S浓度可能能促使AECOPD患者向稳定状态转归，减轻氧化应激损伤。维生素B6与H2S可能成为AECOPD患者的一个新的治疗点。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 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.
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.