Abstract： Objective To introduce the new procedure of endobronchial ultrasoundguided transbronchial needle aspiration (EBUSTBNA) for staging lung cancer and diagnosing thoracic diseases, in order to determine its value in the evaluation of thoracic diseases. Methods We retrospectively reviewed the data of all patients examined with EBUSTBNA our institution between September 2009 and May 2010. Among the patients, there were 75 males and 31 females with an average age of 62.3 years old. Based on their primary indication, we divided all the 106 patients into three categories. (1) There were 76 patients with known or bly suspected lung cancer. Enlarged mediastinal lymph nodes on radiographic examination of the chest (≥1.0 cm) were detected in all the patients. (2) There were 22 patients with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin. (3) There were 8 patients with pulmonary mass located close to the central airways. Results (1) 76 patients underwent EBUSTBNA for known or bly suspected lung cancer. Among them, 58 patients were confirmed to have mediastinal lymph nodes metastasis on EBUSTBNA. Sixteen in the 18 patients with negative EBUSTBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection. Postoperative pathology confirmed that 12 patients did not have metastatic nodes, 2 patients had metastatic nodes and 2 other patients had benign lesions within the lung. The diagnostic sensitivity, specificity and accuracy of EBUSTBNA for the mediastinal staging of lung cancer were 96.66%(58/60), 100.00%(12/12) and 97.22%(70/72), respectively. (2) 22 patients underwent EBUSTBNA for the evaluation of mediastinal adenopathy or mass in the absence of any identifiable pulmonary lesion. Among them, 7 had malignancy, 13 had benign diseases on EBUSTBNA and the sensitivity of EBUSTBNA in distinguishing malignant mediastinal diseases was 87.50% (7/8). (3) 8 patients with pulmonary mass located close to the central airways were accessed by EBUSTBNA. Definite diagnosis was achieved in 7 patients, and lung cancer was detected in 6 patients. The sensitivity and the diagnostic accuracy of EBUSTBNA for the diagnosis of unknown pulmonary mass was 85.71%(6/7) and 87.50%(7/8), respectively. All the procedures were uneventful, and there were no complications. Conclusion EBUSTBNA is a highly effective and safe procedure. We believe that EBUSTBNA should be used routinely in the diagnosis and staging of thoracic diseases.
Objective To evaluate the anti-tussive effect of a total alkaloid agent extracted from Papaver Somniferum L. on simple chronic bronchitis of which the syndrome was counterflow ascent of lung qi according to traditional Chinese medicine (TCM). Methods Randomised, double blind method, placebo control and add on design were applied. Forty-five patients with counterflow ascent of lung qi of simple chronic bronchitis were randomly divided into two groups: treatment group (n=21) with alkaloid agent and control group (n=24) with placebo. Results The incidences of obvious coughing in treatment and control groups were 66.67% and 70.83% (P=0.763 3) respectively. The cough alleviation time of patients was 14.64±16.30 h and 15.12±15.28 h (P=0.795 6) respectively. The loss of cough rates on the third day was 28.57%, 16.67% (P=0.337 7) respectively. The average scores decreased were 4.29 and 2.88 (P=0.054 8) respectively. Conclusions The study indicates that total alkaloid agent extracted from Papaver somniferum L. has no significant anti-tussive effect on patients with counterflow ascent of lung qi of simple chronic bronchitis treated with cefaclor sustained release capsules simultaneously. The trial was interrupted by the advice from experts who disagreed with the selection of drug indication.
Objective To investigate the operative procedure and the therapeutic effects of unstable femoral intertrochanteric fracture in elderly patients with rebuild septum bronchiale in artificial femoral head replacement. Methods From October 2005 to October 2007, 113 elderly patients with unstable femoral intertrochanteric fracture were treated with artificial femoral head replacement with fixation of femoral greater trochanter and smaller trochanter in the help of bone cement in 58 cases (test group) and with γ-type bone nail in 55 cases (control group). In test group, there were 21 males and 37 females with an average age of 75 years, including 10 cases of type IIIA, 16 cases of type IIIB and 32 cases of type IV according to Evans-Jenson standard. In control group, there were 17 males and 38 females with an average age of 72.5 years,including 13 cases of type IIIA, 14 cases of type IIIB and 28 cases of type IV according to Evans-Jenson standard. All fractures were caused by fall damage. The disease course was 3 hours to 7.5 days (mean 1.4 days). The patients of two group compl icated with osteoporosis, and compl icated by one or several compl ications of coronary heart disease, hypertension, diabetes and chronic bronchitis. And all patients did not had fracture at other sites. There was no significant difference in general data between two groups (P gt; 0.05). Results The operations were successful, the incision healed by first intention. There were significant differences in operation time, operative blood loss and blood-transfusion between two groups (P lt; 0.05). The two group were followed 12-36 months. There were significant differences (P lt; 0.05) in the incidence rate of compl ication and the excellent and good rate of hip function (by Harris standard) between the test group (3.4% and 93.1%) and the control group (16.4% and 70.9%) 12 months after operation. Conclusion The aged patients with intertrochanteric fracture can get good result through caput femoris replacement, and rebuild septum bronchiale is of great significance.
Objective To improve the knowledge on dynamic benign central airway stenosis through two typical cases. Methods The clinical features, imaging findings, and bronchial morphologic changes of two cases characterized by dynamic benign central airway stenosis were retrospectively analyzed. The etiologies for the two cases were tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC), respectively. Results Central airway stenosis and reversible airway obstruction were common clinical characteristics for the two cases. However, there were identifiable differences on imaging findings and bronchial morphologic changes between the two cases. Multidetector computed tomography showed sabre-sheath trachea and narrowed trachea in coronal position for TBM, while small sized trachea in exhalation phase and narrowed trachea in sagittal position for EDAC. Bronchoscopy displayed narrowed airway, swelling mucosa, and the absence of annular cartilage for TBM, while crescent airway with membranacea part protruding to lumen in inspiration phase, and the integrity of annular cartilage for EDAC. Conclusion Multidetector computed tomography and bronchoscopy examinations are valid methods to distinguish TBM and EDAC, which are both characterized by dynamic benign central airway stenosis.
Objective To evaluate the efficacy and safety of computed tomography (CT)-guided percutaneous and cone beam CT-guided transbronchial ablation in the treatment of early multiple primary lung cancer (MPLC). Methods Retrospective analysis was performed on patients who met inclusion criteria in Shanghai Chest Hospital between May 2020 to June 2022. According to ablation pathway, lesions were divided into two groups: percutaneous ablation group and transbronchial ablation group. Results A total of 13 MPLC patients with 26 lesions were included (14 percutaneous ablation and 12 transbronchial ablation). There were no statistically significant differences in solid component, lesion location, lung field and lesion size between the two groups. The distance from the parietal pleura in the transbronchial ablation group was longer than that in percutaneous ablation group (P=0.03). The median follow-up period time were 13 months and 12 months for group percutaneous ablation and transbronchial ablation. No significant differences were found in 3-month complete ablation rate (100.0% vs. 83.3%), 1-year local control rate (100.0% vs. 91.7%) and severe complication rate (7.1% vs. 16.7%). The minor complication rate in percutaneous ablation group was higher than that in transbronchial ablation group (50.0% vs 0.0%, P=0.02). Conclusions Percutaneous ablation and transbronchial ablation have high efficacy and safety, and the latter involves lower minor complication rate. They complement each other, which provide the individualized treatments for early MPLC patients who are not suitable for or refuse surgery.
ObjectiveTo study the application of non-real-time ultrasound bronchoscopy combined with Metagenomic Next-Generation Sequencing (mNGS) for diagnosis in focal pulmonary infectious diseases. MethodsProspective inclusion of patients with focal pulmonary infection were randomly divided into two groups, the experimental group used non-real-time ultrasound bronchoscopy positioning to collect bronchial alveolar lavage fluid (BALF), while the control group used chest CT position. BALF was subjected to mNGS and traditional microbial detection including traditional culture, the fungal GM test and Xpert (MTB/RIF). ResultThe positive rate of traditional culture (39.58% vs. 16.67%, P=0.013) and mNGS (89.58% vs. 72.92%, P=0.036) in experimental group was higher. The positive rate of Xpert MTB/RIF (4.17% vs. 2.08%, P=1) and fungal GM test (6.25% vs. 4.17%, P=0.765) was similar. The positive rate of bacteria and fungi detected by mNGS was higher than traditional culture (61.46% vs. 28.13%, P<0.001). Mycobacterium tuberculosis was similar to Xpert MTB/RIF (8.33% vs. 3.13%, P=0.21). Aspergillus was similar to GM test (7.29% vs. 5.21%, P=0.77). The total positive rate of traditional microbial methods was 36.46%, but 81.25% in mNGS (P<0.001). mNGS showed that 35 cases were positive and 13 kinds of pathogens were detected in control group, but 43 patients and 17 kinds of pathogens were detected in experimental group. The average hospitalization time [(12.92±3.54) days vs. (16.35±7.49) days] and the cost [CNY (12209.17±3956.17) vs. CNY (19044.10±17350.85)] of experimental group was less (P<0.001). ConclusionsNon-real-time ultrasound bronchoscopy combined with mNGS can improve the diagnostic rate of focal pulmonary infectious diseases which is worthy of popularization and application in clinical practice.
ObjectiveTo explore the safety and effectiveness of video-assisted thoracoscopic surgery (VATS) pneumonectomy for bronchiectasis.MethodsThe clinical data of 164 patients undergoing VATS pneumonectomy or open thoracotomy for bronchiectasis in our hospital from March 2002 to July 2012 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods: a thoracotomy group (122 patients, 63 males, 59 females) and a thoracoscopic surgery group (42 patients, 15 males, 27 females). Surgical and follow-up indicators were compared between the two groups.ResultsThere was no difference between the two groups in the blood loss, operation time, perioperative mortality or complication. However patients undergoing VATS had shorter length of postoperative stay than those undergoing thoracotomy (6.9±2.6 d vs. 8.1±3.1 d, P=0.030). In the thoracoscopic surgery group, 3 patients were lost to follow-up and in the thoracotomy group, 5 patients were lost to follow-up. In a median follow-up of 51 months (ranging from 2 to 116 months), 36 patients (92.3%) fully recovered with no sputum or haemoptysis and 3 (7.7%) partially recovered with a reduced sputum or haemoptysis in the thoracoscopic surgery group; 105 (89.7%) fully recovered with no sputum or haemoptysis, 10 (8.5%) partially recovered with a reduced sputum or haemoptysis while 2 (1.7%) without any improvement in the thoracotomy group with no statistical difference (P=0.700).ConclusionVATS pneumonectomy for bronchiectasis is equivalent to thoracotomy in terms of safety and effectiveness, and can be used as an alternative surgical procedure for the treatment of bronchiectasis.
ObjectiveTo explore the diagnostic value of endobronchial ultrasonography with a guide sheath (EBUS-GS) for pulmonary fungal disease.MethodsAll patients were collected from January 2015 to December 2018. They were diagnosed with pulmonary fungal disease by tissue biopsy, body fluid or blood test, and without other diseases such as pneumonia, lung cancer, lung abscess, tuberculosis, or organizing pneumonia, etc. After clinical anti-fungal treatment, clinical symptoms were relieved, chest CT lesions were absorbed, laboratory-related checks were turned negative in these patients. All patients underwent bronchoscopy, bronchoalveolar lavage fluid/brush examination, and blood galactomannan antigen test/latex agglutination test. They were divided into an EBUS-GS group and a non-EBUS-GS group according to whether EBUS-GS check was performed. Non-parametric test was used to analyze the diagnostic value of EBUS-GS in pulmonary fungal diseases.ResultsFifty-one patients were included and 20 patients in the EBUS-GS group and 31 patients in the non-EBUS-GS group. The EBUS-GS group had a higher positive rate of pulmonary fungal disease. The diagnostic rates of the EBUS-GS group and the non-EBUS-GS group were statistically different (90.0% vs. 48.4%, P<0.05).ConclusionEBUS-GS can improve the diagnosis rate of pulmonary fungal disease and provides further evidence for a clear diagnosis.
Objective To investigate the effects of methylprednisolone on airway inflammation of chronic bronchitis in rats, and to explore its possible mechanism. Methods Forty SD rats were randomly divided into five groups, ie. a blank control group, amethylprednisolone control group, a model group, and two methylprednisolone intervention groups. Chronic bronchitis model was established by cigarette inhalation in the model group and two intervention groups. Methylprednisolone was injected intraperitoneally in the two intervention groups before exposing to cigarette smog ( at the dose of 1 mg/ kg and 10 mg/ kg, qd,respectively) . The protein expression of phosphodiesterase 4D ( PDE4D ) in trachea and lung samples was determined by immunohistochemical staining. The average optical density of positive staining of PDE4D was determined by image analysis technique and gray scale scanning. Bronchoalveolar lavage fluid ( BALF) was collected for total and differential cell counts, and the concentrations of TNF-αand interleukin-8 ( IL-8) in BALF were detected by ELISA. Results Cigarette smoking induced obvious airway inflammation in themodel group, and the inflammation was alleviated in the two methylprednisolone intervention groups.Compared with the two control groups, the expression of PDE4D was obviously elevated in tracheal and lungs in the model group( P lt; 0. 05) . Moreover, the increased expression of PDE4D was positively related with theincreased release of TNF-αand IL-8 in BALF. The expression of PDE4D and the release of TNF-αand IL-8 in BALF were decreased after the treatment with methylprednisolone in a dose-dependent manner ( P lt;0. 05) . Compare with the low dose intervention group, there was no markedly difference related to PMNnumber and TNF-α release in the high dose intervention group ( P gt; 0.05) . Conclusions Methylprednisolone may alleviate airway inflammation of chronic bronchitis by inhibiting the expression of PDE4D in rats. Inhibition of PDE4D may down-regulate TNF-αactivity, which may further reduce IL-8 release and alleviate airway inflammation.
Objective To evaluate the therapeutic effect, safty and tolerance of Gankeshuangqing Capsule in the treatment of patients suffering from wind-heat syndrome (acute upper respiratory infection or acute bronchitis). Methods The clinical trials were designed multicentered, double blind, double dummy, randomized and parallel positive drug controlled. A total of 289 patients participated in the trials. Those who suffered from acute upper respiratory infection were given throat virus-detection to make a definite diagnosis of the origins of disease. Results Among the 40 patients who were diagnosed with virus infection, 81.82% in Gankeshuangqing group were healed, but only 50.00% in control group, and significant differences were observed between the two groups (Plt;0.05). At the end of the third day of treatment, the rates of cure and excellence in patients suffering from acute upper respiratory infection were 80.00% in Gankeshuangqing group, and 68.57% in control group, and both groups showed good therapeutic effect，but there was no significant difference between the two groups (Pgt;0.05). At the end of the seventh day of treatment, the rates of cure and excellence in patients suffering from acute bronchitis were 82.35% in Gankeshuangqing group, and 63.77% in control group, and both groups showed good therapeutic effect, and there were significant differences between the two groups (Plt;0.05)；only one patient in Gankeshuangqing group had constipation during the treatment, but there was no evidence showing that it is caused by Gankeshuangqing. Conclusion The results show that Gankeshuangqing Capsule has a definite effect on wind-heat syndrome (acute upper respiratory infection or acute bronchitis) with good safety.