Objective To evaluate the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 ( sTREM-1 ) in endotracheal aspirate and plasma of patients with ventilator-associated pneumonia ( VAP) . Methods The consentration of sTREM-1 in plasma and endotracheal aspirate, and serum high-sensitivity C-reactive protein ( hs-CRP) were measured by enzyme-linked immunosorbent assay ( ELISA) in 68 patients with VAP ( VAP group) , 50 patients underwent ventilation without VAP ( non-VAP group) , and 50 healthy individuals ( control group) . The sensitivity and specificity of each parameter were calculated. Results In the patients with VAP, sTREM-1 in plasma and endotracheal aspirate before treatment were significantly higher than that in the non-VAP group [ ( 143.62 ±46.82) pg/mL vs. ( 68.56 ±16.24) pg/mL, ( 352.86 ±92.57) pg/mL vs. ( 126.21 ±42.28) pg/mL, Plt;0.05] ; sTREM-1 in plasma and endotracheal aspirate on the 3rd and the 7th day during treatment were significantly decreased ( Plt;0. 05) . By ROC analysis, the cut-off value of sTREM-1 in endotracheal aspirate were 193.64 pg/mL, with sensitivity and specificity of 93.84% and 89.51% respectively. The areas under ROC curve of sTREM-1 in endotracheal aspirate were 0.912. Clinical diagnostic value of sTREM-1 in endotracheal aspirate was better than plasma sTREM-1 and serum hs-CRP ( areas under ROC curve were 0. 768 and 0. 704 respectively) . Conclusions sTREM-1 may be helpful for evaluating the therapeutic effect in patients with VAP. The diagnostic value of sTREM-1 in endotracheal aspirate may be superior to plasma sTREM-1 and serum hs-CRP.
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.
【摘要】 目的 比较喉罩和气管内插管吸入七氟烷全麻用于小儿无痛苦纤支镜检查的麻醉效果、苏醒时间、苏醒质量。 方法 将2008年3月-2009年3月40例行纤支镜检查的患儿随机分为喉罩组（L组，21例）和气管内插管组（T组，19例）。两组均采用逐渐诱导法吸入七氟烷，静脉给予芬太尼1 μg/kg；L组置入喉罩，T组气管插管后控制呼吸。手术中，两组均吸入2%～5%七氟烷维持麻醉。分别记录麻醉前（T0）、麻醉后纤支镜进入前（T1）、进镜至咽部（T2）、声门部（T3）、气管内（T4）及第15 min（T5）时的血压（BP）、心率（HR）、MAP和动脉血氧饱和度（SPO2）。观察纤支镜检查期间有无呛咳、气道痉挛或体动；记录停药至拔管的时间，苏醒后是否再入睡及麻醉满意度。 结果 两组HR在T1、T3、T4时升高，与T0时比较，有统计学意义（Plt;0.05）；其中HR在T1时T组高于L组，组间比较有统计学意义（Plt;0.05）；MAP在T1、T2、T3、T4时，T组低于L组，组间比较有统计学意义（Plt;0.05）。两组患儿镜检期间均无呛咳、气道痉挛或体动；L组苏醒时间短于T组（Plt;0.05），苏醒后再入睡率低于T组（Plt;0.05），麻醉满意度高于T组（Plt;0.05）。 结论 喉罩吸入七氟烷全麻用于小儿无痛苦纤支镜检查，能保证稳定的血流动力学状态，苏醒快速，效果满意。【Abstract】 Objective To assess the feasibility and safety of Laryngeal mask combined with sevoflurane in painless fiberoptic bronchoscopy anesthesia in children. Methods Forty children from March 2008 to March 2009 were randomized divided into laryngeal mask airway group (group L) and endotracheal intubation group (group T). Anaesthesia was induced and maintenanced with 2%-5% sevoflurane and fentanyl 1 μg/kg. The blood pressure (BR), heart rate (HR) and oxygen saturation by pulse oximeter (SPO2)were recorded before anaesthesia (T0), immediately after anaesthesia induction (T1), when FOB at the level of pharynx(T2), vocal cords (T3), trachea (T4) and in 15 min of the FOB (T5). Extubation time, recovery quality and anesthesia effects were also analyzed. Results Compared with T0, there were significant increases in HR at T1、T3 and T4 (Plt;0.05), and HR was significantly higher in the group T than that in the group L at T1 (Plt;0.05). MAP was significantly lower in group T than that in group L at T1、T2、T3 and T4, respectively(Plt;0.05). Recovery time was significantly shorter in group L than that in group T. Incidence of sleep after recovery was lower in group L than that in group T. Anesthesia satisfaction was higher in the group L than that in the group T. Conclusions Laryngeal mask combined with Sevoflurane provide satisfactory anesthesia for painless fiberoptic bronchoscopy in children.
Objective To compare three approaches of lipopolysaccharides ( LPS) administration for inducing acute lung injury ( ALI) in mice. Methods LPS ( 5 mg/kg) was intratracheally aerosol administered ( ITA group) , intratracheally instilled ( ITI group) , or intraperitoneally injected ( IPI group) to induce ALI in BLAB/ c mice. Evans Blue instead of LPS was intratracheally administered to observe the liquid distribution in the lungs. Two hours after LPS administration, the mice were sacrificed and the lungs were removed to determine wet-to-dry lung weight ratio ( W/D) , and the histological changes were evaluated by HE staining. Phosphorylation level of IκB-αand NF-κB p65 in lung tissue were investigated by Western blot. Transcription intensity of TNF-α and IL-1β mRNA in lung tissue were detected by real-time quantitative PCR. Results Evans Blue distributed more uniformly in the ITA group than the ITI group. The lung W/D ratio and histological changes score in three LPS administration groups were all significantly higher than the normal control group ( P lt;0. 01) , with the ITA group being the highest. The phosphorylation levels of IκB-αand NF-κB p65 were significantly higher in the ITA group than the ITI group ( P lt;0. 05) , and were significantly higher in the ITI group than the IPI group ( P lt; 0. 05) . Transcription intensity of TNF-αand IL-1βmRNA was significantly higher in the ITA group than the ITI group ( P lt;0. 05) , and were significantly higher in the ITI group than the IPI group ( P lt;0. 05) . Conclusion Being non-invasive and convenient,intratracheal LPS aerosol inhalation is an optimal method to induce ALI in mice because it induces more extensive and uniformly distributed injuries in lung.
ObjectiveTo analyse epidermal growth factor receptor (EGFR) gene mutations in pathologically confirmed lung adenocarcinoma (LAC) samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MethodsClinical data of 964 consecutive patients who underwent EBUS-TBNA in Department of Thoracic Surgery, Fudan University Shanghai Cancer Center from April 2009 to September 2013 were retrospectively reviewed. EGFR gene mutations in 77 LAC patients who were comfirmed by cell morphology and immunohistochemistry were analyzed. There were 48 males and 29 females with their median age of 61 (range 33-78) years, and 43 patients were smokers. ResultsAll the 77 LAC patients were confirmed by immunohistochemistry. Among them, 31 patients (40.26%) were found to have EGFR gene mutations. There was no statistical difference in EGFR gene mutations between male and female patients (P=0.088). Mutation rate of EGFR genes of non-smokers was significantly higher than that of smokers (P=0.032). ConclusionSamples obtained by EBUS-TBNA can be used for EGFR gene mutations analysis. The mutation rate of EGFR genes of non-smokers is higher than that of smokers.
目的探讨单腔气管内插管保留自主呼吸的静脉全身麻醉下小儿胸腔镜手术的可行性及安全性。 方法选取郑州大学第一附属医院胸外科2012年2～12月采用单腔气管内插管保留自主呼吸行静脉全身麻醉下胸腔镜手术治疗的14例患儿作为试验组，男9例、女5例，年龄4～9岁；选取2010年5月至2011年10月采用常规双腔气管内插管全身麻醉下胸腔镜手术治疗的20例小儿患者作为对照组，男13例、女7例，年龄3～10岁。比较两组手术时间、术中失血量、术毕至拔管时间、住院费用、住院时间及术后并发症发生率等指标。 结果两组患儿手术均顺利，无术中术后死亡。试验组和对照组患儿平均手术时间[（85.7±16.9）min vs.（83.5±16.5）]及术中失血量[（90.0±55.0）ml vs.（85.0±50.0）ml]差异无统计学意义（P>0.05）。试验组的术毕至拔管时间[（0.5±0.1）min vs.（8.3±1.4）min]、住院费用[（24.3±4.7）千元vs.（27.8±5.3）千元]、住院时间[（6.6±0.9）d vs.（12.7±3.2）d]、术后并发症发生率（7.1%vs.25.0%）都显著短或少于对照组（P < 0.05）。 结论单腔气管内插管保留自主呼吸静脉全身麻醉下小儿胸腔镜手术治疗小儿胸部疾病具有一定的安全性及可行性。
Objective To evaluate the role of guide sheath (GS) utilization in radial endobronchial ultrasound guided transbronchial lung biopsy (EBUS-TBLB) for diagnosis of peripheral pulmonary lesions (PPLs). Methods The clinical data of patients who underwent EBUS-TBLB in Peking University First Hospital from July 2012 to June 2015 were retrospectively reviewed. The patients were divided into three groups,ie. a GS group, a non-GS group, and a double biopsy group. Results A total of 118 patients with 126 PPLs were collected. The overall diagnostic yield of EBUS-guided bronchoscopy was 60.3%. The diagnostic yield of GS group, non-GS group and double biopsy group was 65.4%(36/55), 61.5%(8/13), 59.6%(31/52), respectively. The diagnostic yield of the non-GS group was significantly lower than other two groups when PPLs≤20 mm (χ2=6.8,P=0.033), whereas no significant difference was observed when PPLs>20 mm (χ2=2.301,P=0.301). Conclusion GS significantly improves diagnostic yield in EBUS-TBLB when PPLs≤20 mm.
ObjectiveTo investigate the diagnostic value and safety of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary nodules.MethodsThe clinical imaging, surgical and pathological data of 60 patients with 76 peripheral pulmonary nodules who underwent electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound guided biopsy in the Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School from June 2020 to June 2021 were retrospectively analyzed. The diagnosis rate and complications were analyzed and summarized. The 76 pulmonary nodules were divided into a small pulmonary nodules group (10 nodules, diameter≤1 cm) and a pulmonary nodules group (1 cm<diameter≤3 cm, 66 nodules) according to diameter. The two groups were compared in terms of operation and diagnosis rate.ResultsPulmonary nodules diameter was 1.8±0.6 cm, operation time 29.8±8.6 min, navigation 2.9±0.9 times, biopsy 9.5±1.9 pieces. In the 76 pulmonary nodules, 55 were confirmed by pathology, with a total diagnosis rate of 72.4%, including 32 of malignant lesions and 23 of benign lesions. In the 76 pulmonary nodules, 59 had grade 0 hemorrhage, 17 had grade 1 hemorrhage, and none had grade 2 or more serious hemorrhage. Eight patients developed pneumothorax after surgery, and the degree of lung compression was less than 30%, which was improved after symptomatic treatment with oxygen inhalation. The operation time in the small pulmonary nodules group was significantly longer than that in the pulmonary nodules group, and there was no significant difference in diagnosis rate or complications between the two groups.ConclusionElectromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound is a safe and effective method for the diagnosis of periphery pulmonary nodules, and it also has a high diagnostic rate for small pulmonary nodules (≤1 cm), which is worthy of clinical promotion and application.