Objective To explore the clinical characteristics, diagnosis and treatment plan of pulmonary lymphomatoid granulomatosis in order to deepen the understanding of this disease. MethodsA case of pulmonary lymphomatoid granulomatosis complicated with tuberculosis and human immunodeficiency virus (HIV) infection was reported. Literature reviews were searched in PubMed database with "pulmonary, lung, lymphomatoid granulomatosis" as the key words, and in China Knowledge Network and Wanfang database with "lung, lymphomatoid granulomatosis" as the key words. The search time was from January 1, 2017 to December 31, 2021. ResultsThe patient was diagnosed as pulmonary tuberculosis at the beginning of the disease, and the lesion was obviously absorbed and improved after regular anti-tuberculosis treatment. Six months after anti-tuberculosis treatment, chest CT examination showed multiple new circular nodules in both lungs. Intensive anti-tuberculosis treatment did not improve, further lung biopsy, pathology revealed lymphomatoid granulomatosis, grade 2; During the period, HIV infection was proven, and the patient underwent anti-viral infection and re-examination of chest CT lung lesions significantly improved absorption. Literature reviews found 47 same patients, therefore totally 48 patients were analyzed, in which this former case was included. Among the 48 patients, 26 were male (54.2%) and 22 were female (45.8%), with a median age of 60 years old (4 to 87 years old). The most common symptoms were cough, fever and shortness of breath, some of them may be accompanied with fatigue, weight loss, night sweats and loss of appetite. 20.9% of the patients had rashes, mainly manifested as erythema or papules. 39.6% of the patients were accompanied by immune system related diseases or immunosuppressants; The most common manifestations of chest CT were multiple nodules or masses involving both lungs. The main way of diagnosis was surgical lung biopsy, or CT-guided lung puncture biopsy. The positive rate of bronchoscopy biopsy was low. The pathological grade was mainly grade 3 (56.3%). The treatment plan was mainly R-CHOP, with an effective rate of 71.4%. For patients considered drug-induced disease, it was necessary to stop using induced drugs first, and then combined chemotherapy if there was no improvement. For HIV-infected patients, highly active antiretroviral therapy should be given first, if there was no improvement, then took combined chemotherapy; Of the 48 patients, 41 patients had clear follow-up results with a median follow-up time of 12 months, of which 14 patients were dead (34.1%), and the others got better in different degrees. Conclusions Pulmonary lymphomatoid granulomatosis is a rare disease. Clinicians should improve their understanding of it in order to identify the disease early, and choose the appropriate treatment scheme to improve its prognosis.
Objective To investigate the evaluation value of serum interleukin-34 (IL-34), macrophage migration inhibitor (MIF), osteopontin (OPN) and hypersensitive C-reactive protein (hs-CRP) in the diagnosis and prognosis of active pulmonary tuberculosis. Methods Clinical data of 100 patients with active pulmonary tuberculosis admitted from June 2019 to June 2022 were selected as an observation group and retrospectively analyzed. All patients received standardized anti-tuberculosis therapy for 6 months and were divided into a good prognosis group (76 cases) and a poor prognosis group (24 cases) according to the prognosis. Another 80 healthy volunteers who underwent physical examination during the same period were selected as the control group. Serum levels of IL-34, MIF, OPN and hs-CRP were detected in each group, and the value of serum IL-34, MIF, OPN and hs-CRP in the diagnosis and prognosis of active pulmonary tuberculosis was analyzed by receiver operating characteristic curve (ROC curve). Results Serum levels of IL-34, MIF, OPN and hs-CRP in the observation group were higher than those in the control group (all P<0.05). ROC curve showed that serum IL-34, MIF, OPN, hs-CRP had a certain diagnostic value in active pulmonary tuberculosis, with area under ROC curve (AUC) of 0.864, 0.870, 0.865, and 0.880, respectively (all P<0.01), and the combination of the four indexes had a higher diagnostic value (AUC=0.902, P<0.01). Serum levels of IL-34, MIF, OPN and hs-CRP in the good prognosis group were lower than those in the poor prognosis group (all P<0.05). ROC curve showed that serum IL-34, MIF, OPN, hs-CRP had a certain value in evaluating the prognosis of active pulmonary tuberculosis, with AUC of 0.850, 0.874, 0.837, and 0.842, respectively (all P<0.01), and the combined value of the four indexes was higher (AUC=0.923, P<0.01). Conclusion The combined detection of serum IL-34, MIF, OPN and hs-CRP has high value in the diagnosis and prognosis assessment of active pulmonary tuberculosis.
Objective Series of compl icated molecule signal pathway are involved in the bone regeneration. To explore the possibil ity of nuclear factore kappa B (NF-κB) which is taken as the “key activation” during the fracture healing and provide the laboratory evidence for the gene therapy of nonunion or delayed union of fractures. Methods Thirtythree adult male Wistar rats (weighing 180-220 g) were selected and divided randomly into 4 groups: group A (the control group, n=3), the rigth lower segments of radius were injected with normal sal ine 0.3 mL for 7 days, once per day; group B (Bay 11-7082 injection group, n=6), the middle and distal radius were injected with normal sal ine containing 50 μmol/L NF- κB inhibitor Bay 11-7082 0.3 mL for 7 days, once per day; group C (fracture group, n=12), the right middle and distal radius were cut by a sharp scissors to form per fracture model; and group D (Bay 11-7082 treatment group, n=12), based on group C, 0.3 mL of 50 μmol/L Bay 11-7082 were injected into the fracture site for 7 days, once per day. The callus tissues were harvested at 3, 7, 14, and 28 days after fracture for Western blot analysis, alkal ine phosphatase (ALP) activity assessment, prostaglandins E2 (PGE2) production assay, and histological observation. Results The rats of all groups were survivaltill the experiment completion. At 3 and 7 days after injection, there was no significant difference in the ALP activity and PGE2 production between group B and group A (P gt; 0.05); but group C was significantly higher than group A (P lt; 0.01) and group D was significantly lower than group A (P lt; 0.01). The expressions of NF-κB p65, bone morphogenetic protein 7 (BMP-7), and inhibitor of DNA binding 2 (Id2) were observed at fracture sites of 4 groups. There was no significant difference in the expressions of NF-κB p65, BMP-7, and Id2 between group B and group A (P gt; 0.05); the expressions of NF-κB p65 and BMP-7 were significantly higher and the expression of Id2 was significantly lower in group C than group A (P lt; 0.01); and the expressions of NF-κB p65 and BMP-7 were significantly lower and the expression of Id2 was significantly higher in group D than group A (P lt; 0.01). The histological observation showed that a lot of osseous callus formed in group C at 14 and 28 days, but osseous callus just began to form in group D at 28 days. Conclusion NF-κB p65 can facil itate early fracture heal ing of rat radius by elevating the PGE2 production and regulating BMP-7 and Id2 expression.