ObjectiveTo evaluate the clinical application and the efficacy of contrast enhanced ultrasonography (CEUS)guided percutaneous radiofrequency ablation (RFA) in patients with liver metastases. MethodsTotal 136 patients with 219 liver metastatic tumors, which were detected by CEUS before RFA therapy, were analyzed retrospectively. The diamter of tumors was (3.2±1.2) cm. Among them, the largest tumor more than 3 cm in diameter were found in 48.5% (66 patients), and 57.4% (78 patients) were with solitary metastasis. Enhanced CT and (or) MRI, and laboratory tests were applied to evaluate the outcomes after RFA treatment by regular followup. ResultsTumors were not detected by conventional ultrasonography in two cases, and 47.0% (63/134) of the patients with the largest tumor were 0.3 cm larger by CEUS than by conventional ultrasonography. More 40 tumors were detected in 18.4% (25/136) patients by CEUS. Followup ranged from 3 to 68 months (median time of 12 months). Early tumor necrosis rate one month after therapy was 98.2% (215/219 tumors). The incidence of local recurrence, new intrahepatic metastasis, and extrahepatic metastasis was 16.9% (23/136), 38.2% (52/136), and 8.8% (12/136), respectively. Local recurrence and new intrahepatic metastasis happened 2-25 months (median time of 6 months) after treatment. Local recurrence rates of the largest tumors ≥ 3 cm and tumor lt; 3 cm was 22.7% and 11.4%， respectively (P=0.079). The rate of new intrahepatic metastasis for the solitary metastasis cases was significantly lower than that for multiple metastases cases (25.6% versus 55.2%, P=0.000). The 1, 2, 3year survival rates were 82.5%, 64.3%, and 50.1%, and the 1, 2, 3year local recurrence free survival rates were 67.7%, 53.8%, and 38.3%, respetively. Patients with solitary metastasis survived longer than that with multiple metastases (P=0.034). ConclusionPatients with liver metastases treated by CEUSguided percutaneous RFA can get better survival rate, and CEUS is of much value for clinic application.
ObjectiveTo investigate the effect of echinococcus granulosus protoscolices on the differentiation of bone marrow mesenchymal stem cells (BMSCs) into fibroblasts.MethodsFemur bone marrow of 4-week-old C57BL/6 mice was taken and BMSCs were isolated and cultured by adherent culture. Echinococcus granulosus protoscolices was extracted from the liver of sheep infected with echinococcus granulosus. The experiment was divided into two groups. The experimental group was co-cultured with the 3rd generation BMSCs and the echinococcus granulosus protoscolices, and the control group was the 3rd generation BMSCs. Before and after co-culture, the morphology of BMSCs and the activity of echinococcus granulosus protoscolices were observed by inverted microscope. After cultured for 1, 3, 5, and 7 days, the mRNA expressions of transforming growth factor β1 (TGF-β1), collagen type Ⅰ, and collagen type Ⅲ were detected by real-time fluorescent quantitative PCR, the protein expressions of TGF-β1, collagen type Ⅰ, collagen type Ⅲ, Smad7, and phosphorylated Smad2/3 were detected by Western blot, and the contents of collagen type Ⅰ and collagen type Ⅲ in the supernatant of the two groups were detected by ELISA.ResultsAfter 7 days of co-culture, the morphology of BMSCs changed into fusiform and irregular triangle, which was closer to the mouse fibroblasts. The relative mRNA expressions of TGF-β1, collagen type Ⅰ, and collagen type Ⅲ in the experimental group were significantly higher than those in the control group; the relative protein expressions of TGF-β1, collagen type Ⅰ, collagen type Ⅲ, and phosphorylated Smad2/3 in the experimental group were significantly higher than those in the control group, and the relative protein expression of Smad7 in the experimental group was significantly lower than that in the control group; the contents of collagen type Ⅰ and collagen type Ⅲ in the supernatant of the experimental group were significantly higher than those in the control group. The differences between the two groups were significant (P<0.05).ConclusionEchinococcus granulosus protoscolices may promote the secretion of collagen type Ⅰ, collagen type Ⅲ, and TGF-β1 by TGF-β1/Smad signal pathway, which can promote the fibrosis of BMSCs that related to the formation of fibrocystic wall by echinococcosis.
Objective To study the role of E-selection and macrophage inflammatory protein-2（MIP-2） in the airway inflammation in a rat model of chronic obstructive pulmonary disease（COPD）.Methods Twenty-four male SD rats were randomly divided into a normal control group and a COPD group.The rat model of COPD was established by exposure to cigarette smoking.Lung function，pathologic features of lung tissues and inflammatory cell differentials in bronchoalveolar lavage fluid（BALF） were investigated.Immunohistochemistry was employed to examine the expression of E-selection in lung tissue.The levels of MIP-2 in BALF，serum and lung tissues were measured with ELISA.Results The changes in histopathology and pathophysiology in the rat COPD model were similar to those in COPD patients.The expression of E-selection on bronchopulmonary vein endothelial cells of the COPD group significantly increased as compared with the normal control group（Plt;0.05） and was positively correlated with the neutrophil counts in BALF in the COPD group（ｒ=0.809，Plt;0.01）.The levels of MIP-2 in BALF and lung tissues in the rats with COPD were signicantly higher than those in normal rats，both of which were positively correlated with the neutrophil counts in BALF in the COPD group（r=0.893，Plt;0.01；r=0.716，Plt;0.05）.Conclusion Both E-selection and MIP-2 may be involved in the process of airway inflammation in COPD.
ObjectiveTo evaluate the role of surgical resection on synchronous multiple pulmonary nodules identified difficultly in clinics.MethodsThe clinical data of 97 patients with synchronous multiple pulmonary nodules who received surgical resection between 2012 and 2019 in Hunan Cancer Hospital were retrospectively analyzed. There were 72 males and 25 females, aged 58.1±9.0 years. Among these patients, there were 78 patients with ipsilateral and 19 patients with bilateral pulmonary nodules. Clinicopathological parameters between main nodules and secondary nodules were evaluated. Perioperative morbidity was also assessed.ResultsThe operation was successfully completed on all patients for the ipsilateral and bilateral lesions. Totally, 71.1% of mian lesions was mostly removed by lobectomy, and the completion rate of video-assisted thoracoscopic surgery (VATS) was 69.1% (67/97); 80.4% of secondary lesions were mostly removed by wedge resection, and the completion rate of VATS was 71.1% (69/97). The incidence of grade 3 or higher complications after unilateral or bilateral surgery was 12.8% and 5.3%, respectively. Postoperative pathology confirmed that the main lesions were malignant in 65 patients (67.0%), mainly adenocarcinoma (63.1%), of which 43.1% were in the stage Ⅰ; 32 patients were benign, mainly tuberculoma (56.3%). There were 29 patients of malignant secondary lesions, 67 benign, and 1 both benign and malignant; the pathological agreement rate of primary and secondary lesions was 54.6% (lung cancer metastases in the lung and all the benign). When the primary lesion was malignant with its diameters of <3 cm, 3-<5 cm, 5-7 cm, >7 cm, the metastatic rate of secondary lesions was 42.5%, 15.8%, 20.0%, 0, respectively. When the primary lesion was malignant with lymph node metastasis, the probability of the secondary lesion being a metastatic tumor was higher than that without lymph node metastasis (46.7% vs. 30.0%, P>0.05). When the primary lesion was malignant and the primary and secondary lesions were located in the same lobe, the secondary lesions were more likely to metastasize (54.5%), while when they were located on different lobes on the same side or different sides, the secondary lesions were more likely to be benign (58.1%, 72.7%), and the possibility of metastasis was small ( 32.6%, 9.1%). When the primary lesion was benign and clinical differential diagnosis was difficult, the secondary lesion was benign.ConclusionFor synchronous multiple pulmonary nodules, the diameter of the primary lesion is large, the metastatic rate of secondary lesions tends to decrease. In ipsilateral synchronous multiple pulmonary nodules, especially with node metastasis, the risk of metastatic nodule increases. Bilateral surgical resection does not significantly increase the perioperative morbidity.
Objective To investigate the relationship between delayed diagnosis time (time from symptom onset to diagnosis) in patients with chronic obstructive pulmonary disease (COPD) and the burden of type 2 inflammation (defined as the persistent inflammatory status assessed by blood EOS counts, EOS%, and Fractional exhaled nitric oxide(FeNO) among other biomarkers).MethodsThis study was a single-center, observational study that included patients with COPD first diagnosis at the respiratory outpatient department of our hospital from June 2023 to December 2024. Asthma-COPD overlap (ACO) were identified according to the 2017 Spanish COPD guidelines. Clinical data were collected, including gender, age, delayed diagnosis time, acute exacerbations in the past year, pulmonary function tests, exhaled nitric oxide (FeNO), and type 2 inflammatory markers such as blood eosinophil counts (EOS). The correlation between the delayed diagnosis time and type 2 inflammation burden, as well as its influencing factors, were analyzed. Results A total of 195 patients were included, with 98 cases of COPD and 97 cases of ACO. The mean delayed diagnosis time was 18.0 (2.8, 37.5) months for the overall patients, 24.0 (1.0, 60.0) months for COPD, and 16.5 (3.0, 36.0) months for ACO, with no significant difference between the COPD and ACO groups (P>0.05). The median blood EOS counts, EOS%, andFeNO levels were 180 cells/μL, 1.9%, and 18 ppb in the COPD group, respectively, compared to 350 cells/μL, 4.7%, and 28 ppb in the ACO group, indicating higher type 2 inflammation levels in the ACO group (all P<0.001). A significant correlations were found between the disease course and the blood EOS counts and EOS% of the patients (respectively r=0.159, 0.152, all P<0.05).FeNO levels showed no significant correlation with delayed diagnosis time of COPD (P>0.05). Patients with a history of asthma and acute exacerbations in the past year had longer delayed diagnosis time and higher peripheral blood eosinophil counts (all P<0.05). Binary logistic regression analysis revealed that BMI and delayed diagnosis time were independent influencing factors for blood EOS counts (all P<0.05). ConclusionDelayed diagnosis of COPD was associated with aggravated type 2 inflammatory burden. Clinical practice should emphasize early recognition of COPD symptoms and implement prompt therapeutic interventions.