Rapid on- site evaluation (ROSE) had gradually become an essential tool in interventional section, especially in pulmonary diseases. People were no longer limited to routine endoscopic operation. ROSE combined with fine-needle aspiration (FNA) enhanced the diagnostic efficiency and diagnostic accuracy of routine bronchoscopes, endobronchial ultrasound- guided transbronchial needle aspiration (EBUS-TBNA) and percutaneous lung biopsy. ROSE can read out the specimen on site , give preliminary diagnosis, and provide help for next operation. The ROSE included cytological ROSE (C-ROSE) and microbiological ROSE (M-ROSE). Now in clinic, C-ROSE was used more broadly. C-ROSE expanded the check range of routine endoscopic operation, and it had been proven to be safe and useful tools.

Objective To investigate the feasibility and primary therapeutic effect of Dumon Y-shaped airway stent for complex airway disease (stenosis or fistula). Methods Seven patients with complex airway disease underwent placement of Dumon Y-shaped airway stent via rigid bronchoscope, and selected stent depend on carefully measuring the diameter and length of the stenosis or fistula. We retrospectively analyzed the therapeutic efficacy of the patients placed Dumon Y-shaped airway stent. Results All the Dumon Y-shaped airway stent placed successfully. The diameter of the narrowest tracheal stenosis under the carina was improved significantly from (8.03 ± 5.45) mm to (13.08 ± 3.41) mm after the operation. Medical Research Council dyspnea grade improved significantly from Ⅲ~Ⅳ to Ⅰ~Ⅱ and the oxygen saturation improved significantly from (93.86 ± 1.07) % to (98.14 ± 1.07) %. There is no treatment-related complication and death in the seven patients. Conclusion As a new choice, the technique of Dumon Y-shaped airway stent is feasible and safety for the complex airway disease (stenosis or fistula), and worthy of widely promoting.

Obiective To compare the sensitivity and specificity of strain imaging(SI)and restredistribution Tl-201(RR-201 TI)SPECT imaging in evaluating myocardial viability among patients with STelevation acute myocardial infarction(AMI).Methods Twenty-six AMI patients underwent echocardiography and RR-201 Tl-SPECT imaging a week(baseline)after percutaneous coronary intervention(PCI)therapy.At baseline,wall motion score(WMS)and systolic strain were assessed,SPECT scoring were performed on 16 segments of left ventricle(LV).WMS was repeated more than 3 months later to assess myocardial viability,which is deemed as reference.Results ①Two hundred and sixty segments in the"at risk"regions were followed up for(5±2)months,among which 201 were identified as viable and 59 were not,according to the WMS.②In comparison to the reference standard,the sensitivity and specificity of RR-201 Tl-SPECT to predict myocardial viability were 87%(175/201)and 58%(34/59)respectively.③The sensitivity and specificity of systolic strain(Set)to predict myocardial viability after AMl were 81% and 66% respectively at the optimal cut-off value of-60%.④Set was moderately concordant with SPECT scoring(Kappa=0.40)and the agreement between the two methods was 77%(199/260).Conclusions In ST-elevation AMI,SI and RR-201 Tl-SPECT appears equivalent in predicting segmental recovery after reperfusion,and SI could be a convenient and low-cost alternative for the non-invasive evaluation of myocardial viability.

Objective To evaluate the safety and efficacy of bovine pericardium wrapping stump after distal pancreatectomy in a porcine model.Methods Thirty-two swine were randomly assigned to control group (n =16,conventional scalpel transection with hand-sewn closure of the pancreatic remnant)and experiment group (n =16,bovine pericardium wrapping stump combined with hand-sewn).Closedsuction drainage was collected daily until the tenth postoperative day.Animals were killed for necropsy at 3 weeks postoperatively and the pancreatic remnant was sampled for histology.Results The incidence of pancreatic leak in the wrapping group was lower than that in the control group (6.2 vs.46.7％,P ＜0.05).The amount of drainage fluid was higher in the control group during the postoperative period (25.1 ml vs.54.2 ml,P ＜ 0.01).There were no differences in operative time or other clinical parameters measured.No other significant differences were found in macroscopic changes between the two groups.Histology demonstrated focal,chronic inflammation with necrosis at the stump in all animals.Conclusions Bovine pericardium wrapping stump effectively reduced the incidence of pancreatic leakage after distal pancreatectomy.

Objective To evaluate the effect of sustained silencing Forkhead box Ml (F0XM1) gene by short-hairpin RNA (shRNA) expression vector on cell growth of hepatocelluar carcinoma (HCC) in vitro.Methods Four shRNA expression vectors targeting different sequences of human F0XM1 mRNA were constructed.The expression vector with the best interfering effect and the negative control plasmid were used to transfect HCC cell line QGY-7703, stably transfected cell clones were selected by neomycin (G418).Cell growth was evaluated by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and colony formation was assessed by clonogenic assay.Cell apoptosis was detected by double staining with APC conjugated Annexin V and PI.Results F0XM1 protein was detected with different levels in all these studied human cell lines.The expression vector shRNA-1026 exhibited excellent interference effect after transient transfection, which showed 38.5% and 53.2% reduction of FOXM1 mRNA and protein level respectively.The growth of QGY-7703 cells was inhibited after stable inhibition of FOXM1 expression by shRNA-1026, which was indicated by decreased absorbance value of the test group after culture for 48, 72 and 96 h compared to control group (t = 10.830,3.578 and 5.734 respectively, P ＜ 0.05).Stable inhibition of F0XM1 also led to reduced colony formation ( t = 5.336, P ＜ 0.05 ) and increased apoptosis of QGY-7703 cells in comparison to control cells (t = 6.827, P ＜ 0.05 ).Conclusions Stable silencing F0XM1 gene by shRNA suppresses the growth of HCC cells in vitro.

Objective:To explore the imaging features of 18F-fluorodeoxyglucose (FDG) PET/CT (high-resolution CT, HRCT) imaging in focal organizing pneumonia (FOP). Methods:Patients with solid nodular FOP ( n=45; 33 males, 12 females, age (58±9) years) and early peripheral non-mucinous solid lung adenocarcinoma ( n=47; 21 males, 26 females, age (63±10) years) confirmed by postsurgical pathology between May 2012 and December 2018 in Zhongshan Hospital, Fudan University were retrospectively analyzed. All patients underwent 18F-FDG PET/CT (HRCT) imaging followed by surgery within 3 weeks. The imaging findings and characteristics of the lesions were recorded. Differences of the maximum standardized uptake value (SUV max) and maximum diameter between FOP and adenocarcinoma were analyzed by Mann-Whitney U test or t′ test. Spearman correlation or Pearson correlation analysis was performed to analyze the relation between SUV max and maximum diameter. Binary logistic regression analysis was performed to identify the predictive factors for FOP. Finally, the receiver operating characteristic (ROC) curve analysis was used for evaluation of diagnostic efficiency. Results:The SUV max of FOP was lower than that of lung adenocarcinoma (3.1(1.7, 4.9) vs 6.5(3.8, 9.3); z=-4.598, P<0.01), and the maximum diameter of FOP was smaller than that of lung adenocarcinoma ((18.0±6.3) mm vs (21.8±4.3) mm; t′=-3.424, P<0.01). The SUV max was positively correlated with the maximum diameter in FOP group ( r s=0.509, P<0.01), while the SUV max of lung adenocarcinoma was not correlated with the lesion size ( r=0.076, P>0.05). HRCT of the PET/CT system showed the fusiform shape were more common in FOP ( χ2=9.549, P<0.05). Multivariate regression analysis identified that SUV max≤7.1, diameter≤18.3 mm, and fusiform shape were independent factors to predict FOP, with odds ratio ( OR) of 10.585, 4.674, 9.073, respectively (all P<0.05). ROC curve analysis showed that the area under the curve (AUC) of SUV max≤7.1 combined with diameter≤18.3 mm and fusiform nodule was 0.860, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 97.8%(44/45), 70.2%(33/47), 75.9%(44/58), 97.1%(33/34), and 83.7%(77/92), respectively. Conclusion:SUV max≤ 7.1 combined with maximum diameter≤ 18.3 mm and fusiform shape may predict solid nodular FOP.

Objective:To explore the epidemic situation and brucellosis in key occupational populations of brucellosis monitoring sites in Jiangsu Province, and provide a basis for development of prevention and control strategies against brucellosis.Methods:From 2013 to 2017, according to the requirements of the "National Brucella Surveillance Programme", two brucellosis monitoring sites in Yixing City of Wuxi and Huaiyin District of Huai'an, Jiangsu Province were established to monitor brucellosis. Brucellosis epidemic data were collected and analyzed of the two monitoring sites in Yixing City and Huaiyin District from 2013 to 2017 (data were from Jiangsu Provincial Legal Infectious Disease Reporting System). Blood samples were collected from the general occupational populations (health check-up population) and the key occupational populations (people engaged in livestock trading, livestock slaughtering, and the fur, milk and meat processing) in the monitoring sites. Tiger red plate agglutination test (RBPT) and serum tube agglutination test (SAT) were used for serological examination. Results:From 2013 to 2017, a total of 18 cases of brucellosis were reported at the two monitoring sites in Yixing City and Huaiyin District, Jiangsu Province, including 13 males and 5 females, with a male to female sex ratio of 2.6∶1.0; the age of onset was mainly 35 - 64 years, accounting for 72.22% (13/18); the time of onset was mainly from January to June, accounting for 94.44% (17/18); and the occupational distribution was mainly farmers, accounting for 77.78% (14/18); there was no epidemic and outbreaks of brucellosis. A general occupational populations survey was conducted in 17 743 cases, serological tests were negative, no infection and no signs and symptoms were found in the two monitoring sites. In 2013 - 2017, a total of 113 cases of serological tests were positive in the key occupational populations of brucellosis in Jiangsu Province, with a positive rate of 7.83% (113/1 444), and the overall trend was downward year by year ( t = 6.463, P < 0.05). Among them, the positive rates in Yixing City and Huaiyin District were 11.79% (106/899) and 1.28% (7/545), respectively. The difference between different regions was statistically significant (χ 2 = 51.926, P < 0.01). The positive rates of occupational groups engaged in livestock trading, livestock slaughtering, and the fur, milk and meat processing were 5.10% (20/392), 9.74% (49/503), and 8.01% (44/549), respectively. The differences were statistically significant between different occupations (χ 2 = 6.618, P < 0.05); and the positive rates of livestock slaughtering occupations and the fur, milk and meat processing occupations were higher than that of livestock trading occupations ( P < 0.05). Conclusions:The positive rate of brucellosis in key occupational populations has showed a general downward trend, the livestock slaughtering occupations and the fur, milk and meat processing occupations are more susceptible to Brucella infection. It is still necessary to strengthen the health education for the key occupational populations of brucellosis and inspection and quarantine work for prevention of the epidemic of brucellosis in humans.

Objective: To describe and compare the epidemiology of Sepsis-1 and Sepsis-3 in Yuetan Subdistrict of Beijing, and to estimate the incidence of Sepsis-3 in China. Methods: A population-based cohort study was conducted. Through the database of Beijing Public Health Information System, the medical records of all adult residents hospitalized from July 1st, 2012 to June 30th, 2014 in Yuetan Subdistrict were reviewed. According to the clinical data of these patients, patients with Sepsis-1 and Sepsis-3 were enrolled in this analysis and the demographic characteristics of them were compared. Incidence and in-hospital mortality was calculated. Logistic regression method was used to analyze the risk factors of sepsis. Results: Compared with non-septic patients with infections, patients with Sepsis-1 or Sepsis-3 were more likely to be male, older, had more comorbidities and lower body mass index (BMI), had more lower respiratory tract infections, more intra-abdominal infections and more blood flow infections, but had fewer urogenital tract infections, fewer upper respiratory tract infections, fewer gastrointestinal infections and fewer skin and soft tissue infections, and had pure prognosis with longer length of hospital stay [days, Sepsis-1 compared with non-Sepsis-1: 18 (10, 34) vs. 14 (9, 22), Sepsis-3 compared with non-Sepsis-3: 20 (11, 39) vs. 14 (9, 25)] and higher mortality [Sepsis-1 compared with non-Sepsis-1: 20.6% (353/1 716) vs. 2.5% (44/1 733), Sepsis-3 compared with non-Sepsis-3: 32.0% (299/935) vs. 3.9% (98/2 514), all P < 0.01]. Logistic regression analysis showed that male, elder (age ≥ 65 years old), low BMI, bed-rest state, and combined with cerebrovascular disease and hematological malignancies were risk factors for Sepsis-1 [all odds ratio (OR) > 1, all P < 0.05], while the male, elder (age ≥ 65 years old), low BMI, bed-rest state, and combined with cerebrovascular disease, rheumatic immune disease, malignant diseases of blood system and dementia were risk factors for Sepsis-3 (all OR > 1, all P < 0.05). Sepsis-3 was more common in males [OR = 1.19, 95% confidence interval (95%CI) was 1.01-1.40, P < 0.05] and elderly patients (age 65-84 years old: OR = 1.60, 95%CI was 1.28-1.99, P < 0.01; age ≥ 85 years old: OR = 1.76, 95%CI was 1.39-2.23, P < 0.01) as compared with Sepsis-1. After adjusted for gender and age, the standardized incidence of Sepsis-1 was 461 per 100 000 person-year, and that of Sepsis-3 was 236 per 100 000 person-year, with the standardized mortality of 79 per 100 000 person-year and 67 per 100 000 person-year, respectively, in Yuetan Subdistrict of Beijing. Corresponding to a speculative extrapolation of 4 856 532 new cases for Sepsis-1 and 2 487 949 new cases for Sepsis-3, there were 831 674 deaths and 700 437 deaths per year in China, respectively. Conclusions Male, elder, more comorbidities and low BMI were risk factors for sepsis. The standardized incidence of Sepsis-3 in Yuetan Subdistrict of Beijing was 236 per 100 000 person-year, and speculated there were 2.5 million new cases of Sepsis-3 per year, resulting in more than 700 000 deaths in China. According to the diagnostic criterion of Sepsis-3, 2.36 million new cases per year were reduced, and the mortality was increased by 11.4%, as compared with the criterion of Sepsis-1.

OBJECTIVE To study the effects of cy cloastragenol （CAG） on carbon tetrachloride （CCl4）-induced hepatic fibrosis（HF）and glycolysis in mice. METHODS Male ICR mice were randomly divided into blank group ，model group ，CAG low-dose，medium-dose and high-dose groups （60，120，240 mg/kg），with 6 mice in each group. Except that blank group was given olive oil intraperitoneally ，the mice in other groups were intraperitoneally injected with 10％CCl4-olive oil solution （5 mL/kg） three times a week for 8 weeks to induce HF model. From the 4th week after modeling ，mice in each drug group were given corresponding drug solution intragastrically （10 mL/kg），and mice in blank group and model group were given 0.5％ sodium carboxymethyl cellulose solution intragastrically （10 mL/kg），once a day for 4 weeks. During the experiment ，the body weight of mice were weighted ；after last gastrogavage ，the liver weight was weighted and liver indexes of mice were calculated. The changes of hepatic injury indexes [aspartate aminotransferase （AST）， alanine aminotransferase （ALT）]， related indexes of HF [hematoxylin-eosin （HE）staining score ，Masson and Picrosirius red staining collagen volume fraction ，collagen Ⅰ，α-smooth muscle actin （α-SMA）] and related indexes of glycolysis [lactic acid （LD），hexokinase（HK），phosphofructokinase（PFK）， pyruvate kinase （PK）] were all detected. RESULTS Compared with model group ，the collagen deposition and fibrosis of mice in each drug group were reduced ，and the body weights of mice （except for CAG low-dose group ）were increased to some extent （P＜0.05）. Liver indexes ，serum levels of ALT and AST ，HE staining score of liver histopathology ，Masson and Picrosirius red staining collagen volume fraction ，protein expression of collagen Ⅰ and α-SMA，serum content of LD ，the levels of HK ，PFK and PK in serum and hepatic tissues （except for hepatic tissue of CAG low-dose group ）were all decreased significantly （P＜0.05）. CONCLUSIONS CAG can improve HF in mice induced by CCl 4，and reduce the levels of key enzymes and products of glycolysis.

Background and objective As computed tomography (CT) screening for lung cancer becomes more common in China, so too does detection of pulmonary ground-glass nodules (GGNs). Although anumber of national or international guidelines about pulmonary GGNs have been published,most of these guidelines are produced by respiratory, oncology or radiology physicians, who might not fully understand the progress of modern minimal invasive thoracic surgery, and these current guidelines may overlook or underestimate the value of thoracic surgery in the management of pulmonary GGNs. In addition, the management for pre-invasive adenocarcinoma is still controversial. Based onthe available literature and experience from Shanghai Pulmonary Hospital, we composed this consensus about diagnosis and treatment of pulmonary GGNs. For lesions which are considered as adenocarcinoma in situ, chest thin layer CT scan follow-up is recommended and resection can only be adopt in some specific cases and excision should not exceed single segment resection. For lesions which are considered as minimal invasive adenocarcinoma, limited pulmonary resection or lobectomy is recommended. For lesions which are considered as early stage invasive adenocarcinoma, pulmonary resection is recommend and optimal surgical methods depend on whether ground glass component exist, location, volume and number of the lesions and physical status of patients. Principle of management of multiple pulmonary nodules is that primary lesions should be handled with priority, with secondary lesions taking into account.
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Adenocarcinoma ; diagnosis ; diagnostic imaging ; surgery ; Adenocarcinoma of Lung ; China ; Consensus ; Hospitals ; Humans ; Lung Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Physicians ; psychology ; Positron Emission Tomography Computed Tomography ; Practice Guidelines as Topic ; Retrospective Studies ; Solitary Pulmonary Nodule ; diagnosis ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed