Objective To evaluate the safety of CT guided percutaneous lung biopsy in the elderly,and to analyze the risk factors for its complications.Methods Totally 204 elderly patients aged ≥65 years underwent transthoracic needle biopsy under CT guidance.Clinical data,complication and its risk factors were analyzed retrospectively.Results The complications included pneumothorax accounting for 15.2％ (31/204),hemoptysis 21.6％ (44/204),and no mortality was found.Logistic regression analysis showed that needle path ≥5.00 cm,lesion size ≤2.00 cm and emphysema around the lesion were the independent risk factors for postoperative pneumothorax (OR=4.05,2.54 and 3.97,all P＜0.05).Meanwhile,the enhancement degree by CT ＞40 HU,needle path ≥5.00 cm and lesion size ≤2.00 cm were the independent risk factors for postoperative bleeding (OR=2.27,2.82 and 2.33,all P＜0.05) in elderly patients undergoing lung biopsy.The sensitivity and specificity for postoperative pneumothorax and bleeding obtained by forecasting equation were 87.1％ and 49.1％,54.5％ and 80.8％ respectively.Conclusions The length of needle path,lesion size and emphysema around the lesion are correlated with pneumothroax,and length of needle path,lesion size and the CT enhancement degree are correlated with bleeding after percutaneous lung biopsy in the elderly.

Due to the presence of various organotins from numerous anthropogenic sources, a widespread human exposure to these pollutants can be suggested. Human exposed to organotins mainly from dietary besides skin and lung absorption. Based on the exposure routes of organotins to human, such as air, drinking water, food and household commodities, the exposure level of organotins to human and its harmful effects were reviewed. Finally, the methods of human risk assessment of organotins were simply introduced, and the primary problems at present were put forward.

Objective To evaluate the role of clinical features,radiography and histopathology in differential diagnosis between chronic necrotizing pulmonary aspergillosis(CNPA)and aspergilloma.Methods Thirty-four patients including 8 cases of CNPA and 26 of aspergilloma comfirmed by operation and histopathology in First Affiliated Hospital,Zhejiang University were investigated retrospectively.The clinical manifestations,radiological and pathological findings of all the patients were analyzed and related references were reviewed. Results The age of onset was not significantly different between CNPA and aspergilloma.Obsolete pulmonary tuberculosis and lung abscess were predisposing factors of them.Productive cough was presented in all 8 cases of CNPA,haemoptvsis in 7,and 5 were presented with constitutional symptoms.The most common symptom of aspergilloma was haemoptysis, which was presented in 25 cases.The less common symptoms were cough and sputum,which was presented in 17 cases.Only two cases were presented with constitutional symptoms."Air crescent"sign at radiography was typical and suggestive of diagnosis in both CNPA and aspergilloma,but the wall of cavity in CNPA was thicker and irregular,infiltrates were often to be seen around the cavity.Histologically,CNPA and aspergilloma both showed septate fungal hyphae branching at an acute angle.CNPA was characterized with the presence of tissue invasion by aspergillus,tissue necrosis and granulomatous inflammation. Fungal hyphae ware only found in a preexistent cavity or ectatic bronchus without tissue invasion in aspergilloma.Conclusions Histopathology is gold standard of differential diagnosis of CNPA and aspergilloma. Meanwhile, clinical features and radiological findings appear to be valuable for the diagnosis.

OBJECTIVETo investigate the clinicopathological features and the differential diagnosis of poroma and porocarcinoma.

METHODSHistopathological characteristics and clinical data of 35 cases of poroma and 10 cases of porocarcinoma were analyzed retrospectively.

RESULTSThe average age of 35 patients of poroma was 48 years. The average age of 10 patients of porocarcinoma was 65 years. Both poroma and porocarcinoma occured most frequently on the scalp and face,as well as the extremities. Histologically, cases of poroma were divided into three subtypes, including classic poroma (23 cases), hidroacanthoma simplex (3 cases) and dermal duct tumor (9 cases). Residual foci of benign poroma were found in all cases of porocarcinoma, most of which were classic poroma. The malignant components showed severe dysplasia and/or stromal infiltration.

CONCLUSIONThe diagnosis of poroma and porocarcinoma is mainly based on the microscopic characteristics. An invasive architectural pattern and/or significant cytologic pleomorphism are the most important clues for the diagnosis of porocarcinoma. Neither focal mitotic activity nor the presence of necrosis was the diagnostic feature of porocarcinoma. Malignant transformation can occur in some cases of long existing poroma with recent, rapid tumor enlargement.

Aged ; Cell Transformation, Neoplastic ; Diagnosis, Differential ; Eccrine Porocarcinoma ; pathology ; Extremities ; Head and Neck Neoplasms ; pathology ; Humans ; Middle Aged ; Poroma ; pathology ; Retrospective Studies ; Scalp ; Skin Neoplasms ; pathology ; Sweat Gland Neoplasms ; pathology

Objective To investigate the clinico-pathological characteristics of nodular goiter (NG) with lymphocytes infiltration and its relationship with Hashimoto′s disease. Methods Clinical and histologic data were collected and reviewed for 1121 cases of nodular goiter and 55 cases of thyroid adenoma, among which 83 cases had lymphocytes infiltration. These 83 cases of NG with lymphocytes infiltration were observed histologically in detail, followed up and assessed for the correlation of thyroid function to histologic findings. Results The overall incidence of lymphocytic infiltration in non-toxic nodular goiter was 7.4% (83/1121). Most of them were women of middle age. All had lymphocytes infiltration, follicule atrophy and oxiphilic epithelia in the background of nodular goiter. Seventy-six percent underwent cystic degeneration or had fibrous scar. Nineteen percent with lymphocytes infiltration in NG developed post-operative hypothyroidism. Six cases (7%) had high levels of thyroid auto-antibodies. None of the 55 cases of thyroid adenoma had overt lymphocytes infiltration. Conclusion Nodular goiter with lymphocytes infiltration and Hashimoto′s disease shares similar morphology and clinical presentation in some degree. It seems that NG with lymphocytes infiltration is a kind of inflammatory hyperplasia relating to autoimmunity and perhaps the beginning of some cases of Hashimoto′s disease.

AIM: To study the difference in glucose and lactate levels between brain extracellular fluid (ECF) and plasma in rabbits in the different blood glucose levels. METHODS: Using intracerebral microdialysis technology, brain ECF levels of glucose and lactate were measured in every 10 min under basal conditions and during a hyperglycemia-hypoglycemia clamp study. RESULTS: Under basal condition, brain ECF glucose levels were markedly lower than ambient plasma levels (30% of plasma), whereas ECF lactate levels were substantially higher (165% of plasma). During the hyperglycemia-hypoglycemia clamps, the relationship between plasma and ECF levels of glucose remained similar, but changes in ECF glucose lagged about 30 min. There were no substantially changes in ECF levels of lactate during dynamical study. CONCLUSION: There are striking differences in glucose and lactate levels between brain ECF and plasma. Lactate may involve in the metabolic process of central nervous system.

Objective To evaluate the robustness of body mass index (BMI) adapted tube current selection method for obtaining consistent image quality in MSCT coronary artery imaging Methods Initially one hundred patients in the control group ( C group) underwent cardiac scans using GE 64-row VCT with standard scan protocol (640 mA, 120 kV, 0.35 see, body bewtie, C2 filter). Noise measurement was obtained for each patient using the average of three consecutive slices in the ascending aorta with ROI of 10 mm×10 mm to establish the relationship between BMI, desired image noise (IN) and required mA. An excel table was established to predict the required mA to achieve a desired IN for each patient with different BMI. A second group of one hundred cardiac patients (L group) was scanned with BMI-aclapted mA from the table to evaluate the practicability of this method. BMI, IN, CT dose index(CTDI),effective dose (ED) were all recorded. Results For the control group of 100 patients, the mean values and standard deviations of image quality score (IQS), BMI, IN and ED were 3.71±0.54, 25.08±2.63, 24.56±5.03 and (17.63±1.68 ) mSv (with range of 15-22 msy). Regression analysis indicated linear relationship between BMI and image noise with fixed mA. Using the relationship between tube current and image noise and noise ratio between large bowtie and cardiac bowtie, the following equation for the required tube current Xma to achieve present image noise of Ins for patient with certain BMI value when using cardiac bowtie could be then obtained: Xma = Fma×( k1 x BMI + c1 )/Ina]2, where Fma = 640 mA, k1 = 1. 033, c1 = - 3.2, Ins = 27 in the study. (2) For the patients in L group, the mean values and standard deviations of IQS, BMI, and IN were 3.69±0.53, 25.07±2.91, and 26.61±3.44, respectively. The average tube current used was (469.95±113.45) mA, depending on patient's BMI values. The average effectively dose was(9.08±2.25) mSv. There was no statistically difference between the two groups in image quality( F= 0.068,P=0.794). Conclusions In 64-MSCT cardiac imaging, the use of BMI dependent tube current selection method, in conjunction with dose reduction techniques, can provide individualized scan protocol to obtain consistent image quality across patient population and to optimize dose delivery to patients.

Objective To analyze clinicopathologic features and malignant transformation of spiradenoma (SA).Methods Clinicopathologic data on 25 cases of SA were retrospectively analyzed.An immunohistochemical study was conducted on 5 of the 25 patients.Clinicopathologic features of SA were summarized based on clinicopathologic data,immunohistochemical results and relevant literature.Results The average age of these patients was 40 years.Lesions were acquired and solitary in 24 cases (96％,24/25),and occurred most frequently in the extremities.The diameter of tumors was less than 2 cm in 20 cases (87％,20/23).Twenty-three cases were benign SA with various histological manifestations,including 15 cases (65％,15/23) of typical SA,8 cases (35％,8/23) of cylindroma.VarTing numbers of mitotic figures were observed in different cases.The immunohistochemical study showed epithelial and myoepithelial differentiation.Two cases of SA experienced malignant transformation into poorlydifferentiated basal cell adenocarcinoma and well-differentiated adenocarcinoma respectively.Lymphocytes decreased significantly in number or disappeared in the malignant area,and both the malignant tumors exceeded 2 cm in diameter.Conclusions SA is a kind of neoplasm with distinct histological characteristics and nonspecific clinical manifestations.Most SA cases have a benign clinical course,but malignant transformation should be considered in some cases with longterm clinical course and large size.

Objective To compare blood pressure control in community hypertensive patients with different management methods.Methods Two neighborhood committees in a community of Pudong were selected as study area using cluster sampling method.A total of 5 166 residents aged ≥35 y were screened for blood pressure; the subjects with high blood pressure and had antihypertensive medication in last 6 months were included,and patients with secondary hypertension was excluded.The patients who entered community hypertension management program and got medication from community were included in community group; those who did not enter in community management program and/or not get medication from community were included in non-community group.Self-designed questionnaire was used for investigation.The medication compliance,awareness of hypertension risk factors and high blood pressure control were compared between two groups.Results Among 5 166 residents 4 763 were surveyed for hypertension with a response rate of 92.2％ and hypertension prevalence rate of 23.2％ (1 105/4 763).Among 1 012 patients with drug treatment for more than 6 months,there were 878 cases in community (86.8％) and 134 cases (13.2％) in non-community group.There were no significant differences in gender,age,education,working condition between community group and non-community group (P ＞ 0.05).44.3％ (389/878) patients in community group had a history of high blood pressure ＞ 10 y and that was 56.7％ (76/134) in non-community group (P =0.011) ; 28.6％ (251/878) patients in community group were at high risk for risk stratification and that in non-community group was 47.8％ (64/134) (P ＜0.001).The awareness of hypertension risk factors in community group and non-community group was 83.9％ and 95.5％,respectively (P ＜ 0.001).The medication compliance and blood pressure control rates in two groups were 93.2 ％ and 84.3 ％ (P ＜ 0.001),68.6％ and 51.5 ％,respectively (P ＜ 0.001).Conclusion The outcomes of hypertension management in terms of medication compliance and blood pressure control in community group are better than those in non-community group.

AIM:To evaluate the effects of treatment with HP 1188-immunoglobulin yolk ( HP1188-IgY) on Helicobacter pylori ( H.pylori)-infected gastritis in BALB/c mice.METHODS:BALB/c mice were used to establish an animal model of H.pylori-infected gastritis, and the mice were divided into 8 groups (10 mice per group).Oral antibiotics were used in group 1, 1 mg HP1188-IgY in group 2, 1 mg HP1188-IgY plus 30%sucralfate in group 3, 5 mg HP1188-IgY in group 4, 5 mg HP1188-IgY plus 30%sucralfate in group 5, PBS in group 6, and 30% sucralfate in group 7 with the treatment once per day for 10 d;and 2.5 mg HP1188-IgY was injected hypodermically twice with a 48-h interval in group 8.Another 10 mice were used as normal control in group 9.The planting of bacteria in the stomach was assayed by bacteri-al culture, rapid urease test, PCR and pathological sectioning .RESULTS:Intragastric administration with 1 mg HP1188-IgY plus 30%sucralfate per day effectively cured the injury of gastric mucosa caused by H.pylori infection, and the effect has no significant difference compared with antibiotics (P>0.05).CONCLUSION:We establish a BALB/c mouse mod-el infected with H.pylori successfully.Sucralfate (30%) is an ideal protectant for HP1188-IgY, which might decrease H. pylori infection in the stomach of BALB/c mice by oral inoculation .