Objective To investigate the roles of fiberoptic bronchoscopy in diagnosis and treatment for infants with refractory and persistent wheezing. Methods From Jun. 2012 to Dec. 2013, 52 hospitalized children with age between four 4 months and 1 year old were recruited for ifberoptic bronchoscopy, who had been wheezing for at least four weeks and treated ineffectively with conventional anti-inlfammatory agents:budesonide and compound ipratropium bromide solution. Then, the pathogenesis of refractory and persistent wheezing was summarized based on clinical features, detection of CT imaging of three-dimensional airway reconstruction and cardiac CT, results of bronchoscopy inspection, and bronchoalveolar lavage lfuid culture. Results Among the 52 cases, 40 were with ground glass-like changes (76.92%) in pulmonary spiral CT testing, 4 with mosaic perfusion syndrome (7.69%), 8 with segmental pulmonary consolidation (15.38%), 8 with obstructive pulmonary emphysema (15.38%), and 1 with left primary bronchial foreign body. In addition, through bronchofibroscopy, there were 52 cases with imlfammation (100%),3 with tracheal stenosis (5.77%), 3 with left and/or right main bronchus stenosis of the external pressure, 18 with bronchomalacia(34.62%), 2 cases with foreign body (3.84%), one in trachea (1.92%), the other in left main bronchus (1.92%), 10 with bronchial mucus plug (19.23%), and 8 (15.38%) with congenital airway malformations (including 3 at tracheal bronchus, 1 at left upper lobe bronchial stenosis and 1 at bronchial Bridge). The culture of bronchoalveolar lavage lfuid were conducted for all patients. The positive rate of bronchoalveolar lavage lfuid was 9.62%(5/52 cases), including 2 cases with tip Escherichia coli, 2 with Haemophilus inlfuenzae, and 1 with Acinetobacter baumannii. Conclusions First, infection is the primary cause of refractory and persistent wheezing, which is persistent in airway resulted from multi-drug resistant bacteriua. Second, refractory and persistent wheezing is often caused by multi-factors including infection, congenital airway malformations, the endogenous and exogenous foreign body, cardiovascular malformation, etc. These factors often lead to dififcult wheezing control. The last, the diagnosis rate of the refractory and persistent wheezing can be improved by combination of ifberoptic bronchoscopy and lung spiral CT.

Objective To study the therapeutic effect of recombinant adeno-associated virus carrying human endostatin gene therapy on endometriosis in mice model. Methods Recombinant adeno-associated virus vector carrying human endostatin gene and enhanced green fluorescent proteins gene (rAAV2-endostatin-EGFP) was constructed. Endometrium was from 12 patients with leiomyoma undergoing hysterectomy in Second Hospital, Tianjin Medical University between November and December 2008. Endometriosis models of nude mice were established by transplanting human endometrial fragments intooperitoneal surface. After 1 week, those 60 mice were divided into 3 groups: treatment group including 20 mice injected with rAAV2-endostatin-EGFP to ectopic lesion, control group including 20 mice injected with rAAV2-EGFP to ectopic lesion and blank control group including 20 mice injected with phosphate buffered saline (PBS) to the ectopic lesion. At 1, 2 and 3 weeks after treatment, those mice underwent laparotemy to observe the location and size of ectopic lesion in abdominal cavity. The expression of endostain protein, number of gland, microvessel density (MVD) and vascular endothelial growth factor (VEGF) were measured in ectopic lesions. The serum level of estradiol and progesterone were detected in nude mice among every groups. Results (1) All endometriosis of nude mice models were established successfully through peritoneum transplanting. After 1 week's treatment, flat lesion nodes, decreased gland number and narrow and atrophy glandular cavity were observed by light microscope. (2) The endostatin gene was transferred into nude mice successfully and expressed effectively. It was observed that endostatin protein expression was shown with enhanced green fluorescent proteins in ectopic lesion. (3) Glands number of ectopic lesion in rAAV2-endostatin-EGFP group(7.8±1.9,7.0±1.5 and 5.5±1.7) were significantly less than 10.1± 1.7, 10.2±2.0 and 9.8±2.4 in rAAV2-EGFP control group and 10.2±2.2,10.0±2.0 and 9.7±2.2 in PBS control group at 1,2 and 3 weeks after treatment(all P<0.05). Glands number of ectopic lesion in rAAV2-endostatin-EGFP group at 3 weeks was significantly less than those at 1 and 2 weeks after treatment (P<0.05). (4) MVD of ectopic lesion in rAAV2-endostatin-EGFP group (12.2±1.5,11.4±2.1 and 9.0±1.4) was significantly less than those at rAAV2-EGFP control group (16.5±1.7,16.5±1.9 and 16.9±1.9) and PBS control group (16.2±1.6,16.0±1.6 and 16.3±1.7) at 1,2 and 3 weeks after treatment (all P<0.05) . MVD of ectopic lesion in rAAV2-endostatin-EGFP group at 3 weeks was significantly less than those at 1 and 2 weeks after treatment(P<0.05). (5) The rate and density of VEGF expression at ectopic lesion in rAAV2-endostatin-EGFP group (35%, 30%, 25% and 1.60±0. 43,1.33± 0. 30,1.03±0.36) were significantly less than those at rAAV2-EGFP control group (80% ,75% ,85% and 2.43±0.53,2.43±0.29,2.66±0.45) and PBS control group (85% ,90% ,90% and 2.36±0.53,2.64± 0.57,2.53±0.52) at one 1, 2 and 3 ,weeks after treatment (all P<0.05). The expression of VEGF at ectopic lesion in rAAV2-endostatin-EGFP group at 3 weeks was significantly less than those at 1 and 2 weeks after treatment (P<0.05). (6) The level of estradial and progesterone in serum of nude mice of rAAV2-endostatin-EGFP group [ E_(2)> : (48±7 ) pmol/L, P: (61±8 ) nmol/L ] did not reach statistical difference when compared with those at rAAV2-EGFP control group [ E_(2): (50±9) pmol/L, P: (60±10) nmol/L] and PBS control group [E_(2):(48±7)pmol/L,P: (58±10)nmol/L,P>0.05]. Conclusions The recombinant adeno-asseciated virus carrying human endostatin gene therapy could inhibit angiogenesis at endometriotic lesions and not influence steroid level. The antiangiogenic gene therapy might become a novel option for endometriosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ascites ; pathology ; Biopsy ; Biopsy, Fine-Needle ; Child ; Cytodiagnosis ; methods ; Diagnosis, Differential ; Female ; Humans ; Leukemia-Lymphoma, Adult T-Cell ; pathology ; Lymphoma, B-Cell ; pathology ; Lymphoma, Large B-Cell, Diffuse ; pathology ; Lymphoma, T-Cell ; pathology ; Male ; Middle Aged ; Pleural Effusion ; pathology ; Young Adult

Objective To discuss the correlation between dynamic changes in pulmonary function and chronic cough in 5-to-14-year-old children with Mycoplasma pneumoniae pneumonia(MPP)after acute period(about 2 weeks after admission). Methods One hundred and fifty - six hospitalized children diagnosed with MPP from Lianyungang Maternal and Child Health Care Hospital Affiliated to Yangzhou University from February 2014 to May 2017 were selected. According to the results of routine ventilatory pulmonary function before discharge(10-14 days in hospital;acute phase group),there were 50 patients with normal pulmonary function and 106 patients with abnormal pulmonary function. All patients continued to take oral azithromycin for 2 to 3 courses after discharge,and the indexes of lung function were dynamically tracked in 1 month(1-month group)and 2 months(2-month group)in the group of abnormal lung function after leaving the hospital,and the incidences and causes of chronic cough were followed up. Results (1)There were 106 cases with abnormal pulmonary function in 156 cases with MPP in acute phase group,and the rate of incidence was 67. 95%. Twenty-seven(29. 35%)out of 97 children were still abnormal in pulmonary functional testing 1 month after leaving hospital( 1-month group). Among the 27 cases,about 18. 52%(5/27 cases) of them still did not return to normal 2 months after discharge( 2-month group ). There were significant differences in the occurrence of abnormal pulmonary function among 3 groups mentioned above(χ2 ＝162. 64,P<0. 001).(2)Ratios of measured values and predicted ones of forced vital capacity( FVC ),forced expiratory volume in one second (FEV1 ),peak expiratory flow(PEF)and maximum mid-expiratory flow(MMEF 25% -75%)in the lung function of 2-month group after the acute phase of MPP were significantly higher than those of 1-month group and acute phase group,and the values of 1 -month group were better than those in acute phase one,which were statistically different among 3 groups(P<0. 01).(3)The rate of occurrence of chronic cough in normal lung function group was about 18. 00%(9/50 cases),and in abnormal pulmonary function group,it was about 70. 75%(75/106 cases). There was a significant difference between them(χ2 ＝35. 96,P<0. 05). Abnormal pulmonary functions were the influencing factors of chronic cough(r＝0. 55,P<0. 01).(4)There were 5 cases with upper airway cough syndrome(UACS)and 4 cases with post-infection cough(PIC)found in the normal lung function group. By contrast,75 cases suffered from chronic cough in abnormal pulmonary functions group,of which 36 cases with cough variant asthma( CVA),24 cases with UACS,8 cases with comorbidity of CVA and UACS and 7 cases with PIC. Conclusions Abnormal lung function after acute period of MPP may last 4 to 8 weeks,or probably even longer. In normal lung function group,UACS is the most common cause,then followed by PIC. On the contrary,the main cause of chronic cough in abnormal pulmonary function group is CVA,followed by UACS. Chronic cough is related to abnormal lung function after acute phase of MPP.

Objective To evaluate the efficacy and safety of endovascular thrombectomy for acute ischemic stroke due to basilar artery occlusion,and analyze the correlation between baseline clinical features and prognoses.Methods The clinical data of 27 patients with acute stroke due to basilar artery occlusion,admitted to and underwent emergency endovascular thrombectomy in our hospital from February 2016 to March 2017,were analyzed retrospectively.The re-canalization rate and complications were determined and the clinical outcomes were assessed.The correlation between clinical features and prognoses were analyzed.Results Successful re-canalization was achieved in 24 out of 27 patients (88.9 ％),and the mean time from onset to re-canalization was (418.92±223.96) min.Symptomatic intracerebral hemorrhage (SICH) was observed in 2 patients (7.4 ％) and mortality in the first 3 months was 29.6％ (8/27).At 3-month follow up,14 patients (51.8 ％) showed good prognosis (modified Rankin scale [mRS] scores≤＜2) and 13 had poor prognosis.Baseline NIHSS scores (23[12.5,33.8] vs.35[23,39]) and posterior circulation-Alberta Stroke Program Early CT Scale scores (9 [8,10] vs.7 [4,9]) between patients with good prognosis and poor prognosis were significantly different (Z=-2.043,P=0.041;Z=-2.387,P=0.017).Conclusions Endovascular thrombectomy can contribute to a high re-canalization rate and safety.Baseline clinical severity and collateral circulation compensation are associated with clinical prognosis.

Objective To compare the efficacy and safety of direct thrombectomy and bridging therapy for acute large-vessel occlusion in anterior circulation stroke.Methods A retrospective study was performed on clinical data of 146 patients with anterior circulation large-vessel occlusion stroke who accepted direct thrombectomy in our hospital from March 2016 to July 2017;85 patients were in direct thrombectomy group and 61 patients were in bridging therapy group.The clinical characteristics,procedural complications and clinical outcomes between the two groups were compared.Results There were no significant differences between the two groups in age,gender,baseline National Institutes of Health Stroke Scale (NIHSS) scores,percentages of patients with hypertension,diabetes and atrial fibrillation,baseline blood glucose,platelet count,creatinine level,baseline systolic blood pressure,stroke etiology,occlusion site,and anesthesia methods (P＞0.05).There were no significant differences between the two groups in admission-to-CT time,admission-to-puncture time,puncture-to-re-canalization time,and admission-to-re-canalization time (P＞0.05).The successful reperfusion rate (91.8％ vs.95.1％),incidence of symptomatic intracranial hemorrhage (11.8％ vs.21.3％),favorable outcome rate 90 d after treatment (41.2％ vs.47.5％),and mortality (20.0％ vs.18.0％) were not significantly different between the two groups (P＞0.05).Conclusion The efficacy and safety of direct thrombectomy and bridging therapy are similar for acute large-vessel occlusion in anterior circulation stroke.

Objective To assess whether degrees of leukoaraiosis (LA) severity is associated with prognoses of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy.Methods Clinical data of patients with acute anterior circulation large-artery occlusive stroke who underwent mechanical thrombectomy in our hospital from January 2016 to August 2017 were collected. The subjects were divided into non-to-moderate LA group and severe LA group according to preoperative degrees of LA severity; the baseline data, successful reperfusion rate, and symptomatic intracranial hemorrhage rate within 24 h of surgery, good prognosis rate 90 d after surgery (modified Rankin scale [mRS] scores≤2) and mortality 90 d after surgery were analyzed. According to the prognoses, the patients were divided into good prognosis group and poor prognosis group; univariate regression analysis and multivariate Logistic regression analysis were used to evaluate the relations of degrees of LA severity with prognoses 90 d after surgery.Results In these 146 patients, 100 patients were into the non-to-moderate LA group and 46 patients were into the severe LA group. As compared with patients in the non-to-moderate LA group, patients in the severe LA group had significantly older age (70.50 [59.75, 79.75] yearsvs. 79 [73, 82] years), significantly higher baseline NIHSS scores (20 [16, 25])vs. 22 [18, 28]), significantly higher rate of symptomatic intracranial hemorrhage 24 h after surgery (11.0％ [11/100])vs. 26.1％ [12/46]), statistically higher mortality rate 90 d after surgery (14.0％[14/100]) vs. 14.0％ [14/46]), significantly lower successful reperfusion rate (97.0％ [97/100]vs. 84.8％ [39/46]), and statistically lower good prognosis rate (54.0％ [54/100]vs. 21.7％ [10/46],P<0.05). Among the 146 patients, 64 had good prognosis and 82 had poor prognosis; univariate analysis showed that as compared with than those from the good prognosis group, patients from the poor prognosis group had significantly older age (70.50 [59.75, 79.75] years oldvs. 79 [73, 82] years old) and statistically higher baseline NIHSS scores (20 [16, 25]vs. 22 [18, 28]), and significantly higher proportion of central source embolism by TOAST etiology classification (68.8％ [44/64]vs. 76.8％[63/82]) and proportion of severe LA (15.6％ [10/64]vs. 43.9％ [36/82],P<0.05); multivariate Logistic regression analysis showed that severe LA (OR=3.109, 95％CI: 1.241-7.788,P=0.015), age, baseline NIHSS scores, and TOAST etiology classification were all independent risk factors for poor prognosis 90 d after surgery (P<0.05). ConclusionSevere LA may be associated with poor prognosis of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy.

OBJECTIVETo study the pathologic features and immunophenotype of 3 cases of melanotic epithelioid clear cell tumor of kidney.

METHODSMore than 2000 cases of renal tumors were retrospectively reviewed. Three cases of melanotic epithelioid clear cell tumor were identified. Immunohistochemical study was carried out using the paraffin-embedded tissue samples. Electron microscopy was also performed in 1 case.

RESULTSAmongst the 3 cases studied, the male-to-female ratio is 1:2. Histologically, 2 cases showed a clear cell carcinoma-like pattern. Papillary structures covered by clear cells and eosinophilic cells were observed in 1 case. Immunohistochemical study showed that the tumor cells in all cases expressed HMB 45. Two of them were also positive for Melan A. The staining for epithelial markers and S-100 protein was negative. Melanosomes were not identified by ultrastructural examination.

CONCLUSIONSMelanotic epithelioid clear cell tumor is a rarely seen neoplasm of kidney. There are some histologic overlaps with renal cell carcinoma, epithelioid angiomyolipoma and melanoma. Immunohistochemical study is useful in confirming the diagnosis. The tumor represents a morphologic variant of epithelioid angiomyolipoma.

Adolescent ; Adult ; Angiomyolipoma ; metabolism ; pathology ; surgery ; Carcinoma, Renal Cell ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Epithelioid Cells ; metabolism ; pathology ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms ; metabolism ; pathology ; surgery ; MART-1 Antigen ; metabolism ; Male ; Melanoma-Specific Antigens ; metabolism ; Retrospective Studies

OBJECTIVEGastrointestinal stromal tumors (GISTs) have a broad spectrum of biological behaviors ranging from benign, borderline and malignant. This study aimed to screen differentially expressed microRNAs (miRNAs) between malignant and borderline GISTs and to investigate the potential role of miRNAs in the malignant transformation of GISTs.

METHODSSix GIST samples including borderline tumors (n = 3) and malignant tumors (n = 3) were collected based on the clinical and pathological characteristics. Total RNA was extracted, followed by miRNA microarray analysis to screen the differentially expressed miRNAs. The most significantly expressed 4 miRNAs were then chosen for further validation by real-time PCR in 22 additional GIST samples.

RESULTSDirect comparison of malignant group versus borderline group revealed 14 significantly and differentially expressed miRNAs (P < 0.05, with a fold change of < 0.5 or > 2). Five miRNAs were up-regulated and nine were down-regulated in the malignant group. Four miRNAs (miR-221, miR-135b, miR-675(*) and miR-218) were most significantly and differentially expressed between the two groups. The differential expression of 2 miRNAs (miR-221 and miR-675(*)) were subsequently confirmed with good concordance by real-time PCR.

CONCLUSIONSThe differential miRNA expression profiles between two groups are revealed by miRNA microarray assay, and confirmed by real-time PCR. Among differentially expressed miRNAs, miR-221 and miR-675(*) might be related to the malignant transformation of GISTs, and have a potential value in predicting biological behavior of GISTs.

Adult ; Aged ; Aged, 80 and over ; Cell Transformation, Neoplastic ; Down-Regulation ; Female ; Gastrointestinal Neoplasms ; genetics ; pathology ; Gastrointestinal Stromal Tumors ; genetics ; pathology ; Gene Expression Profiling ; Humans ; Male ; MicroRNAs ; genetics ; metabolism ; Microarray Analysis ; Middle Aged ; Real-Time Polymerase Chain Reaction ; Up-Regulation

ObjectiveTo evaluate the effect of Shengmaisan granules on myocardial fibrosis in chronic heart failure patients with Qi-Yin deficiency syndrome by cardiac magnetic resonance （CMR） imaging and serological indicators. MethodSixty-six chronic heart failure patients with Qi-Yin deficiency syndrome who visited the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine， Nanjing University of Chinese Medicine from October 2021 to January 2023 were selected. The patients were assigned into a control group （33 cases） and an observation group （33 cases） by the minimization random method. Both groups received standardized Western medicine treatment for heart failure. In addition， the control group was treated with placebo granules， and the observation group with Shengmaisan granules for a course of 6 months. The baseline data， clinical efficacy， TCM symptom scores， serological indicators ［high-sensitivity C-reactive protein （hs-CRP）， soluble growth stimulation expressed gene 2 protein （sST2）， pro-collagen Ⅲ N-terminal peptide （PⅢNP）， interleukin （IL）-6， IL-11， transforming growth factor-β₁ （TGF-β₁）］， echocardiography ［Left atrial diameter （LAD）， left ventricular end systolic diameter （LVEDs）， left ventricular end diastolic diameter （LVEDd）］ and CMR indicators ［left ventricular ejection fraction （LVEF）， myocardial extracellular volume fraction （ECV）， and longitudinal relaxation time （T1）］ were compared between the two groups. ResultFinally， 31 patients in the control group and 30 patients in the observation group were included. There was no significant difference in baseline data or indicators between the two groups before treatment. Compared with those before treatment， the scores of TCM symptoms （shortness of breath， fatigue， palpitations， spontaneous or night sweats， thirst/dry throat， feverish feeling in palms and soles， and edema in lower limbs）， total score of TCM symptoms， ECV， T1， inflammation/fibrosis indicators （hs-CRP， sST2， PⅢNP， IL-6， IL-11， and TGF-β₁） in observation group decreased （P<0.05， P<0.01）， and the scores of TCM symptoms （except feverish feeling in palms and soles）， T1， and inflammation/fibrosis indicators in the control group decreased （P<0.05， P<0.01）. After treatment， the observation group had lower scores of TCM symptoms （except feverish feeling in palms and soles and edema in lower limbs）， ECV， T1， and inflammation/fibrosis indicators than the control group （P<0.05， P<0.01）. After treatment， the total response rate in the observation group was 93.33% （28/30）， which was higher than that （80.65%， 25/31） in the control group （Z=2.976， P<0.01）. There was no significant difference in adverse reactions between the two groups during treatment. ConclusionFor patients with chronic heart failure with Qi-Yin deficiency syndrome， Shengmaisan Granules can alleviate the TCM symptoms， reduce inflammation， and inhibit myocardial fibrosis by regulating the TGF-β₁/IL-11 signaling axis.