Purpose To evaluate the correlations between high resolution CT (HRCT) findings and IASLC/ATS/ERS pathological classification of ground glass nodule (GGN). Materials and Methods 121 patients with confirmed GGN were selected, and divided into benign group (22 cases), PIL group (21 cases), microinvasive carcinoma group (26 cases) and invasive carcinoma group (52 cases), then the imaging, pathology and prognosis data of patients with pulmonary GGN were reviewed, and the differences among GGN of different pathological types were analyzed.Results Maximum diameter, margin, vacuole sign, solid component, shape and blood vessels through of GGN were significantly different among the four groups (χ2=9.945-31.068,P<0.05). Maximum diameter and margin were significantly different between invasive adenocarcinoma and other groups (P<0.008); vacuole sign of the benign group was significantly different with other groups (P<0.008); the existence of solid component and shape were significantly different between invasive adenocarcinoma and minimally invasive adenocarcinoma (P<0.008); there was significant difference of blood vessels through between invasive adenocarcinoma and benign lesions (P<0.008). Among the 121 lesions, no metastasis except one invasive adenocarcinoma case complicated with distant metastasis.Conclusion Maximum diameter of GGN greater than 16.35 mm, with spiculation or lobulation represent invasive adenocarcinoma; vacuole sign within the GGN represent malignancy; with solid component and irregular shape can be used to identify invasive adenocarcinoma from minimally invasive adenocarcinoma; while blood vessels through can be used to identify invasive adenocarcinoma from benign lesions; the prognosis of GGNs is well with only 0.83% probability of distant metastasis.

Objective To study the characteristics of work disability and its influencing factors in patients with ankylosing spondylitis (AS). Methods The demographic data, work conditons and disease related characteristics of 277 patients with AS were recorded, and randomly selected from the Department of Rheumatology, Chinese PLA General Hospital from November 2014 to January 2016. Work and productivity activity impair-ment questionnaire (WPAI) was used to survey the work disability and productivity loss, then explore its in-fluencing factors and the relationships between patient-reported outcomes and WPAI scores. Logistic regression was used to analyze the associated factors of work disability. Multivariate linear regression was used to analyze the predictive factors of lose of work productivity. Results The prevalence of work disability was 30.3%. Twenty patients were unemployed because of working disability. Two hudreds patients were employed, with average 36.5 (24.0, 50.0) hours workingtime in the past week. Average AS related absenteeism was 4.4 (0, 10) hour. Average workproductivity loss was 26.4%(2.5%, 40.0%). Logistic multiple regression analysis showed that Bath AS disease activity index (BASDAI), SF-36 physical component summary (PCS) scores might be the important influencing factors among those clinical measures ( OR=1.270, 0.959). Presenteeism and overall work impairment were moderately correlated with patients' global assessment of disease activity (VAS), BASDAI, bath AS functional index (BASFI), SF-36 physical Functioning (PF), SF-36 body pain (BP) and SF-36 Physical Component Summary (PCS) (|r|=0.539-0.648). Linear multivariate analyses indicated that work presente-eismand absenteeismwere significantly associated with BASDAI (P<0.01). Conclusion High prevalence of work disability in patients with AS is noted, which is closely related with disease activity and body function;High attention should be paid to AS patients with work disability.

OBJECTIVETo review tension-free repairing for the patients with inguinal hernia complicated with cirrhosis and ascites.

METHODSTension-free herniorrhaphy was performed in 16 cases with inguinal hernia complicated with cirrhosis and ascites from November 1999 to November 2003. The laboratory data before and after the operation were compared and analyzed in this group.

RESULTSOf the patients, 13 cases were male and 3 were female, the mean age was (64 ± 12) years (range, 37 - 85 years). The liver function was classified as A degree in 4 case, B degree in 10 cases and C degree in 2 patients by using Child score. The operation was successfully carried out in all patients without complications and post-operative hepatoencephalopathy. There was no significant change in the plasma total protein, bilirubin, prothrombin activity and international normalized ratio (INR) after the operation. And the levels of albumin, globulin and white blood cell count changed remarkably after the operation (all P < 0.05). Plasma albumin level was obviously effected by the operation and treatment (P = 0.006). The mean follow-up time was 72.5 months (57 - 102 months). No recurrence occurred during the follow-up. There was no patient died in 30 days after the operation. Seven cases (43.8%) died in the later period of follow-up.

CONCLUSIONSThe tension-free repairing is feasible for the inguinal hernia complicated with cirrhosis and ascites. More attention should be paid to the level of plasma albumin and it should be corrected in time. The liver cirrhosis and its complications will progress after the operation with a poor prognosis.

Adult ; Aged ; Aged, 80 and over ; Ascites ; complications ; Female ; Follow-Up Studies ; Hernia, Inguinal ; complications ; surgery ; Humans ; Liver Cirrhosis ; complications ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

OBJECTIVETo evaluate the clinical efficiency and safety of two-micron laser resection of the prostate-tangerine technique (TmLRP-TT) for the treatment of large-volume ( > 70 ml) prostate in patients with benign prostatic hyperplasia (BPH).

METHODSThis retrospective analysis included 80 BPH patients with the prostatic volume larger than 70 ml, all treated by TmLRP-TT. We comparatively analyzed the levels of hemoglobin and serum sodium before and after surgery, recorded intra- and post-operative com- plications, and followed up the patients at 6 and 12 months after operation for International Prostate Symptom Score (IPSS), quality of life (QOL), maximum flow rate (Qmax), and postvoid residual urine volume (PVR).

RESULTSAll the operations were successfully completed. The mean hemoglobin decreased (0.68 +/- 0.43) g/dl intraoperatively, but no apparent reduction was observed in serum sodium. Lower urinary tract symptoms were relieved significantly in all the cases. At 12 months after surgery, IPSS was decreased by 73.89% as compared with the baseline (20.03 +/- 6.9 vs 5.23 +/- 3.59), QOL by 64.55% (4.09 +/- 1.19 vs 1.45 +/- 1.36), and PVR by 79.30% (97.31 +/- 57.90 vs 20.14 +/- 24.20 ml), while Qmax increased by 140.42% ([8.04 +/- 3.62] vs [19.33 +/- 3.28] ml/s). The incidence of complications was low either intraoperatively or during the 12 months after operation.

CONCLUSIONTmLRP-TT is a safe and effective surgical endoscopic approach to the treatment of large-volume prostate in BPH patients.

Aged ; Follow-Up Studies ; Humans ; Laser Therapy ; methods ; Male ; Middle Aged ; Prostatic Hyperplasia ; surgery ; Retrospective Studies ; Transurethral Resection of Prostate ; methods ; Treatment Outcome

OBJECTIVETo compare the conventional pulmonary function test results of children with asthma or cough variant asthma (CVA).

METHODSA total of 140 children, who were diagnosed with asthma or CVA from May 2010 to May 2011, were divided into acute asthma attack (n=50), asthma remission (n=50) and CVA groups (n=40); 30 healthy children were included as a control group. The forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), forced expiratory flow after 25% of vital capacity has been expelled (FEF25), forced expiratory flow after 50% of vital capacity has been expelled (FEF50), forced expiratory flow after 75% of vital capacity has been expelled (FEF75) and maximal midexpiratory flow (MMEF75/25) were measured.

RESULTSThe mean percent predicted values of all the above indices were lower than 80% in the acute asthma attack group, with FEF50, FEF75 and MMEF75/25 declining markedly; the mean percent predicted values of FEF75 and MMEF75/25 were lower than 80% in the CVA group. All the pulmonary function indices in the acute asthma attack group were lower than those in the control group. The mean percent predicted values of FVC, FEV1, FEF25 and MMEF75/25 in the asthma remission and CVA groups were lower than in the control group. All the pulmonary function indices in the acute asthma attack group were lower than in the asthma remission and CVA groups, but there were no significant differences between the asthma remission and CVA groups.

CONCLUSIONSThere is small and large airway dysfunction, particularly small airway dysfunction, in children with acute asthma attack. Children with CVA present mainly with mild small airway dysfunction, as do those with asthma in remission.

Asthma ; physiopathology ; Child ; Cough ; physiopathology ; Female ; Forced Expiratory Volume ; Humans ; Lung ; physiopathology ; Male ; Vital Capacity

Humans ; Magnetic Resonance Imaging ; Male ; Meningeal Neoplasms ; diagnosis ; pathology ; Meningioma ; diagnosis ; pathology ; Middle Aged

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Renal Cell ; genetics ; metabolism ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Kidney Neoplasms ; genetics ; metabolism ; Male ; Matrix Metalloproteinase 2 ; genetics ; metabolism ; Middle Aged ; Transforming Growth Factor beta1 ; genetics ; metabolism ; Tumor Cells, Cultured ; Young Adult

OBJECTIVETo assess the significance of central compartment dissection in papillary thyroid cancer with negative clinical lymph node metastasis.

METHODSClinical and pathological data of 641 papillary thyroid cancer patients with negative clinical lymph node metastasis who were treated from January 1998 to April 2006 were collected. The positive rate of the lymph nodes metastasis was analyzed. The relations between the central compartment lymph nodes and the patients' gender, age, tumor size and number were concerned. Among the 641 cases, 114 case who received operation more than five years were followed up for the relations between the pathological status of central compartment lymph nodes and ipsilateral neck metastasis or contra thyroid lobe recurrence.

RESULTSThe median number of the central compartment lymph nodes was 4 each case and 53.0% (340/641) cases of papillary thyroid cancer patients with negative clinical lymph node metastasis had positive central compartment lymph nodes metastasis. Large tumor size and multiple origins were related to central compartment lymph nodes involvement, but the patients' gender or age was not. In the 114 follow-up cases, ipsilateral neck metastasis occurred in 12 cases, among which 11 cases had high positive central compartment lymph nodes metastasis. Contra thyroid lobe recurrence occurred in 5 cases, whose statuses of central compartment lymph nodes were different.

CONCLUSIONSPapillary thyroid cancer patients with negative clinical lymph node metastasis deserve formal central compartment dissection. The pathological status of central compartment lymph nodes relates to the tumor size and number. High positive rate of central compartment lymph nodes may lead to possible ipsilateral neck metastasis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Papillary ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Retrospective Studies ; Thyroid Neoplasms ; pathology ; surgery

BACKGROUNDOver-expression of epidermal growth factor receptor (EGFR) is thought to be related to cell proliferation, invasion, metastasis, resistance to chemoradiotherapy and poor prognosis of various human cancers. Forty percent to fifty percent of glioblastoma multiforme (GBM) possess deregulated EGFR, which may contribute to the aggressive and refractory course of GBM. Therefore, blockade of EGFR signal transduction may be a promising treatment strategy for GBM.

METHODSMTT assay, cell growth curve assay and tumor xenograft model were used to evaluate the antitumor activity of F90 against SHG-44 in vitro and in vivo. Western blot assay was applied to evaluate the expression of p-EGFR, p-ERK1, p-JNK, p-P38, Bcl2 and P53 proteins.

RESULTSF90 inhibited the cell proliferation in a dose-dependent manner in vitro. The growth of SHG-44 tumor xenografts was suppressed by F90 at a high dose level (100 mg x kg(-1) x d(-1)). Phosphorylation of EGFR and activated downstream signaling proteins, such as ERK1, JNK and P38, were found to be depressed after incubation with F90 for 48 hours in vitro. Down-regulated Bcl2 protein and up-regulated P53 protein were also observed.

CONCLUSIONSThe results demonstrate that F90 is effective in inhibiting the proliferation of SHG-44 cells in vitro and tumor growth in vivo, suggesting that F90 may be a new therapeutic option for treatment of GBM.

Animals ; Antineoplastic Agents ; pharmacology ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Glioblastoma ; drug therapy ; pathology ; Humans ; MAP Kinase Signaling System ; drug effects ; Mice ; Mice, Inbred BALB C ; Phosphorylation ; Protein Kinase Inhibitors ; pharmacology ; Proto-Oncogene Proteins c-bcl-2 ; analysis ; Quinazolines ; pharmacology ; Receptor, Epidermal Growth Factor ; antagonists & inhibitors ; metabolism ; Tumor Suppressor Protein p53 ; analysis

Perioperative stroke is cerebral infarction occurring in the perioperative period.The incidence of perioperative stroke in non-cardiac,and non-neurologic surgery is about 0.7％,but the mortality can be as high as 26％ to 40％.The outcome of the patients with perioperative stroke can be disastrous.Here we report a case of perioperative ischemic stroke that occurred after surgery of lumbar decompression and pedical screw fixation.A 76-year-old female admitted to our hospital because of lumbar spinal stenosis.Her medical history included hypertension and diabetes for ten years.Her personal history included a smoking history of 60 years by 2 cigarettes per day,not quitting.Her carotid artery ultrasound showed multiple low echo plaques on the right side and multiple high echo plaques on the left side of the carotid artery,but without distinct stenosis.Other examinations and tests showed no distinct abnormality.She went on a lumbar decompression and pedical screw fixation uneventfully.The blood loss was 400 mL and autologous blood transfusion 150 mL.The arterial blood pressure (ABP) maintained during 100-130 mmHg/60-80 mmHg (1 mmHg =0.133 kPa).Sixty minutes after she recovered from general anesthesia,the patient developed symptoms of slurred speech and right limbs weakness.The anesthesiologist evaluated the patient immediately with National Institute of Health Stroke Scale (NIHSS).The NIHSS score was 11 and a stroke was highly suspected.The acute stroke team was therefore initiated and fast responded.Within 4 h,digital subtraction angiography (DSA) was proceeded,which showed the M1 segment of the left middle cerebral artery was occluded and the local stenosis of her right middle cerebral artery was up to 80％.After the successful embolectomy by Solitaire stent,the left middle cerebral artery reflowed and the forward blood flow was thrombolysis in myocardial infarction (TIMI) grade 3.The patient was discharged after 33 days after the surgery with a NIHSS of 9.Our case provides an example that an acute stroke team that included the department of anesthesiology can be beneficial to the patients' perioperative strokes.During the perioperative period,anesthesiologists should be included into the acute stroke team,because anesthesiologists and anesthesia nurses might be first observers of those early onset strokes.Our case also put forward this thought that a standard peri-operative stroke evaluation tool,like NIHSS,should be discussed and applied to facilitate and accelerate the initiation of perioperative acute stroke team.