Application of Clinico-Radiologic-Pathologic Diagnosis of Diffuse Parenchymal Lung Diseases in Children in China

Diffuse parenchymal lung diseases in children (chDPLD) or interstitial lung diseases in children (chILD) represent a heterogeneous group of respiratory disorders that are mostly chronic and associated with high morbidity and mortality. However, the incidence of chDPLD is so low that most pediatricians lack sufficient knowledge of chDPLD, especially in China. Based on the clinico- radiologic- pathologic (CRP) diagnosis, we tried to describe (1) the characteristics of chDPLD and (2) the ratio of each constituent of chDPLD in China. Data were evaluated, including clinical, radiographic, and pathologic results from lung biopsies. We collected 25 cases of chDPLD, 18 boys and 7 girls with a median age of 6.0 years, from 16 hospitals in China. The most common manifestations included cough (n = 24), dyspnea (n = 21), and fever (n = 4). There were three cases of exposure-related interstitial lung disease (ILD), three cases of systemic disease-associated ILD, nineteen cases of alveolar structure disorder-associated ILD, and no cases of ILD specific to infancy. Non-specific interstitial pneumonia (n = 9) was the two largest groups. Conclusion: Non-specific interstitial pneumonia is the main categories of chDPLD in China. Lung biopsy is always a crucial step in the final diagnosis. However, clinical and imaging studies should be carefully evaluated for their value in indicating a specific chDPLD.     

纤维支气管镜刷插入取材法在肺癌诊断中的应用价值探讨

目的：探讨纤维支气管镜刷插入取材法在肺癌诊断中的应用价值。方法：选择2006年6月至2011年6月入住我院肿瘤科的178例肺癌患者为研究对象,将所有研究对象随机分为观察组与对照组,每组各有患者89例,观察组患者采用纤维支气管镜刷插入组织中取材法进行肺癌的诊断,对照组患者采用纤维支气管镜刷常规刷检取材法进行肺癌的诊断。结果：经X。检验发现,观察组患者肺癌的检出率为89．9％,显著性高于对照组患者肺癌的检出率（76．4％）,差异有统计学意义（P〈0．05）,观察组不同类型肺癌患者的检出构成比与对照组不同类型肺癌患者的检出构成比差异无统计学意义（P〉0．05）。结论：纤维支气管镜刷插入取材法可以提高肺癌患者的检出率,在肺癌诊断上具有较高的应用价值。     

Bronchoscopic Diagnosis of Pulmonary Infections—Comparison of Protected-Specimen Brush and Cytology Brush With Lung Aspirates

In a recent study the use of a new plugged double-lumen protected-specimen brush with the flexible fiberoptic bronchoscope was advocated to isolate pathogens in lower respiratory tract infections while avoiding upper respiratory tract contamination. To compare the efficacy of this brush and a standard single-lumen cytology brush in identifying the etiologic agent in lower respiratory tract infections, we studied 18 patients with lung infections. Transthoracic lung aspiration was done in all but two patients in an attempt to identify the specific etiologic agent. In these two cases, cultures of specimens of blood or postmortem lung tissue yielded the causative organism. In 12 patients anaerobic or aerobic bacteria (or both) were identified, whereas one patient had a mixed bacterial and fungal infection. Using the cytology brush and the protected-specimen brush we identified at least one pathogen in 10 of 12 and 10 of 13 cases, whereas both brushes missed one or more causative organisms in 8 of 12 and 8 of 13 cases, respectively. Nonetiologic organisms were found in 8 of 12 cases by the cytology brush and 8 of 13 cases by the protected-specimen brush. Quantitative culture techniques improved the specificity of the brush results in infections where aerobes predominated. Our data show that bronchoscopic cultures of lower respiratory tract infections do not consistently recover the causative agent and are frequently subject to contamination by nonetiologic organisms. There was no difference between the brushes in avoiding contamination.     

DNA Methylation Profiling for the Diagnosis and Prognosis of Patients with Nontuberculous Mycobacterium Lung Disease

The incidence of nontuberculous Mycobacterium (NTM) lung disease is rapidly increasing; however, its diagnosis and prognosis remain unclear while selecting patients who will respond to appropriate treatment. Differences in DNA methylation patterns between NTM patients with good or poor prognosis could provide important therapeutic targets. We used the Illumina MethylationEPIC (850k) DNA methylation microarray to determine the pattern between differentially methylated regions (DMRs) in NTM patients with good or poor prognosis (n = 4/group). Moreover, we merged and compared 20 healthy controls from previous Illumina Methylation450k DNA methylation microarray data. We selected and visualized the DMRs in the form of heatmaps, and enriched terms associated with these DMRs were identified by functional annotation with the “pathfinder” package. In total, 461 and 293 DMRs (|Log2 fold change| > 0.1 and P < 0.03) were more methylated in patients with four poor and four good prognoses, respectively. Furthermore, 337 and 771 DMRs (|Log2 fold change| > 0.08 and P < 0.001) were more methylated in eight NTM patients and 20 healthy controls, respectively. TGFBr1 was significantly less methylated, whereas HLA-DR1 and HLA-DR5 were more methylated in patients with poor prognosis (compared to those with good prognosis). LRP5, E2F1, and ADCY3 were the top three less-methylated genes in NTM patients (compared with the controls). The mTOR and Wnt signaling pathway-related genes were less methylated in patients with NTM. Collectively, genes related to Th1- cell differentiation, such as TGFBr1 and HLA-DR, may be used as biomarkers for predicting the treatment response in patients with NTM lung disease.     

Effect of Parenchymal Stiffness on Canine Airway Size with Lung Inflation

Although airway patency is partially maintained by parenchymal tethering, this structural support is often ignored in many discussions of asthma. However, agonists that induce smooth muscle contraction also stiffen the parenchyma, so such parenchymal stiffening may serve as a defense mechanism to prevent airway narrowing or closure. To quantify this effect, specifically how changes in parenchymal stiffness alter airway size at different levels of lung inflation, in the present study, we devised a method to separate the effect of parenchymal stiffening from that of direct airway narrowing. Six anesthetized dogs were studied under four conditions: baseline, after whole lung aerosol histamine challenge, after local airway histamine challenge, and after complete relaxation of the airways. In each of these conditions, we used High resolution Computed Tomography to measure airway size and lung volume at five different airway pressures (0, 12, 25, 32, and 45 cm H₂O). Parenchymal stiffening had a protective effect on airway narrowing, a fact that may be important in the airway response to deep inspiration in asthma. When the parenchyma was stiffened by whole lung aerosol histamine challenge, at every lung volume above FRC, the airways were larger than when they were directly challenged with histamine to the same initial constriction. These results show for the first time that a stiff parenchyma per se minimizes the airway narrowing that occurs with histamine challenge at any lung volume. Thus in clinical asthma, it is not simply increased airway smooth muscle contraction, but perhaps a lack of homogeneous parenchymal stiffening that contributes to the symptomatic airway hyperresponsiveness.     

酶联免疫吸附(ELISA)诊断肺肿瘤方法的建立

目的:早期确诊并得到及时治疗是有效防止肺肿瘤恶化的有效途径,本文旨在探讨建立ELISA的鉴定标准,以便早期筛选肺肿瘤特异蛋白质,有助于对该病的早期诊断.方法:实验主要以酶联免疫吸附(ELISA)试验为基础,以期获得诊断肺肿瘤的ELISA方法.以CA-125作为抗原,按照常规ELISA方法进行实验,确定抗原包被浓度、一抗稀释度及一抗最佳作用时间,达到优化ELISA检测肺肿瘤条件.结果:初步建立了ELISA方法检测肺肿瘤的条件,同时确定了抗原的最佳包被浓度为5μg/mL,血清一抗的最佳稀释比为1∶800,最佳作用时间为1.5 h.结论:ELISA检测肺肿瘤方法的建立,为临床中早期检测肿瘤的发生提供了数据支持,为进一步研究与优化肺肿瘤的检测方法奠定基础.     

Robust Discriminant Functions in Assisting Medical Diagnosis. Application to the Chronic Obturative Lung Disease Data

The results of assisting medical diagnosis in bronchial asthma and chronic bronchitis via robust discriminant functions are presented in the paper. The robust discriminant functions are obtained by replacing classical estimates of mean vectors and covariance matrices by their robust equivalents. The new methods were compared with classical ones. These methods resulted in the improvement of automatic diagnosis especially when the “new” data set was classified on the basis of individuals collected earlier.     

鸡痘的诊断与防治技术研究

鸡痘是危害养鸡业发展的一种传染病,不分日龄大小均可发病,肉鸡和蛋鸡均可感染,发病期1—2周,雏鸡死亡率较高,可达5％～30％不等,近年来发病率和死亡率有上升趋势,并且免疫失败的病例时有发生。为了建立接种疫苗后抗体监测手段和研究感染鸡痘病毒后抗体产生规律,我们建立了间接     

鸡痘的诊断与防治技术研究

鸡痘是危害养鸡业发展的一种传染病,不分日龄大小均可发病,肉鸡和蛋鸡均可感染,发病期1-2周,雏鸡死亡率较高,可达5%～30%不等[1],近年来发病率和死亡率有上升趋势,并且免疫失败的病例时有发生[2].为了建立接种疫苗后抗体监测手段和研究感染鸡痘病毒后抗体产生规律,我们建立了间接ELISA检测鸡痘病毒抗体的方法,进一步做了中和试验和用阳性血清治疗鸡痘的试验,报告如下.     

快速现场细胞学评价在经支气管针吸活检术诊断肺部良恶性疾病的临床应用

目的:超声引导下的经支气管针吸活检术(Endobronchial ultrasound guided transbronchial needle aspiration, EBUS-TBNA)是临床上广泛开展的经支气管的微创介入技术,在EBUS-TBNA过程中,快速现场细胞学评价(Cytologicalrapidon-siteevaluation,C-ROSE)是切实可行的临床辅助技术。本研究探讨C-ROSE在EBUS-TBNA对肺部疾病诊断的细胞学特点及诊断价值。方法:对41例经胸部计算机断层扫描(Computed tomography,CT)发现存在纵隔和(或)肺门病灶(包括肿大的淋巴结/肿块)而行EBUS-TBNA及C-ROSE患者进行回顾性分析。结果:C-ROSE镜下的细胞学具有明显特点,对肺部良恶性疾病的穿刺成功率无差异,诊断率分别为90.48%和66.67%(P0.05),且C-ROSE可完全排除恶性疾病的诊断,二组并发症发生率分别为9.52%和6.67%(P0.05)。结论:C-ROSE在EBUS-TBNA中对肺部良恶性病变均具有诊断价值,可以提高穿刺成功率及诊断率、减少并发症,值得在临床医疗介入中心推广。     

Accuracy of Screening Methods for the Diagnosis of Breast Disease

Clinical examination, thermography, and 70-mm. mammography were performed in 891 patients—414 presented to hospital with symptoms of breast disease and 477 were asymptomatic. Comparison of the diagnostic accuracy of these methods showed that neither thermography nor 70-mm. mammography has a useful place as an isolated screening procedure for breast cancer. In fact, we consider such a policy dangerous.     

肺癌早期诊断的研究进展

大多数肺癌患者在确诊时已属中晚期,5年生存率极低,早期诊断是改善其预后和提高生存率的关键。目前常用的肺癌早期诊断方法包括影像学、内镜和分子生物学技术等。除传统的X线胸片、磁共振（Magnetic Resonance Imaging,MRI）、正电子发射断层显像（Positron Emission Tomography-Computed Tomography,PET-CT）等方法外,近年来逐步应用的高分辨CT（High-ResolutionComputed Tomography,HRCT）、低剂量CT（Low Dose Computed Tomography,LDCT）、自荧光纤维支气管镜（AutomaticFluorescence Bronchoscopy,AFB）、超声支气管内镜（Endo-Bronchial Ultra-Sound,EBUS）、荧光共聚焦显微镜支气管镜（FiberedConfocal Fluorescence Microscopy,FCFM）、细胞内镜（Endocytoscopy,EC）、电磁导航支气管镜（Electromagnetic NavigationBronchoscopy,ENB）、经支气管针吸活检术（Transbronchial Needle Aspiration,TBNA）、呼出气体分析和肿瘤标记物联合检测等,对于肺癌的早期诊断起到了重要作用,明显改善预后。本文就肺癌早期诊断的研究进展进行综述。