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。     

靶向AXL克服肺腺癌EGFR-TKIs获得性耐药

目的:探索AXL在肺腺癌细胞(Lung adenocarcinoma cell, LAC)EGFR-TKIs获得性耐药中的作用,为肺癌临床治疗和新型药物的研发提供实验依据。方法:构建EGFR-TKIs获得性耐药的肺腺癌模型并通过CCK-8法检测耐药株对肺腺癌靶向治疗药物吉非替尼(Gefitinib)、厄洛替尼(Erlotinib)和奥希替尼(Osimertinib)的敏感性。基于基因组学分析筛选出潜在的克服耐药的靶点AXL,通过Western blot和qRT-PCR技术检测AXL的表达情况,并同时检测上皮-间质转化(Epithelial-mesenchymal transition,EMT)分子标志物。R428是AXL的小分子抑制剂,通过CCK-8法、Transwell以及划痕实验等探究靶向AXL对肺腺癌亲本及耐药株增殖和迁移能力的影响。结果:AXL在构建的耐药株中显著高表达,其蛋白表达水平上调15-20倍(P0.001),m RNA水平上调2-5倍(P0.01);EGFR-TKIs耐药株发生上皮间质转化(EMT);靶向AXL选择性抑制耐药株的增殖能力并且恢复了耐药株对EGFR-TKIs的敏感性(P0.001);靶向AXL显著抑制耐药株增强的迁移能力,与亲本株相比最高抑制率可达80%左右(P0.001)。结论:用遗传学和药理学手段靶向AXL可以显著逆转肺腺癌对EGFR-TKIs耐药,逆转耐药株所增强的迁移等肿瘤生物学特征,对克服EGFR-TKIs获得性耐药有着重要的临床治疗价值以及转化医学前景。     

A review of automatic lung tumour segmentation in the era of 4DCT

AimTo review the literature on auto-contouring methods of lung tumour volumes on four-dimensional computed tomography (4DCT).BackgroundManual delineation of lung tumour on 4DCT has been the gold standard in clinical practice. However, it is resource intensive due to the high volume of data which results in longer contouring duration and uncertainties in defining target. Auto-contouring may present as an attractive alternative by decreasing manual inputs required, thus improving the contouring process. This review aims to assess the accuracy, variability and contouring duration of automatic contouring compared with manual contouring in lung cancer on 4DCT datasets.Materials and methodsA search and review of literature were conducted to identify studies regarding lung tumour contouring on 4DCT. Manual and auto-contours were assessed and compared based on accuracy, variability and contouring duration.ResultsThirteen studies were included in this review and their results were compared. Accuracy of auto-contours was found to be comparable to manual contours. Auto-contouring resulted in lesser inter-observer variation when compared to manual contouring, however there was no significant reduction in intra-observer variability. Additionally, contouring duration was reduced with auto-contouring although long computation time could present as a bottleneck.ConclusionAuto-contouring is reliable and efficient, producing accurate contours with better consistency compared to manual contours. However, manual inputs would still be required both before and after auto-propagation.     

Dosimetric impact of statistical uncertainty on Monte Carlo dose calculation algorithm in volumetric modulated arc therapy using Monaco TPS for three different clinical cases

AimTo study the dosimetric impact of statistical uncertainty (SU) per plan on Monte Carlo (MC) calculation in Monaco? treatment planning system (TPS) during volumetric modulated arc therapy (VMAT) for three different clinical cases.BackgroundDuring MC calculation SU is an important factor to decide dose calculation accuracy and calculation time. It is necessary to evaluate optimal acceptance of SU for quality plan with reduced calculation time.Materials and methodsThree different clinical cases as the lung, larynx, and prostate treated using VMAT technique were chosen. Plans were generated with Monaco? V5.11 TPS with 2% statistical uncertainty. By keeping all other parameters constant, plans were recalculated by varying SU, 0.5%, 1%, 2%, 3%, 4%, and 5%. For plan evaluation, conformity index (CI), homogeneity index (HI), dose coverage to PTV, organ at risk (OAR) dose, normal tissue receiving dose ≥5 Gy and ≥10 Gy, integral dose (NTID), calculation time, gamma pass rate, calculation reproducibility and energy dependency were analyzed.ResultsCI and HI improve as SU increases from 0.5% to 5%. No significant dose difference was observed in dose coverage to PTV, OAR doses, normal tissue receiving dose ≥5 Gy and ≥10 Gy and NTID. Increase of SU showed decrease in calculation time, gamma pass rate and increase in PTV max dose. No dose difference was seen in calculation reproducibility and dependent on energy.ConclusionFor VMAT plans, SU can be accepted from 1% to 3% per plan with reduced calculation time without compromising plan quality and deliverability by accepting variations in point dose within the target.     

Epithelial-vascular cross talk mediated by VEGF-A and HGF signaling directs primary septae formation during distal lung morphogenesis

There is increasing evidence that epithelial-vascular interactions are essential for tissue patterning. Here we identified components of the molecular cross talk between respiratory epithelial cells and pulmonary capillaries necessary for the formation of the gas exchange surface of the lung. Selective inactivation of the Vegf-A gene in respiratory epithelium results in an almost complete absence of pulmonary capillaries, demonstrating the dependence of pulmonary capillary development on epithelium-derived Vegf-A. Deficient capillary formation in Vegf-A deficient lungs is associated with a defect in primary septae formation, a morphogenetic process critical for distal lung morphogenesis, coupled with suppression of epithelial cell proliferation and decreased hepatocyte growth factor (Hgf) expression. Lung endothelial cells express Hgf, and selective deletion of the Hgf receptor gene in respiratory epithelium phenocopies the malformation of septae, confirming the requirement for epithelial Hgf signaling in normal septae formation and suggesting that Hgf serves as an endothelium-derived factor that signals to the epithelium. Our findings support a mechanism for primary septae formation dependent on reciprocal interactions between respiratory epithelium and the underlying vasculature, establishing the dependence of pulmonary capillary development on epithelium-derived Vegf-A, and identify Hgf as a putative endothelium-derived factor that mediates the reciprocal signaling from the vasculature to the respiratory epithelium.     

Bioelectrical impedance vs. four-compartment model to assess body fat change in overweight adults

Objective: The Tanita TBF‐305 body fat analyzer is marketed for home and clinical use and is based on the principles of leg‐to‐leg bioelectrical impedance analysis (BIA). Few studies have investigated the ability of leg‐to‐leg BIA to detect change in percentage fat mass (%FM) over time. Our objective was to determine the ability of leg‐to‐leg BIA vs. the four‐compartment (4C) model to detect small changes in %FM in overweight adults. Research Methods and Procedures: Thirty‐eight overweight adults (BMI, 25.0 to 29.9 kg/m²; age, 18 to 44 years; 31 women) participated in a 6‐month, randomized, double‐blind, placebo‐controlled study of a nutritional supplement. Body composition was measured at 0 and 6 months using the Tanita TBF‐305 body fat analyzer [using equations derived by the manufacturer (%FM_T‐Man) and by Jebb et al. (%FM_T‐Jebb)] and the 4C model (%FM_4C). Results: Subjects in the experimental group lost 0.9%FM_4C (p = 0.03), a loss that did not reach significance using leg‐to‐leg BIA (0.6%FM_T‐Man, p = 0.151; 0.6%FM_T‐Jebb, p = 0.144). We observed large standard deviations (SDs) in the mean difference in %FM between the 4C model and the Tanita_Manufacturer (2.5%) and Tanita_Jebb (2.2%). Ten subjects fell outside ±1 SD of the mean differences at 0 and 6 months; those individuals were younger and shorter than those within ±1 SD. Discussion: Leg‐to‐leg BIA performed reasonably well in predicting decreases in %FM in this group of overweight adults but resulted in wide SDs vs. %FM_4C in individuals. Cross‐sectional determinations of %FM of overweight individuals using leg‐to‐leg BIA should be interpreted with caution.     

表面增强激光解吸电离飞行时间质谱技术筛查肺癌血清特异性蛋白质及其临床意义

目的:探讨用表面增强激光解吸电离飞行时间质谱(SELDI-TOF-MS)技术筛查肺癌血清特异性蛋白质的临床意义。方法:应用SELDI-TOF-MS对35例正常对照组、43例治疗前肺癌病人的血清样品进行蛋白质指纹图谱测定,用BioMarker Wizard 3．01及BioMarker Parrern System 5．01分析软件对测得的数据进行处理及建立诊断模型。结果:共检测到251个蛋白质峰,筛选出差异蛋白质峰11个,以质荷比(m/z)分别为M2799_26,M3227_41,M5739_70和M8164_30的4个蛋白质峰为依据组合构建分类决策树模型,分出5个终节点。决策树模型的原始判别总准确率为91．0%(71/78),敏感性为88．4%(38/43),特异性为94．3%(33/35);交叉验证总准确率为85．9%(67/78),敏感性为88．4%(38/43),特异性为82．9%(29/35)。结论:SELDI-TOF-MS在肺癌血清特异性蛋白质的筛选及诊断模型的建立有一定的临床意义。     

硝黄散外敷联合加味五虎汤口服治疗痰热闭肺型肺炎支原体肺炎患儿对肺功能和血清TNF-α、IFN-γ、IL-4水平的影响

目的:观察硝黄散外敷联合加味五虎汤口服治疗痰热闭肺型肺炎支原体肺炎(MPP)患儿对肺功能和血清肿瘤坏死因子-α(TNF-α)、γ-干扰素(IFN-γ)、白介素-4(IL-4)水平的影响。方法:研究对象为我院2019年6月~2021年1月期间收治的MPP患儿80例,采用随机数字表法将患儿分为对照组(n=40,阿奇霉素抗感染治疗)和研究组(n=40,对照组基础上加用硝黄散外敷联合加味五虎汤口服治疗),均治疗7 d。比较两组患儿临床疗效,比较两组治疗前、治疗7 d后的中医证候积分、临床症状改善情况、肺功能和血清TNF-α、IFN-γ、IL-4水平。结果:研究组治疗7 d后的临床总有效率为92.50%(37/40),高于对照组的72.50%(29/40),差异有统计学意义(P<0.05)。与对照组相比,研究组的症状(咳嗽憋喘、发热、肺部干湿啰音)消失时间均更短(P<0.05)。与对照组相比,研究组治疗7 d后用力肺活量(FVC)、最高呼气峰流速(PEF)、第1秒最大呼气容积(FEV1)、FEV1/FVC均更高(P<0.05),研究组治疗7 d后的中医证候积分及血清TNF-α、IFN-γ和IL-4水平均更低(P<0.05)。结论:痰热闭肺型MPP患儿采用硝黄散外敷联合加味五虎汤口服治疗,可有效缩短患儿症状消失时间,显著改善其肺功能、血清炎症因子水平,疗效显著。     

脂蛋白脂肪酶基因敲除对急性高脂血症性胰腺炎所致肺损伤的影响及其机制研究

摘要 目的：研究脂蛋白脂肪酶（lipoprotein lipase,LPL）基因敲除对雨蛙素诱导的高脂血症急性胰腺炎小鼠肺损伤的影响。方法：将C57BL/6小鼠分为三组,Control组和AP-Model组为野生型C57 BL/6小鼠,LPL ko组为LPL基因敲除C57 BL/6小鼠;Control组小鼠正常饲养,AP-Model和LPL ko组小鼠建立高脂血症性急性胰腺炎模型,比较三组小鼠死亡率、胰腺和肺病理损伤以及血清淀粉酶（amylase, AMY）、丙二醛（malondialdehyde, MDA）、肿瘤坏死因子-α（Tumor necrosis factor-α, TNF-α）和白介素-6（Interleukin-6, IL-6）含量。结果：急性胰腺炎建立48 h后,Control组、AP-Model组和LPL ko组小鼠死亡率分别为0 %、20 %和40 %。与Control组相比,AP-Model组和LPL ko组小鼠急性胰腺炎诱导24和48 h后的胰腺和肺组织湿/干重比值,胰腺和肺组织病理评分,血清AMY、MDA、TNF-α和IL-6含量均显著升高（P<0.05）;与AP-Model组相比,LPL ko组小鼠急性胰腺炎诱导24和48 h后的胰腺和肺组织湿/干重比值,胰腺和肺组织病理评分,血清AMY、MDA、TNF-α和IL-6含量均显著升高（P<0.05）。结论：LPL基因敲除小鼠急性高脂血症性胰腺炎肺损伤更严重,其机制可能与LPL基因敲除引起更强的氧化应激和炎症有关。     

HNRNPC可能成为肺腺癌独立的预后因子

为探讨RNA m⁶A甲基化调节因子在肺腺癌中的作用,从TCGA数据库下载肺腺癌患者的RNA表达数据和临床数据。通过limma软件包分析12种m⁶A调节剂的表达情况。使用Pheatmap、vioplot和corrplot软件包生成热图、小提琴图和表达相关图。采用Kaplan-Meier方法分别计算肺腺癌中12种RNA m⁶A调节因子的生存曲线。使用Cox回归和Kaplan-Meier方法分析TCGA肺腺癌患者的总体存活相关的临床病理学特征。最后用Kruskal(KS)检验和logistic回归分析临床病理学特征与HNRNPC表达的关系。 在肺腺癌的TCGA队列中,发现HNRNPC、WTAP、YTHDF3、FTO、ZC3H13、METTL14、METTL3、YTHDF1、YTHDF2这些基因是差异表达的。Kaplan-Meier生存分析显示,在这些差异表达的基因中仅仅HNRNPC和YTHDF2的表达与生存显著相关。然后,通过多因素Cox回归结果表明HNRNPC的表达在肺腺癌TCGA队列中是个独立危险因素。最后,HNRNPC在肺腺癌中的表达与临床分期(IV vs I, OR=3.692 308)和组织浸润(T2 vs T1, OR=1.776 471;T4 vs T1, OR=6.303 03)显著相关(所有p<0.05)。 结论认为HNRNPC可能作为肺腺癌的独立的预后因子。