Endotracheal infiltration by lymphoma is uncommon. We present 2 cases of endotracheal infiltration by non-Hodgkin lymphoma. One case had a solitary lesion in the middle trachea. Bronchoscopic biopsy of the lesion revealed diffuse large B-cell lymphoma. The tumor showed focal FDG uptake with SUVmax of 15. The other case had diffuse endotracheal lesions. Bronchoscopic biopsy revealed diffuse submucosal infiltration by natural killer/T-cell lymphoma. The thickened trachea showed diffuse FDG uptake with SUVmax of 8.4. These 2 cases indicate lymphoma should be included in the differential diagnosis of focal or diffuse endotracheal FDG accumulation.
Abstract Background: The 2019 novel coronavirus disease has caused a global pandemic with substantial morbidity and mortality. Chinese medicine has been extensively employed in the coronavirus-related pandemic in China. We aim to assess the efficacy and safety of Chinese medicine in treatment of coronavirus-related pneumonia with the updated results of relevant clinical trials. Methods: Six electronic databases including PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP, and SinoMed will be searched to identify randomized controlled trials up to May 2020. Patients diagnosed with coronavirus-related pneumonia including severe acute respiratory syndrome, Middle East respiratory syndrome, and 2019 novel coronavirus disease and administrated with Chinese medicine will be included. The primary outcome is the all cause mortality at the longest follow up available. The second outcomes include the length of stay in hospital and intensive care units, the duration of mechanical ventilation, and adverse events. The pooled effects will be analyzed and reported as risk ratios for dichotomous data using the Mantel–Haenszel method or mean differences for continuous data using the inverse-variance method. Sensitivity and subgroup analyses will be performed to test the robustness of the results and to explore the potential sources of heterogeneities. The Egger test and/or funnel plots will be used for the examination of publication bias. The grades of recommendation assessment, development, and evaluation methodology will be used to summarize the quality of evidence. The trial sequential analysis will be conducted to test whether the meta-analysis has a sufficient sample size after adjustment of the increased type I and II error risks. Results: The evidence to date of Chinese medicine in treatment of coronavirus-related pneumonia will be systematically reviewed and meta-analyzed. Conclusion: The relevant studies will be summarized and further evidence will be provided. PROSPERO registration number: CRD42020178879
Hepatic pseudolymphoma, also known as reactive lymphoid hyperplasia or nodular lymphoid hyperplasia, is a rare benign lymphoproliferative lesion. Preoperative diagnosis of hepatic pseudolymphoma is challenging. We present 2 cases of hepatic pseudolymphoma with focal intense FDG uptake on FDG PET/CT mimicking malignancy. These 2 cases suggest that hepatic pseudolymphoma should be considered as a rare differential diagnosis in patients with focal hypermetabolic hepatic lesion.
A 37-year-old man presented with left upper abdominal pain for 13 months. Laboratory examinations showed elevated peripheral eosinophils. Chest CT showed thickened wall of the entire esophagus. FDG PET/CT was performed showing diffuse FDG uptake in the thickened esophageal wall. Esophageal endoscopy showed pale and edematous mucosa. Histologic examination of the esophageal biopsy specimens revealed marked eosinophil infiltration of the mucosa. The clinical and pathologic findings were consistent with eosinophilic esophagitis (EoE). This case indicates EoE should be included in the differential diagnosis of abnormal FDG accumulation in the esophageal wall along with malignant and nonmalignant conditions.
Objective
To explore the learning curve characteristics of Mckeown-type minimally invasive esophagectomy and effects of the para-recurrent laryngeal nerve lymphadenectomy on efficacy.
Methods
The retrospective cohort study was conducted. The clinicopathological data of 163 patients with esophageal squamous cell carcinoma (ESCC) who underwent Mckeown-type minimally invasive esophagectomy in the Affiliated Tumor Hospital of Xinjiang Medical University between January 2011 and December 2015 were collected. According to the para-recurrent laryngeal nerve lymphadenectomy in the different learning curve stages (early, medium and later stages), 49 patients who didn′t undergo right para-recurrent laryngeal nerve lymphadenectomy were allocated into the group A, 65 who underwent para-recurrent laryngeal nerve lymphadenectomy were allocated into the group B, and 49 underwent bilateral para-recurrent laryngeal nerve lymphadenectomy were allocated into the group C. Observation indicators: (1) comparisons of intra- and post-operative recovery among groups; (2) comparisons of follow-up and survival among groups; (3) correlation analysis between operation time or volume of intraoperative blood loss and cases of learning curve of Mckeown-type minimally invasive esophagectomy. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to April 2017. Measurement data with normal distribution were represented as ±s. Comparison among groups was analyzed using the ANOVA, and pairwise comparison was done using the independent-sample t test. Measurement data with skewed distribution were described as M (range), and comparison of count data was done using the chi-square test. The survival time was calculated by the Kaplan-Meier method, and Log-rank test was used for survival analysis.Correlation analysis was done by Spearman rank correlation.
Results
(1) Comparisons of intra- and post-operative recovery among groups: patients in the 3 groups underwent successful Mckeown-type minimally invasive esophagectomy of ESCC, without conversion to open surgery. The operation time, total number of lymph node dissected, number of thoracic lymph node dissected and volume of intraoperative blood loss were respectively (395±94)minutes, 14.7±6.9, 9.6±5.4, (175±100)mL in the group A and (329±67)minutes, 20.4±9.1, 11.4±7.3, (117±49)mL in the group B and (301±51)minutes, 25.8±11.0, 14.8±10.1, (115±50)mL in the group C, with statistically significant differences in above indicators among groups (F=21.962, 1.992, 5.775, 12.744, P 0.05). There were statistically significant differences in total number of lymph node dissected and number of thoracic lymph node dissected between group B and group C (t=2.751, 3.245, P 0.05). Number of lymph node dissected at right and left para-recurrent laryngeal nerve were respectively 0, 0 in the group A and 1.9±1.8, 0 in the group B and 2.6±2.1, 1.1±0.8 in the group C. Of 35 patients with unilateral recurrent laryngeal nerve were treated with symptomatic and supportive treatment of neuro nutrition, 18 encountered permanent hoarseness and 17 recovered well. Patients with anastomotic fistula and pneumonia were improved by sufficient drainage and antibiotic therapy. (2) Comparisons of follow-up and survival among groups: 149 of 163 patients were followed up for 17-65 months, with a median time of 32 months, including 43 in the group A, 61 in the group B and 45 in the group C. Survival time of patients who received follow-up was recpectively (31.3±2.6)months, (32.2±1.6)months and (25.5±2.5)months in group A, B and C, with no statistically significant differences (χ2=4.412, P>0.05). (3) Correlation analysis between operation time or volume of intraoperative blood loss and cases of learning curve of Mckeown-type minimally invasive esophagectomy: results of correlation analysis showed that there was a significant negative correlation between operation time or volume of intraoperative blood loss and cases of learning curve of Mckeown-type minimally invasive esophagectomy (r=-0.632, -0.451, P<0.05), showing a decreasing trend in operation time and volume of intraoperative blood loss with increasing surgical cases.
Conclusions
The operation time and volume of intraoperative blood loss are gradually declining with learning curve process of Mckeown-type minimally invasive esophagectomy. Para-recurrent laryngeal nerve lymphadenectomy cannot increase the incidence of recurrent laryngeal nerve injury, with more completely lymphadenectomy.
Key words:
Esophageal neoplasms; Radical resection; Minimally invasive surgery; Thoracoscopy; Laparoscopy; Lymphadenectomy; Recurrent laryngeal nerve; Learning curve
Transgelin is a 22 000 actin-binding protein of the calponin family.It is an early marker of vascular smooth muscle cell differentiation.Transforming growth factor-β (TGF-β) can drive the transgelin gene expression.Transgelin makes G-actin assembled to form F-actin by binding with actin.Though transgelin is not required for vascular and visceral smooth muscle basal function,it is related to calcium-independent smooth muscle contraction.Recent evidence suggests that transgelin is involved in tissue remodeling by suppressing matrix metalloproteinase-9,so this may be a new clue to investigate pulmonary fibrosis or lung injury.In addition,transgelin may act as a suppressor on migration and infiltration of tumor cells.
Key words:
Transgelin; SM22; Transforming growth factor β; Matrix metalloproteinase-9
Purpose: The aim of this study was to evaluate the feasibility, safety and therapeutic effects of ultrasound (US)-guided high intensity focused US (HIFU) ablation in the treatment of extra-abdominal desmoid tumours.Materials and methods: From May 2006 to May 2010, ten consecutive patients with pathologically proven extra-abdominal desmoid tumours were treated by US-guided HIFU ablation. Eight patients with multiple recurrent tumours were treated with a palliative aim, two patients with new solitary tumours were treated with a curative aim. The mean size of the largest tumour was 9.2 cm (range 5.9–12.8 cm). An acoustic power of 300–500 W was used according to the echogenic changes after energy exposure, intermittent HIFU exposure of 2–3 s was applied until the planned target area became hyperechoic on US. Outcome of HIFU ablation was observed by serial contrast-enhanced imaging examinations during follow up.Results: HIFU ablation was successfully performed without major complications. Large volume coagulation necrosis was obtained in all patients. During a mean follow up of 30 months (range 8–55 months), the treated tumours (n = 25) shrank significantly (>50% in volume). Complete tumour necrosis was observed in the two patients with solitary new tumours. Two patients received repeat HIFU ablation for enlarged residual tumours. No tumour spread along the treated area was observed in any patient.Conclusion: US-guided HIFU ablation could be used as an effective minimally invasive therapy for local control of extra-abdominal desmoid tumours.
Purpose: The aim of this study was to evaluate the clinical benefit of different radiation doses in concurrent chemoradiotherapy (CCRT) for esophageal carcinoma using modern radiotherapy techniques. Methods: A systematic review was conducted by screening PubMed, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases with prespecified searching strategy. Studies which compared high radiation dose group with low-dose radiation group using modern radiotherapy techniques for esophageal cancer patients in CCRT were identified. The hazard ratios (HR) for overall survival (OS) and the odds ratios (OR) for local-regional failure (LRF), distant metastasis (DM), and toxicities were considered as the outcomes of interest. R 3.6.2 software was used for statistical analysis. Results: Twelve studies involving 10,896 patients were included for analyses. The results showed that the high-dose group had better OS (HR = 0.79, 95% CI = 0.70-0.90, P = 0.0004) and the local-regional control (OR = 0.59, 95% CI = 0.46-0.76, P < 0.0001), especially for patients who were diagnosed with squamous cell carcinoma (SCC). The subgroup analyses further indicated that ≥ circa 60 Gy can significantly improve the OS (HR = 0.73, 95% CI = 0.68-0.80, P < 0.0001) as well as the local-regional control (OR = 0.54, 95% CI = 0.40-0.74, P < 0.0001) as compared with < circa 60 Gy. Another subgroup analysis comparing ≤ 50.4 Gy with > 50.4 Gy showed no substantial difference in OS (HR = 0.98, 95% CI = 0.93-1.03, P = 0.43). In addition, there are no significant differences between the two groups in grade 3-5 radiation pneumonitis (OR = 1.05, 95% CI = 0.54-2.05, P = 0.89), grade 3-5 radiation esophagitis (OR = 1.40, 95% CI = 0.93-2.11, P = 0.11), treatment-related death (OR = 1.60, 95% CI = 0.70-3.66, P = 0.27), and DM (OR = 1.21, 95% CI = 0.92-1.59, P = 0.17). Conclusions: For esophageal carcinoma receiving CCRT with modern radiation techniques, evidence suggested that high-dose radiotherapy, especially ≥circa 60 Gy, had potentials to improve the OS and local-regional control without increase in severe toxicities when compared with low-dose radiotherapy. The result needs to be confirmed by randomized clinical trials.
Abstract Objective This study aimed to explore the association of integrin α7 with clinicopathological characteristics and overall survival (OS) in clear cell renal cell carcinoma (ccRCC) patients. Methods 179 ccRCC patients who underwent nephrectomy were included in this retrospective study. Tumor tissue and paired adjacent tissue specimens of patients were obtained. Immunohistochemistry assay was performed to detect integrin α7 expression. OS was calculated with the median follow‐up duration of 91.0 months (range: 3.0‐116.0 months). Results Integrin α7 was highly expressed in tumor tissue compared to paired adjacent tissue ( P < .001), and tumor integrin α7 high expression was correlated with higher pathological grade ( P = .004), increased T stage ( P = .017), and advanced TNM stage ( P = .033). Kaplan–Meier curve showed that patients with integrin α7 high expression (mean OS = 69.8, 95%CI: 60.5‐79.1 months) presented with worse OS compared to patients with integrin α7 low expression (mean OS = 101.8, 95%CI: 96.0‐107.7 months; P < .001). Multivariate Cox's regression analysis further disclosed that tumor integrin α7 high expression independently predicted poor OS ( P < .001). Conclusion Integrin α7 is upregulated and correlates with higher pathological grade, increased T stage, and advanced TNM stage, meanwhile it also acts as a valuable prognostic factor for worse survival in ccRCC patients.
Comparing with conservative strategy, early invasive approach has been shown to be beneficial for initially stabilized patients with non–ST-elevation myocardial infarction (NSTEMI). However, concerns of increased risk of bleeding and other complications associated with early revascularization in patients aged ≥75 years persist. A routinely deferred invasive strategy aiming to facilitate revascularization after stabilizing the culprit lesion predominates across China. The aim was to compare efficacy and safety of deferred invasive strategy versus guideline-recommended early invasive strategy in initially stabilized Chinese patients aged ≥75 years with NSTEMI. Twenty qualified centers from 10 different provinces throughout mainland China will contribute to the study. Eligible patients will be central randomized to a routine deferred invasive approach or an early invasive approach (coronary angiography >72 hours or <24 hours of admission and appropriate revascularization). Patients meeting the inclusion criteria but not randomized for any reason will be registered. The primary end point of the present study is a composite of all-cause mortality, nonlethal (re) MI, ischemic stroke, and urgent revascularization at 1 year. Noninferiority design is used, and the inferiority margin was set to be 5%. The goal is to enroll 696 patients with expected primary end point rates of 30%, 2-tailed α of .05, power of 80%, and dropout rate of 5%. The DEAR-OLD trial is a prospective, nationwide, multicenter, noninferiority-designed, open-label randomized clinical trial evaluating efficacy and safety of routinely deferred invasive strategy compared with early invasive strategy in Chinese elderly patients with NSTEMI.
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