孤立性肺结节危险因素及良恶性预测模型

目的分析孤立性肺结节的危险因素并探讨肺部结节良恶性预测模型。 方法收集雅安市人民医院2017年1月至2018年8月经胸外科手术切除且有明确病理诊断的112例孤立性肺结节患者的临床资料。回顾性分析其年龄、性别、吸烟史、肿瘤家族史、既往肿瘤史、血清癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段(CYFRA21-1),以及肺部结节密度、直径、位置、分叶、毛刺、胸膜凹陷征、血管集束征、空泡征、空气支气管征、钙化等影像学特征。根据病理诊断分为良性、恶性两组,进行单因素分析,将单因素分析中有显著性差异的临床信息纳入Logistic回归分析,筛选出恶性结节的独立危险因素并建立预测模型。 结果单因数分析中年龄、既往肿瘤史、CEA、CYFRA21-1、结节密度、分叶、毛刺、胸膜凹陷征、血管集束征、空泡征、钙化征有统计学差异(P<0.05)。Logjistic回归分析显示患者年龄、CEA、CYFRA21-1、磨玻璃密度、分叶为恶性结节的独立危险因素。恶性肺部结节的预测模型公式为：P＝e^x/(1+e^x),x＝-8.816+(3.018×密度)+(0.073×年龄)+(0.482×CEA)+(0.426×CRFRA21-1)+(1.421×分叶)。 结论患者年龄、血CEA、血CYFRA21-1、磨玻璃密度、分叶为恶性结节的独立危险因素,预测模型对恶性肺结节有较好的敏感性及特异性,诊断准确性较高。     

孤立性肺结节116例良恶性高危因素分析

目的 探讨孤立性肺结节良恶性的高危因素.方法 根据良、恶性将116例孤立性肺结节分为两组,应用多因素分析强制进入法进行二分类Logistic回归分析,诊断结果为应变量(良性疾病=0,恶性疾病=1),自变量:年龄,结节直径,结节形态,结节内部特征,磨玻璃征,毛刺分叶,周边特征,结节钙化,结节界面,吸烟史,咯血.结果 经Logistic回归分析,孤立性肺结节恶性诊断的高危因素中,年龄≥60岁的OR值为28.098,P=0.004;结节直径＞1 cm的OR值为41.886,P=0.016;毛刺或分叶征的OR值为138.386,P=0.001;空泡征,支气管充气征的OR值为57.602,P=0.003.结论 年龄(≥60岁)、结节大小(直径＞1 cm)、毛刺分叶、结节内部特征(空泡征,支气管充气征)是恶性孤立性肺结节的高危因素.     

81例恶性肺微小结节的影像学征象分析

目的:探讨恶性微小孤立性肺结节(SPN)的影像学特征。方法:收集我院门诊就诊经术后病理证实的恶性SPN患者81例,回顾性分析其SPN的影像学特征。结果:81例恶性SPN患者中纯磨玻璃样结节(p GGO)21例,混合性结节(m GGO)24例,实性结节(SN)36例。分叶征及胸膜凹陷征在p GGO中的检出率低于m GGO和SN(χ~2分别为21.13、28.56,均P0.001),随着结节实性成分增多,密度增高,分叶征及胸膜凹陷征也更明显(趋势χ~2分别为18.64、28.28,均P0.001)。而毛刺、支气管充气征和血管集束征在3种类型恶性SPN中检出率均较高,但组间差异无统计学意义(P0.05)。结论:3种类型恶性SPN的影像学特征各有不同,而血管集束征在3种类型恶性SPN中检出率均较高,评判SPN与血管之间的关系对肺微小结节的良恶性鉴别可能更有价值。     

多层螺旋CT征象对孤立性肺结节的诊断价值

目的探讨多层螺旋CT(MSCT)征象对肺内孤立性结节(slitary pulmonary nodule,SPN)良恶性的鉴别诊断价值。方法回顾性分析经病理证实或临床随访确诊的69例SPN患者的CT表现,使用卡方检验对不同CT征象在良恶性SPN中的发生率进行比较,计算具有统计学意义的单一征象及组合征象的敏感性、特异性、阳性预测值及阴性预测值;判断单一征象和组合征象的诊断效能是否存在差异。结果 69例SPN包括45例恶性结节和24例良性结节,预测恶性结节前4位的单一CT征象依次为分叶征、毛刺征、胸膜凹陷征和血管集束征,均高于在良性结节的发生率(P0.05),其中诊断效能前三位的征象,其敏感性、特异性、准确性、阳性预测值及阴性预测值分别为:分叶征:88.9%、79.2%、85.5%、88.9%、79.2%,毛刺征:68.9%、70.8%、69.6%、81.6%、54.8%,胸膜凹陷征:64.4%、70.8%、66.7%、80.6%、51.5%。组合CT征象的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为:分叶征+毛刺征:64.4%、91.7%、73.9%、93.5%、57.9%,分叶征+胸膜凹陷征:60.0%、91.7%、71.0%、93.1%、55.0%。毛刺征+胸膜凹陷征:44.4%、83.3%、58.0%、83.3%、44.4%。分叶征+毛刺征+胸膜凹陷征:44.4%、100%、63.8%、100%、50.0%。结论MSCT能够清晰显示SPN的形态特征。分叶征、毛刺征、胸膜凹陷征和血管集束征是鉴别SPN良恶性的重要CT征象。单一征象诊断效能高,但是随着组合征象增多,可进一步提高鉴别诊断的阳性预测值和特异性。     

孤立性肺结节的危险因素

目的通过对孤立性肺结节(solitary pulmonary nodules,SPN)相关危险因素的分析,为临床医师判断SPN的良、恶性提供依据。方法回顾性分析2009年1月-2016年6月经新疆医科大学第一附属医院手术病理证实的293例SPN患者,共收集29项可能判断SPN良、恶性的危险因素包括患者年龄、性别、民族、BMI、体重下降(kg)、吸烟量、戒烟时间、肿瘤史、肿瘤家族史、肺结核病史、慢性支气管炎史;影像学:肿瘤部位、肿瘤最大直径(mm)、钙化、分叶、毛刺、胸膜凹陷征、边界清楚、血管集束征、支气管充气征、空洞、密度均匀、坏死、规则、CT平扫峰值、峰强化CT值;以及CEA(癌胚抗原)、CA125、颈部淋巴结肿大(B超提示),通过对以上资料进行单因素及多因素分析筛选出有意义的危险因素。结果单因素分析显示:年龄、性别、民族、体重下降、吸烟量、戒烟时间、肿瘤部位、钙化、分叶、毛刺、胸膜凹陷征、边界清楚、规则、CT平扫峰值、峰强化CT值、CA125、颈部淋巴结肿大,在SPN良恶性中具有统计学意义;多因素logistic回归分析表明:年龄、吸烟量、肿瘤部位、钙化、分叶、胸膜凹陷征、边界清楚、峰强化CT值、颈部淋巴结肿大,在其良恶性中的差异有统计学意义。结论患者年龄、吸烟量、肿瘤部位、胸膜凹陷征、分叶、峰强化CT值、颈部淋巴结肿大,为SPN的危险因素,而钙化、边界清楚,在SPN中起保护性作用。     

早期周围型肺癌96例CT影像学特点分析

目的提高早期周围型肺癌的CT诊断水平。方法回顾性分析96例经手术或CT引导下穿刺病理证实的早期周围型肺癌的CT影像学资料。结果①病灶形态:孤立结节影89例,不规则片状影7例;②病灶内部结构:空泡征31例,细支气管征27例,空洞征4例,钙化7例;③病灶边缘征:分叶征76例;细短毛刺征67例,棘状突起23例;④病灶周围征:胸膜凹陷征61例,血管集束征69例;⑤增强扫描特征:CT值增强幅度在20～50 HU之间。结论早期周围型肺癌CT的常见征象包括空泡征、空气支气管征、分叶征,毛刺征、棘状突起、胸膜凹陷征及血管集束征。空泡征及空气支气管征对提示病灶倾向恶性有较大价值。增强后癌性结节的CT值强化幅度有助于结节性质判断。     

MSCT在肺孤立性磨玻璃结节鉴别诊断中的价值

目的探讨多层螺旋CT(Multi-slice spiral CT,MSCT)在鉴别良恶性肺孤立性磨玻璃结节(sp GGO)中的价值。方法回顾性分析2015年1月至2017年7月间经MSCT检查有肺孤立性磨玻璃结节的44例患者的MSCT资料,根据病理结果将所有病例分为良性、恶性两组,其中良性结节有13例,包括9例不典型腺瘤样增生(AAH),4例慢性炎症;恶性结节有31例,均为腺癌。观察肺孤立性磨玻璃结节的CT征象特点,包括病灶形态、大小、边缘、实性成分、空气支气管征、空泡征、胸膜凹陷征、瘤肺界面、毛刺征、分叶征、血管集束征,对照病理结果,统计分析CT征象与肺磨玻璃结节良恶性的相关性。结果肺孤立性磨玻璃结节的病灶形态、大小、边缘、实性成分、空泡征、胸膜凹陷征、毛刺征、分叶征、血管集束征与sp GGO的良恶性有相关性,结果具有统计学差异(P0.05),而两组sp GGO的空气支气管征、瘤肺界面没有统计学差异(P0.05)。结论 MSCT对肺孤立性磨玻璃结节的良恶性鉴别诊断具有重要价值。     

螺旋CT靶扫描及重建联合Fisher判别在孤立性肺结节良恶性诊断中的作用

目的探讨螺旋CT靶扫描及三维重建技术联合Fisher判别法在孤立性肺结节良恶性鉴别诊断中的价值及临床作用。方法收集分析80例孤立性肺结节(SPN)患者的CT及临床基本资料,按手术病理为金标准分为良性(n=22)、恶性(n=58)两组,通过多平面重组(MPR)、最小密度投影(MIP)、容积再现(VR)、曲面重建(CPR)等后处理重建技术充分显示肺结节CT形态学特征,如分叶征、支气管截断征、空泡征、毛刺征、血管集束征、胸膜凹陷征、棘突征等,将三维数据依据病理结果分为良、恶性两组,以两组间具有统计学意义的的CT形态学特征(分叶征、支气管截断征、空泡征、毛刺征、血管集束征、胸膜凹陷征、棘突征)为指标并行Fisher判别,得出标准判别式后,采用交叉核实法计算误判概率。结果靶扫描三维重建技术所获得的SPN阳性征像明显比传统的二维图像多,依据SPN三维重建数据得出的Fisher判别公式为Z=1.094X1+0.614X2-0.420X3-0.960X4-0.310X5+0.679X6+1.035X7,误判率为7.5%,鉴别诊断的准确率达92.5%。结论螺旋CT靶扫描及重建联合Fisher判别在孤立性肺结节良恶性的定性诊断具有较高的临床价值。     

908例恶性孤立性肺小结节影像学征象的分析

目的:探讨恶性孤立性肺小结节的影像学征象。方法:收集孤立性肺小结节病例908例,分析其肿瘤微血管CT成像征、血管集束征、分叶征及毛刺等影像学征象,并寻找恶性肺小结节特征性的影像学征象。结果:908例肺小结节病例中恶性825例,良性83例。恶性肺小结节中肿瘤微血管CT成像征、血管集束征和毛刺的检出率高于良性肺小结节(均P0.001)。按恶性肺小结节密度分的3组中肿瘤微血管CT成像征、血管集束征、分叶征和毛刺的检出率均不同(P0.001)。随着肺小结节密度升高,血管集束征、分叶征和毛刺的检出率也增加(趋势P0.001)。按腺癌浸润深度分的3组中肿瘤微血管CT成像征、血管集束征、分叶征和毛刺的检出率均不同(P0.001)。随着浸润加深,肿瘤微血管CT成像征、血管集束征、分叶征和毛刺的检出率也增加(趋势P0.001)。结论:肿瘤微血管CT成像征在非实性结节和部分实性结节定性诊断中起提示作用,而血管集束征、分叶征及毛刺在实性结节的定性诊断中更有价值,这些影像学征象将在肺小结节定性诊断中发挥作用。     

容积再现技术在孤立性肺结节鉴别诊断中的价值

目的探讨容积再现技术(Volume rendering,VR)在孤立性肺结节(Solitary Pulmonary Nodules,SPN)鉴别诊断中的价值。方法收集我院门诊就诊,经术后病理证实的SPN患者482例,通过VR分析良恶性SPN的影像学特征。结果 482例患者包括恶性SPN 416例,良性SPN 66例。在恶性SPN中肿瘤微血管CT成象征(卡方值225. 51,P 0. 001)、血管集束征(卡方值19. 79,P 0. 001)、毛刺(卡方值14. 83,P 0. 001)和支气管充气征(卡方值3. 48,P 0. 05)检出率高于良性SPN,随着SPN密度的增加,肿瘤微血管CT成像征(趋势卡方值55. 08)的检出率逐渐降低(P 0. 001),而血管集束征(趋势卡方值92. 78),分叶征(趋势卡方值35. 87)及毛刺(趋势卡方值55. 62)的检出率逐渐增高(P 0. 001)。结论肿瘤微血管CT成象征在非实性结节和部分实性结节定性诊断中起到重要作用,而血管集束征、分叶征及毛刺在实性结节的定性诊断中更有价值。通过VR来评判SPN与血管之间的关系对恶性SPN早期诊断更有意义。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.     

Morphological and immunocytochemical heterogeneity of cultured pinealocytes from one-week-and two-month-old rats: Planimetric and densitometric investigations

Abstract: In vitro preparations of rat pinealocytes are widely used for biochemical analyses of signal transduction processes. This paper deals with morphological and immunocytochemical features of such preparations. Special attention was paid to the problems of whether pinealocytes represent a heterogeneous cell population and how such heterogeneity may develop during ontogeny. The investigations were performed with cells which were obtained from the pineal organ of one-week-and two-month-old rats, attached to synthetic peptide-coated coverslips or tissue culture chamber slides, and maintained under in vitro conditions overnight. The attached cells were then fixed with paraformaldehyde. These preparations yielded monolayers of spherical cells of different sizes; most cells were isolated, but some of them were aggregated and formed small clusters. On the average, the cells from the one-week-old animals were smaller than the cells from the two-month-old animals. Immunocytochemical demonstration of S-antigen, a pinealocyte-specific marker, showed that the majority of the cells from two-month-old animals were intensely or moderately labelled. Pinealocytes from one-week-old animals were less S-antigen immunoreactive. Only very few cells (less than 1% displayed glial fibrillary acidic protein (GFAP)-immunoreactivity. Planimetric investigations of the cell size and semiquantitative densitometric investigations of the intensity of the S-antigen immunoreaction revealed that (i) pinealocytes kept in vitro form a heterogeneous cell population, and that (ii) this heterogeneity increases during postnatal development from one-week-old to two-month-old animals. Two groups of pinealocytes can be distinguished based on their developmental fate: pinealocytes of one group grow dramatically, but show only a moderate increase in S-antigen immunoreactivity, and pinealocytes of the other group retain their size, but display a distinct increment in S-antigen immunoreacti vitv.     

Effects of pinealectomy and melatonin administration on certain indices of ovarian hyperplasia and/or hypertrophy in rats with both ovaries intact or after unilateral ovariectomy

Abstract: In earlier studies from other laboratories it was shown that melatonin decreased ovarian weight in rats and inhibited compensatory hypertrophy of the remaining ovary after unilateral ovariectomy. This study was designed to examine the influence of melatonin on certain indices of ovarian hyperplasia and/or hypertrophy in adult female rats with both ovaries preserved and with either an intact pineal gland or with the pineal gland removed (pinealectomy, PX) or, finally, in sham-PX animals. Similar studies were conducted on rats after unilateral ovariectomy, referring the examined parameters to the remaining intact ovary. The studies included mitotic activity of granulosa layer cells and corpus luteum cells, ovarian weight, ovarian cross-sectional area, cross-sectional area of the granulosa layer of all the Graafian follicles and the cross-sectional areas of the corpora lutea, visible on the ovarian cross-section. On the basis of results, we conclude that: 1) the effect of PX on the processes of ovarian hyperplasia and hypertrophy may vary; analogously, exogenous melatonin administration may influence ovarian hyperplasia and hypertrophy in different ways; 2) PX and exogenous melatonin may, under certain conditions, exert similar biological effects, even synergistic effects; 3) melatonin inhibits ovarian growth processes, while the effects of PX are variable; 4) the results indicate that in experiments performed on rats, with the use of two control groups, i.e., intact and sham-PX, melatonin effects on these two groups may differ.