NSCLC患者血清sB7-H3和CYFRA21-1检测及临床应用

目的 探讨血清可溶性B7-H3（sB7-H3）和细胞角蛋白19片段抗原（CYFRA21-1）检测对非小细胞肺癌（non-small cell lung cancer,NSCLC）的诊断价值.方法 分别采用 ELISA和电化学发光法检测 72 例 NSCLC及 68 例肺部良性病患者血清sB7-H3 和 CYFRA21-1水平.结果 NSCLC 患者血清sB7-H3水平及阳性率[（98.34±35.17）ng/ml,61.11%]均明显高于肺部良性病患者[（70.89±20.62）ng/ml,7.32%];NSCLC 患者血清CYFRA21-1 水平及阳性率[（15.08±7.98）ng/ml,66.67%]均明显高于肺部良性病患者[（3.21±2.65）ng/ml,4.41%];差异均具有统计学意义（P〈0.05）.NSCLC 经TNM分期后,随着肿瘤分级级别的升高,sB7-H3水平[Ⅰ/Ⅱ期、Ⅲ期和Ⅳ期分别为（85.21±36.14）ng/ml、（98.62±＋40.38）ng/ml和（107.17±41.66）ng/ml],CYFRA21-1水平和[Ⅰ/Ⅱ期、Ⅲ期和Ⅳ期分别为（10.23±5.65）ng/ml、（15.52±6.84）ng/ml和（18.08±5.93）ng/ml]也升高.sB7-H3 和 CYFRA21-1联检后,灵敏度和一致性增高,特异性降低.结论 sB7-H3 和 CYFRA21-1对 NSCLC 有一定的辅助诊断价值,另外,或可应用于对TNM的分期,联检可提高对NSCLC的阳性诊断.     

非小细胞肺癌患者血清CYFRA21-1浓度与病理分期关系的探讨

目的：研究非小细胞肺癌患者血清CYFRA21-1浓度与病理分期的关系。方法：应用放射免疫分析224例非小细胞肺癌患者血清CYFRA21-1的浓度,统计分析其与术后病理T、N分期的关系。结果：非小细胞肺癌患者血清CYFRA21-1浓度与T分期（T1vsT2,T1vsT3,P〈0.05）及淋巴结转移（pN0vspN1,pN0vspN2,pN1vspN2,P〈0.05）有显著统计学差异。结论：术前检测非小细胞肺癌患者血清CYFRA21-1浓度对判断T、N分期有重要的临床意义。     

非小细胞肺癌的CYFRA21-1、CA125与CEA联合检测的临床意义

探讨联合检测CYFRA21-1、CA125、CEA对非小细胞肺癌的临床应用价值. 1995年8月至2000年8月由病理证实的非小细胞肺癌患者165例, 同时测定血清CYFRA21-1、CA125、CEA值. CYFRA21-1在鳞癌中阳性率最高为54.55%(30/55); CA125、CEA在腺癌中阳性率最高, 分别为58.59%(58/99)、52.53%(52/99).三项联检总阳性率明显升高为81.82%(135/165), 其中Ⅲ期和Ⅳ期非小细胞肺癌的阳性检出率分别为89.13%(41/46)、86.52%(77/89), 均高于Ⅰ期和Ⅱ期的阳性检出率. 结论: 联合检测CYFRA21-1、CA125和CEA可起到互补作用, 从而明显提高非小细胞肺癌的阳性检出率, 且肿瘤的阳性检出率随病情的进展而升高.     

细胞角蛋白-19片段抗原联合癌胚抗原检测对肺癌患者的诊断价值分析

目的探究细胞角蛋白-19片段抗原联合癌胚抗原检测对肺癌患者的诊断价值。方法选取我院2016年2月至2018年10月收治的50例肺癌患者为肺癌组,另选取本院同期体检的50例健康人群为健康对照组。比较两组研究者的CEA和CYFRA21-1的含量和不同检测方式对肺癌的诊断效能。结果肺癌组患者的CEA含量为(11.89±9.51)ng/mL,明显高于健康对照组的(2.18±1.07)ng/mL,差异具有统计学意义(P0.05);肺癌组患者的CYFRA21-1为(8.12±6.47)ng/mL,明显高于健康对照组(5.24±4.26)ng/mL,差异具有统计学意义(P0.05)。CEA+CYFRA21-1联合检测诊断肺癌的特异性、准确度、灵敏度分别为96.00%、90.00%、88.00%,明显高于单一CEA、CYFRA21-1检测,差异具有统计学意义(P0.05)。结论 CEA+CYFRA21-1联合检测诊断肺癌的特异性、准确度、灵敏度高,值得临床推广应用。     

CYFRA21-1、CA15-3测定在乳腺癌术后监测中的意义

目的:测定乳腺癌患者血清CYFRA21-1、CA15-3水平及探讨其临床意义.方法:采用电化学发光免疫分析观察了30例术前乳腺癌患者,33例术后复发转移患者血清CYFRA21-1、CA15-3浓度变化.结果:①33例术后复发转移患者血清CFYRA21-1浓度为(10.97±6.19)ng/ml,30例术前乳腺癌患者血清CYFRA21-1浓度为(2.06±0.76)ng/ml,两组比较差异非常显著(P＜0.001).②33例术后复发转移患者血清CA15-3浓度为(88.72±32.91)U/ml,30例术前乳腺癌患者CA15-3浓度为(28.71±6.32)U/ml,两组比较差异非常显著(P＜0.001).③乳腺癌术后复发转移患者血清CYFRA21-1和CA15-3含量之间存在显著正相关(r=0.638,P＜0.0010).结论:血清CYFRA21-1、CA15-3浓度测定有助于乳腺癌患者术后复发转移的监测和疗效判断.     

肺癌肿瘤标志物CYFRA21-1的临床应用及其评价

应用免疫放射分析法(IRMA)检测327例肺癌,297例肺部良性疾病患者CYFRA21-1的血清水平,肺癌组水平16.9±8.4ng/ml,非肿瘤组水平1.9±1.6ng/ml(p<0.001)。肺癌阳性率62.4％,良性疾患阳性率5％。测定灵敏度为62.4％,特异性为94.5％,准确率77.9％,结果均好于CEA、NSE、CA-242。肺癌病人随病期的增加,血清CYFRA21-1含量也随之上升(P<0.02)。对8例肺癌手术病人和10例化疗病人含量变化分析,在手术3～5周后,血清含量由术前的6.4±3.1ng/ml,降到1.8±0.6ng/ml,10例化疗病人,其中8例血清含量均有降低,由17.4±9ng/ml降至4.9±2.0ng/ml,临床证实均有良好的治疗效果,另2例临床证实治疗无效,血清CYFRA21-1水平相应增高。     

肺癌患者血清CYFRA21—1检测的临床价值探讨

非小细胞肺癌患者血清中CYFRA21-1升高。本实验室对108例肺癌患者作CYFRA21-1检测,以探讨CYFRA21-1检测对非小细胞肺癌的诊断价值。     

肺癌患者血清TSGF、CEA、CYFRA21—1和NSE水平的临床价值

目的:探讨血清TSGF、CEA、CYFRA21-1和NSE水平的临床价值。方法:采用放射免疫分析测定了179例肺癌、48例肺良性病变和51例正常对照组的血清TSGF、CEA、CYFRA21-1和NSE的水平。结果:在NSCLC中,37例I～II期鳞癌血清中TSGF、CEA和NSE水平与肺良性病变无明显差异(P均>0.05),32例I～II期腺癌血清中NSE也与肺良性病变无明显差异(P>0.05);其余,NSCLC和SCLC血清中TSGF、CEA、CY-FRA21-1和NSE水平明显增高,均与肺良性病变具有明显差异(P<0.05～0.01),从总体而言,随着病变的严重程度增加,肺癌标志物水平也增高。51例正常对照组血清TSGF、CEA、CYFRA21-1和NSE水平分别为(64.1±14.8)U/ml,(3.51±1.1)ng/ml,(2.6±1.4)ng/ml和(5.1±3.6)ng/ml。结论:肺癌的诊断中,以血清CY-FRA21-1测定为最佳,其次为TSGF和CEA,最差NSE,故肺癌标志物的联检是诊断肺癌的最佳选择。     

血清和肺泡灌洗液中肿瘤标志物检测对肺癌的诊断价值分析

目的：分析血清和肺泡灌洗液中肿瘤标志物对肺癌的诊断价值,研究其表达水平与肺癌的相关性及用于肺癌诊断的可行性。方法：应用流式细胞术检测40例肺癌组和肺良性病变组hnRNPA2/B1的表达情况;同时用化学发光免疫法检测血清肿瘤标志物CEA、NSE、CYFRA21-1和SCCAg的含量。结果：hnRNPA2/B1在肺癌组与肺良性病变组表达率分别为86.01%±32.48%和32.1%±10.02%,差异显著（P〈0.01）。肺癌组hnRNPA2/B1检测阳性率为85%,40例肺癌组样本肿瘤标志物CEA、NSE、CYFRA21-1、SCCAg联检阳性率52.5%,肺泡灌洗液中hnRNPA2/B1的阳性检出率明显高于CEA、NSE、CYFRA21-1及SCCAg四项肿瘤标志物的联检。结论：血清CEA、NSE、CYFRA21-1及SCCAg四项肿瘤标志物联检肺泡灌洗液脱落细胞内hnRN-PA2/B1对肺癌辅助诊断有较大的临床应用价值。     

血清TK-1、SE-CAD表达及联合HE4、CEA、CYFRA21-1检测在非小细胞肺癌诊断中的意义

目的探讨可溶性E-钙黏蛋白(soluble E-cadherin,SE-CAD)、胸苷激酶-1(thymidine kinase 1,TK-1)在非小细胞肺癌(NSCLC)患者血清中的水平,并分析其与附睾蛋白4(HE4)、癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)联合检测在NSCLC诊断中的临床应用价值。方法收集本院2016年1月至2018年1月期间初诊NSCLC患者86例、小细胞肺癌患者45例、同期良性疾病患者42例、同期初诊其他恶性肿瘤(除肺癌外)患者30例、健康受试者的血清标本40例,应用液态芯片技术对受试者血清标本进行CEA、CYFRA21-1水平检测,ELISA方法检测SE-CAD、TK-1、HE4。结果①非小细胞肺癌患者血清中SE-CAD水平明显高于良性对照组、正常对照组( P <0.05),差异具有统计学意义,但与小细胞肺癌组及其他恶性肿瘤组比较差异无统计学意义( P >0.05);②非小细胞肺癌组患者血清 TK1 与CYFRA21-1水平明显高于良性对照组、小细胞肺癌组、其他恶性肿瘤组和健康对照组,差异均有统计学意义(均 P <0.05)。③单项检测时,CYFRA21-1对非小细胞肺癌的诊断灵敏度最高,为87.2%,TK-1的诊断特异性最高。5种肿瘤标志物联合检测,灵敏度高达93.2%,特异性有所降低为85.7%。结论 SE-CAD、TK1 与CYFRA21-1均可作为鉴别良恶性肿瘤的检验指标,联合HE4、CEA、CYFRA21-1等指标对非小细胞肺癌诊断的灵敏度远高于单项检测。     

Transthoracic ultrasound assessment of B-lines for identifying the increment of extravascular lung water in shock patients requiring fluid resuscitation

Introduction:

Several studies have shown that the number of B-lines was related to the amount of extravascular lung water (EVLW). In our study, we aimed to demonstrate the magnitude of the incremental B-lines in shock patients with positive net fluid balance and the association with gas exchange impairment.

Materials and Methods:

We performed trans-thoracic ultrasound at admission (T₀) and at follow-up period (T_FL) to demonstrate the change of B lines (ΔB-lines) after fluid therapy. We compared the total B-line score (TBS) at T₀ and T_FL and calculated the Pearson''s correlation coefficient between the ΔB-lines and PaO₂/FiO₂ ratio.

Results:

A total of 20 patients were analyzed. All patients had septic shock. Net fluid balance was + 2228.05 ± 1982.15 ml. The TBS at T₀ and T_FL were 36.6 ± 23.73 and 63.80 ± 29.25 (P < 0.01). The ΔB-lines along anterior axillary line (AAL) correlated to the ΔTBS (r = 0.90, P < 0.01). The ΔB-lines along AAL had inverse correlation to PaO₂/FiO₂ ratio (r = −0.704, P < 0.05). The increase of B-lines ≥ 10 was related to the decrease of PaO₂/FiO₂ ratio. The inter-observer reliability between two ultrasound readers was high (r = 0.92, P < 0.01).

Discussion:

The number of B-lines increased in shock patients with positive net fluid balance and correlated to impaired oxygenation. These data supported the benefit of ultrasound for assessing the EVLW.     

Branching of lung epithelium in vitro occurs in the absence of endothelial cells

Background: Early lung morphogenesis is driven by tissue interactions. Signals from the lung mesenchyme drive epithelial morphogenesis, but which individual mesenchymal cell types are influencing early epithelial branching and differentiation remains unclear. It has been shown that endothelial cells are involved in epithelial repair and regeneration in the adult lung, and they may also play a role in driving early lung epithelial branching. These data, in combination with evidence that endothelial cells influence early morphogenetic events in the liver and pancreas, led us to hypothesize that endothelial cells are necessary for early lung epithelial branching. Results: We blocked vascular endothelial growth factor (VEGF) signaling in embryonic day (E) 12.5 lung explants with three different VEGF receptor inhibitors (SU5416, Ki8751, and KRN633) and found that in all cases the epithelium was able to branch despite the loss of endothelial cells. Furthermore, we found that distal lung mesenchyme depleted of endothelial cells retained its ability to induce terminal branching when recombined with isolated distal lung epithelium (LgE). Additionally, isolated E12.5 primary mouse lung endothelial cells, or human lung microvascular endothelial cells (HMVEC‐L), were not able to induce branching when recombined with LgE. Conclusions: Our observations support the conclusion that endothelial cells are not required for early lung branching. Developmental Dynamics 244:553–563, 2015. © 2015 Wiley Periodicals, Inc.     

脑死亡供体肺脏病理改变及临床移植应用前景探讨

目的观察脑死亡供体肺病理改变,探讨临床移植应用的可行性。方法对23例脑死亡供体肺进行了病理活检,HE染色、网状纤维染色及PASM染色观察肺脏组织变化,电镜观察超微结构变化。结果气管、支气管及肺泡结构尚完整,仅见局灶肺泡上皮细胞及支气管纤毛上皮细胞脱落,未见肺透明膜形成;肺泡间隔未见明显增宽、血管充血易见,血管内皮细胞未见明显改变,未见纤维化表现。电镜下肺泡Ⅱ型上皮细胞胞质轻微水肿,但结构尚完整;内质网扩张,基底膜未见明显改变。结论严格限定纳入标准,脑死亡供肺可以实施移植。     

Morphometric Examination of the Equine Adult and Foal Lung

To understand the mechanisms of airway inflammation associated with equine diseases such as Rhodococcus equi infection, we must identify baseline “normal” structural characteristics of the horse lung. To develop a detailed understanding of the morphology of the horse lung, we adapted and applied stereological methods to the lungs from healthy adult horses (N = 4) and 1‐day (N = 5) and 30‐day (N = 5) old foals. The left lung was fixed in situ by intrabronchial instillation of glutaraldehyde/paraformaldehyde fixative at 25 cm H₂O column and sampled using a fractionator design followed by embedding in glycol methacrylate. The lung was characterized into parenchyma and non‐parenchyma, where median parenchymal density was 81.0% in 1‐day‐old foals, 84.4% in 30‐day‐old foals and 93.7% in adult lungs. The median volume density of alveolar airspace per lung was 45.9% in 1‐day‐old, 55.5% in 30‐day and 66.9% in adult horse lungs. The median alveolar surface area increased with age, from 205.3 m², 258.2 m², and 629.9 m² in 1‐day‐old foals, 30‐day‐old foals, and adults, respectively. While the median alveolar surface density decreased with age, the mean linear intercept (mean free distance within acinar airspaces) increased with age. Alveolar surface area was greater than endothelial surface area within each lung. The ratio between alveolar and endothelial surface density remains unchanged with age. The median endothelium surface area was 106.2 m² in 1‐day, 147.5 m² in 30‐day, and 430 m² in adult lungs. The data suggest the foal lung is functionally developed and postnatal lung development and remodelling is driven by alveolar expansion paralleled with angiogenesis. Anat Rec, 297:1950–1962, 2014. © 2014 Wiley Periodicals, Inc.     

Design of a new artificial breathing system for simulating the human respiratory activities

The purpose of this work is the conception and implementation of an artificial active respiratory system that allows the simulation of human respiratory activities. The system consists of two modules, mechanical and electronical. The first one represents a cylindrical lung adjustable in resistance and compliance. This lung is located inside a transparent thoracic box, connected to a piston that generates variable respiratory efforts. The parameters of the system, which are pressure, flow and volume, are measured by the second module. A computer application was developed to control the whole system, and enables the display of the parameters. A series of tests were made to evaluate the respiratory efforts, resistances and compliances. The results were compared to the bibliographical studies, allowing the validation of the proposed system.     

Primary sarcomas of the lung: a clinicopathological and immunohistochemical study of 14 cases

The clinicopathological features and immunohistochemical findings in 14 primary sarcomas of the lung collected over a 30-year-period are presented. This represents one sarcoma per 550 bronchogenic carcinomas undergoing resection in this centre. The study group comprised six leiomyosarcomas, five malignant peripheral nerve sheath tumours, two haemangiopericytomas and one epithelioid haemangioendothelioma. The majority of cases occurred in men (nine males: five females), with mean age at presentation of 54 years for men and 47 years for women. All leiomyosarcomas were seen in men, whereas malignant peripheral nerve sheath tumours showed no particular sex preponderance. Leiomyosarcomas were larger tumours than malignant peripheral nerve sheath tumours, mean tumour diameter 15 cm (range 10–25 cm) compared to 9.5 cm (7–15 cm), respectively. All leiomyosarcomas were situated intraparenchymally whereas two of the five malignant peripheral nerve sheath tumours were endobronchial in site. Extrathoracic metastates were seen at death in two of the six leiomyosarcomas but not in any of the malignant peripheral nerve sheath tumours. Overall survival was 28 months although for the leiomyosarcoma/malignant peripheral nerve sheath tumour group alone survival was 8 months. Tumour grading appeared to be a more useful prognostic factor than tumour site (endobronchial/parenchymal) or tumour size. Haemangiopericytoma and epithelioid haemangioendothelioma were associated with a more favourable prognosis.     

Magnetic resonance elastography of the lungs: A repeatability and reproducibility study

Lung diseases are one of the leading causes of death worldwide, from which four million people die annually. Lung diseases are associated with changes in the mechanical properties of the lungs. Several studies have shown the feasibility of using magnetic resonance elastography (MRE) to quantify the lungs' shear stiffness. The aim of this study is to investigate the reproducibility and repeatability of lung MRE, and its shear stiffness measurements, obtained using a modified spin echo‐echo planar imaging (SE‐EPI) MRE sequence. In this study, 21 healthy volunteers were scanned twice by repositioning the volunteers to image right lung both at residual volume (RV) and total lung capacity (TLC) to assess the reproducibility of lung shear stiffness measurements. Additionally, 19 out of the 21 volunteers were scanned immediately without moving the volunteers to test the repeatability of the modified SE‐EPI MRE sequence. A paired t‐test was performed to determine the significant difference between stiffness measurements obtained at RV and TLC. Concordance correlation and Bland–Altman's analysis were performed to determine the reproducibility and repeatability of the SE‐EPI MRE‐derived shear stiffness measurements. The SE‐EPI MRE sequence is highly repeatable with a concordance correlation coefficient (CCC) of 0.95 at RV and 0.96 at TLC. Similarly, the stiffness measurements obtained across all volunteers were highly reproducible with a CCC of 0.95 at RV and 0.92 at TLC. The mean shear stiffness of the lung at RV was 0.93 ± 0.22 kPa and at TLC was 1.41 ± 0.41 kPa. TLC showed a significantly higher mean shear stiffness (P = 0.0004) compared with RV. Lung MRE stiffness measurements obtained using the SE‐EPI sequence were reproducible and repeatable, both at RV and TLC. Lung shear stiffness changes across respiratory cycle with significantly higher stiffness at TLC than RV.     

Primary malignant 'triton' tumour of the lung

Two cases of malignant 'triton' tumour arising within lung parenchyma are described. The patients were a three-year-old child and a 53-year-old man. Both patients presented with shortness of breath and a large intrapulmonary mass on chest X-ray. Neither patient had a history of von Recklinhausen's neurofibromatosis. The lesions were treated by pneumonectomy. Grossly, both tumours presented as large, soft and gelatinous intraparenchymatous masses measuring 130 mm and 80 mm, respectively. Histologically, they were characterized by an atypical spindle cell proliferation embedded in an abundant myxoid stroma. Focal areas of rhabdomyoblastic differentiation characterized by large cells with abundant eosinophilic cytoplasm and occasional cytoplasmic cross-striations could be seen admixed with the atypical spindle cell elements. Immunohistochemical studies showed a focal positive reaction for S-100 protein in the atypical spindle cells embedded within the myxoid stroma, and a strong positive reaction for desmin and myoglobin in the rhabdomyoblastic areas. The child died three months after diagnosis with extension of the tumour into the thoracic cavity. The second patient has been lost to follow-up. Although rare, malignant 'triton' tumour should be considered in the differential diagnosis of primary spindle cell sarcomas of the lung.