Increased Expression of Aquaporin-1 on the Pleura of Rats with a Tuberculous Pleural Effusion

Objective The purpose of this study was to investigate whether the expression of AQP-1 on the pleura is altered in a rat model with a tuberculous pleural effusion (TPE) and to study its function. Methods A TPE model was established by intrapleural inoculation with 0.03 mg (2 ml) standard tuberculosis bacillus (H₃₇Rv). The rats with TPE were sacrificed at different time points (day 1, 3, or 5) after inoculation. The control group received a 2-ml intrapleural injection of saline. The visceral and parietal pleural tissues were harvested and processed for real-time RT-PCR, Western blot, immunohistochemistry, and determination of tissue AQP-1 levels. Recombinant adenovirus Ad-rAQP-1 containing full-length cDNA of AQP-1 was constructed. Six groups of seven Wistar rats were assigned to receive the following treatments: group 1: intrapleural administration of normal saline; group 2: intrapleural administration of tuberculosis bacilli (TB); group 3: intrapleural inoculation with TB at day 7 following intrapleural administration of Ad-rAQP-1 vector; group 4: intrapleural inoculation with 0.03 mg TB at day 7 following intrapleural administration of control Ad-GFP vector; group 5: intrapleural administration of Ad-rAQP-1; group 6: intrapleural administration of control Ad-GFP vector. The expression of AQP-l on the pleural tissue was detected by immunohistochemistry and Western blot analysis. Histopathologic changes of the pleura and the volume of pleural fluid were examined on day 7 following gene intervention or on day 3 following TB inoculation. Results Bilateral pleural effusions appeared within 5 days in all rats who received an intrapleural inoculation with TB. The peak amount of pleural fluid occurred on day 3. The AQP-1 expression at protein and mRNA was increased in the early phase of TPE. The expression of AQP-1 was increased in the Ad-rAQP-1 gene transfer group, indicating successful adenovirus gene transfer. The volume of pleural fluid in group 3 (6.1 ± 0.7 ml) was significantly increased compared with that in group 2 (3.8 ± 1.0 ml) and group 4 (4.0 ± 1.1 ml). Conclusion These findings suggested that AQP-1 was increased in TPE and it may be involved in the formation of TPE.     

先天性食管闭锁两种手术途径的对比研究

目的 比较经胸腔和经胸膜外两种手术途径治疗先天性食管闭锁的疗效差异.方法 回顾性分析2002年1月至2007年4月在本院手术治疗的34例先天性食管闭锁（Ⅲ型）患儿临床资料,男27例,女7例,均行食管气管瘘结扎、食管端端吻合术.其中经胸腔手术（为经胸腔手术组）19例,经胸膜外手术（为经腹膜外手术组）15例.两组术前均有肺炎,心脏彩超检查提示21例有房面分流（考虑为房间膈缺损或卵圆孔未闭）和（或）动脉导管未闭,但均无肺动脉高压,心功能正常.结果 经胸腔手术组平均手术时间（2.17±0131）h,呼吸机使用时间为（21.07±25.42）h;术后需呼吸机辅助通气15例,发生气胸11例、胸腔积液10例、吻合口瘘5例;治愈16例,治愈率84.2%.经胸膜外手术组平均手术时间为（2.13±0.45）h,呼吸机使用时间为（9.27±13.70）h;术后需呼吸机辅助通气6例,发生气胸3例、胸腔积液2例、吻合口瘘6例;治愈13例,治愈率86.7%.结论 经胸腔和经胸膜外两种手术途径治疗先天性食管闭锁治愈率相当,所需手术时间和呼吸机使用时间无显著差异;但术后经胸膜外手术组需呼吸机辅助通气的几率明显降低,且发生气胸、胸腔积液的几率亦明显低于经胸腔手术组.     

Pleural and pericardial morbidity after minimal access repair of pectus excavatum

Purpose  The aim of this study was to evaluate the pleural and pericardial morbidity in patients that had undergone pectus excavatum corrections using minimal access repair of pectus excavatum (MARPE) at a single center. Materials and methods  Data from patients after MARPE from 2000 to 2007 were prospectively collected. Patients with pneumothorax and pleural and pericardial effusions were identified. Results  One hundred eighty patients were corrected by MARPE. Eighty-four were identified to have pleural or pericardial morbidities. Pneumothorax was documented in 33 patients and five required placement of a chest tube. Pleural effusions were recorded in 53 and were found to recur in four patients. Drainage was necessary in 18 patients. Pericardial effusions were observed in five patients; in two cases, they were associated with recurring pleural effusions, suggesting postcardiomyotomy syndrome. Conclusions  MARPE is associated with a high rate of pleural and pericardial morbidities, but only a small number requires interventions.     

自发性气胸的胸膜窗MSCT及CT仿真内镜表现

目的 评价CE-MRA脊髓造影鉴别脊髓血管畸形（SCVM）和脊髓非血管畸形所致继发性血管纡曲的价值。方法 回顾性分析30例CE-MRA疑诊SCVM患者资料,根据DSA或手术结果分为SCVM组（16例）及脊髓非血管畸形组（14例）,对比分析2组CE-MRA脊髓纡曲血管的数量、长度、位置、纡曲程度及纡曲血管周围是否存在异常供血动脉差异。结果 与脊髓非血管畸形组比较,SCVM组脊髓纡曲血管数量更多,纡曲血管长度更长,血管纡曲程度评分更高。SCVM组仅2例（2/16,12.50%）血管纡曲局限于下胸椎段（T7~T12椎体）,而脊髓非血管畸形组11例（11/14,78.57%）局限于下胸椎段（T7~T12椎体）,2组间纡曲血管位置差异有统计学意义（P=0.020）。结论 CE-MRA脊髓血管造影可鉴别SCVM与脊髓非血管畸形引起的继发性血管纡曲。     

结核性胸膜炎不同分型的彩色多普勒超声表现

目的 探讨彩色多普勒超声在结核性胸膜炎分型及治疗中的价值,进一步提高结核性胸膜炎的诊治水平.方法 收集2009年2月至2013年4月在西安市结核病胸部肿瘤医院行胸腔镜检查或手术治疗的结核性胸膜炎患者165例,术前均行超声检查,以开胸手术或胸腔镜手术检查为标准,分析超声分型结果与手术病理分型的一致性;超声分型与胸腔镜分型一致性采用SPSS 19.0统计学软件卡方检验中的Kappa检验,以P＜0.05为差异有统计学意义.结果 165例患者彩色多普勒超声分型诊断发现工型18例（与胸腔镜或手术分型一致13例）、Ⅱ型28例（与胸腔镜或手术分型一致28例）、Ⅲ型43例（与胸腔镜或手术分型一致43例）和76例Ⅳ型（与胸腔镜或手术分型一致75例）,与胸腔镜或病理分型一致率96.4％（159/165）,Kappa值为0.946,具有很好的一致性.结论 彩色多普勒超声在结核性胸膜炎的临床分型和指导治疗方面有重要价值.     

基于CT图像对游离胸腔积液简易定量方法

目的探讨基于CT图像客观测量和计算游离胸腔积液量的方法。方法纳入40例有游离胸腔积液的成年患者。采用Philips EBW 4.5.3.40140工作站处理图像,获得游离性游离胸腔积液数字模型,并自动获取游离胸腔积液的体积(V)。测量液面到胸腔壁的垂直最大距离a、液体宽度b以及游离胸腔积液垂直长度c。将游离胸腔积液V与a、b、c、a×c、a×b、a×b×c关联。采用SPSS 19.0统计分析软件进行回归分析,获得曲线拟合方程。结果对V选取9种函数进行回归计算,并选取相关值的最佳函数。a的3次方程较为理想(R2=0.847,P<0.005),其单值计算公式为:V=-195.672+36.150a-1.064a2+0.013a3;a×c符合度最高(R2=0.937,P<0.005),其关于游离胸腔积液V的最佳计算3次方程式为V=-139.325+0.126(a×c)-1.269(E-5)×(a×c)2+5.720(E-10)×(a×c)2。结论针对游离胸腔积液V计算,a和a×c的回归方程均能满足计算要求。使用a的回归方程测量单值,即可获得游离胸腔积液V。还可使用a×c回归公式得到更加准确的结果。使用相对计算公式可提高游离胸腔积液量的估计精度,减少时间,为临床计算游离胸腔积液提供了一个便捷的方法。     

The Pleural Sandwich Sign in Two Cases of Primary Pleural Lymphoma

The sandwich sign is used to describe mesenteric lymphoma in which mesenteric vessels and fat are enveloped by enlarged mesenteric lymph nodes. We present two cases of primary pleural lymphoma demonstrating the "pleural sandwich sign". Contrast-enhanced computed tomography showed conglomerated parietal pleural and extrapleural masses encasing the intercostal arteries. Histopathological examinations confirmed low grade marginal zone B-cell lymphoma in an 80-year-old man and diffuse large B-cell lymphoma in a 68-year-old man. The pleural sandwich sign may suggest the diagnosis of primary pleural lymphoma.     

EGFR mutation status in primary lung adenocarcinomas and corresponding metastatic lesions: discordance in pleural metastases

Introduction

The aim of this study was to compare epidermal growth factor receptor (EGFR) and KRAS mutations between primary tumors and corresponding metastases including pleural metastases in lung adenocarcinoma.

Methods

Thirty-seven paired primary lung adenocarcinomas and corresponding metastatic tumors were analyzed for EGFR and KRAS mutations. In addition, 21 pleural metastases including malignant pleural effusion or pleural biopsy were used in performing these mutation analyses.

Results

EGFR mutations were detected in 18 primary lung adenocarcinomas (48.6%) and in 16 corresponding metastases (43.2%). EGFR mutations showed a discordance rate of 16.2% (6 of 37 patients) between primary lung adenocarcinomas and corresponding metastases. Among 21 pleural metastases, 3 patients (14.3%) showed that the EGFR mutation was discordant. KRAS mutations were detected in one primary tumor and in two metastatic tumors. Eighteen patients were treated with EGFR tyrosine kinase inhibitors. One of seven patients who experienced partial response had EGFR mutations only in the metastasis, and two of seven patients who experienced progressive disease carried wild-type EGFR only in the metastasis.

Conclusions

EGFR mutations were discordant between primary tumors and corresponding metastases in a significant portion of lung adenocarcinomas. Furthermore, these discordance was also observed in metastases to the pleura, the nearest metastatic site.     

Imaging of parapneumonic pleural effusions and empyema in children

Pleural empyema in children is increasing in incidence. The British Thoracic Society published guidelines for the management of empyema in children in 2005, including recommendations regarding imaging. In this article we review the pathophysiology, treatment options and imaging findings of complicated parapneumonic effusion and empyema in children. We also review the published evidence that supports the roles imaging is called upon to play in the management of these conditions. Imaging in the form of chest radiography and US is recommended to identify and guide drainage of complicated parapneumonic effusions. CT is recommended in special circumstances only. Imaging techniques have not been shown to accurately stage empyema, predict outcome or guide decisions regarding surgical versus medical management.     

Pulmonary toxicity of carbon nanotubes and asbestos — Similarities and differences

Carbon nanotubes are a valuable industrial product but there is potential for human pulmonary exposure during production and their fibrous shape raises the possibility that they may have effects like asbestos, which caused a worldwide pandemic of disease in the20th century that continues into present. CNT may exist as fibres or as more compact particles and the asbestos-type hazard only pertains to the fibrous forms of CNT. Exposure to asbestos causes asbestosis, bronchogenic carcinoma, mesothelioma, pleural fibrosis and pleural plaques indicating that both the lungs and the pleura are targets. The fibre pathogenicity paradigm was developed in the 1970s–80s and has a robust structure/toxicity relationship that enables the prediction of the pathogenicity of fibres depending on their length, thickness and biopersistence. Fibres that are sufficiently long and biopersistent and that deposit in the lungs can cause oxidative stress and inflammation. They may also translocate to the pleura where they can be retained depending on their length, and where they cause inflammation and oxidative stress in the pleural tissues. These pathobiological processes culminate in pathologic change — fibroplasia and neoplasia in the lungs and the pleura. There may also be direct genotoxic effects of fibres on epithelial cells and mesothelium, contributing to neoplasia. CNT show some of the properties of asbestos and other types of fibre in producing these types of effects and more research is needed. In terms of the molecular pathways involved in the interaction of long biopersistent fibres with target tissue the events leading to mesothelioma have been a particular area of interest. A variety of kinase pathways important in proliferation are activated by asbestos leading to pre-malignant states and investigations are under way to determine whether fibrous CNT also affects these molecular pathways. Current research suggests that fibrous CNT can elicit effects similar to asbestos but more research is needed to determine whether they, or other nanofibres, can cause fibrosis and cancer in the long term.