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PubMed | University Hospitals Leuven, Sun Yat Sen University, the First Affiliated Hospital of Guangzhou Medical University, Chinese Institute of Clinical Medicine and 7 more.
Type: Journal Article | Journal: Journal of thoracic disease | Year: 2017

We aimed to summarize the diagnostic accuracy of white light bronchoscopy (WLB) and advanced techniques for airway pre-cancerous lesions and early cancer, such as autofluorescence bronchoscopy (AFB), AFB combined with WLB (AFB + WLB) and narrow-band imaging (NBI) bronchoscopy.We searched for eligible studies in seven electronic databases from their date of inception to Mar 20, 2015. In eligible studies, detected lesions should be confirmed by histopathology. We extracted and calculated the 22 data based on the pathological criteria of lung tumor, including high-grade lesions from moderate dysplasia (MOD) to invasive carcinoma (INV). Random-effect model was used to pool sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the receiver-operating characteristic curve (AUC).In 53 eligible studies (39 WLB, 39 AFB, 17 AFB + WLB, 6 NBI), diagnostic performance for high-grade lesions was analyzed based on twelve studies (10 WLB, 7 AFB, 7 AFB + WLB, 1 NBI), involving with totally 2,880 patients and 8,830 biopsy specimens. The sensitivity, specificity, DOR and AUC of WLB were 51% (95% CI, 34-68%), 86% (95% CI, 73-84%), 6 (95% CI, 3-13) and 77% (95% CI, 73-81%). Those of AFB and AFB + WLB were 93% (95% CI, 77-98%) and 86% (95% CI, 75-97%), 52% (95% CI, 37-67%) and 71% (95% CI, 56-87%), 15 (95% CI, 4-57) and 16 (95% CI, 6-41), and 76% (95% CI, 72-79%) and 82% (95% CI, 78-85%), respectively. NBI presented 100% sensitivity and 43% specificity.With higher sensitivity, advanced bronchoscopy could be valuable to avoid missed diagnosis. Combining strategy of AFB and WLB may contribute preferable diagnosis rather than their alone use for high-grade lesions. Studies of NBI warrants further investigation for precancerous lesions.


PubMed | the First Affiliated Hospital of Guangzhou Medical University
Type: Journal Article | Journal: Journal of thoracic disease | Year: 2016

Pulmonary lymphoepithelioma-like carcinoma (LELC) is one of the rare histological non-small cell lung cancers. Only a few case reports have been published. The knowledge of its characteristics and prognosis in western population is limited. Based on the data of the Surveillance, Epidemiology, and End Results database (SEER), an analysis was performed to fill the gap of our knowledge.Characteristics, treatment and outcomes of all pulmonary LELC patients was extracted both from the SEER database from 1973 to 2011 using SEER*Stat 8.2.1 statistical analysis was performed using SPSS 16.0 and GraphPad Prism 5.A total of 62 patients with pulmonary LELC are identified and analyzed. The median age at diagnosis is 65. Among them, the majority was male (64.4%). Early stage patients account for the largest proportion (67.8%). The median survival of all LELC patients is 107 months [95% confidence interval (CI), 67-147]. The 1, 3 and 5 years survival rates of LELC are 85.6%, 74.5% and 55.2%. In the comparisons incorporating with other types of large cell lung cancer (LCC), adenocarcinoma (AD) and squamous cell lung cancer (SQ), the overall survival (OS) of LELC is superior to others. Most of the early stage (localized and regional) LELC patients (37/45, 82.2%) received surgical resection as the primary treatment. Patients older than 65 years predicted a worse prognosis.Pulmonary LELC is a rare pathological type of lung cancer. In this cohort, most LELC cases were male and in early stage. Majority of early stage LELC patients have received surgical resection. Patients older than 65 years had worse survival. Unfortunately, no other prognostic factor has been identified in our study. In addition, we observed that LELC had an ideal prognosis comparing to other types of LCC, AD and SQ. In order to understand pulmonary LELC more thoroughly, more cases are required.


PubMed | Zhengzhou University and The First Affiliated Hospital of Guangzhou Medical University
Type: Journal Article | Journal: Respirology (Carlton, Vic.) | Year: 2016

Both COPD and emphysema are associated with an increased incidence of lung cancer, but the impacts of these comorbidities on lung cancer prognosis are still unclear. Herein, we conducted a meta-analysis to clarify whether the presence of these comorbidities indicates poor survival in patients with lung cancer. A comprehensive search was conducted using PubMed, Embase, Web of Science, ASCO Abstracts and Cochrane library for articles published before 1 June 2015. Papers referenced by the obtained articles were also reviewed. Main outcomes were overall survival (OS) and disease-free survival (DFS) in patients with lung cancer. Pooled hazard ratio (HR) and 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup and sensitivity analyses were also conducted. Of 58 full texts reviewed, 26 met our inclusion criteria that were derived from 21 and seven studies examining the impacts of COPD and emphysema on survival of lung cancer, respectively. Meta-analyses revealed that concomitant COPD was associated with poorer OS (HR, 1.17; 95% CI: 1.10-1.25, n = 20), which was independent of tumour staging, diagnostic criteria of COPD or location, and DFS (HR, 1.52; 95% CI: 1.04-2.23, n = 6) with high heterogeneity (I(2) = 78%). The presence of emphysema in patients with lung cancer predicted worse OS (HR, 1.66; 95% CI: 1.25-2.22, n = 7), but not poorer DFS. The presence of COPD and emphysema are robust predictors of poor survival in patients with lung cancer. Early detection of these diseases should be taken into account for lung cancer surveillance and management.


PubMed | Tongji University, the First Affiliated Hospital of Guangzhou Medical University, Zhengzhou University, the Chinese Medicine Hospital of Jiangsu Province and 4 more.
Type: | Journal: The Journal of urology | Year: 2017

To assess the efficacy and safety of External Physical Vibration Lithecbole (EPVL) for the treatment of residual stone after retrograde intrarenal surgery (RIRS).A total of 173 patients (128 male and 45 female) were selected for the study. All the patients had residual fragments after RIRS for the renal or upper ureteral stones. They were prospectively randomized into two groups, one received EPVL one week after RIRS (group ER), another only underwent RIRS as a control (group CR). Stone size and location, stone free rate, and the complications were compared.Of 173 cases, there were 87 (66 male and 21 female) in ER group and 86 (62 male and 24 female) in CR group. The stone free rate (SFR) in ER and CR group at 2 weeks after RIRS was 52.9% and 31.4%, at 3 weeks 71.3% and 51.2%, and at 5 week 89.7% and 59.3%, respectively (all P <0.05). The hematuria incidence at 5 week after RIRS was 3.4% in ER compared to 20.9% in CR group (P <0.05). The positive urine leukocytes in ER and CR group at 3 week after RIRS was 4.6% VS 19.8%, at 5 week was 3.4% VS 11.6% (P<0.05).EPVL supplementary to RIRS was more effective than RIRS alone in terms of stone clearance speed, SFR and the patients compliance.


PubMed | U.S. Center for Disease Control and Prevention, 3 Guangzhou Yuexiu Center for Disease Control and Prevention, Southern Medical University and The First Affiliated Hospital of Guangzhou Medical University
Type: Journal Article | Journal: Vector borne and zoonotic diseases (Larchmont, N.Y.) | Year: 2016

Herpesviruses (HVs) can cause asymptomatic, benign, or fatal infections in a variety of animal species. However, the prevalence and phylogenetic characteristics of HVs in rodents and shrews in China are poorly understood. We thus performed a molecular detection and phylogenetic analysis of rat and shrew HVs in southern China between 2012 and 2014. Seventeen (6.7%) of 255 rectal swab specimens from rats and six (6.7%) of 90 rectal swab specimens from shrews tested positive for HVs. Phylogenetic analysis revealed that rodent and shrew HVs detected in this study were species specific, clustering in the Betaherpesvirinae and Gammaherpesvirinae clade. Novel Macavirus was detected in Rattus norvegicus (RN/13YX52/24 and RN/14HC50) and gammaherpesviruses in Suncus murinus (SM/14BY7/16/20/97/99/106).These findings have contributed to our understanding of the taxonomy, phylogeny, and biology of HVs.


PubMed | Guangzhou University and The First Affiliated Hospital of Guangzhou Medical University
Type: Journal Article | Journal: Interactive cardiovascular and thoracic surgery | Year: 2016

Through a retrospective study, we assessed the feasibility and safety of simultaneous bilateral thoracoscopic wedge resection of blebs or bullae for the treatment of primary spontaneous pneumothorax (PSP) under thoracic epidural anaesthesia with spontaneous ventilation.This retrospective analysis involved a cohort of 37 consecutive patients undergoing simultaneous bilateral thoracoscopic bullectomy under spontaneous ventilation thoracic epidural anaesthesia (n = 15) or intubated general anaesthesia (n = 22) between July 2011 and September 2015. The perioperative data, short-term outcomes and recurrence rates of the two groups were compared.The two groups had comparable preoperative demographic profiles. There were no conversions to thoracotomy or intubated single-lung ventilation. The peak end-tidal carbon dioxide in the non-intubated group was significantly higher than that in the intubated group (mean: 48 vs 34 mmHg, P < 0.001). Both groups had comparable surgical duration, blood loss and lowest intraoperative pulse oxygen saturation level. Postoperatively, the two groups had comparable chest tube duration, volume of fluid administration, length of hospital stay and complication rates. No mortality occurred. The total anaesthesia cost in non-intubated group was significantly lower (mean: CNY 4584 vs 5649, P = 0.016). The mean follow-up was 23.6 12.9 months in the non-intubated group and 21.1 13.4 months in the intubated group. Two recurrent pneumothoraxes in 2 patients were observed after surgical procedures for PSP. One recurrence developed in the non-intubated group (7%) and one in the intubated group (5%).Simultaneous bilateral non-intubated thoracoscopic bullectomy is not only well tolerated and technically feasible but also a safe alternative for selected patients with simultaneous bilateral PSP or with high risk of contralateral recurrence.


PubMed | The First Affiliated Hospital of Guangzhou Medical University
Type: | Journal: Clinica chimica acta; international journal of clinical chemistry | Year: 2016

Pulmonary embolism (PE) is a life-threatening manifestation of venous thromboembolism. Rivaroxaban is an oral anticoagulant, which directly inhibits Factor Xa. The objective of the current study was, in comparison to the standard-therapy method, to investigate the potential of rivaroxaban to improve the treatment of patients with PE, and to reduce hemorrhage in the standard-therapy group through adjusting the dose of warfarin by CYP2C9 and VKORC1 genotypes.Sixty-two PE patients with or without deep venous thrombosis (DVT) was randomized to rivaroxaban mono-therapy or standard-therapy with enoxaparin followed by vitamin K antagonist (VKA). Concentration of the anticoagulants was adjusted according to the results of CYP2C9 and VKORC1 genotypes in order to stabilize the international normalized rate (INR) at 2.0-3.0 range. Length of hospital stay at initial hospitalization was compared, therapeutic efficacy was examined by computed tomographic pulmonary angiography (CTPA) and ventilation/perfusion (V/Q) scan, and side-effect of anti-coagulants was monitored at 1-month, and 3- or 6-months follow-up check points.We found that, overall, patients who received rivaroxaban mono-therapy had a significantly shorter length of hospital stay compared with patients who received standard-therapy of enoxaparin followed by VKA (9.293.70 versus 11.383.12days, P=0.021). The therapeutic efficacy was of no marked difference between these two groups. However, after one month treatment, 50% (16/32) of the standard-therapy group had mild hemorrhage, which was significantly higher than that of rivaroxaban mono-therapy group (16.7%, 5/30, P=0.006). Moreover, a significantly higher rate in the standard-therapy group (22.2% versus 3.4%, P=0.032) was found after 3 or 6months therapy. Major bleeding was slightly but not significantly higher in the standard-therapy group than that in the rivaroxaban therapy group. In addition, 2 (6.3%) patients died from Life-threatening bleeding in the standard-therapy group.Findings of the current study suggested that rivaroxaban mono-therapy result in shorter hospital stay compared to the standard-therapy. Implication of CYP2C9 and VKORC1 genotypes in determining dose of warfarin, however, remains to be further examined in larger cohort studies.


PubMed | the First Affiliated Hospital of Guangzhou Medical University
Type: Journal Article | Journal: Journal of thoracic disease | Year: 2016

To investigate the estimated value of spiral computed tomography (CT) post-processing techniques in preoperative stage T3, central-type non-small cell lung cancer (NSCLC) with double sleeve lobectomy under complete video-assisted thoracoscopic surgery (c-VATS).Preoperative clinical date and CT reconstructed data of 10 patients who underwent double sleeve lobectomy with upper lobe stage T3, central-type NSCLC were retrospectively analysed and compared to surgical pathological results and cross-sectional CT data. The diagnostic criterions of tumour invasion of pulmonary artery and bronchus were divided into five grades, which included estimation of upper lobe pulmonary arteries and bronchi (40 branches, respectively).The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of cross-sectional CT images of pulmonary artery tumour invasion were 78.57%, 58.33%, 81.48%, 53.85%, and 72.50%, respectively, while the respective values for CT reconstructed images were 93.55%, 87.50%, 96.67%, 70.00%, and 90.00%, showing statistical significance ((2)=4.021, P=0.045). Similarly, the evaluate, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of cross-sectional CT images of bronchial tumour invasion were 82.76%, 45.45%, 80.00%, 50.00%, and 72.50%, respectively, while the respective values for CT reconstructed images were 97.06%, 66.67%, 94.29%, 80.00%, 92.50%; these results were also statistically significant ((2)=5.541, P=0.019).The sensitivity, specificity, and diagnostic accuracy of the spiral CT post-processing techniques were better than cross-sectional CT images in estimating the extent of tumour invasion in the pulmonary arteries and bronchi of central-type NSCLC. CT post-processing techniques are essential tools in preoperative examination and operative method selection of central-type lung cancer with double sleeve lobectomy under c-VATS.


PubMed | The First Affiliated Hospital of Guangzhou Medical University
Type: Journal Article | Journal: Journal of thoracic disease | Year: 2016

We report a case of video-assisted thoracoscopic surgery (VATS) tracheal resection and carinal reconstruction in a patient with tracheal tumor. The patient presented with adenoid cystic carcinoma (ACC) of the distal trachea, extending along the right main bronchus with carinal invasion. The reconstruction procedure was assisted with cross-field ventilation. Postoperative clinical course of this case was good. The forced expiratory volume in the first second (FEV1) improved from 0.461 L (17% pred.) to 2.31 L (87% pred.) 1 month after the operation. VATS tracheal resection and carinal reconstruction is a feasible option for patients with tracheal tumor with carina involvement.


PubMed | The First Affiliated Hospital of Guangzhou Medical University
Type: | Journal: International journal of pediatric otorhinolaryngology | Year: 2016

To investigate the efficacy and safety of the airway foreign body removal by balloon catheter via flexible bronchoscope in children.Retrospective analysis was performed of 26 cases of airway foreign body removal in children by balloon catheter via flexible bronchoscope in the First Affiliated Hospital of Guangzhou Medical University between December 2006 and December 2014.There were 14 males and 12 females, aging between 1 and 12 years (median age: 25 months). The clinical course ranged from 0.5h to 60 days (median: 3 days). The foreign bodies consisted of peanuts (16 cases), soybeans (3 cases), pumpkin seeds (3 cases), porcine bone (1 case), olive nut (1 case), and a plant-based object (1 case). All foreign bodies were successfully removed. The operation duration ranged from 3 to 15 (5.32.9)min. No complication was observed such as hemorrhage, pneumothorax, or airway laceration.Balloon catheter via flexible bronchoscope is a safe, effective, and easily performed method of removing airway non-sharp foreign bodies in children.

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