BACKGROUND Bronchial cysts are congenital malformations usually located in the mediastinum,and intrapulmonary localization is very rare.Cryoablation is a novel therapeutic approach that promotes tumor necrosis and sti...BACKGROUND Bronchial cysts are congenital malformations usually located in the mediastinum,and intrapulmonary localization is very rare.Cryoablation is a novel therapeutic approach that promotes tumor necrosis and stimulates anti-tumor immune responses.CASE SUMMARY This article reports a case of a 68-year-old male patient who was diagnosed with an intrapulmonary bronchogenic cyst by computed tomography examination and pathology,and the patient subsequently underwent cryoablation therapy and achieved complete response with after 3 months of follow-up.CONCLUSION Intrapulmonary bronchogenic cysts are very rare,cryoablation therapy is feasible,safe,and effective for intrapulmonary bronchial cysts.展开更多
Objective: Survival benefit of adjuvant chemotherapy(AC) of patients with intrapulmonary lymph node(IPLN)metastasis(level 12-14) needs investigation.We evaluated the impact of AC on patients whose metastatic nodes wer...Objective: Survival benefit of adjuvant chemotherapy(AC) of patients with intrapulmonary lymph node(IPLN)metastasis(level 12-14) needs investigation.We evaluated the impact of AC on patients whose metastatic nodes were limited to intrapulmonary levels after systematic dissection of N1 nodes.Methods: First,155 consective cases of lung cancer confirmed as pathologic N1 were collected and evaluated.Patients received systematic dissection of N2 and N1 nodes.For patients with IPLN metastasis,survival outcomes were compared between those receiving AC and those not receiving AC.Results: In this group,112 cases(72.3%) had IPLN metastasis and 55 cases(35.5%) had N1 involvement limited to level 13-14 without further disease spread to higher levels.Patients with IPLN involvement had a better prognosis than that of patients with hilar-interlobar involvement.For the intrapulmonary N1 group(level 12-14-positive,level 10-11-negative or unknown,n=112),no survival benefit was found between the AC group and nonAC group [5-year overall survival(OS): 54.6±1.6 vs.50.4±2.4 months,P=0.177].However,76 of 112 cases for whom harvesting of level-10 and level-11 nodes was done did not show cancer involvement in pathology reports(level 12-14-positive,level 10-11 both negative),oncologic outcome was better for patients receiving AC than those not receiving AC in this subgroup(5-year OS: 57.3±1.5 vs.47.1±3.2 months,P=0.002).Conclusions: Oncologic outcome may be improved by AC for patients with involvement of N1 nodes limited to intrapulmonary levels after complete examination of N1 nodes.展开更多
Background: The effect of intravenously administered dexmedetomidine on oxygenation during one-lung ventilation has not been studied. The hypothesis of this prospective, randomized study was that dexmedetomidine would...Background: The effect of intravenously administered dexmedetomidine on oxygenation during one-lung ventilation has not been studied. The hypothesis of this prospective, randomized study was that dexmedetomidine would be associated with an improvement in oxygenation during one-lung ventilation. The secondary outcome was the change in the intrapulmonary shunt. Materials and Methods: Thirty patients undergoing one-lung ventilation were included. Patients in Group D (n = 15) received a bolus dose of 1 μg·kg-1 dexmedetomidine at 10 min after induction of anaesthesia followed by an infusion of 0.4 μg·kg-1·hr-1 that was stopped at the end of the surgery, and those in the control group(Group C, n = 15) were given saline at the same dosage. Vital signs, PaO2, and pulmonary shunting (Qs/Qt) were compared. Results: During one-lung ventilation, the PaO2 in Group D increased significantly and Qs/Qt significantly decreased compared to Group C (PaO2, 203.7 ± 42.3 mmHg vs. 173 ± 37.6 mmHg [P = 0.04] and Qs/Qt 19.8% ± 4.5% vs. 31% ± 2.4% [P < 0.0001], Group D and Group C, respectively). Conclusion: Intravenous administration of dexmedetomidine achieved an improvement in oxygenation during one-lung ventilation. This was associated with a decrease in pulmonary shunt. Use of intraoperative dexmedetomidine during thoracic surgery can be suggested.展开更多
BACKGROUND Cardiopulmonary changes in noncirrhotic portal hypertension(NCPH)are poorly understood.AIM To investigate cardiopulmonary changes using transthoracic echocardiography(TTE)in NCPH and their correlation with ...BACKGROUND Cardiopulmonary changes in noncirrhotic portal hypertension(NCPH)are poorly understood.AIM To investigate cardiopulmonary changes using transthoracic echocardiography(TTE)in NCPH and their correlation with clinical features.METHODS Prospective cohort including 10 preclinical NCPH[without portal hypertension(PH)]and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed.PH was defined by presence of either varices,ascites or portosystemic shunting.Intrapulmonary vascular dilatation(IPVD)is defined as appearance of microbubbles in the left atrium after three heartbeats.Right ventricular systolic pressure(RVSP)>38 mmHg was used to identify possible porto-pulmonary hypertension.Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria.RESULTS Among 42 subjects,17(40%)had IPVD,4(9.5%)had RVSP>38 mmHg,and 6(14%)had cardiomyopathy.Aspartate aminotransferase to alanine aminotransferase(AST/ALT)(1.3 vs 1,P=0.04)and liver stiffness measurement(LSM)(12.4 kPa vs 7.1 kPa,P=0.03)were higher in those with IPVD.Presence of either LSM>10 or AST/ALT>1.2 aided in identifying subjects with IPVD-sensitivity,specificity,and accuracy of 76%.RVSP correlated with oxygen saturation(r=-0.33),and free right hepatic vein pressure(r=0.43).Those with PH had higher left atrial volume(LAV)(62 mL vs 48 mL,P<0.01),and LAV index(LAVI)(35 m^(2) vs 23 m^(2),P<0.01)compared to those without PH.Total bile acids,especially primary bile acids positively correlated with LAV(r=0.36),and LAVI(r=0.41).CONCLUSION Similar to cirrhotic patients,cardiopulmonary changes are prevalent in NCPH,especially among those with PH.In NCPH,cardiopulmonary changes occur despite preserved synthetic function,suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.展开更多
Background:Intrapulmonary lipoma is extemely rare in children.So far,all reported pulmonary lipomas were from adult patients.Methods:We present herein a case of intrapulmonary lipoma in a child and a review of the rel...Background:Intrapulmonary lipoma is extemely rare in children.So far,all reported pulmonary lipomas were from adult patients.Methods:We present herein a case of intrapulmonary lipoma in a child and a review of the related literature.Results:A 13-month-old boy was hospitalized because of cough and fever.Chest CT showed patchy infiltration and round-shape,hypodense homogeneous lesions located in the lung.After 19 days of antibiotic treatment,his clinic symptoms disappeared,but the round lesions remained without any change.One month and one year later,he was examined by chest MRI with technique of fat suppression.The child was diagnosed as having an intrapulmonary lipoma without biopsy.Conclusions:Intrapulmonary lipoma is rare in children.Chest CT and MRI are very important for the correct diagnosis of intrapulmonary lipoma.展开更多
Background and Aims:Screening for hepatopulmonary syndrome in cirrhotic patients is limited due to the need to perform contrast enhanced echocardiography(CEE)and arterial blood gas(ABG)analysis.We aimed to develop a s...Background and Aims:Screening for hepatopulmonary syndrome in cirrhotic patients is limited due to the need to perform contrast enhanced echocardiography(CEE)and arterial blood gas(ABG)analysis.We aimed to develop a simple and quick method to screen for the presence of intrapulmonary vascular dilation(IPVD)using noninvasive and easily available variables with machine learning(ML)algorithms.Methods:Cirrhotic patients were enrolled from our hospital.All eligible patients underwent CEE,ABG analysis and physical examination.We developed a twostep model based on three ML algorithms,namely,adaptive boosting(termed AdaBoost),gradient boosting decision tree(termed GBDT)and eXtreme gradient boosting(termed Xgboost).Noninvasive variables were input in the first step(the NI model),and for the second step(the NIBG model),a combination of noninvasive variables and ABG results were used.Model performance was determined by the area under the curve of receiver operating characteristics(AUCROCs),precision,recall,F1-score and accuracy.Results:A total of 193 cirrhotic patients were ultimately analyzed.The AUCROCs of the NI and NIBG models were 0.850(0.738–0.962)and 0.867(0.760–0.973),respectively,and both had an accuracy of 87.2%.For both negative and positive cases,the recall values of the NI and NIBG models were both 0.867(0.760–0.973)and 0.875(0.771–0.979),respectively,and the precisions were 0.813(0.690–0.935)and 0.913(0.825–1.000),respectively.Conclusions:We developed a two-step model based on ML using noninvasive variables and ABG results to screen for the presence of IPVD in cirrhotic patients.This model may partly solve the problem of limited access to CEE and ABG by a large numbers of cirrhotic patients.展开更多
Background:Distinguishing multiple primary lung cancer(MPLC)from intrapulmonary metastasis(IPM)is critical for their disparate treatment strategy and prognosis.This study aimed to establish a non-invasive model to mak...Background:Distinguishing multiple primary lung cancer(MPLC)from intrapulmonary metastasis(IPM)is critical for their disparate treatment strategy and prognosis.This study aimed to establish a non-invasive model to make the differentiation pre-operatively.Methods:We retrospectively studied 168 patients with multiple lung cancers(307 pairs of lesions)including 118 cases for modeling and internal validation,and 50 cases for independent external validation.Radiomic features on computed tomography(CT)were extracted to calculate the absolute deviation of paired lesions.Features were then selected by correlation coefficients and random forest classifier 5-fold cross-validation,based on which the lesion pair relation estimation(PRE)model was developed.A major voting strategy was used to decide diagnosis for cases with multiple pairs of lesions.Cases from another institute were included as the external validation set for the PRE model to compete with two experienced clinicians.Results:Seven radiomic features were selected for the PRE model construction.With major voting strategy,the mean area under receiver operating characteristic curve(AUC),accuracy,sensitivity,and specificity of the training versus internal validation versus external validation cohort to distinguish MPLC were 0.983 versus 0.844 versus 0.793,0.942 versus 0.846 versus 0.760,0.905 versus 0.728 versus 0.727,and 0.962 versus 0.910 versus 0.769,respectively.AUCs of the two clinicians were 0.619 and 0.580.Conclusions:The CT radiomic feature-based lesion PRE model is potentially an accurate diagnostic tool for the differentiation of MPLC and IPM,which could help with clinical decision making.展开更多
BACKGROUND Metabolic associated fatty liver disease frequently occurs in patients with hypopituitarism and growth hormone(GH)deficiency.Some patients may develop to hepatopulmonary syndrome(HPS).HPS has a poor prognos...BACKGROUND Metabolic associated fatty liver disease frequently occurs in patients with hypopituitarism and growth hormone(GH)deficiency.Some patients may develop to hepatopulmonary syndrome(HPS).HPS has a poor prognosis and liver transplantation is regarded as the only approach to cure it.CASE SUMMARY A 29-year-old man presented with progressive dyspnea for 1 mo.At the age of 10 years,he was diagnosed with panhypopituitarism associated with pituitary stalk interruption syndrome.Levothyroxine and hydrocortisone were given since then.To achieve ideal height,he received GH treatment for 5 years.The patient had an oxygen saturation of 78%and a partial pressure of arterial oxygen of 37 mmHg with an alveolar–arterial oxygen gradient of 70.2 mmHg.Abdominal ultrasonography showed liver cirrhosis and an enlarged spleen.Perfusion lung scan demonstrated intrapulmonary arteriovenous right-to-left shunt.HPS(very severe)was our primary consideration.His hormonal evaluation revealed GH deficiency and hypogonadotropic hypogonadism when thyroid hormone,cortisol,and desmopressin were administrated.After adding with long-acting recombinant human GH and testosterone for 14 mo,his liver function and hypoxemia were improved and his progressive liver fibrosis was stabilized.He was off the waiting list of liver transplantation.CONCLUSION Clinicians should screen HPS patients'anterior pituitary function as early as possible and treat them primarily with GH cocktail accordingly.展开更多
Severe chronic liver disease(CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary patho...Severe chronic liver disease(CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary pathology that they may have. Among them the hepatopulmonary syndrome(HPS), portopulmonary hypertension(PPH) and hepatic hydrothorax(HH) are described in detail in this literature review. HPS is encountered in approximately 15% to 30% of the patients and its presence is associated with increase in mortality and also requires liver transplantation in many cases. PPH has been reported among 4%-8% of the patient with CLD who have undergone liver transplantation. The HH is another entity, which has the prevalence rate of 5% to 6% and is associated in the absence of cardiopulmonary disease. These clinical syndromes occur in similar pathophysiologic environments. Most treatment modalities work as temporizing measures. The ultimate treatment of choice is liver transplant. This clinical review provides basic concepts; pathophysiology and clinical presentation that will allow the clinician to better understand these potentially life-threatening complications. This article will review up-to-date information on the pathophysiology, clinical features and the treatment of the pulmonary complications among liver disease patients.展开更多
Hepatopulmonary syndrome(HPS)is characterized by defects in oxygenation caused by intra-pulmonary vasodilation occurring because of chronic liver disease,portal hypertension,or congenital portosystemic shunts.Clinical...Hepatopulmonary syndrome(HPS)is characterized by defects in oxygenation caused by intra-pulmonary vasodilation occurring because of chronic liver disease,portal hypertension,or congenital portosystemic shunts.Clinical implications of portal hypertension are very well-known,however,awareness of its effect on multiple organs such as the lungs are less known.The presence of HPS in chronic liver disease is associated with increased mortality.Medical therapies available for HPS have not been proven effective and definitive treatment for HPS is mainly liver transplantation(LT).LT improves mortality for patients with HPS drastically.This article provides a review on the definition,clinical presentation,diagnosis,and management of HPS.展开更多
BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension.This syndrome occurs most oft...BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension.This syndrome occurs most often in cirrhotic patients(4%-32%) and has been shown to be detrimental to functional status,quality of life,and survival.The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (i.e.,diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects,preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient,respectively.AIM To compare brain and whole-body uptake of technetium for diagnosing HPS.METHODS Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included.Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs,respectively.RESULTS Thirty-two (46%) patients had IPVD as detected by contrast-enhancedechocardiography.The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71±0.18 mg/dL vs 0.83±0.23 mg/dL;P=0.041),alveolararterial oxygen gradient (23.2±13.3 mmHg vs 16.4±14.1 mmHg;P=0.043),and arterial partial pressure of oxygen (81.0±12.1 mmHg vs 90.1±12.8 mmHg;P=0.004).Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0%±6.1%vs 40.1%±8.1%;P=0.001).The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54;P=0.025).The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7%and 42.5%,respectively,based on Youden’s index.The sensitivity,specificity,and accuracy of brain uptake> 5.7%and whole-body uptake> 42.5%for detecting IPVD were23%,89%,and 59%and 100%,52%,and 74%,respectively.CONCLUSION Whole-body uptake is superior to brain uptake for diagnosing HPS.展开更多
Hepatopulmonary syndrome (HPS) is a severe complication of end-stage hepatic disease. However, the majority of HPS patients present with non-specific clinical manifestations and imaging features. They are constantly m...Hepatopulmonary syndrome (HPS) is a severe complication of end-stage hepatic disease. However, the majority of HPS patients present with non-specific clinical manifestations and imaging features. They are constantly misdiagnosed as interstitial pneumonia, pulmonary infection or heart failure and appropriate treatment is thus delayed. In this report, clinical manifestations, diagnosis and treatment of one case of HPS were retrospectively analyzed and literature review was conducted. When the heapatic failure liver disease patients present with hypoxemia, pulmonary angiography, contrast echocardiography for right-sided heart (contrast enhanced echocardiogram) and lung perfusion scan (99mTc-MAA) should be done to exclude HPS. Orthotopic liver transplantation serves as the unique effective therapy of HPS.展开更多
文摘BACKGROUND Bronchial cysts are congenital malformations usually located in the mediastinum,and intrapulmonary localization is very rare.Cryoablation is a novel therapeutic approach that promotes tumor necrosis and stimulates anti-tumor immune responses.CASE SUMMARY This article reports a case of a 68-year-old male patient who was diagnosed with an intrapulmonary bronchogenic cyst by computed tomography examination and pathology,and the patient subsequently underwent cryoablation therapy and achieved complete response with after 3 months of follow-up.CONCLUSION Intrapulmonary bronchogenic cysts are very rare,cryoablation therapy is feasible,safe,and effective for intrapulmonary bronchial cysts.
基金supported in part by National Key R&D Program of China(No.2018YFC0910700)the Beijing Municipal Administration of Hospitals'Youth Programme(No.QML20171103)+2 种基金the Special Fund of Beijing Municipal Administration of Hospitals Clinical Medicine Development(No.XMLX201841)the Beijing Municipal Science&Technology Commission(No.Z161100000516063)Beijing Human Resources and Social Security Bureau(Beijing Millions of Talents Project,2018A05)
文摘Objective: Survival benefit of adjuvant chemotherapy(AC) of patients with intrapulmonary lymph node(IPLN)metastasis(level 12-14) needs investigation.We evaluated the impact of AC on patients whose metastatic nodes were limited to intrapulmonary levels after systematic dissection of N1 nodes.Methods: First,155 consective cases of lung cancer confirmed as pathologic N1 were collected and evaluated.Patients received systematic dissection of N2 and N1 nodes.For patients with IPLN metastasis,survival outcomes were compared between those receiving AC and those not receiving AC.Results: In this group,112 cases(72.3%) had IPLN metastasis and 55 cases(35.5%) had N1 involvement limited to level 13-14 without further disease spread to higher levels.Patients with IPLN involvement had a better prognosis than that of patients with hilar-interlobar involvement.For the intrapulmonary N1 group(level 12-14-positive,level 10-11-negative or unknown,n=112),no survival benefit was found between the AC group and nonAC group [5-year overall survival(OS): 54.6±1.6 vs.50.4±2.4 months,P=0.177].However,76 of 112 cases for whom harvesting of level-10 and level-11 nodes was done did not show cancer involvement in pathology reports(level 12-14-positive,level 10-11 both negative),oncologic outcome was better for patients receiving AC than those not receiving AC in this subgroup(5-year OS: 57.3±1.5 vs.47.1±3.2 months,P=0.002).Conclusions: Oncologic outcome may be improved by AC for patients with involvement of N1 nodes limited to intrapulmonary levels after complete examination of N1 nodes.
文摘Background: The effect of intravenously administered dexmedetomidine on oxygenation during one-lung ventilation has not been studied. The hypothesis of this prospective, randomized study was that dexmedetomidine would be associated with an improvement in oxygenation during one-lung ventilation. The secondary outcome was the change in the intrapulmonary shunt. Materials and Methods: Thirty patients undergoing one-lung ventilation were included. Patients in Group D (n = 15) received a bolus dose of 1 μg·kg-1 dexmedetomidine at 10 min after induction of anaesthesia followed by an infusion of 0.4 μg·kg-1·hr-1 that was stopped at the end of the surgery, and those in the control group(Group C, n = 15) were given saline at the same dosage. Vital signs, PaO2, and pulmonary shunting (Qs/Qt) were compared. Results: During one-lung ventilation, the PaO2 in Group D increased significantly and Qs/Qt significantly decreased compared to Group C (PaO2, 203.7 ± 42.3 mmHg vs. 173 ± 37.6 mmHg [P = 0.04] and Qs/Qt 19.8% ± 4.5% vs. 31% ± 2.4% [P < 0.0001], Group D and Group C, respectively). Conclusion: Intravenous administration of dexmedetomidine achieved an improvement in oxygenation during one-lung ventilation. This was associated with a decrease in pulmonary shunt. Use of intraoperative dexmedetomidine during thoracic surgery can be suggested.
基金Supported by Division of Intramural Research Program at National Institute of Diabetes and Digestive and Kidney Diseases,No.1ZIADK075008。
文摘BACKGROUND Cardiopulmonary changes in noncirrhotic portal hypertension(NCPH)are poorly understood.AIM To investigate cardiopulmonary changes using transthoracic echocardiography(TTE)in NCPH and their correlation with clinical features.METHODS Prospective cohort including 10 preclinical NCPH[without portal hypertension(PH)]and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed.PH was defined by presence of either varices,ascites or portosystemic shunting.Intrapulmonary vascular dilatation(IPVD)is defined as appearance of microbubbles in the left atrium after three heartbeats.Right ventricular systolic pressure(RVSP)>38 mmHg was used to identify possible porto-pulmonary hypertension.Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria.RESULTS Among 42 subjects,17(40%)had IPVD,4(9.5%)had RVSP>38 mmHg,and 6(14%)had cardiomyopathy.Aspartate aminotransferase to alanine aminotransferase(AST/ALT)(1.3 vs 1,P=0.04)and liver stiffness measurement(LSM)(12.4 kPa vs 7.1 kPa,P=0.03)were higher in those with IPVD.Presence of either LSM>10 or AST/ALT>1.2 aided in identifying subjects with IPVD-sensitivity,specificity,and accuracy of 76%.RVSP correlated with oxygen saturation(r=-0.33),and free right hepatic vein pressure(r=0.43).Those with PH had higher left atrial volume(LAV)(62 mL vs 48 mL,P<0.01),and LAV index(LAVI)(35 m^(2) vs 23 m^(2),P<0.01)compared to those without PH.Total bile acids,especially primary bile acids positively correlated with LAV(r=0.36),and LAVI(r=0.41).CONCLUSION Similar to cirrhotic patients,cardiopulmonary changes are prevalent in NCPH,especially among those with PH.In NCPH,cardiopulmonary changes occur despite preserved synthetic function,suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.
文摘Background:Intrapulmonary lipoma is extemely rare in children.So far,all reported pulmonary lipomas were from adult patients.Methods:We present herein a case of intrapulmonary lipoma in a child and a review of the related literature.Results:A 13-month-old boy was hospitalized because of cough and fever.Chest CT showed patchy infiltration and round-shape,hypodense homogeneous lesions located in the lung.After 19 days of antibiotic treatment,his clinic symptoms disappeared,but the round lesions remained without any change.One month and one year later,he was examined by chest MRI with technique of fat suppression.The child was diagnosed as having an intrapulmonary lipoma without biopsy.Conclusions:Intrapulmonary lipoma is rare in children.Chest CT and MRI are very important for the correct diagnosis of intrapulmonary lipoma.
基金The project was supported by the National Key R&D Program of China(No.2018YFC0116702 to BY)National Natural Science Foundation of China(No.82070630 to BY and No.81600035 to YC)+1 种基金Medical Innovation Capacity Improvement Program for Medical Staff of the First Affiliated Hospital of the Third Military Medical University(No.SWH2018QNKJ-27 to YJL)Technology Innovation and Application Research and Development Project of Chongqing City(cstc2019jscx-msxmX0237 to BY).
文摘Background and Aims:Screening for hepatopulmonary syndrome in cirrhotic patients is limited due to the need to perform contrast enhanced echocardiography(CEE)and arterial blood gas(ABG)analysis.We aimed to develop a simple and quick method to screen for the presence of intrapulmonary vascular dilation(IPVD)using noninvasive and easily available variables with machine learning(ML)algorithms.Methods:Cirrhotic patients were enrolled from our hospital.All eligible patients underwent CEE,ABG analysis and physical examination.We developed a twostep model based on three ML algorithms,namely,adaptive boosting(termed AdaBoost),gradient boosting decision tree(termed GBDT)and eXtreme gradient boosting(termed Xgboost).Noninvasive variables were input in the first step(the NI model),and for the second step(the NIBG model),a combination of noninvasive variables and ABG results were used.Model performance was determined by the area under the curve of receiver operating characteristics(AUCROCs),precision,recall,F1-score and accuracy.Results:A total of 193 cirrhotic patients were ultimately analyzed.The AUCROCs of the NI and NIBG models were 0.850(0.738–0.962)and 0.867(0.760–0.973),respectively,and both had an accuracy of 87.2%.For both negative and positive cases,the recall values of the NI and NIBG models were both 0.867(0.760–0.973)and 0.875(0.771–0.979),respectively,and the precisions were 0.813(0.690–0.935)and 0.913(0.825–1.000),respectively.Conclusions:We developed a two-step model based on ML using noninvasive variables and ABG results to screen for the presence of IPVD in cirrhotic patients.This model may partly solve the problem of limited access to CEE and ABG by a large numbers of cirrhotic patients.
基金supported by Grants from the National Natural Science Foundation of China(No.82102109)by Grants from Development Center for Medical Science&Technology National Health Commission of China(No.WA2020RW10)by Grants from Shanghai Municipal Commission of Health and Family Planning Program(No.20184Y0037).
文摘Background:Distinguishing multiple primary lung cancer(MPLC)from intrapulmonary metastasis(IPM)is critical for their disparate treatment strategy and prognosis.This study aimed to establish a non-invasive model to make the differentiation pre-operatively.Methods:We retrospectively studied 168 patients with multiple lung cancers(307 pairs of lesions)including 118 cases for modeling and internal validation,and 50 cases for independent external validation.Radiomic features on computed tomography(CT)were extracted to calculate the absolute deviation of paired lesions.Features were then selected by correlation coefficients and random forest classifier 5-fold cross-validation,based on which the lesion pair relation estimation(PRE)model was developed.A major voting strategy was used to decide diagnosis for cases with multiple pairs of lesions.Cases from another institute were included as the external validation set for the PRE model to compete with two experienced clinicians.Results:Seven radiomic features were selected for the PRE model construction.With major voting strategy,the mean area under receiver operating characteristic curve(AUC),accuracy,sensitivity,and specificity of the training versus internal validation versus external validation cohort to distinguish MPLC were 0.983 versus 0.844 versus 0.793,0.942 versus 0.846 versus 0.760,0.905 versus 0.728 versus 0.727,and 0.962 versus 0.910 versus 0.769,respectively.AUCs of the two clinicians were 0.619 and 0.580.Conclusions:The CT radiomic feature-based lesion PRE model is potentially an accurate diagnostic tool for the differentiation of MPLC and IPM,which could help with clinical decision making.
基金Supported by the National Natural Science Foundation of China,No.81771576 and No.81971375the Beijing Municipal Natural Science Foundation,No.7202151 and No.7212080.
文摘BACKGROUND Metabolic associated fatty liver disease frequently occurs in patients with hypopituitarism and growth hormone(GH)deficiency.Some patients may develop to hepatopulmonary syndrome(HPS).HPS has a poor prognosis and liver transplantation is regarded as the only approach to cure it.CASE SUMMARY A 29-year-old man presented with progressive dyspnea for 1 mo.At the age of 10 years,he was diagnosed with panhypopituitarism associated with pituitary stalk interruption syndrome.Levothyroxine and hydrocortisone were given since then.To achieve ideal height,he received GH treatment for 5 years.The patient had an oxygen saturation of 78%and a partial pressure of arterial oxygen of 37 mmHg with an alveolar–arterial oxygen gradient of 70.2 mmHg.Abdominal ultrasonography showed liver cirrhosis and an enlarged spleen.Perfusion lung scan demonstrated intrapulmonary arteriovenous right-to-left shunt.HPS(very severe)was our primary consideration.His hormonal evaluation revealed GH deficiency and hypogonadotropic hypogonadism when thyroid hormone,cortisol,and desmopressin were administrated.After adding with long-acting recombinant human GH and testosterone for 14 mo,his liver function and hypoxemia were improved and his progressive liver fibrosis was stabilized.He was off the waiting list of liver transplantation.CONCLUSION Clinicians should screen HPS patients'anterior pituitary function as early as possible and treat them primarily with GH cocktail accordingly.
文摘Severe chronic liver disease(CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary pathology that they may have. Among them the hepatopulmonary syndrome(HPS), portopulmonary hypertension(PPH) and hepatic hydrothorax(HH) are described in detail in this literature review. HPS is encountered in approximately 15% to 30% of the patients and its presence is associated with increase in mortality and also requires liver transplantation in many cases. PPH has been reported among 4%-8% of the patient with CLD who have undergone liver transplantation. The HH is another entity, which has the prevalence rate of 5% to 6% and is associated in the absence of cardiopulmonary disease. These clinical syndromes occur in similar pathophysiologic environments. Most treatment modalities work as temporizing measures. The ultimate treatment of choice is liver transplant. This clinical review provides basic concepts; pathophysiology and clinical presentation that will allow the clinician to better understand these potentially life-threatening complications. This article will review up-to-date information on the pathophysiology, clinical features and the treatment of the pulmonary complications among liver disease patients.
文摘Hepatopulmonary syndrome(HPS)is characterized by defects in oxygenation caused by intra-pulmonary vasodilation occurring because of chronic liver disease,portal hypertension,or congenital portosystemic shunts.Clinical implications of portal hypertension are very well-known,however,awareness of its effect on multiple organs such as the lungs are less known.The presence of HPS in chronic liver disease is associated with increased mortality.Medical therapies available for HPS have not been proven effective and definitive treatment for HPS is mainly liver transplantation(LT).LT improves mortality for patients with HPS drastically.This article provides a review on the definition,clinical presentation,diagnosis,and management of HPS.
基金Supported by National Key R and D Program of China,No.2017YFC0107800CAMS Initiative for Innovative Medicine,No.2016-12M-2-004
文摘BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension.This syndrome occurs most often in cirrhotic patients(4%-32%) and has been shown to be detrimental to functional status,quality of life,and survival.The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (i.e.,diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects,preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient,respectively.AIM To compare brain and whole-body uptake of technetium for diagnosing HPS.METHODS Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included.Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs,respectively.RESULTS Thirty-two (46%) patients had IPVD as detected by contrast-enhancedechocardiography.The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71±0.18 mg/dL vs 0.83±0.23 mg/dL;P=0.041),alveolararterial oxygen gradient (23.2±13.3 mmHg vs 16.4±14.1 mmHg;P=0.043),and arterial partial pressure of oxygen (81.0±12.1 mmHg vs 90.1±12.8 mmHg;P=0.004).Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0%±6.1%vs 40.1%±8.1%;P=0.001).The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54;P=0.025).The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7%and 42.5%,respectively,based on Youden’s index.The sensitivity,specificity,and accuracy of brain uptake> 5.7%and whole-body uptake> 42.5%for detecting IPVD were23%,89%,and 59%and 100%,52%,and 74%,respectively.CONCLUSION Whole-body uptake is superior to brain uptake for diagnosing HPS.
文摘Hepatopulmonary syndrome (HPS) is a severe complication of end-stage hepatic disease. However, the majority of HPS patients present with non-specific clinical manifestations and imaging features. They are constantly misdiagnosed as interstitial pneumonia, pulmonary infection or heart failure and appropriate treatment is thus delayed. In this report, clinical manifestations, diagnosis and treatment of one case of HPS were retrospectively analyzed and literature review was conducted. When the heapatic failure liver disease patients present with hypoxemia, pulmonary angiography, contrast echocardiography for right-sided heart (contrast enhanced echocardiogram) and lung perfusion scan (99mTc-MAA) should be done to exclude HPS. Orthotopic liver transplantation serves as the unique effective therapy of HPS.
