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Background: Malignant pleural effusion (MPE) is a common clinical problem that requires cytological and/or histological confirmation obtained by invasive examination to establish a definitive diagnosis. Radiomics is rapidly evolving and can provide a non-invasive tool to identify MPE. Objectives: We aimed to develop a model based on radiomic features extracted from unenhanced chest computed tomography (CT) images and investigate its value in predicting MPE. Method: This retrospective study included patients with pleural effusions between January 2016 and June 2020. All patients underwent a chest CT scanning and medical thoracoscopy after artificial pneumothorax. Cases were divided into a training cohort and a test cohort for modelling and verifying respectively. The Mann-Whitney U test and the least absolute shrinkage and selection operator (LASSO) were applied to determine the optimal features. We built a radiomics model based on support vector machines (SVM) and evaluated its performance using ROC and calibration curve analysis. Results: Twenty-nine patients with MPE and fifty-two patients with non-MPE were enrolled. A total of 944 radiomic features were quantitatively extracted from each sample and reduced to 14 features for modeling after selection. The AUC of the radiomics model was 0.96 (95% CI: 0.912-0.999) and 0.86 (95% CI: 0.657~1.000) in the training and test cohorts, respectively. The calibration curves for model were in good agreement between predicted and actual data. Conclusions: The radiomics model based on unenhanced chest CT has good performance for predicting MPE and may provide a powerful tool for doctors in clinical decision-making.
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Background: Pulmonary infarction (PI) is an uncommon complication of pulmonary embolism (PE). The risk factors of PI are still relatively unclear. Methods: This was a single-center retrospective review conducted on 500 patients with PE. After applying the inclusion and exclusion criteria, 386 patients diagnosed with PE were enrolled in our study. These patients were then categorized into the PI group (n=64) and the non-PI group (n=322). A comparison was conducted between the two groups regarding the clinical characteristics. Results: The occurrence of PI secondary to PE was 16.58%. In univariate analysis, recent trauma (21.9% vs. 9.9%, P=0.007), pleuritic chest pain (46.9% vs. 17.4%, P<0.001), hemoptysis (29.7% vs. 2.5%, P<0.001), fever (26.6% vs. 8.1%, P<0.001), lower limb edema/pain (37.5% vs. 14.0%, P<0.001), white blood cell (WBC) counts (37.5% vs. 24.5%, P=0.032), C-reactive protein (CRP) (65.6% vs. 41.3%, P<0.001), and pleural effusion (45.3% vs. 18.6%, P<0.001) were associated with an increased risk of PI. Multivariate analysis demonstrated that age [odds ratio (OR) 0.975, 95% confidence interval (CI): 0.951-0.999, P=0.045], pleuritic chest pain (OR 2.878, 95% CI: 1.424-5.814, P=0.003), hemoptysis (OR 10.592, 95% CI: 3.503-32.030, P<0.001), lower limb edema/pain (OR 2.778, 95% CI: 1.342-5.749, P=0.006) and pleural effusion (OR 3.127, 95% CI: 1.531-6.388, P=0.002) were independent factors of PI due to PE. No significant difference was recorded between the two groups in treatment and mortality. Conclusions: Young patients were found to be a higher risk of PI. Pleural effusion was found to be a factor for PI. PI should be considered when pleuritic chest pain, hemoptysis, or lower limb edema/pain are present with peripheral opacity.
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Background: Pulmonary actinomycosis (PA), a chronic indolent infection, is a diagnostic challenge. Actinomyces graevenitzii is a relatively rare Actinomyces species isolated from various clinical samples. Case Presentation: A 47-year-old patient presented with a 3-month history of mucopurulent expectoration and dyspnea and a 3-day history of fever up to 39.0°C. He had dental caries and a history of alcoholism. Computed tomography (CT) images of the chest revealed a consolidation shadow in the right upper and middle lobes, with necrosis containing foci of air. Actinomyces graevenitzii was isolated from bronchoalveolar lavage fluid (BALF) culture and was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. He received treatment with intravenous piperacillin-sulbactam for 10 days and oral amoxicillin-clavulanate for 7 months. His clinical condition had considerably improved. The consolidation shadow was gradually absorbed. Conclusion: Early diagnosis and treatment of pulmonary actinomycosis are crucial. Bronchoscopy plays a key role in the diagnostic process, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS) is an accurate tool for Actinomyces identification.
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BACKGROUND: Pulmonary thromboembolism (PTE) is a common disease which may be a serious condition and has high mortality. Recently, it has been shown that circRNAs play an important role in the development of various diseases, including thromboembolic disease. However, circRNAs expression profiling is not clear in PTE, this study aims to identify the circRNAs expressed in PTE and to elucidate their possible role in pathophysiology of PTE. METHODS: A total of 5 patients with CTPA-confirmed PTE and 5 healthy controls were recruited for the present study. The circRNAs expression profile was analyzed by microarray. RESULTS: In total, 256 differentially expressed circRNAs (up 142, down114) and 1162 mRNA (up 446, down 716) were summarized by analyzing the circRNAs microarray data. The top 3 up-regulated and 3 down-regulated circRNAs were validated by Real-Time Polymerase Chain Reaction (qRT-PCR). Two differentially expressed circRNAs (hsa_circ_0000891, hsa_circ_0043506) were selected for further analysis. Finally, we construct a circRNA-miRNA-mRNA ceRNA network with a bioinformatic prediction tool. Pathway analysis shows that the enriched mRNAs targets take part in Protein processing in endoplasmic reticulum, Systemic lupus erythematosus, Endocytosis, Spliceosome, HTLV-I infection and Ubiquitin mediated proteolysis. CONCLUSION: Our findings indicated that aberrantly expressed circRNAs (hsa_circ_0000891, hsa_circ_0043506) may be involved in the development of PTE.
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Malignant pleural effusion (MPE) is a common complication of lung cancer. Accumulating evidence has suggested that circular RNAs (circRNAs) play important roles in oncogenesis and progression of cancer. However, the expression pattern of circRNAs in MPE remains largely unknown and awaits investigation. The study was designed to elucidate the potential roles of differentially expressed circRNAs in MPE. Herein, we detected a total of 1350 differentially expressed circRNAs and 1727 differentially expressed mRNAs in lung adenocarcinoma-associated malignant pleural effusion (LA-MPE) compared with tuberculous pleural effusion (TPE) by Clariom D Human Microarray. Among the top 5 up-regulated circRNAs (hsa_circ_0067705, hsa_circ_0025542, hsa_circ_0072793, hsa_circ_0084927, and hsa_circ_0085386), four were verified significantly up-regulated in LA-MPE by qRT-PCR and hsa_circ_0085386 had an increasing trend. CircRNA-miRNA-mRNA network for the top 5 up-regulated circRNAs was constructed and pathway analysis indicated that the enriched mRNA targets involved in PI3K-Akt signaling pathway, Axon guidance, Regulation of actin cytoskeleton and Rap1 signaling pathway were potentially regulated by these aberrantly expressed circRNAs. We generated specific circRNA profiles in LA-MPE for the first time. And analysis of circRNA regulatory network could provide evidence that circRNAs are important in MPE development because they participate in cancer-related pathways by sequestering miRNAs. Our findings suggested that aberrantly expressed circRNAs may be involved in the development of LA-MPE.