CT-guided microcoil localization of pulmonary nodules: the effect of the position of microcoil proximal end on the incidence of microcoil dislocation

Author(s):  
Zhen-Guo Huang ◽  
Cun-li Wang ◽  
Hong-liang Sun ◽  
Shu-Zhu Qin ◽  
Chuan-Dong Li ◽  
...  

Objectives: To evaluate the effect of the position of microcoil proximal end on the incidence of microcoil dislocation during CT-guided microcoil localization of pulmonary nodules (PNs). Methods: This retrospective study included all patients with PNs who received CT-guided microcoil localization before video-assisted thoracoscopic urgery (VATS) resection from June 2016 to December 2019 in our institution. The microcoil distal end was less than 1 cm away from the nodule, and the microcoil proximal end was in the pleural cavity (the pleural cavity group) or chest wall (the chest wall group). The length of microcoil outside the pleura was measured and divided into less than 0.5 cm (group A), 0.5 to 2 cm (group B) and more than 2 cm (group C). Microcoil dislocation was defined as complete retraction into the lung (type I) or complete withdrawal from the lung (type II). The rate of microcoil dislocation between different groups was compared. Results: A total of 519 consecutive patients with 571 PNs were included in this study. According to the position of microcoils proximal end on post-marking CT, there were 95 microcoils in the pleural cavity group and 476 in the chest wall group. The number of microcoils in group A, B, and C were 67, 448 and 56, respectively. VATS showed dislocation of 42 microcoils, of which 30 were type II and 12 were type I. There was no statistical difference in the rate of microcoil dislocation between the pleural cavity group and the chest wall group (6.3% vs 7.6%, x2 = 0.18, p = 0.433). The difference in the rate of microcoil dislocation among group A, B, and C was statistically significant (11.9%, 5.8%, and 14.3% for group A, B, and C, respectively, x2 = 7.60, p = 0.008). In group A, 75% (6/8) of dislocations were type I, while all eight dislocations were type II in group C. Conclusions: During CT-guided microcoil localization of PNs, placing the microcoil proximal end in the pleura cavity or chest wall had no significant effect on the incidence of microcoil dislocation. The length of microcoil outside the pleura should be 0.5 to 2 cm to reduce the rate of microcoil dislocation. Advances in knowledge: : CT-guided microcoil localization can effectively guide VATS to resect invisible and impalpable PNs. Microcoil dislocation is the main cause of localization failure. The length of microcoil outside the pleura is significantly correlated with the rate and type of microcoil dislocation. Placing the microcoil proximal end in the pleura cavity or chest wall has no significant effect on the rate of microcoil dislocation.

2020 ◽  
Author(s):  
Yanyan Xu ◽  
Lingchuan Ma ◽  
Hongliang Sun ◽  
Zhenguo Huang ◽  
Zhenrong Zhang ◽  
...  

Abstract Background: To evaluate the feasibility and safety of microcoil in simultaneous localization for multiple pulmonary nodules before video-assisted thoracic surgery (VATS). Methods: Twenty-eight consecutive patients (26 two-nodule, 2 three-nodule; totally 58 nodules; Group A) underwent simultaneous CT-guided localization for multiple pulmonary nodules before VATS using microcoil. Successful targeting, localization, and VATS were defined as implantation of microcoil at the target site on CT image obtained immediately after the marking procedure, visualization of nodule location, and complete resection of the target nodule with adequate margin, respectively. Meanwhile, the clinical characteristics, localization procedure-related variables of the nodules and procedure-related complication in group A were also assessed and compared with those in a control group (221 single-localization procedures in 221 patients; Group B). Results: The similar rates of success targeting, localization and VATS were observed in group A and B (96.6% vs 98.2%; 91.4% vs 91.0%; 100% vs 99.1%). Although the rate of overall complications (including localized pneumothorax and intrapulmonary hemorrhage) was a bit higher in group A than that in group B (32.8% vs 30.8%, p =0.771), only minor complications were observed in the subjects of the two groups with no need for further treatment. In addition, the duration of simultaneous localization procedures was significantly longer than that of single localization ones (24±7.5 vs 13±6 min, p <0.001). Conclusions: CT-guided simultaneous microcoil localization for multiple pulmonary nodules before VATS was clinical feasible and safe with acceptable increasing the procedure time. Compared with localization for a single pulmonary nodule, simultaneous microcoil localizations for multiple nodules were prone to the occurrence of pneumothorax and hemorrhage. However, no statistically significant differences were observed between the two groups.


2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Qiang Li

Objective: To investigate the effects of different hemodialysis treatments on abnormal mineral and bone metabolism in patients with chronic renal failure. Methods: A random number table was used to divide 80 patients with chronic renal failure admitted to our hospital from January 2018 to January 2019 into 2 groups, with 40 cases in each group. Group A was treated with low-flux hemodialysis, and group B was treated with high-flux hemodialysis. The related indicators of mineral and bone metabolism of the two groups were compared. Results: Before treatment, the blood calcium, blood phosphorus, intact parathyroid hormone (iPTH), type I procollagen amino terminal peptide (PINP), fibroblast growth factor 23 (FGF23), serum creatinine (Scr) indicators of the two groups were compared. The difference was not statistically significant(P>0.05); After treatment, the blood calcium levels of the two groups were higher than before treatment, the blood phosphorus, iPTH, PINP, FGF23, and Scr levels were lower than before treatment, and the blood calcium level of group B was higher than that of group A, while blood phosphorus, iPTH, PINP, FGF23, and Scr levels were lower than group A, the difference was statistically significant (P<0.05). Conclusion: Compared with low-flux hemodialysis, patients with chronic renal failure treated with high-flux hemodialysis have better results, which can correct abnormal bone metabolism and improve Scr levels.


2020 ◽  
Author(s):  
Yanyan Xu ◽  
Lingchuan Ma ◽  
Hongliang Sun ◽  
Zhenguo Huang ◽  
Zhenrong Zhang ◽  
...  

Abstract Background: To evaluate the feasibility and safety of microcoil in simultaneous localization for multiple pulmonary nodules before video-assisted thoracic surgery (VATS).Methods: Twenty-eight consecutive patients (26 two-nodule, 2 three-nodule; totally 58 nodules; Group A) underwent simultaneous CT-guided localization for multiple pulmonary nodules before VATS using microcoil. Successful targeting, localization, and VATS were defined as implantation of microcoil at the target site on CT image obtained immediately after the marking procedure, visualization of nodule location, and complete resection of the target nodule with adequate margin, respectively. Meanwhile, the clinical characteristics, localization procedure-related variables of the nodules and procedure-related complication in group A were also assessed and compared with those in a control group (221 single-localization procedures in 221 patients; Group B). Results: The similar rates of success targeting, localization and VATS were observed in group A and B (96.6% vs 98.2%; 91.4% vs 91.0%; 100% vs 99.1%). Although the rate of overall complications (including localized pneumothorax and intrapulmonary hemorrhage) was a bit higher in group A than that in group B (32.8% vs 30.8%, p=0.771), only minor complications were observed in the subjects of the two groups with no need for further treatment. In addition, the duration of simultaneous localization procedures was significantly longer than that of single localization ones (24±7.5 vs 13±6 min, p<0.001).Conclusions: CT-guided simultaneous microcoil localization for multiple pulmonary nodules before VATS was clinical feasible and safe with acceptable increasing the procedure time. Compared with localization for a single pulmonary nodule, simultaneous microcoil localizations for multiple nodules were prone to the occurrence of pneumothorax and hemorrhage. However, no statistically significant differences were observed between the two groups.


2021 ◽  
Author(s):  
Yanyan Xu ◽  
Lingchuan Ma ◽  
Hongliang Sun ◽  
Zhenguo Huang ◽  
Zhenrong Zhang ◽  
...  

Abstract Background: To evaluate the feasibility and safety of microcoil in simultaneous localization for multiple pulmonary nodules before video-assisted thoracic surgery (VATS).Methods: Twenty-eight consecutive patients (26 two-nodule, 2 three-nodule; 58 nodules in total; Group A) underwent simultaneous CT-guided localization of multiple pulmonary nodules before VATS using microcoil. Successful targeting, localization, and VATS were defined as implantation of microcoil at the target site on CT image which was obtained immediately after the marking procedure, visualization of nodule location, and complete resection of the target nodule with adequate margin, respectively. Meanwhile, the clinical characteristics, localization procedure-related variables of the nodules and procedure-related complications in group A were also assessed and compared with those in a control group (221 single-localization procedures in 221 patients; Group B). Results: Similar rates of successful targeting, localization and VATS were observed in group A and B (96.6% vs 98.2%; 91.4% vs 91.0%; 100% vs 99.1%). Although the rate of overall complications (including localized pneumothorax and intrapulmonary hemorrhage) was a bit higher in group A than that in group B (32.8% vs 30.8%, p=0.771), only minor complications were observed in the subjects of the two groups with no need for further treatment. In addition, the duration of simultaneous localization procedures was significantly longer than that of single localization (24±7.5 vs 13±6 min, p<0.001).Conclusions: CT-guided simultaneous microcoil localization for multiple pulmonary nodules before VATS was clinically feasible and safe with acceptable increase in the procedure time. Compared with localization for a single pulmonary nodule, simultaneous microcoil localizations for multiple nodules were prone to pneumothorax and hemorrhage. However, no statistically significant differences were observed between the two groups.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanyan Xu ◽  
Lingchuan Ma ◽  
Hongliang Sun ◽  
Zhenguo Huang ◽  
Zhenrong Zhang ◽  
...  

Abstract Background To evaluate the feasibility and safety of microcoil in simultaneous localization for multiple pulmonary nodules before video-assisted thoracic surgery (VATS). Methods Twenty-eight consecutive patients (26 two-nodule, 2 three-nodule; 58 nodules in total; Group A) underwent simultaneous CT-guided localization of multiple pulmonary nodules before VATS using microcoil. Successful targeting, localization, and VATS were defined as implantation of microcoil at the target site on CT image which was obtained immediately after the marking procedure, visualization of nodule location, and complete resection of the target nodule with adequate margin, respectively. Meanwhile, the clinical characteristics, localization procedure-related variables of the nodules and procedure-related complications in group A were also assessed and compared with those in a control group (221 single-localization procedures in 221 patients; Group B). Results Similar rates of successful targeting, localization and VATS were observed in group A and B (96.6% vs. 98.2%; 91.4% vs. 91.0%; 100% vs. 99.1%). Although the rate of overall complications (including localized pneumothorax and intrapulmonary hemorrhage) was a bit higher in group A than that in group B (32.8% vs. 30.8%, p = 0.771), only minor complications were observed in the subjects of the two groups with no need for further treatment. In addition, the duration of simultaneous localization procedures was significantly longer than that of single localization (24 ± 7.5 vs.13 ± 6 min, p < 0.001). Conclusions CT-guided simultaneous microcoil localization for multiple pulmonary nodules before VATS was clinically feasible and safe with acceptable increase in the procedure time. Compared with localization for a single pulmonary nodule, simultaneous microcoil localizations for multiple nodules were prone to pneumothorax and hemorrhage. However, no statistically significant differences were observed between the two groups.


Author(s):  
Umesh Kumar ◽  
Pradeep Jain

Abstract Background The sagittal maxillary fracture often coexists with maxillary fractures and warrants a definitive management strategy together with other maxillary fractures. Method This study was conducted on 60 patients suffering from sagittal maxillary fracture. Palatal fractures were classified into six subgroups. During management, patients were divided into three groups. In group A, patients with type I, IV, V, and VI were managed with maxillomandibular fixation and anterior maxillary buttress stabilization. Group B patients included type II, III, and IV palatal fractures. These fractures were undisplaced and were managed with maxillomandibular fixation, anterior alveolar plating, and anterior maxillary buttress stabilization. Group C included type II and III fractures with visible gap in the palate and were managed with maxillomandibular fixation, palatal vault plating, anterior alveolar plating, and anterior maxillary buttress stabilization. Result Sagittal maxillary fracture was more common in young males. Le Fort I and II fractures were more frequently associated with it in isolation or in combination. Parasagittal and sagittal fractures were the most common types. Sixteen patients of group A, twenty patients of group B, and twenty-four patients of group C were managed. Malocclusion (2), plate extrusion (2), and oroantral fistula (2) were the most common complications. Conclusion Sagittal maxillary fracture can be diagnosed with clinical and radiological examination. Palatal vault plating is required in displaced palatal fractures of type II and III. Single plate fixed in posterior half of middle one-third of palate gives sufficient stability to the palatal vault.


Blood ◽  
2000 ◽  
Vol 96 (4) ◽  
pp. 1574-1581 ◽  
Author(s):  
Brian R. Curtis ◽  
Jennifer T. Edwards ◽  
Martin J. Hessner ◽  
John P. Klein ◽  
Richard H. Aster

It is widely thought that expression of ABH antigens on platelets is insufficient to materially affect the survival of ABH-incompatible platelets in transfusion recipients, but anecdotal reports of poor survival of A and B mismatched platelets suggest that this is not always the case. The A and B antigen expression on platelets of 100 group A1 and group B blood donors was measured, and 7% and 4%, respectively, had platelets whose A and B antigen levels consistently exceeded the mean plus 2 SD. On the basis of flow cytometric and statistical analysis, donors whose platelets contained higher than normal levels of A antigen were subdivided into 2 groups, designated Type I and Type II (“high expressers”). Serum A1- and B-glycosyltransferase levels of A and B high expressers were significantly higher than those of group A1 and B individuals with normal expression. H antigen levels were low on the red cells of high expressers, indicating that the anomaly affects other cell lineages. Immunochemical studies demonstrated high levels of A antigen on various glycoproteins (GPs) from high-expresser platelets, especially GPIIb and PECAM (CD31). The A1 Type II high-expresser phenotype was inherited as an autosomal dominant trait in one family. The sequences of exons 5, 6, and 7 of the A1-transferase gene of one Type II A1 high expresser and exon 7 from 3 other genes were identical to the reported normal sequences. Further studies are needed to define the molecular basis for the high-expresser trait and to characterize its clinical implications.


2019 ◽  
Vol 3 (11) ◽  
pp. 1738-1749 ◽  
Author(s):  
Mathivanan Chinnaraj ◽  
William Planer ◽  
Vittorio Pengo ◽  
Nicola Pozzi

Abstract Anti-phosphatidylserine/prothrombin (aPS/PT) antibodies are often detected in patients with antiphospholipid syndrome (APS), but how aPS/PT engage prothrombin at the molecular level remains unknown. Here, the antigenic determinants of immunoglobulin G aPS/PT were investigated in 24 triple-positive APS patients at high risk of thrombosis by using prothrombin mutants biochemically trapped in closed and open conformations, and relevant fragments spanning the entire length of prothrombin. Two novel unexpected findings emerged from these studies. First, we discovered that some aPS/PT are unique among other anti-prothrombin antibodies insofar as they efficiently recognize prothrombin in solution after a conformational change requiring exposure of fragment-1 to the solvent. Second, we identified and characterized 2 previously unknown subpopulations of aPS/PT, namely type I and type II, which engage fragment-1 of prothrombin at different epitopes and with different mechanisms. Type I target a discontinuous density-dependent epitope, whereas type II engage the C-terminal portion of the Gla-domain, which remains available for binding even when prothrombin is bound to the phospholipids. Based on these findings, APS patients positive for aPS/PT were classified into 2 groups, group A and group B, according to their autoantibody profile. Group A contains mostly type I antibodies whereas group B contains both type I and type II antibodies. In conclusion, this study offers a first encouraging step toward unveiling the heterogeneity of anti-prothrombin antibodies in correlation with thrombosis, shedding new light on the mechanisms of antigen–autoantibody recognition in APS.


Blood ◽  
2000 ◽  
Vol 96 (4) ◽  
pp. 1574-1581 ◽  
Author(s):  
Brian R. Curtis ◽  
Jennifer T. Edwards ◽  
Martin J. Hessner ◽  
John P. Klein ◽  
Richard H. Aster

Abstract It is widely thought that expression of ABH antigens on platelets is insufficient to materially affect the survival of ABH-incompatible platelets in transfusion recipients, but anecdotal reports of poor survival of A and B mismatched platelets suggest that this is not always the case. The A and B antigen expression on platelets of 100 group A1 and group B blood donors was measured, and 7% and 4%, respectively, had platelets whose A and B antigen levels consistently exceeded the mean plus 2 SD. On the basis of flow cytometric and statistical analysis, donors whose platelets contained higher than normal levels of A antigen were subdivided into 2 groups, designated Type I and Type II (“high expressers”). Serum A1- and B-glycosyltransferase levels of A and B high expressers were significantly higher than those of group A1 and B individuals with normal expression. H antigen levels were low on the red cells of high expressers, indicating that the anomaly affects other cell lineages. Immunochemical studies demonstrated high levels of A antigen on various glycoproteins (GPs) from high-expresser platelets, especially GPIIb and PECAM (CD31). The A1 Type II high-expresser phenotype was inherited as an autosomal dominant trait in one family. The sequences of exons 5, 6, and 7 of the A1-transferase gene of one Type II A1 high expresser and exon 7 from 3 other genes were identical to the reported normal sequences. Further studies are needed to define the molecular basis for the high-expresser trait and to characterize its clinical implications.


Author(s):  
N.K. Svyrydova ◽  
G.M. Chupryna ◽  
V.M. Dubуnetska ◽  
Z.L. Tyzhuk

The article analyzes the physical and psychological components of the quality of life (QOL) in patients with diabetic polyneuropathy (DP) on the background of type I and II diabetes mellitus (DM) with comorbidity. Has been demonstrated the prevalence of more frequent multimorbidity in this nosology and its effect on patients’ QOL. QOL is recognized as an integral part of a comprehensive analysis of new methods of diagnosis, treatment, prevention, quality of treatment and medical assistance [2]. With the highest frequency in DM detect sensory or sensorimotor forms of distal symmetrical DP. However, there are motor symptoms in DM, including cranial neuropathy and Bruns-Garland syndrome (diabetic amyotrophy) [3], which interfere with the satisfactory functioning of patients. The purpose of our work was to assess the extent of physical and mental functioning of people with DP on the background of multimorbidity. Materials and methods. We examined 92 patients with DP on the background of type I and II DM, aged from 19 to 69 years, which were divided into 2 groups: from DP on the background of type 1 DM (group I) and type II (group II). We distinguished such subgroups: DP on the background of type I DM and concomitant cardiovascular pathology (CVP) (group A), DP on the background of type II DM and concomitant CVP (group B), DP on the background of type I DM and gastroenterological pathology (GEP) (group C), DP on the background of type II DM and GEP (group D), DP on the background of type I DM and pathology of the thyroid gland (thyroid) (group E), DP on the background of type II DM and thyroid pathology (group F). Patients underwent clinical and neurological examination, laboratory tests and ultrasound examination of the abdominal cavity and thyroid gland, electromyography (EMG). Static calculation was done in MS Excel 2003. Results and discussion. In groups A and B with the highest frequency among CVP was arterial hypertension - 91% vs 97% and coronary heart disease - 27% vs 41%. In group C - chronic hepatitis (40%), chronic cholecystitis (40%), chronic pancreatitis (40%), chronic gastroduodenitis (40%). In people of group D, gallstone disease was diagnosed more often than in other pathologies (43%). The leading place in group E was occupied by autoimmune thyroiditis (29%), idiopathic hypothyroidism (29%), thyrotoxicosis (29%), in group F - nodular goiter (57%). The longest duration of DM was observed in group A - 24.54 ± 2.46 years, the smallest in group D - 7.14 ± 1.01 years. Diabetic foot syndrome was diagnosed in patients of groups A and B in 14%, group C - in 2%. In patients of group I, the indicators of QOL were higher than in group II. The highest indicators were of groups I and II in the domains social (SF) and physical functioning (PF) - 66.75 ± 2.41; 65.5 ± 3.23 and 63.39 ± 3.54; 61.42 ± 3.88. In group A, the level of QOL was slightly higher than in group B, in particular in the domains of mental health (MH) - 53.09 ± 3.12, bodily pain (BP) - 50.90 ± 4.05. In addition, the manifestations of DP in such group of individuals (group A) were manifested by the absence or mild pain, which causes in people of this group higher rate of QOL. QOL in patients of group C was higher than in group D, in particular, the indicators of physical functioning (PF) - 68.75 ± 5.88, social functioning (SF) - 65.62 ± 5.35, role emotional (RE) - 58.33 ± 18.75, mental health (MH) - 54 ± 5.36. In group D, the data were high in the domains of social functioning (SF) 60.71 ± 16.0 and physical functioning (PF) 57.14 ± 8.37. In the examined patients of group F the level of QOL was higher than in group E, it was, in the domains of physical functioning (PF) - 76.42 ± 7.99, bodily pain (BP) - 61.28 ± 11.18, general health (GH) - 60.85 ± 7.33. Physical health (PH) was low in all groups, but slightly higher in group F (47.90 ± 3.45). The mental health (MH) was low in all groups of patients, slightly higher in group C (47.89 ± 3.59). Conclusions. The level of QOL in persons with DP on the background of type I and II DM with multimorbidity was generally not high. Patients in group D showed the lowest levels of QOL, they also had a level of glycated hemoglobin much higher than in other groups. In group F, the data of QOL were higher, because people with DP on the background of type I DM (group E) had a higher frequency of concomitant thyroid damage, the manifestations of which significantly complicate the course of the underlying disease and reduce levels of functioning. Often manifestations of diabetic foot occur in the onset of DP, when the fibers responsible for sensitivity were damaged, which causes the appearance of the neuropathic component of pain, so in persons of group B the lowest among all groups was the level of QOL in the domain of pain intensity. In addition, it was convenient to monitor the results of treatment by conducting a QOL survey several times a year. Careful analysis of QOL in all areas of functioning in patients with DP allowed detecting early mental disorders and timely start treatment, including psychotherapy sessions. Keywords: quality of life, diabetic polyneuropathy, comorbidity, diabetic foot.


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