Background: Patients with pulmonary tuberculosis (PTB) have a high risk of concomitant tracheobronchial tuberculosis (TBTB), which commonly causes severe complications such as tracheobronchial stenosis. The prevalence and predictors of TBTB in China remain unclear due to the lack of prospective and large-scale studies. Objectives: To investigate the incidence of TBTB in PTB patients in southern China, and elucidate the predictors of TBTB and related tracheobronchial stenosis. Methods: We prospectively performed bronchoscopy in PTB patients to diagnose TBTB at four medical centres in southern China from September 2015 to August 2016. Clinical and epidemiological data were recorded and analysed to determine predictors of TBTB and related tracheobronchial stenosis. Results: A total of 345 (23.9%) of the 1,442 PTB patients undergoing bronchoscopy were diagnosed with TBTB. Female sex (OR 2.53), age < 50 years (OR 1.88), living in urban (OR 2.19), diabetes (OR 1.84), coughing (OR 2.61), and symptoms ≥4 weeks (OR 1.66) were predictors of PTB concomitant with TBTB. About 59.7% TBTB patients developed tracheobronchial stenosis, of which 23.3% cases presented severe airway narrowing. Female sex (OR 2.27), age < 50 years (OR 2.11), shortness of breath (OR 1.97), and symptoms ≥4 weeks (OR 1.71) were predictors of TBTB-related tracheobronchial stenosis. Conclusions: About 23.9% of PTB patients undergoing bronchoscopy present with TBTB in Guangdong province, southern China. Young and middle-aged females with symptoms persisting for ≥4 weeks (the main predictors of TBTB and related tracheobronchial stenosis) should receive bronchoscopy immediately when diagnosed with PTB.
Background: Transbronchial cryobiopsy (TBCB) is an option to surgical biopsy for the diagnosis in interstitial lung diseases. Several impact factors have received wide attention, including the freezing time, cryoprobe size, and contact pressure. However, the effect of the applied gas pressure on the specimen size has not been well elucidated. The purpose of this study is to investigate the effect of the applied gas pressure on the TBCB specimen size. Methods: Cryoprobes with a diameter of 1.9 mm were used to perform TBCB on 4 beagle canines under general anesthesia. TBCB was performed with a total of 16 time-pressure combinations that were randomly combined with 4 freezing times (3, 4, 5, and 6 s) and 4 gas pressures (40, 50, 55, and 60 bar). For each combination, 8 biopsies were performed. The size and quality of specimens, as well as complications, were evaluated. Results: A total of 128 TBCB specimens were obtained. With the same freezing time, the specimen sizes obtained by different applied gas pressures were significantly different (P<0.05) and positively correlated with the gas pressures (r: 0.797-0.867). With the same gas pressure, the size of the TBCB specimens was positively correlated with the freezing time (r: 0.503-0.752). In the 40-bar group, no tissues were obtained when the freezing times were 3-5 s. In the 50-bar and 55-bar groups, qualified specimens were obtained when the freezing times were 5 and 6 s. In the 60-bar group, qualified specimens were obtained when the freezing times were 3-6 s.
Conclusions:The TBCB specimen size was positively correlated with the applied gas pressure. The applied gas pressure contributed to the sample size and quality. To obtain qualified specimens with a 1.9-mm cryoprobe during TBCB, the lowest limit of the normal working gas pressure range should be increased to greater than 50 bar.
To demonstrate the discrepancy of cerebral blood flow volume (BFV) estimation with 2D phase-contrast (2D PC) MRA guided with 3D time-of-flight (3D TOF) MR localization by using an "internal" standard. 20 groups of the common (CCA), internal (ICA), and external (ECA) carotid arteries in 10 healthy subjects were examined with 2D PC MRA guided by 3D TOF MR angiograms. The sum BFV of the internal and external carotid arteries was then compared with the ipsilateral common carotid artery flow. An accurate technique would demonstrate no difference. The difference was therefore a measure of accuracy of the method. 3D TOF MRA localization is presented to allow the determination of a slice orientation to improve the accuracy of 2D PC MRA in estimate the BFV. By using the combined protocols, there was better correlation in BFV estimate between the sum of ICA+ECA with the ipsilateral CCA (R2=0.729, P=0.000). The inconsistency (mean +/- SD) was found to be 6.95 +/- 5.95% for estimate the BFV in ICA+ECA and ipsilateral CCA. The main inconsistency was contributed to the ECA and its branches. Guided with 3D TOF MRA localization, 2D PC MRA is more accurate in the determination of blood flow volume in the carotid arteries.
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