Search

With the advent of molecularly targeted therapy, it is necessary to reconsider the strategy for malignant pleural effusion in non-small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations. The aim of this study was to evaluate the efficacy of a two-line sequential treatment strategy in this patient subgroup. First-line treatment was gefitinib (250 mg/day) until disease progression. Second-line treatment was thoracoscopic talc pleurodesis followed by chemotherapy. Primary endpoints were the overall response and progression-free survival rates after first-line treatment, and the overall survival rate after first- and second-line treatment. Secondary endpoints were the success rate of thoracoscopic talc pleurodesis and gefitinib toxicity. Among the 76 patients enrolled, 61 (80%) were female and the median age was 62 years. The overall response rate after first-line treatment was 92.1% and median progression-free survival was 15 months. The success rate for thoracoscopic talc pleurodesis in 33 patients was 94%. Median follow-up was 35 months. Median overall survival was 39 months. The 1- and 3-year overall survival rates were 86.4% and 46.1%, respectively. The two-line sequential treatment strategy enhanced survival. These preliminary findings provide an insight into novel therapeutic models for malignant pleural effusion in NSCLC harbouring EGFR mutations. [ABSTRACT FROM PUBLISHER]

Monotherapy of lung cancer shows limited therapeutic effects due to its poorly targeted enrichment and low bioavailability. Using nanomaterials as carriers to form drug delivery systems has become a popular method to improve the targeting of anticancer drug therapy and patients' safety. However, the uniformity of the loaded drugs and the unsatisfactory effects are still the bottleneck in this field up to now. This study aims to construct a novel nanocomposite carrying 3 different types of anticancer drugs to enhance treatment efficacy. Herein, mesoporous silica (MSN) with high loading rate was constructed by dilute sulfuric acid thermal etching as the framework. Hyaluronic acid (HA) was loaded with CaO 2 , p53 and DOX to construct nanoparticle complexes-SiO 2 @CaO 2 @DOX@P53-HA. First, MSN was proved to be a porous sorbent with a mesoporous structure through BET analysis. The images obtained from the uptake experiment clearly show the gradual enrichment of the DOX and Ca 2+ within the target cell. For in vitro experiments, the pro-apoptotic effects of SiO 2 @CaO 2 @DOX@P53-HA significantly increased compared to that of the single-agent group at different time points. Furthermore, in the tumor-bearing mouse experiment, the tumor volume was remarkably inhibited in the SiO 2 @CaO 2 @DOX@P53-HA group compared to that in the single-agent group. By observing the pathological sections of the euthanized mice, it is obvious that the tissues of the mice treated with the nanoparticles were more intact. Based on these beneficial results, it is believed that multimodal therapy is a meaningful treatment strategy for lung cancer.

Objective: To evaluate the cosmetic effect and safety of transaxillary concealing single incision endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis (PH)., Methods: Retrospective study was conducted for 326 PH cases undergoing transaxillary concealing single incision endoscopic thoracic bilateral sympathectomy during January 2009 and March 2011., Results: All operations were successfully performed without severe complication and mortality. No conversion into open technique was necessary. The mean unilateral operative duration was 5.8 (5-8) min. It was calculated from the time of skin incision to the application of dressing over wound. The mean follow-up period was 25 (8-38) months. All patients achieved excellent cosmetic effects with undetectable incision., Conclusion: Transaxillary concealing single incision endoscopic thoracic sympathectomy is a safe and effective procedure for treating primary PH. Incision is undetectable with excellent cosmetic effect. It is worthy of wider popularization.

Objective: To evaluate the cosmetic effects and safety profiles of trans-areola single port endoscopic thoracic sympathectomy., Methods: A retrospective study was conducted for 45 males and 7 females with palmar hyperhidrosis undergoing trans-areola single port endoscopic thoracic bilateral sympathectomy during April and June 2011., Results: All operations were successfully performed without severe morbidity and mortality. No conversion to open technique was necessary. The mean unilateral operative duration was 6 minutes (range: 5 - 8). The time was calculated from the time of skin incision to that of dressing application over wound. The mean hospitalization duration was 2.2 days (range: 2 - 3). The mean follow-up period was 2.8 months (range: 1 - 7). All patients achieved excellent cosmetic effects. No incision scar was found., Conclusion: Trans-areola single port endoscopic thoracic sympathectomy is a safe and effective therapeutic procedure for primary palmar hyperhidrosis. The incision is undetectable with excellent cosmetic effects. The trans-areola route is a new ideal and promising approach for endoscopic thoracic sympathectomy.

Objective: To evaluate the clinical value of video-assisted thoracoscopic extended thymectomy for myasthenia gravis(MG)., Methods: Sixty-two MG cases underwent video-assisted thoracoscopic extended thymectomy. The operative extension included thymus tissue and adipose tissue in anterior superior mediastinum., Results: All operations were performed successfully. The mean operating duration, mean intraoperative blood loss and mean postoperative hospital stay was 98 ± 26 minutes, 60 ± 29 ml and 8.2 ± 2.5 days respectively. All cases were followed up for 5 to 48 months. Among them, 20 (32.3%) patients achieved a complete relief, 32 (51.6%) had their improved symptoms, 8 (12.9%) remained stable and 2 (3.2%) became worse. And the overall relief rate was 83.9%., Conclusion: Video-assisted thoracoscopic extended thymectomy is both feasible and reliable for MG with the advantages of a minimal trauma and a rapid recovery.

Objective: To evaluate the efficacy of video-assisted thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis and introduce the clinical experience in the prevention of complications., Methods: The clinic data of 588 cases of palmar hyperhidrosis who underwent bilateral sympathectomy from January 2003 and March 2007 was analyzed retrospectively. The curative results were compared between the T(2) levels denervation group (group A) and the T(2) levels remained denervation group (group B)., Results: All operations were successfully performed under thoracoscope without severe morbidity and mortality. The curative rate of palmar hyperhidrosis was 99.8%. Accompanied axillary sweating and plantar sweating were improved in 84.0% and 71.0% patients respectively. All the patients were evaluated by a follow-up for 1 to 48 months with an average time of (20.3 +/- 2.3) months on the aspects of curative effect and occurrence of compensatory sweating. During one week after surgery, the transient postoperative hand sweating recurred in 10 cases and then disappeared within 1 to 3 days. Two cases experienced gustatory hyperhidrosis. One case experienced hand sweating at 8 th month postoperative. Side-effect of compensatory sweating were observed in 28.0 percent of group A and 13.4 percent of group B (P < 0.01)., Conclusions: Video-assisted thoracoscopic sympathectomy is an effective, safe and minimally invasive method for the treatment of hyperhidrosis. The method of T(2) levels remained denervation appears associated with less compensatory sweating.

Objective: To compare the curative effects of sympathectomy at different segments on palmar hyperhidrosis., Methods: Four hundred patients with palmar hyperhidrosis, 191 males and 209 females, aged 21.9 +/- 3.4 (10 - 53), underwent bilateral sympathectomy However, bilateral sympathectomy was forced to be given up and replaced by unilateral sympathectomy in 2 patients because of severe pleural adhesion The 398 patients on which bilateral sympathectomy was successfully performed were randomly divided into 3 groups: Group A (n = 207) undergoing T2-4 sympathectomy, Group B (n = 131) undergoing T3 sympathectomy, and Group C (n = 60) undergoing T3-4 sympathectomy. The curative effects were compared., Results: Operation was successfully performed on all patients and their palmar hyperhidrosis was completely alleviated after operation. No surgery-related post-operative complication occurred. The compensatory hyperhidrosis (CH) rate of Group B was 5.3%, not significantly different from that of Group C (6.7%, P > 0.05). The CH rate of the combined group, Group B + C was 5.8%, significantly lower than that of Group A (28.0%, P < 0.01)., Conclusion: Safe and mini-invasive, T3 or T3-4 sympathectomy effectively reduce the development of CH and improves the patients' quality of life post-operatively.