Abstract: Objective To summarize the method and effective result of thoracoscopic intrapleural perfusion hyperthermochemotherapy(TIPHC) for treating malignant pleural effusion caused by lung cancer. Methods Fiftyeight patients with malignant pleural effusion caused by lung cancer were randomly divided into therapeutic group(30 cases) and control group(28 cases) between February 1999 and March 2005. Pleural biopsy and TIPHC under general ansthesia with unilateral ventilation were performed in the therapeutic group, and intrapleural injection of cisplatin was administered in control group after drainage of pleural effusion. The effect on malignant pleural effusion， the change for the concentration of carcinoembryonic antigen(CEA)， cytokeratin-19 fragments (CYFRA21-1)， neuronspecific enolase (NSE) and the side effect were compared before and after the treatment. Results The therapeutic group achieved total response rate of 100.0%, but only 53.6% in control group, with significant difference(χ 2=3.863, Plt;0.05). Furthermore, the concentration of CEA， CYFRA21-1， NSE in therapeutic group dramatically descended than control group(t=2.562,Plt;0.05). But there was no significant difference in side effect (Pgt;0.05). The pathological diagnosis of all the patients were determined in the therapeutic group. Conclusion TIPHC has the advantage of both diagnosis and treatment of malignant pleural effusions. It is safe and effective, and also able to determine the diagnosis. Furthermore, it offers the superiority of small wound， best visualization and convenient pleural biopsy.
Objective To assess clinical outcomes of therapeutic video-mediastinoscopy （VMS）. Methods Clinical data of 82 patients undergoing VMS in Zhongshan Hospital of Dalian University from December 2008 to October 2011 were retrospectively analyzed. Among them，24 patients received therapeutic VMS，including 18 men and 6 women with their median age of 56 （22-81） years. Three patients underwent operation through a neck incision，4 patients through a parasternal incision，and 17 patients through a lateral intercostal incision. Five patients received local anesthesia and basal anesthesia，and all the other patients received general anesthesia through single-lumen or double-lumen endotracheal intubation. Results Twelve patients with pleural effusion underwent pleural or lung biopsy and talc pleurodesis. Pathology examination showed malignant diseases in 11 patients and tuberculous pleural effusion in 1 patient. The median operation time was 35 （30-50） minutes，and postoperative hospital stay was 3-6 days. These patients were followed up for 1 month without recurrence of pleural effusion. Ten patients with mediastinal mass received pathological diagnosis and complete mass resection with their median operation time of 55 （30-270） minutes and median hospital stay of 7 （5-40） days. Two patients with hyperhidrosis underwent bilateral intercostal VMS sympathectomy. Their operation time was 60 minutes and 50 minutes respectively，and their hospital stay was 3 days. Postoperatively their sweating symptoms obviously resolved. They were followed up for 3 months，and their hands，feet and armpit were warm and dry. There was no in-hospital death in this group. Two patients （8.3%） had postoperative complications including 1 patient with phrenic nerve injury and another patient with pneumonia. Opioid analgesic drugs were not used postoperatively in 9 patients. Conclusion Therapeutic VMS is a safe，effective，minimally invasive and cosmetic procedure，but it is not suitable for resection of a large mediastinal mass.
Objective To investigate the expression of aquaporin-1( AQP-1) in pleural mesothelial cells ( PMCs) and the influence of glucose thereupon. Methods Rat PMCs were isolated, cultured, and divided into two groups, ie. a glucose group, cultured with glucose of different concentrations for 24 hours,and a control group, cultured in D-MEM/ F-12 medium. The 100 mmol / L glucose group was administered at the time points of 6, 12, 18, and 24 hours respectively. RT-PCR and Western blotting were used to analyze the mRNA and protein expression of AQP-1. Results The absorbance values of AQP-1 protein expression were 54. 02 ±4. 61, 127. 84 ±9. 41, and 231. 62 ±22. 63, respectively in the PMCs treated with glucose of the concentrations of 50, 100, and 200 mmol / L, all significantly higher than those in the control group( 22. 45 ±2. 16, all P lt; 0. 01) . The absorbance values of AQP-1 protein expression were 24. 68 ±2. 56, 58. 68 ±3. 67, 89. 61 ±6. 62, and 113. 41 ±7. 65 in the PMCs treated with glucose of the concentration of 100 mmol / L after 6, 12, 18, and 24 hours, all significantly higher than those in the control group ( 11. 81 ±1. 45, P lt;0. 01) .Conclusions Glucose induces the expression of AQP-1 mRNA and protein. AQP-1 participates in the pleural fluid formation.
ObjectiveTo analyze the results and diagnostic value of postoperative chylous test of pleural effusion and to verify the clinicopathological factors affecting the results of chylous test.MethodsThe clinical data of 265 consecutive patients undergoing selective surgery at the Department of Thoracic Surgery, Shangjin Nanfu Hospital between May and August 2020 were retrospectively analyzed, including 106 males and 159 females with an average age of 53.0±12.2 years. According to the results of the chylous test on the operation day and postoperative first and second days, the patients were divided into two subgroups, including a positive group and a negative group, and the clinical data of the two groups were compared. Sensitivity and specificity of the chylous test were calculated. The influencing factors for chylous test were analyzed by multiple logistic regression analysis.ResultsThe positive rate of chylous test was 91.7%, 95.8% and 87.9% on the operation day and postoperative first and second days, respectively. There was no statistical difference in age, sex, surgical type, surgical approach, surgical site, surgical time, degree of lymph node dissection, treatment of thoracic duct, 24 hours pleural fluid drainage or 24 hours protein and fat food intake between the positive group and the negative group (P>0.05). The diagnostic sensitivity and specificity of the chylous experiment were 100.0% and 4.0%, respectively. Multiple logistic regression analysis showed that the surgical site (left/right chest) might be an influencing factor for the results of the chylous test (P=0.043, OR=0.458, 95%CI 0.216-0.974).ConclusionThe positive rate of chylous test of pleural effusion after thoracic surgery is very high. The chylous test produces a high misdiagnosis rate of chylothorax. The surgical site (left/right chest) may be an influencing factor for chylous test. The positive result of chylous test is not recommended as the direct diagnostic basis for postoperative chylothorax and guidance of the subsequent treatment.
Objective To investigate the expression of aquaporin-1（AQP-1） on pleura in rats with carrageenan-induced pleural effusion and explore the role of AQP-1 in effusion formation.Methods Fifty-six healthy Wistar rats were randomly divided into a normal control group and 6 pleuritis groups（6，12，24，36，48 and 72 h groups respectively）.The rat model of inflammatory pleurisy was induced by injecting l-Carrageenan into the pleural cavity.The expression of AQP-1 on pleura was detected with immunohistochemistry.The mRNA and protein expression of AQP-1 on visceral pleura and parietal pleura were measured by RT-PCR and Western blot assay respectively.The volume of pleural effusions were measured.Results The volume of pleural effusion was 2.10±0.22，4.10±0.15，4.40±0.36，3.20±0.27，2.60±0.18，0.12±0.02 mL in the 6，12，24，36，48 and 72 h pleuritis groups respectively.AQP-1 were mainly expressed on visceral and parietal pleural mesothelial cells and capillary endothelial cells，and significantly increased in all pleuritic rats The mRNA and protein expression of AQP-1 on parietal pleura increased after 6 h and reached peak level at 24 h in pleuritic groups.The mRNA and protein expression of AQP-1 on visceral pleura increased after 12 h and reached peak level at 24 h in pleuritic groups.The expression of AQP-1 on parietal pleura at 12 h and 24 h in pleuritic groups was correlated positively with the volume of pleural effusion（r=0.857，r=0.846，all Plt;0.01）.The expression of AQP-1 on visceral pleura at 24 h in pleuritic groups was positively correlated with the volume of pleural effusion（r=0.725，Plt;0.05）.Conclusion The expression of AQP-1 on pleura were increased in rats with e carrageenan-induced pleural effusion.AQP-1 may play a role in pleural fluid transportation in pleural effusion.
Objective To evaluate the clinical efficacy and safety of pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion. Methods Twenty-three patients with malignant tumor confirmed by biopsy or postoperative pathology, complicated with malignant pleural effusion confirmed by exfoliative cytology, were treated between March 2013 and June 2014. All the 23 patients underwent thoracic puncture and catheter drainage for the removal of contraindications for chemotherapy. Then, pleural infusion chemotherapy was performed with docetaxel (40 mg/m2), normal saline (250 mL) and dexamethasone (10 mg), 21 days as a cycle. Before pleural infusion chemotherapy with docetaxel, all the patients were given standard pretreatment with dexamethasone, cimetidine/ranitidine or promethazine. The efficacy and safety of the treatment were evaluated in each cycle. Results Among the 23 selected patients, 6 were evaluated as complete remission and 11 as partial remission, with an effective rate of 73.91%. All the patients had acceptable tolerance in the process of the treatment. The most common side effects were bone marrow suppression (78.26%), and nausea and vomiting (82.61%). No such complications as allergy, fluid retention, cardiac toxicity or degree-Ⅳ adverse reactions were detected. Conclusion Pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion is effective with mild adverse reactions, which is worthy to be popularized.
Objective To systematically evaluate the clinical effectiveness and safety of raltitrexed plus cisplatin in the treatment of malignant pleural mesothelioma (MPM) when compared with other chemotherapy regimens. Methods We electronically searched PubMed, Embase, The Cochrane Library and Chinese Biomedicine Database to March, 2007. Randomized controlled trials (RCTs) and quasi-RCTs were identified, and Revman 4.2.10 was applied for statistical analyses. Results One RCT involving 250 patients was included, which compared raltitrexed plus cisplatin versus cisplatin alone in the treatment of MPM. In the intention-to-treat population, the median survival time was statistically longer in the raltitrexed plus cisplatin group as compared to cisplatin alone group. (11.4 versus 8.8 months, P=0.048). The incidence of grade 3/4 toxicities was similar between the two groups. Conclusion The current evidence available showed that, the combination of raltitrexed and cisplatin may prolong the survival time for MPM patients, with a low incidence of grade 3/4 toxicities. However, more high-quality RCTs are required to further define its clinical effectiveness.
Objective To evaluate the value of Sysmex XT-4000i hematology analyzer in its body-fluid mode in cell count and cell differential count of pleural effusion, ascites and cerebrospinal fluid samples. Methods A total of 95 pleural effusion, ascites and cerebrospinal fluid samples were collected from patients hospitalized between May and September 2015. The samples were tested by Sysmex XT-4000i hematology analyzer (instrument method) and modified Neubauer hemocytometer (manual method) for cell count, and the results of them were compared and analyzed. Results The instrument method and the manual method had a good consistency in nuclear cell count and erythrocyte count (kappa=0.965,P< 0.001; kappa=0.988,P<0.001). There was no significant difference in the count of mononuclear cells (P> 0.05). However, there was a significant difference in the count of multiple nuclear cells (P<0.05). Conclusions Hematology analyzer in its body-fluid mode may replace manual method in cell count of pleural effusion, ascites and cerebrospinal fluids for its high precision, high efficiency and easy operation. However, cell differential count of this method needs microscopic examination assistance.
Objective To analyze the clinical features and survival of lung cancer with pleural effusions. Methods A total of 982 consecutive patients with a newly diagnosed lung cancer from January 2008 to December 2014 were retrospectively reviewed. To analyze the clinical features and survival differences, the total patients were divided into the following two groups: with (n=204) or without (n=778) pleural effusions. Results Lung cancer comprised 682 (69.5%) males and 300 (30.5%) females, with an average age of 59.74 years (19–93 years). There were 487(49.6%) squamous carcinoma, 254 (25.9%) adenocarcinoma and 166 (16.9%) small cell lung cancer; 113 (11.5%) lung cancer at early stage (Ⅰ–Ⅱ), 247 (25.2%) cases at stage Ⅲ and 567 (57.7%) at stage Ⅳ. The median survival time of all patients was 12 months. Patients with pleural effusions had a worse prognosis compared to patients without (median survival time: 11 vs.12 months, P=0.003), the median survival time could be reduced by 1 month in males (P=0.004), 3 months in elder patients over 60 years (P<0.001), 4 to 8 months in carcinoma and small cell lung cancer (P≤0.001), and 2 to 3 months in advanced lung cancer (stage Ⅲ and Ⅳ) (P<0.05). Any or combined treatment of surgery, radiotherapy, chemotherapy and targeted therapy was associated with an improved overall survival of about 2 months (P=0.009), and targeted therapy could even improve the median survival time by 1 to 8 months (P=0.002). Conclusions About 20.8% of the patients developed pleural effusion at the same time during the course of lung cancer. Pleural effusion is a poor prognostic factor of lung cancer.
ObjectiveTo systematically review the diagnostic value of procalcitonin (PCT) for tuberculous pleural effusion. MethodsWe electronically searched CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library and EMbase from inception to April, 2013, to collect the literature about the diagnostic value of PCT for tuberculous pleural effusion compared with gold standard (positive outcomes of mycobacterium tuberculosis culture). Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. MetaDiSc 1.4 were used to conduct the meta-analysis. ResultsEight studies were finally included. The results of meta-analysis showed the pooled sensitivity and specificity were 0.63 (95%CI 0.58 to 0.68) and 0.76 (95%CI 0.70 to 0.81), respectively. The positive likelihood ratio and negative likelihood ratio were 2.72 (95%CI 1.48 to 5.02) and 0.49 (95%CI 0.29 to 0.82), respectively. The diagnostic odds ratio (DOR) was 5.77 (95%CI 1.89 to 17.58). And the SROC AUC was 0.79. Heterogeneity was mainly derived from the QUADAS score and Begg's test showed there was no presence of publication bias. ConclusionPCT is a potential marker in the diagnosis of benign and tuberculous pleural effusion, which can be used to determine diagnosis identification of tuberculous pleural effusion.