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.
目的：探讨胸膜活检对胸腔积液病因诊断的价值。方法:对268例胸腔积液患者行经胸壁胸膜活检术。结果:268例患者共行胸膜活检289次，二次及以上活检者19例，获取胸膜组织244例，穿刺成功率91%，经病理检查有18例为正常胸膜组织，阳性诊断者为226例，阳性率92.6%（226/244），其病理诊断为结核104例（46%）、肿瘤54例（23.9%）、慢性炎症68例（30.1%）；发生并发症者19（6.6%），全部为气胸，肺压缩均小于30%，未做特殊处理数日后自行吸收。结论:从本组资料可以看出，经胸壁胸膜活检术对于胸腔积液的病因诊断具有非常好的效果，相比胸水涂片或病理检查具有更高的阳性率。因此经胸壁胸膜活检术由于它的简单、安全、高效等特点，目前在胸腔积液病因诊断方面仍是一项重要的手段。
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 compare the effects of heparin versus urokinase injection intrapleurally in the management of pleural thickening and adhesion due to tuberculous exudative pleurisy. Methods Sixty patients with tuberculous pleurisy were allocated into three groups randomly. Sodium heparin ( heparin group) , urokinase ( urokinase group) , and 0. 9% saline ( control group) were intrapleurally injected respectively. The concentrations of fibrinogen and D-dimer in pleural effusion were measured before and after the injection. The duration of absorption and the total drainage volume of pleural effusion were recorded. The pleural thickness and adhesion were observed two months after the injection. Results In 72 hours after the intrapleural injection, the concentration of fibrinogen( g/L) in the pleural effusion was significantly increased in the heparin group( 1. 13 ±0. 44 vs 0. 34 ±0. 19, P lt; 0. 001) , and significantly decreased in the urokinase group( 0. 25 ±0. 16 vs 0. 38 ±0. 15, P lt; 0. 05) when compared with baseline. Concentrations of D-dimer in the pleural effusions were significantly higher than those at baseline in both the heparin group and the urokinase group( 57. 0 ±17. 6 vs 40. 0 ±15. 4, P lt; 0. 05; 74. 5 ±16. 4 vs 43. 8 ±14. 9, P lt; 0. 001) . There were no significant differences in the absorption duration of pleural effusion among the three groups( P gt;0. 05) . The total drainage volume of pleural effusion was higher in the heparin group and the urokinase group compared to the control group( P lt;0. 01) . And the total volume of pleural effusion was significantly higher in the heparin group and the urokinase group than that in the control group( 2863 mL and 2465 mL vs 1828 mL,P lt;0. 01) . Two months after the intervention, the pleura were thinner[ ( 1. 37 ±0. 82) mm and ( 1. 33 ±0. 85) mmvs ( 3. 06 ±1. 20) mm, P lt; 0. 01] and the incidence of pleural adhesion was significantly lower[ 15% and 20% vs 50% , P lt; 0. 05] in the heparin and the urokinase groups than those in the control group.Conclusion Intrapleural heparin has similar effects with urokinase for prevention pleural thickness andadhesion in tuberculous pleurisy with good availability and safety.
Objective To investigate the expression of aquaporin-1( AQP1 ) in visceral and parietal pleura in SD rats and to examine the effect of AQP1 on pleural fluid turnover. Methods Five groups( n = 24 ) of SD rats were randomly assigned to received intrapleural injection of dexamethasone,lipopolysaccharide, erythromycin, hypertonic saline and normal saline, respectively. The AQP1 protein in pleural was detected with immunohistochemistry. The mRNA expression of AQP1 under stimulations at different time points was measured by real time RT-PCR. Results AQP1 was immunolocalized predominantly to the microvessels and mesothelial cells of visceral and parietal pleura. The extent of AQP1expression in parietal pleura was less than that in visceral pleura[ ( 4. 14 ±1. 12) ×104 copy /μg vs ( 7. 43 ±2. 02) ×104 copy / μg, P lt;0. 05] . AQP1 expression increased at all phases in the dexamethasone group andthe hypertonic saline group, whereas decreased in the erythromycin group and the lipopolysaccharide group.Conclusion The stimulations of dexamethasone, lipopolysaccharide, erythromycin and hypertonic saline can significantly change the AQP1 expression in pleura, which indicate that AQP1 may contribute to the accumulation and clearance of pleuritic fluids.
Objective To investigate the postoperative treatment of pleuropneumonectomy for tuberculosis destroyed lung in ICU, in order to improve the therapeutical efficacy for these patients. Methods Clinical data of 52 patients who suffered from tuberculosis destroyed lung and underwent pleuropneumonectomy from June 2008 to June 2010 were analyzed retrospectively. All of subjects received routine treatment in ICU after the operation. Meanwhile，appropriate targeting treatments were applied including diagnosis and treatment of postoperative bleeding; application of fiberbronchoscope to aspirate the sputum after the operation,sequential non-invasive ventilation after the invasive ventilation for acute respiratory failure after operation ,etc.Results A total of 52 patients received the pleuropneumonectomy operation. Bleeding occurred in 11 cases after operation and stopped after the integrated therapy. 8 patients suffered from acute respiratory failure and attenuated after sequential ventilation. No patients died for postoperative bleeding or acute respiratory failure. Conclusions Patients who suffered from tuberculosis destroyed lung and received pleuropneumonectomy with postoperative bleeding and acute respiratory failure have a good prognosis after appropriate postoperative treatment in ICU.
Abstract： Objective To evaluate the effect of 100% carbolic acid via bronchofiberscope for the treatment of bron- chopleural fistula. Methods We retrospectively analyzed clinical data of 12 patients with postoperative bronchopleural fistula in Liaoning Tumor Hospital from February 2009 to March 2012. There were 11 male patients and 1 female patient with their average age of 58.0 （45-71） years. All the patients had primary lung cancer, including squamous cell carcinoma in 8 patients and adenocarcinoma in 4 patients， central lung cancer in 8 patients and peripheral lung cancer in 4 patients. Three patients were after right total pneumonectomy， 6 patients were after left total pneumonectomy， 2 patients were after right middle and lower lobectomy， and 1 patient was after left upper lobectomy. All the patients received 100% carbolic acid instillation via bronchofiberscope， and 0.5-1.0 ml carbolic acid solution was instilled on the mucosal surface around the fistula each time. The presence of bubbles in thoracic drainage was observed. If some bubbles remained, such treatment was repeated after 1 week. The effectiveness was analyzed. Results All the 12 patients were cured after carbolic acid treatment, including 8 patients after 5 times of carbolic acid instillation， 2 patients after 7 times of carbolic acid instillation， and 2 patients after 2 times of carbolic acid instillation. The average time for fistula closure was 33 days. All the patients were treated in our outpatient clinic except 2 patients who were too weak but cured after 42 days and 50 days of hospitalization respectively. Conclusion The use of 100% carbolic acid instillation via bronchofiberscope can provide satisfactory clinical outcomes for the treatment of bronchopleural fistula.