Complications of thoracoscopic talc insufflation for the treatment of malignant pleural effusions: a meta-analysis.

BACKGROUND: Talc pleurodesis is an effective treatment for malignant pleural effusions (MPEs). This study was designed to estimate complication rates of thoracoscopic talc insufflation. METHODS: Literature search was conducted in electronic databases and studies were selected if they reported complication rates of thoracoscopic talc insufflation in cancer patients with MPEs. Meta-analyses of proportions were performed to obtain incidence rates of complications. RESULTS: Twenty-six studies (4482 patients; age 62.9 years [95% confidence interval (CI): 61.5, 64.4]; 50% [95% CI: 43, 58] females) were included. Intraoperative, perioperative, 30-day, and 90-day mortality rates were 0% [95% CI: 0, 1], 2% [95% CI: 0, 4], 7% [95% CI: 3, 13] and 21% [95% CI: 5, 43] respectively. Incidence rates [95% CI] of various complications were: pain (20% [1, 2]), fever (14% [3, 4]), dyspnea (13% [5, 6]), pneumothorax (6% [7, 8]) pneumonia (4% [0, 12]), emphysema (3% [3, 7]), prolonged air leakage (3% [0, 7]), prolonged drainage (3% [9, 10]), thromboembolism (3% [9, 11]), lung injury (2% [7, 12]), respiratory insufficiency (2% [0, 5]), re-expansion pulmonary edema (1% [0, 3]), empyema (1% [0, 2]), respiratory failure (0% [0, 1]), and acute respiratory distress syndrome (ARDS; 0% [0, 1]. CONCLUSIONS: Whereas pain and fever were the most frequent complications of thoracoscopic talc insufflation, the incidence of ARDS was low. Pneumothorax, pneumonia, emphysema, prolonged air leakage, pulmonary embolism, arrythmia, re-expansion pulmonary edema, and empyema are important complications of thoracoscopic talc insufflation.

[Clinical effect of "head-nine-needle" therapy on tension headache].

OBJECTIVE: To observe the effect of the "head-nine-needle" therapy on tension headache. METHODS: A total of 150 patients with tension headache were divided into a head-nine-needle therapy group, a western medicine control group and an acupuncture control group according to the random number table, 50 cases in each one. In the head-nine-needle therapy group, the head-nine-needle therapy was adopted. In the western medicine control group, epiperisone hydrochloride tablets were prescribed for oral administration, 50 mg, three times a day as well as fluoguili hydrochloride capsules, 5 mg, once a day, taking orally before sleep. In the acupuncture control group, the routine acupuncture technique was used at Baihui (GV20), Taiyang (EX-HN5), Fengchi (GB20) and Ashi (extra), etc. The clinical effect was observed in each group. The scores of visual analogy scale (VAS) for headache severity and the scores of headache duration were assessed before and after treatment in the patients of each group. RESULTS: In comparison of the total effective rate among the groups, there was no significant difference between the head-nine-needle therapy group (48/50，96.0%) and the acupuncture control group (47/50，94.0%). The total effective rate of either of the two groups was higher than that of the western medicine control group (40/50，80.0%，P<0.05). The VAS score and the score of headache duration were reduced obviously as compared with those before treatment in each group (P<0.05), and the score was not different significantly between the head-nine-needle therapy group and the acupuncture control group (P>0.05). After 3 weeks and 4 weeks of treatment, the scores in the two acupuncture groups were all better than those in the western medicine control group (P<0.05). CONCLUSION: The "head-nine-needle" therapy achieves the obviously advantages in the alleviation of headache degree as compared with the simple western medicine and its effect is similar to the common acupuncture therapy in the patients with tension headache.

Pre-embedded cervical circular stapled anastomosis in esophagectomy.

BACKGROUND: Mechanical anastomosis is now widely used in surgery for esophageal cancer. An anastomotic fistula is still the most dangerous complication in mechanical anastomosis, especially for patients who undergo cervical anastomosis. However, due to the high anastomosis position and limited space, conventional embedding and suspension are rarely performed. This study aimed to introduce the steps of an improved embedded method in cervical circular stapled anastomosis and evaluate its efficacy in reducing complications. METHODS: In total, 31 patients who underwent minimally invasive esophagectomy were enrolled into the study. Pre-embedded cervical esophagogastrostomy with a circular stapler was adopted after thoracoscopic and laparoscopic esophagectomy for esophageal cancer. RESULTS: The results of surgical duration, blood loss, mean duration of hospitalization and operation complications such as anastomotic fistula, anastomotic stenosis and gastroesophageal reflux were recorded. The operative procedure lasted between 205-300 minutes with an average of 260.3 minutes. The postoperative recovery was good, with no complications such as anastomotic fistula, anastomotic stricture and pulmonary complication, except for two cases of gastroesophageal reflux. The postoperative hospital stay was 8-14 days with an average of 10.3 days. CONCLUSION: Our data revealed that pre-embedded cervical circular stapled anastomosis is an alternative for patients with good stomach length, which can decrease the occurrence rate of anastomotic fistula by full peripheral embedding of anastomotic stoma. KEY POINTS: This new technique can significantly reduce the risk of anastomotic leakage. This study adds further details enabling a smooth pre-embedded procedure to be performed.

Effects of exercise training on patients with lung cancer who underwent lung resection: a meta-analysis.

BACKGROUND: The efficacy of exercise training in patients with lung cancer after lung resection has not been well established yet. Therefore, we performed a meta-analysis to investigate the efficiency of exercise training in patients with lung cancer after lung resection. METHODS: Several databases were searched for eligible randomised controlled trials (RCTs). The primary outcome was quality of life, and the secondary outcomes included 6-min walk distance (6MWD), forced expiratory volume in 1 s (FEV1) and postoperative complications (POCs). Weighted mean differences (WMDs) and relative risks (RRs) with 95% confidence intervals (CIs) were calculated by random-effects model. RESULTS: Six RCTs involving 438 patients were enrolled in this meta-analysis. The pooled WMDs of the scores were 2.41 (95% CI = -5.20 to 10.02; P = 0.54) and -0.46 (95% CI = -20.52 to 19.61; P = 0.96) for the physical and mental components of the 36-item short-form scale, respectively. The pooled WMDs were 23.50 m (95% CI = -22.04 to 69.03; P = 0.31) for 6MWD and 0.03 L (95% CI = -0.19 to 0.26; P = 0.76) for FEV1. Finally, the pooled RRs were 0.79 (95% CI = 0.41 to 1.53; P = 0.49) for POCs. CONCLUSIONS: Insufficient evidence is available to support the efficacy of exercise training in patients with lung cancer after lung resection. Further studies must confirm our findings and investigate the long-term effects of exercise training on patients with lung cancer following lung resection.

ß1-and ß2-adrenoceptors in hippocampal CA3 region are required for long-term memory consolidation in rats.

The existence of ß-adrenoceptors (ARs) in the hippocampus and the importance of ß-ARs in regulating synaptic plasticity and learning/memory function are well documented. As known, ß-ARs in area cornu ammonis 1 (CA1) are involved in regulating memory consolidation. However, little is known about the functional roles of the ß-ARs subtypes, ß1- and ß2-ARs, in the hippocampal cornu ammonis 3 (CA3) region. To address this question, we firstly locally infused the ß1- or ß2-ARs antagonist into the CA3 region and observed that blockage of either ß1-AR or ß2-AR impaired long-term contextual fear memory and water-maze spatial memory. We also found that, following the contextual fear conditioning, the expression of ß1-AR in the CA3 region significantly increased, whereas ß2-AR was unchanged. Then intra-CA3 infusion of recombinant lentiviral RNAi vectors for ß1 or ß2-ARs also produced deficit in contextual memory consolidation. Taken together, the results suggested that the ß1- and ß2-ARs in the CA3 region were involved in hippocampus dependent memory consolidation.

Ultrathin cellulose nanosheet membranes for superfast separation of oil-in-water nanoemulsions.

Oily wastewater is generated in diverse industrial processes, and its treatment has become crucial due to increasing environmental concerns. Herein, novel ultrathin nanoporous membranes of cellulose nanosheets have been fabricated for separation of oil-in-water nanoemulsions. The fabrication approach is facile and environmentally friendly, in which cellulose nanosheets are prepared by freeze-extraction of a very dilute cellulose solution. The as-prepared membranes have a cellulose nanosheet layer with a cut-off of 10-12 nm and a controllable thickness of 80-220 nm. They allow ultrafast water permeation and exhibit excellent size-selective separation properties. A 112 nm-thick membrane has a water flux of 1620 l m(-2) h(-1) bar(-1) and a ferritin rejection of 92.5%. These membranes have been applied to remove oil from its aqueous nanoemulsions successfully, and they show an ultrafast and effective separation of oil-in-water nanoemulsions. The newly developed ultrathin cellulose membranes have a wide application in oily wastewater treatment, separation and purification of nanomaterials.

Reduction of glutamate release probability and the number of releasable vesicles are required for suppression of glutamatergic transmission by ß1-adrenoceptors in the medial prefrontal cortex.

The prefrontal cortex (PFC) plays a critical role in cognitive functions, including working memory, attention regulation and behavioral inhibition. Microinjection of ß1-adrenoceptor (ß1-AR) agonist into the PFC has been shown to impair PFC cognitive function. However, the underlying cellular and molecular mechanisms have not been determined yet. In the present study, we tested the hypothesis that ß1-AR mediated modulation of excitatory synaptic transmission contributes to PFC dysfunction. We found that 1) the ß1-AR agonist Dobutamine (Dobu) suppressed the amplitude evoked excitatory postsynaptic currents (eEPSCs). 2) Dobu induced a significant suppression of the frequency and amplitude of miniature EPSCs (mEPSCs). 3) Dobu-suppressed glutamate release was mediated via decreasing release probability and the number of releasable vesicles. 4) Dobu suppressed inward currents evoked by puff application of glutamate or NMDA via postsynaptic PKA-dependent pathway. The present study indicates that ß1-AR activation suppresses excitatory synaptic transmission in medial PFC (mPFC) via both pre- and post-synaptic PKA-dependent mechanisms. Our results may provide a cellular and molecular mechanism that helps explain ß1-AR-induced PFC dysfunction.

N-acetylcysteine administration is associated with reduced activation of NF-kB and preserves lung dendritic cells function in a zymosan-induced generalized inflammation model.

PURPOSE: In severe sepsis, functional impairment and decreased numbers of dendritic cells (DCs) are essential reasons for immune function paralysis, secondary organ infection, and organ failure. We investigated the effects of N-acetylcysteine (NAC) administration on protecting lung DCs function in a zymosan-induced generalized inflammation (ZIGI) model. METHODS: ZIGI was initiated in 80 Balb/c mice by intraperitoneal injection of zymosan (ZYM; 900 mg/kg). Mice were divided into 4 groups: (1) SHAM+Vehicle; (2) SHAM+NAC; (3) ZYM+Vehicle; and (4) ZYM+NAC. NAC (100 mg/kg) was administered at different time after ZYM injection. After 48 h, we assessed: lung tissue pathological changes; arterial blood gas values; purified lung DCs surface expressions of MHC-II/I-A(d) and co-stimulatory molecules CD80, CD83, and CD86; lung DCs mRNA levels of chemokine receptors CCR5 and CCR7; lung DCs apoptosis; lung DCs ultrastructure by transmission electron microscopy; lung DCs NF-kB transcription factor activity; and LPS-stimulated lung DCs in vitro production of IL-12 and IL-10 were examined. RESULTS: NAC treatment resulted in: significant improvements in ZYM-induced lung tissue damage and impaired lung function; inhibited lung DCs ZYM-induced increased expression of MHC-II/I-A(d), CD83, and CD86, but not CD80; reduced lung DCs ZYM-induced CCR5 and CCR7 mRNA levels; suppressed ZYM-induced lung DCs apoptosis; ameliorated ZYM-induced lung DCs ultrastructural abnormalities; inhibited ZYM-induced lung DCs NF-κB activity; and enhanced lung DCs production of IL-12 and inhibited their production of IL-10. CONCLUSIONS: Repeated injections of NAC during the early stage of severe sepsis effectively inhibited lung DCs activation and their apoptosis, which could preserve DCs function.

[Wedge resection and thermal cautery for malignant pleural effusion caused by lung cancer under vats].

OBJECTIVE: To discuss the treatment effect of wedge resection and thermal cautery of pleura for patients with malignant pleural effusion (MPE) caused by lung cancer under VATS. METHODS: 37 patients with MPE underwent wedge resection and thermal cautery of pleura under VATS, from June 2005 to December 2008. Postoperative tumor markers level was contrasted with the preoperative, and the control rate of pleural effusion and survival rate of the patients were compared with control group, including 25 patients undergoing intrapleural chemotherapeutics in the same period. RESULT: In the group, the control rate of pleural effusion was 100%, but 60% in control group (P = 0.005). The 1-year survival rate of the group and the control group was 78.38% and 60% respectively (P = 0.003). CEA and CA-125 were descended obviously in postoperative day 7 in the group(P = 0.002);in control group, there were no significant change of CEA and CA125 after treatment (P = 0.797). CONCLUSION: Wedge resection and thermal cautery of pleura under VATS can reduce tumor burden of patients with MPE to the maximum, and control MPE effectively and improve the quality of life for lung cancer patients with MPE.

[Early surgical treatment of bronchopleural fistula after pneumonectomy].

OBJECTIVE: To investigate the method of early surgical treatment of bronchopleural fistula after pneumonectomy. METHODS: Twelve patients (9 males and 3 females with a mean age of 58.6-/+5.7 years) with bronchopleural fistula after pneumonectomy received a reoperation within 72 h after a definite diagnosis. Empyema was found in none of the 12 cases. Fistula occurred within 4 to 17 days (8 days in average) after the operation. The fistula of the residual main bronchus was resected, and the thoracic cavity was asepticized by flushing. RESULTS: Ten patients were discharged with complete healing. One patient was discharged following open drainage with daily change of the wound dress. One patient died due to multiple organ failure. The hospital stay of the patients ranged from 18 to 49 days (31 days in average) after the reoperation. CONCLUSION: Bronchopleural fistula after pneumonectomy, in case that empyema and multiple organ failure do not occur, can be healed by closing the fistula with the stapling device in early stage. Flushing the thoracic cavity is also necessary after the reoperation.

Systematic review of clinical trials of acupuncture-related therapies for primary dysmenorrhea.

BACKGROUND: Acupuncture-related therapies might be an effective intervention for primary dysmenorrhea. OBJECTIVE: To evaluate the effects of acupuncture-related therapies for treating primary dysmenorrhea. SEARCH STRATEGY: A specified literature search was performed of the Cochrane Library, MEDLINE, EMBASE, CNKI, and CBM databases. SELECTION CRITERIA: All clinical controlled trials pertaining to acupuncture-related therapies for primary dysmenorrhea were included, and the quality of the trials was assessed. DATA COLLECTION AND ANALYSIS: Two independent reviewers were responsible for data extraction and assessment. The original data of each trial were analyzed with software (Revman 4.2), but a meta-analysis could not be carried out because of the heterogeneity of the trials. MAIN RESULTS: Thirty randomized controlled trails (RCTs) and two controlled clinical trials (CCTs) were identified. Most of the trials were of low methodologic quality (six trials were Grade B and 26 trials were Grade C). Data analysis indicated that there were conflicting results regarding whether acupuncture-related therapies were more effective than control treatments. However, there was a small, methodologic sound trial of acupuncture which suggested that acupuncture was more effective than control groups (placebo acupuncture: WMD=-0.57 and 95% CI=-0.76-0.38; standard control: WMD=-.19 and 95% CI=-0.37-0.01; visitation control: WMD=-1.04 and 95% CI=-1.28-0.80). CONCLUSIONS: Because of low methodologic quality and small sample size, there is no convincing evidence for acupuncture in the treatment of primary dysmenorrhea. There is an urgent need for randomized, blinded, placebo-controlled trials to assess the effects of acupuncture.

Beta1- and beta2-adrenoceptors in basolateral nucleus of amygdala and their roles in consolidation of fear memory in rats.

It is known that beta-adrenoceptor (AR) in the basolateral nucleus of amygdala (BLA) plays an essential role in fear memory formation. However, the cellular and subcellular distributions of beta1- and beta2-ARs in the BLA and their roles in fear memory formation are poorly understood. Here, we report that both beta1- and beta2-ARs are predominantly expressed in BLA neurons but not in astrocytes. beta1-AR is distributed in the cell membrane and cytoplasm of neurons, whereas beta2-AR is localized not only in the cell membrane and cytoplasm but also in the nucleus. Intra-BLA infusion of the beta1-AR antagonist metoprolol and atenolol or the beta2-AR antagonist ICI118551 and butoxamine produces a severe deficit in 24-h auditory fear memory, leaving 1-h memory intact. Western-blot analysis reveals that the protein level of cytoplasmic beta1-AR significantly increases 2- and 4-h postconditioning, whereas that of cytoplasmic or nuclear beta2-AR is unchanged. The present results indicate that beta1- and beta2-ARs in the BLA have differential subcellular localizations and both are required for the consolidation of auditory fear memory.

[Clinical study on the indications of 33 acupoints].

Multi-central randomized controlled method was used to scientifically verify indications of 33 acupoints and provide definite clinical basis for the indications of single acupoint. Of the 52 studies, 40 studies showed that the therapeutic effect in acupuncture observation groups were better than the control group; 11 studies showed similar therapeutic effect of the two groups, and 1 study showed the acupuncture observation group was worse than the control group. Therefore, results indicate that in a certain observation cycle, acupuncture at single acupoint have different effects on diseases.

[Review on clinical application of needling techniques in chapter Guan Zhen (Official Needling Techniques) of Ling Shu (Spiritual Pivot)].

In the present paper, more than 380 theses related with clinical application of "nine needling techniques", "twelve needling techniques" and "five needling techniques" recorded in chapter Guan Zhen (Official Needling Techniques) of Ling Shu (Spiritual Pivot) were found through retrieving the data in the internet in latest 10 years. Among the 130 theses about clinical application of "nine needling techniques", 108 involve the application of opposing needling. Of the 180 theses about clinical application of "twelve needling techniques", 95 involve the application of triple needling. Out of the 60 theses on clinical application of "five needling techniques", 37 involve the application of Hegu needling (multi-direction needling). To sum up, the above-mentioned needling techniques were mainly applied to the treatment of diseases of dermatology, surgery, pediatrics, traumatology, five sense organs, etc.. It indicates that these needling techniques are widely being used in clinical practice now. Therefore, researchers should lay the stress on the scientific methodology, rigorous research process, as well as objective analysis of the results so as to make an objective conclusion and improve the level of the research.