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1.
Respir Med ; 206: 107093, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36549515

RESUMO

BACKGROUND: Indwelling pleural catheters (IPCs) are a mainstay therapy for malignant pleural effusions (MPEs). Many patients treated with IPCs achieve pleurodesis. We aimed to identify the effect of systemic therapies for non-small cell lung cancer (NSCLC) on IPC removal in patients with associated MPEs. METHODS: We completed a retrospective cohort study of adult IPC recipients with metastatic NSCLC at the pleural effusion clinic at the Royal Alexandra Hospital from 2009 to 2020. We used logistic regression to assess the rates of IPC removal and Cox regression to assess the time to IPC removal. RESULTS: 232 patients met inclusion criteria with 248 IPCs reviewed. The overall pleurodesis rate was 42.7% with a median time to pleurodesis of 68 (IQR 38-140) days. In univariate analysis, chemotherapy (OR 1.86, CI 0.99-3.49) and epidermal growth factor receptor (EGFR) targeted therapy (OR 3.81, CI 1.86-7.79) were associated with higher rates of pleurodesis. In multivariate analysis, increased rates of pleurodesis were associated with an Eastern Cooperative Oncology Group Performance Status (ECOG PS) of ≤2 (OR 4.82, CI 2.24-10.37) and EGFR targeted therapy (OR 3.87, CI 1.80-8.32). Earlier IPC removal was associated with EGFR targeted therapy in both univariate (HR 1.84, CI 1.20-2.83) and multivariate analysis (HR 1.86, CI 1.19-2.92). CONCLUSIONS: Treatment with EGFR targeted therapy is associated with increased rates and earlier removal of IPC in patients with NSCLC in our cohort. Further large cohort studies are required to determine if this relationship persists.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Derrame Pleural Maligno , Adulto , Humanos , Derrame Pleural Maligno/terapia , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Estudos Retrospectivos , Talco , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Cateteres de Demora/efeitos adversos , Pleurodese , Drenagem , Imunoterapia
2.
Medicina (Kaunas) ; 58(12)2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36557044

RESUMO

Background and Objectives: This study was designed to evaluate platelet-rich plasma (PRP) as a method of pleurodesis in a rabbit model. Pleurodesis with PRP was compared against the gold-standard use of talc. The secondary evaluation assessed the ideal time for achieving pleurodesis. Materials and Methods: 25 healthy New Zealand white rabbits were assigned to three groups, as follows: 12 animals in the first and second groups, as well as one animal with no intervention in the final group, which was used as a control. The talc pleurodesis group (baseline) underwent pleurodesis with sterile talc, which is the gold-standard sclerosing agent used for pleurodesis. The PRP group underwent pleurodesis using autologous PRP. The last group had one rabbit with no intervention. A total of 12 rabbits (n = 6 for the talc pleurodesis group and n = 6 for the PRP group) were sacrificed 3 days (72 h) after the intervention, and 12 rabbits (n = 6 for the talc pleurodesis group and n = 6 for the PRP group) were sacrificed 6 days (144 h) after the intervention. In both the talc and PRP group, FBC and CRP were measured before the intervention and in 3 or 6 days afterwards, respectively. The pleura and the lungs were evaluated histopathologically. Results: Macroscopically, there were no statistically significant differences between the two groups. In terms of microscopic findings, there were no statistically significant differences in inflammatory reactions provoked in the visceral and parietal pleura between the PRP and talc. In addition, with talc pleurodesis, a foreign-body reaction was observed in about 50% of the cases, which was not observed with PRP. In terms of inflammation between 3 and 6 days, there were no statistically significant differences with PRP, there was only a statistically significant difference between 3 and 6 days regarding the parietal pleura in the talc group. Conclusions: The instillation of autologous PRP in the pleural cavity shows promise in achieving pleurodesis. The efficacy of PRP as a pleurodesis agent should be examined further.


Assuntos
Plasma Rico em Plaquetas , Pleurodese , Coelhos , Animais , Pleurodese/métodos , Talco , Pleura , Pulmão
3.
Risk Anal ; 42(10): 2140-2141, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36377134

RESUMO

Holton and colleagues have performed a risk assessment after measuring asbestos released from several samples of facial makeup. Unfortunately, it is not possible to interpret or generalize their findings because the authors have not described the source(s) of the talc tested or the asbestos concentrations of the samples. The concentration of amphiboles varies widely between sources, and the authors are urged to divulge the locations of the ore bodies providing the talc for their samples, as well as the asbestos concentration of the samples, so that the results may be interpreted and possibly generalized.


Assuntos
Amianto , Talco , Talco/análise , Amianto/toxicidade , Amianto/análise , Amiantos Anfibólicos/toxicidade , Amiantos Anfibólicos/análise , Medição de Risco
4.
Risk Anal ; 42(10): 2142-2144, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36377135

RESUMO

We appreciate the opportunity to respond to the comments of the letter writer. The writer states in his Letter to the Editor that the findings in our publication are not interpretable and/or cannot be generalized due to the lack of understanding of the source mine and bulk content of the cosmetic talc used in the facial makeups. In brief, we performed an exposure simulation study using established industrial hygiene methods, planned and conducted by Certified Industrial Hygienists (CIHs), to assess asbestos exposures during the use of facial makeups that were found to contain very low levels of asbestos below the conventional detection limits of X-ray diffraction and polarized light microscopy. In total, 54 personal air samples and 72 area samples were collected from six different products. Out of the 126 samples collected and analyzed, asbestos was only found in eight samples (five personal samples and three area samples). A 95th percentile 24-h time-weighted average (TWA) result of 0.00008 fibers/cubic centimeter was calculated based on censored data and an assumed three applications per day. We believe these results may be of utility to understand the risk of low-level asbestos content in facial makeups regardless of source or bulk content, as described in our study, and do not find the writer's assertion of generalizability or interpretability to be compelling reasons not to apply our results, as is, for prospective purposes.


Assuntos
Amianto , Exposição Ocupacional , Estudos Prospectivos , Talco , Indústrias
5.
Support Care Cancer ; 30(12): 9833-9840, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36357795

RESUMO

PURPOSE: In many cases, pleurodesis is the only treatment available for the treatment of malignant pleural effusion (MPE), and in the case of excessive daily pleural effusion, its therapeutic effect may be reduced. In this study, we intended to investigate the therapeutic effects and safety of octreotide in patients with MPE undergoing pleurodesis with talc powder. METHODS: This study was a single-center, placebo-controlled, and triple-blind, randomized trial designed to investigate the therapeutic effects and safety of octreotide in patients with MPE in Tehran, Iran, from March 2020 to March 2021. Patients with MPE were randomly divided into two parallel groups, one receiving subcutaneous octreotide (3 doses of 50 µg/day) and the other receiving placebo before and after pleurodesis with talc powder. The patients were followed up with a chest X-ray 1 week, 1 month, and 3 months later. The primary outcome measures of this study were the amount of discharge from the chest tube before and after pleurodesis and the length of hospital stay. Treatment failure, relapse, pleural effusion analysis, and side effects were considered the secondary outcome measures of the study. RESULTS: A total of 46 patients (23 in the octreotide group and 23 in the placebo group) with MPE was included in this study. Our findings demonstrated that adjunctive treatment with subcutaneous octreotide increases the efficacy of pleurodesis with talc powder. We showed that compared to the placebo group, patients in the octreotide group have significantly decreased production of pleural effusion both before (p = 0.009) and after (p = 0.002) pleurodesis. Octreotide treatment led to a decreased hospital stay (p = 0.004 before pleurodesis and p = 0.001 after pleurodesis) and reduced treatment failure (p = 0.022). However, octreotide did not decrease the relapse at 1-week, 1-month, and 3-month follow-ups. Moreover, octreotide did not affect pleural effusion parameters compared to placebo. Ultimately, our results also showed that treatment with octreotide was safe and did not have significant side effects. CONCLUSION: Our findings demonstrated that adjunctive treatment with subcutaneous octreotide increases the efficacy of pleurodesis with talc powder without any significant side effects. Future studies with a larger sample size and longer follow-up time can confirm the results of this study and also determine the appropriate dose of octreotide for the treatment of MPE. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT20210915052492N1. Registered 11 October 2021 - Retrospectively registered, https://www.irct.ir/trial/58776 .


Assuntos
Derrame Pleural Maligno , Pleurodese , Humanos , Pleurodese/métodos , Derrame Pleural Maligno/tratamento farmacológico , Talco , Octreotida/efeitos adversos , Pós , Irã (Geográfico) , Recidiva Local de Neoplasia/tratamento farmacológico , Resultado do Tratamento
6.
Molecules ; 27(22)2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36431780

RESUMO

Essential oils (EOs) are naturally occurring volatile aromatic compounds extracted from different parts of plants. They are made up of components like terpenes, phenols, etc., and are chemically unstable and susceptible to oxidative deterioration, leading to reduced shelf-life and overall degradation of the product. Encapsulation of EOs in a matrix can prevent degradation of the active ingredient and improve the shelf-life. In this paper, we report encapsulation of Dhavana oil (Artemisia pellen) in a modified starch matrix using a spray-drying technique. Physico-chemical properties of neat and encapsulated Dhavana oil were studied. We selected two powder bases: CaCO3 and TALC and, loaded neat and encapsulated Dhavana oil in it, studied their stability and interaction with the base matrices at 3 °C, 22 °C and 45 °C up to 2 months under closed conditions and one week at 22 °C and 45 °C under open condition. Thermal degradation pattern was studied for neat and encapsulated Dhavana oil and modified starch. Release of primary active component of neat and encapsulated Dhavana oil from the base matrices was evaluated with GCMS. Stability study and release mechanism were elucidated to understand the release pattern in different base powders under similar conditions. Retention of hydroxydhavanone was found to be better in TALC than CaCO3, and therefore, the former can be considered a suitable base matrix for developing a stable powder formulation with an optimum release of the oil. Dhavana oil is known for its anti-microbial activity, and hence, neat and encapsulated Dhavana oil was tested on different bacterial and fungal strains. The encapsulated oil depicted good anti-microbial efficacy against various bacterial and fungal strains, which is a step forward for developing anti-microbial formulations. Thus, the reported work will provide helpful information on cosmetic formulation and, therefore, be useful for perfumery, food, and cosmetic industries.


Assuntos
Anti-Infecciosos , Óleos Voláteis , Pós , Talco , Anti-Infecciosos/farmacologia , Óleos Voláteis/farmacologia , Óleos Voláteis/química , Antibacterianos , Amido/química
7.
Trans Am Clin Climatol Assoc ; 132: 44-60, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36196171

RESUMO

The first NHLBI Clinical Trials Research Network was the Asthma Clinical Research Network (ACRN 1), which was born in 1993 to perform multiple controlled clinical trials for asthma: "… dispassionately examine new & existing therapies for asthma" and "… rapidly communicate findings to medical community," and therefore, to perform clinical trials drug companies could not or would not do. Among the many areas studied by the ACRN and its successor networks, through 2019, was how to effectively and safely use long-acting beta-agonists and to find novel alternatives for them. In its Tiotropium Add-On Trial (TALC) trial, the ACRN demonstrated that tiotropium as add on-therapy to inhaled corticosteroids (ICS) was effective and non-inferior to long-acting beta-agonist add on-therapy. During the lifetime of the clinical trial networks (1993-2020), 71 manuscripts including 25 major clinical trials were published, many which have laid the groundwork for precision approaches for asthma therapy and the now ongoing PrecISE Asthma Network.


Assuntos
Asma , National Heart, Lung, and Blood Institute (U.S.) , Administração por Inalação , Corticosteroides/uso terapêutico , Adulto , Asma/tratamento farmacológico , Quimioterapia Combinada , Humanos , Assistência ao Paciente , Medicina de Precisão , Talco/uso terapêutico , Brometo de Tiotrópio/uso terapêutico , Estados Unidos
8.
Appl Opt ; 61(19): 5790-5798, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36255814

RESUMO

Excessive illegal addition of talc in flour has always been a serious food safety issue. To achieve rapid detection of the talc content in flour (TCF) by near-infrared spectroscopy (NIRS), this study used a Fourier transform near-infrared spectrometer technique. The identification of efficient spectral feature wavelength selection (FWS), such as backward interval partial-least-square (BiPLS), competitive adaptive reweighted sampling (CARS), hybrid genetic algorithm (HGA), and BiPLS combined with CARS; BiPLS combined with HGA; and CARS combined with HGA, was also discussed in this paper, and the corresponding partial-least-square regression models were established. Comparing with whole spectrum modeling, the accuracy and efficiency of regressive models were effectively improved using feature wavelengths of TCF selected by the above algorithms. The BiPLS, combined with HGA, had the best modeling performance; the determination coefficient, root-mean-squared error (RMSE), and residual predictive deviation of the validation set were 0.929, 1.097, and 3.795, respectively. BiPLS combined with CARS had the best dimensionality reduction effect. Through the FWS by BiPLS combined with CARS, the number of modeling wavelengths decreased to 72 from 1845, and the RMSE of the validation set was reduced by 11.6% compared with the whole spectra model. The results showed that the FWS method proposed in this paper could effectively improve detection accuracy and reduce modeling wavelength variables of quantitative analysis of TCF by NIRS. This provides theoretical support for TCF rapid detection research and development in real-time.


Assuntos
Farinha , Espectroscopia de Luz Próxima ao Infravermelho , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Talco , Análise dos Mínimos Quadrados , Algoritmos
9.
Inhal Toxicol ; 34(13-14): 380-398, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36227690

RESUMO

This study characterizes airborne asbestos exposures resulting from the adult application of cosmetic talc body powders spiked with known concentrations of tremolite. Raw talc ores were spiked with 0.005% and 0.1% asbestiform or non-asbestiform tremolite. Personal samples were collected during 16 simulated events, including puff and shaker application and associated clean-up activities. Airborne fiber levels (PCM) were not significantly different for simulations involving talc spiked with asbestiform and non-asbestiform tremolite (p = 0.6104). For application and clean-up of talc spiked with 0.005% asbestiform tremolite, 2 of 24 (8.3%) samples were above the LOD for TEM (0.003 f/cc). For application of talc spiked with 0.1% asbestiform tremolite, 21 of 24 (87.5%) were above the LOD for TEM. The corresponding mean PCME asbestos concentrations were 0.016 f/cc for puff and shaker for samples collected in the first 15 min, 0.002 f/cc for puff and 0.004 f/cc for shaker in the second 15 min, and 0.005 f/cc for puff and 0.013 f/cc for shaker for the full 30 min. Mean PCME concentrations for samples collected during clean-up following application of talc spiked with 0.1% asbestiform tremolite were 0.003 f/cc for samples collected in the first 15 min following puff application, 0.005 f/cc for samples collected in the second 15 min following shaker application, and 0 f/cc for the remaining clean-up samples. Using the EPA's exposure factors, we determined the range of cumulative asbestiform fiber exposures that would result from product use, assuming asbestiform tremolite was present at 0.1%.


Assuntos
Amianto , Cosméticos , Exposição Ocupacional , Talco , Amiantos Anfibólicos , Exposição Ocupacional/análise
10.
Front Public Health ; 10: 989111, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36304243

RESUMO

We conducted a systematic review to assess the potential pulmonary carcinogenicity of inhaled talc in humans. Our systematic review methods adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and incorporated aspects from the US Institute of Medicine (IOM) and several United States (US) Environmental Protection Agency (EPA) frameworks for systematic reviews. A comprehensive literature search was conducted. Detailed data abstraction and study quality evaluation, adapting the US Toxic Substances Control Act (TSCA) framework, were central to our analysis. The literature search and selection process identified 23 primary studies that assessed exposure to talc and pulmonary cancer risks in humans (n = 19) and animals (n = 3). Integrating all streams of evidence according to the IOM framework yielded classifications of suggestive evidence of no association between inhaled talc and lung cancer and pleural mesothelioma at human-relevant exposure levels.


Assuntos
Talco , Animais , Estados Unidos , Humanos , Talco/toxicidade
11.
Fertil Steril ; 118(5): 960-969, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36182623

RESUMO

OBJECTIVE: To evaluate the associations between 10 well-established ovarian cancer risk factors and risk of ovarian cancer among women with vs. without endometriosis. DESIGN: Pooled analysis of 9 case-control studies in the Ovarian Cancer Association Consortium. SETTING: Population-based. PATIENT(S): We included 8,500 women with ovarian cancer, 13,592 control women. INTERVENTION(S): Ten well-established ovarian cancer risk factors. MAIN OUTCOME MEASURE(S): Risk of ovarian cancer for women with and without endometriosis. RESULT(S): Most risk factor-ovarian cancer associations were similar when comparing women with and without endometriosis, and no interactions were statistically significant. However, body mass index (BMI) 25-<30 kg/m2 was associated with increased ovarian cancer risk among women with endometriosis (odds ratio [OR] = 1.27, 95% confidence interval [CI] 1.00-1.60), but not associated with the risk among women without endometriosis (OR = 0.97; 95% CI, 0.91-1.05) when compared with BMI 18.5-<25 kg/m2; an increased risk was observed for a BMI ≥30 kg/m2, although there was little difference comparing women with endometriosis (OR = 1.21; 95% CI, 0.94-1.57) to women without (OR = 1.13; 95% CI, 1.04-1.22) (P-interaction = .51). Genital talcum powder use and long-term menopausal estrogen-only therapy use showed increased ovarian cancer risk, but risk appeared greater for those with endometriosis vs. those without (genital talcum powder: OR = 1.38; 95% CI, 1.04-1.84 vs. OR = 1.12; 95% CI, 1.01-1.25, respectively; ≥10 years of estrogen-only therapy: OR = 1.88; 95% CI, 1.09-3.24 vs. OR = 1.42; 95% CI, 1.14-1.76, respectively); neither of these interactions were statistically significant (P-interaction = .65 and P-interaction = .96, respectively). CONCLUSION(S): The associations between ovarian cancer and most risk factors were similar among women with and without endometriosis. However, there was some suggestion of differences by endometriosis status for BMI, menopausal hormone therapy use, and genital talcum powder use, highlighting the complexity of ovarian cancer etiology.


Assuntos
Endometriose , Neoplasias Ovarianas , Feminino , Humanos , Endometriose/diagnóstico , Endometriose/epidemiologia , Endometriose/induzido quimicamente , Talco/efeitos adversos , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/etiologia , Carcinoma Epitelial do Ovário , Fatores de Risco , Estudos de Casos e Controles , Estrogênios
12.
Arch Microbiol ; 204(10): 629, 2022 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-36115881

RESUMO

This work aims at exploring an antagonistic actinobacterial strain isolated from the roots of Ziziphus lotus in bioformulation processes and the biocontrol of Rhizoctonia solani damping-off of tomato seedlings. The strain Streptomyces caeruleatus ZL-2 was investigated for the principal in vitro biocontrol mechanisms and then formulated in three different biofungicides: wettable talcum powder (WTP), sodium alginate propagules (SAP) and clay sodium alginate propagules (CAP). Compared to a marketed control products (Serenade® and Acil 060FS®), the formulated biofungicides were investigated against the R. solani damping-off of tomato cv. Aïcha seedlings. The strain ZL-2 produced chitinases, cellulases, ß-1,3-glucanases, cyanhydric acid and siderophores. It also showed strong antagonistic effect on the mycelial growth of R. solani. Bioautographic and HPLC analysis revealed the production of a single or several co-migrating antifungal compounds. The biofungicide WTP presented an attractive biocontrol effect by significantly reducing the disease severity index (DSI) compared to untreated seeds. No significant differences were obtained compared to the chemical treatment with Acil 060FS®. The viability of spores and biocontrol efficacy of the WTP were confirmed after 1-year storage. Strain ZL-2 has never been reported in the bioformulation of active biofungicides against Rhizoctonia solani damping-off and this work opens up very attractive prospects in the fields of biocontrol and crop improvement.


Assuntos
Celulases , Quitinases , Alginatos , Antifúngicos/farmacologia , Argila , Nitrazepam , Doenças das Plantas/microbiologia , Doenças das Plantas/prevenção & controle , Rhizoctonia , Plântula/microbiologia , Sideróforos , Esporos Fúngicos , Streptomyces , Talco
13.
J Pharm Sci ; 111(11): 2943-2954, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35973604

RESUMO

Titanium dioxide (in the form of E171) is a ubiquitous excipient in tablets and capsules for oral use. In the coating of a tablet or in the shell of a capsule the material disperses visible and UV light so that the contents are protected from the effects of light, and the patient or caregiver cannot see the contents within. It facilitates elegant methods of identification for oral solid dosage forms, thus aiding in the battle against counterfeit products. Titanium dioxide ensures homogeneity of appearance from batch to batch fostering patient confidence. The ability of commercial titanium dioxide to disperse light is a function of the natural properties of the anatase polymorph of titanium dioxide, and the manufacturing processes used to produce the material utilized in pharmaceuticals. In some jurisdictions E171 is being considered for removal from pharmaceutical products, as a consequence of it being delisted as an approved colorant for foods. At the time of writing, in the view of the authors, no system or material which could address both current and future toxicological concerns of Regulators and the functional needs of the pharmaceutical industry and patients has been identified. This takes into account the assessment of materials such as calcium carbonate, talc, isomalt, starch and calcium phosphates. In this paper an IQ Consortium team outlines the properties of titanium dioxide and criteria to which new replacement materials should be held.


Assuntos
Excipientes , Talco , Carbonato de Cálcio , Aditivos Alimentares/química , Humanos , Amido , Comprimidos , Titânio/química
14.
Clinics (Sao Paulo) ; 77: 100098, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36041370

RESUMO

OBJECTIVE: Empyema is a complication of talc-pleurodesis that may lead to further surgical intervention and death. Therefore, the present study's objective was to identify the risk factors for the development of post-pleurodesis empyema after talc slurry pleurodesis in order to better select patients for this procedure and minimize its morbidity. METHODS: Patients with malignant pleural effusion who underwent talc slurry pleurodesis at the present institution from January 2018 to January 2020 were retrospectively analyzed. Post-pleurodesis empyema was defined as pleural infection up to 30 days after pleurodesis. Using Cox regression analysis, significant prognostic factors for the development of empyema were examined. RESULTS: Of the 86 patients identified for inclusion in the study, 62 were women (72%). Their mean age was 56.3±12.6 years. The median pleural drainage time was 9 days, and 20 patients (23.3%) developed empyema. In the univariate analysis, both drainage time (p = 0.038) and the use of antibiotics prior to pleurodesis (p < 0.001) were risk factors for pleural empyema. Multivariate analysis also identified the use of antibiotics as an independent risk factor (Odds Ratio [OR] 9.81; 95% Confidence Interval [95% CI] 2.87‒33.54). Although the pulmonary expansion was not associated with empyema in the multivariate analysis, patients with less than 50% pulmonary expansion had a 4.5-times increased risk of empyema (95% CI 0.90‒22.86; p = 0.067), and patients with 50‒70% pulmonary expansion had a 3.8-times increased risk of empyema (95% CI 0.98‒15; p = 0.053) after pleurodesis. CONCLUSION: The study suggests that antibiotic therapy prior to talc slurry pleurodesis may increase the risk of developing empyema. Furthermore, pleurodesis should be considered with caution in patients with long-duration chest tube placement and incomplete lung expansion.


Assuntos
Empiema Pleural , Derrame Pleural Maligno , Adulto , Idoso , Antibacterianos , Empiema Pleural/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/terapia , Pleurodese/efeitos adversos , Pleurodese/métodos , Estudos Retrospectivos , Fatores de Risco , Talco/efeitos adversos
15.
Front Public Health ; 10: 920032, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35903380

RESUMO

Inhaled particles that are poorly soluble or insoluble and of low toxicity ("poorly soluble low toxicity" or "PSLT" particles), can accumulate in the lung and at lung overload levels induce lung cancers in rats. The question of whether PSLT particles increase lung cancer risk in humans is complicated by large differences between rats and humans and the relatively large particle doses administered in animal studies even when compared with heavy human occupational exposures. We review the findings of epidemiological studies on occupational exposure to each of three different PSLT particles (carbon black, talc and taconite). The epidemiological evidence indicates that at even very high occupational exposure levels at which non-malignant respiratory diseases including pneumoconiosis and even talcosis are observed, lung cancer risks appear not to be elevated. Although positive human cancer risks might be predicted based on extrapolation from overload doses in rats to relevant exposures in humans, the epidemiological "reality check" based on the three examples indicates that these PSLT particles are unlikely to increase lung cancer risk in humans even at high occupational levels of exposure. Therefore, we propose that careful evaluation of the epidemiological evidence can serve as a "reality check" for human risk assessment and help balance the risk evaluation process.


Assuntos
Neoplasias Pulmonares , Exposição Ocupacional , Animais , Humanos , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/epidemiologia , Exposição Ocupacional/efeitos adversos , Ratos , Medição de Risco , Fuligem/toxicidade , Talco/toxicidade
16.
Cir Esp (Engl Ed) ; 100(11): 673-683, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35667609

RESUMO

This article summarizes the clinical guidelines for the diagnosis and treatment of malignant pleural effusion (MPE) sponsored by the Spanish Society of Thoracic Surgery (SECT). Ten clinical controversies were elaborated under the methodology of PICO (Patient, Intervention, Comparison, Outcome) questions and the quality of the evidence and grading of the strength of the recommendations was based on the GRADE system. Immunocytochemical and molecular analyses of pleural fluid may avoid further invasive diagnostic procedures. Currently, the definitive control of MPE can be achieved either by pleurodesis (talc poudrage or slurry) or the insertion of a indwelling pleural catheter (IPC). It is likely that the combination of both techniques (i.e., thoracoscopy with talc poudrage and insertion of a IPC, or instillation of talc slurry through a IPC) will have a predominant role in the future therapeutic management.


Assuntos
Derrame Pleural Maligno , Cirurgia Torácica , Humanos , Derrame Pleural Maligno/cirurgia , Derrame Pleural Maligno/tratamento farmacológico , Talco/uso terapêutico , Pleurodese/métodos , Cateteres de Demora
17.
Thorac Cancer ; 13(15): 2158-2163, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35748347

RESUMO

BACKGROUND: The objective of this nationwide, registry-based study was to compare the two most frequently used procedures for the palliative treatment of a malignant pleural effusion (MPE) and to evaluate differentiated indications for these two procedures. METHODS: This was a retrospective observational study based on data of the "PLEURATUMOR" registry of the German Society for Thoracic Surgery. Patients who were documented in the period from January 2015 to November 2021 and had video-assisted thoracic surgery (VATS) talc pleurodesis or implantation of an indwelling pleural catheter (IPC) were included. RESULTS: A total of 543 patients were evaluated. The majority suffered from secondary pleural carcinomatosis (n = 402; 74%). VATS talc pleurodesis (n = 361; 66.5%) was performed about twice as often as IPC implantation (n = 182; 33.5%). The duration of surgery was significantly shorter in IPC-patients with 30 min compared to VATS talc pleurodesis (38 min; p = 0.000). Postoperative complication rate was 11.8% overall and slightly higher after VATS talc pleurodesis (n = 49; 13.6%) than after IPC implantation (n = 15; 8.2%). After VATS talc pleurodesis patients were hospitalized significantly longer compared to the IPC group (6 vs. 3.5 days; p = 0.000). There was no significant difference in postoperative wound infections between the groups (p = 0.10). The 30-day mortality was 7.9% (n = 41). CONCLUSION: The implantation of an IPC can significantly shorten the duration of surgery and the hospital stay. For this reason, the procedure should be matched with the patient's expectations preoperatively and the use of an IPC should be considered not only in the case of a trapped lung.


Assuntos
Derrame Pleural Maligno , Cateteres de Demora , Humanos , Cuidados Paliativos , Derrame Pleural Maligno/cirurgia , Pleurodese/métodos , Talco/uso terapêutico , Resultado do Tratamento
18.
Trials ; 23(1): 530, 2022 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-35761341

RESUMO

INTRODUCTION: Malignant pleural effusions (MPEs) are common. MPE causes significant breathlessness and impairs quality of life. Indwelling pleural catheters (IPC) allow ambulatory drainage and reduce hospital days and re-intervention rates when compared to standard talc slurry pleurodesis. Daily drainage accelerates pleurodesis, and talc instillation via the IPC has been proven feasible and safe. Surgical pleurodesis via video-assisted thoracoscopic surgery (VATS) is considered a one-off intervention for MPE and is often recommended to patients who are fit for surgery. The AMPLE-3 trial is the first randomised trial to compare IPC (±talc pleurodesis) and VATS pleurodesis in those who are fit for surgery. METHODS AND ANALYSIS: A multi-centre, open-labelled randomised trial of patients with symptomatic MPE, expected survival of ≥ 6 months and good performance status randomised 1:1 to either IPC or VATS pleurodesis. Participant randomisation will be minimised for (i) cancer type (mesothelioma vs non-mesothelioma); (ii) previous pleurodesis (vs not); and (iii) trapped lung, if known (vs not). Primary outcome is the need for further ipsilateral pleural interventions over 12 months or until death, if sooner. Secondary outcomes include days in hospital, quality of life (QoL) measures, physical activity levels, safety profile, health economics, adverse events, and survival. The trial will recruit 158 participants who will be followed up for 12 months. ETHICS AND DISSEMINATION: Sir Charles Gairdner and Osborne Park Health Care Group (HREC) has approved the study (reference: RGS356). Results will be published in peer-reviewed journals and presented at scientific meetings. DISCUSSION: Both IPC and VATS are commonly used procedures for MPE. The AMPLE-3 trial will provide data to help define the merits and shortcomings of these procedures and inform future clinical care algorithms. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ACTRN12618001013257 . Registered on 18 June 2018. PROTOCOL VERSION: Version 3.00/4.02.19.


Assuntos
Derrame Pleural Maligno , Cateteres de Demora/efeitos adversos , Drenagem/métodos , Humanos , Estudos Multicêntricos como Assunto , Derrame Pleural Maligno/complicações , Derrame Pleural Maligno/terapia , Pleurodese/efeitos adversos , Pleurodese/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Talco , Cirurgia Torácica Vídeoassistida/efeitos adversos
19.
Int J Mol Sci ; 23(10)2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35628368

RESUMO

Xanthomonas oryzae pv. oryzae (Xoo) strains that cause bacterial leaf blight (BLB) limit rice (Oryza sativa) production and require breeding more resistant varieties. Transcription activator-like effectors (TALEs) activate transcription to promote leaf colonization by binding to specific plant host DNA sequences termed effector binding elements (EBEs). Xoo major TALEs universally target susceptibility genes of the SWEET transporter family. TALE-unresponsive alleles of clade III OsSWEET susceptibility gene promoter created with genome editing confer broad resistance on Asian Xoo strains. African Xoo strains rely primarily on the major TALE TalC, which targets OsSWEET14. Although the virulence of a talC mutant strain is severely impaired, abrogating OsSWEET14 induction with genome editing does not confer equivalent resistance on African Xoo. To address this contradiction, we postulated the existence of a TalC target susceptibility gene redundant with OsSWEET14. Bioinformatics analysis identified a rice locus named ATAC composed of the INCREASED LEAF INCLINATION 2 (ILI2) gene and a putative lncRNA that are shown to be bidirectionally upregulated in a TalC-dependent fashion. Gain-of-function approaches with designer TALEs inducing ATAC sequences did not complement the virulence of a Xoo strain defective for SWEET gene activation. While editing the TalC EBE at the ATAC loci compromised TalC-mediated induction, multiplex edited lines with mutations at the OsSWEET14 and ATAC loci remained essentially susceptible to African Xoo strains. Overall, this work indicates that ATAC is a probable TalC off-target locus but nonetheless documents the first example of divergent transcription activation by a native TALE during infection.


Assuntos
Oryza , Efetores Semelhantes a Ativadores de Transcrição , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Resistência à Doença/genética , Suscetibilidade a Doenças , Regulação da Expressão Gênica de Plantas , Oryza/metabolismo , Melhoramento Vegetal , Doenças das Plantas/genética , Doenças das Plantas/microbiologia , Proteínas de Plantas/genética , Proteínas de Plantas/metabolismo , Talco/metabolismo , Efetores Semelhantes a Ativadores de Transcrição/metabolismo , Xanthomonas
20.
Cir Esp (Engl Ed) ; 100(4): 209-214, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35534138

RESUMO

BACKGROUND: Pleurodesis is a common technique for treating the accumulation of air or liquid in the pleural space caused by pneumothorax or pleural effusion, it is based on the bounding of pleural layers through induced inflammatory lesions. There are several pleurodesis procedures. OBJECTIVES: To test and describe the inflammatory effect of hyperthermia on the pleural and peritoneal mesothelia of rats, with the aim of testing the effectiveness of this process for inducing pleurodesis. METHODS: 35 Sprague-Dawley (male/female) rats were randomized into four treatment groups: Group A (Talc, 10 individuals); group B (control, 5 individuals); group C (hyperthermic isotonic saline, 10 individuals); and group D (filtrate air at 50°, 10 individuals). Inflammatory effect of hyperthermia was the primary outcome parameter. RESULTS: In the talc group, minimal adhesions between both pleural and peritoneal layers were observed in seven rats. Talc produced peritoneal mesothelium inflammation and fibrosis associated to foreign body giant cells in 80% (8/10) of the sample. Furthermore, clear evidence of a granulomatous foreign-body reaction was detected. No macroscopic and/or microscopic damage was registered in the remaining three groups (control, hyperthermic, and filtrate air). CONCLUSIONS: Talc is an excellent method for producing pleuro-peritoneal inflammatory lesions. On the contrary, hyperthermia apparently does not induce the macroscopic and microscopic damage that is required for efficient pleurodesis. Therefore, hyperthermia should not be used for pleurodesis procedures.


Assuntos
Hipertermia Induzida , Pleurodese , Animais , Feminino , Humanos , Masculino , Pleura/patologia , Pleurodese/métodos , Ratos , Ratos Sprague-Dawley , Talco
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