甘露聚糖肽与高聚生治疗恶性胸腔积液的疗效比较

目的研究甘露聚糖肽与高聚生治疗恶性胸腔积液的疗效。方法 50例恶性胸腔积液患者随机分为两组,分别向胸腔内注入甘露聚糖肽、高聚生治疗,观察两组毒副反应,评价比较二者的有效率。结果两组毒副反应轻微,主要为消化道反应;甘露聚糖肽组治疗有效率52%,高聚生组治疗有效率为80%,两组比较差异有统计学意义。结论胸腔内注入甘露聚糖肽与高聚金葡素对恶性胸腔积液的治疗安全、有效,高聚金葡素的疗效高于甘露聚糖肽。     

高聚金葡素联合博来霉素胸腔内注射治疗恶性胸腔积液42例临床分析

目的观察高聚金葡素联合博来霉素治疗恶性胸腔积液的疗效和不良反应。方法经病理检验确诊为肺癌且出现恶性胸腔积液的患者作为研究对象，42例治疗组将静脉导管置入胸腔内引流，尽量引流干净后，注入高聚金葡素20ml、博来霉素40mg，如疗效不佳，第二周重复一次；对照组采用同样的引流方式引流胸腔积液，仅注入博来霉素40mg。结果治疗组42例有效率为83．3％，对照组30例有效率为60．0％，P〈0．05，差异有统计学意义。两组不良反应均少见，生活质量有明显提高。结论高聚金葡素联合博来霉素治疗恶性胸腔积液有较好的疗效，不良反应轻，患容易耐受，特别适宜于老龄患者。     

高聚金葡素与卡铂联合治疗恶性胸腔积液疗效观察

目的观察高聚金葡素与卡铂联合治疗恶性胸腔积液的疗效.方法治疗组21例采用高聚金葡素与卡铂胸膜腔灌注;对照组10例单用卡铂灌注.结果治疗组胸腔积液减少的有效率为86%,对照组有效率为50%(P＜0.05);胃肠道反应及白细胞下降率低于对照组.结论高聚金葡素与卡铂联合用药治疗恶性胸腔积液疗效高,副作用小.     

胸膜固定术治疗肺癌并发恶性胸腔积液的疗效分析

目的回顾性分析胸膜腔内注入顺铂、高聚金葡素、平阳霉素、胞必佳、肿瘤坏死因子治疗肺癌并发恶性胸腔积液(MPE)的疗效及影响因素。方法对我院2002至2009年确诊肺癌并发MPE共125例患者的临床资料进行分析。结果顺铂组有效率为81.82%,高聚金葡素组为61.90%,平阳霉素组为60.53%,胞必佳组为55.56%,肿瘤坏死因子组为46.67%。除高聚金葡素组外,顺铂组疗效明显高于其他3组(P0.05)。单因素分析显示,疗效受全身应用糖皮质激素、胸水引流方式、胸水部位影响。结论胸膜固定术是治疗肺癌并发MPE的有效方法 ,顺铂疗效最佳。闭式引流较胸穿抽液疗效高,单侧胸水较双侧胸水疗效高(P0.05),全身应用糖皮质激素降低疗效(P0.05)。     

博莱霉素联合局部热疗治疗恶性胸腔积液的临床观察

目的观察博莱霉素联合局部热疗治疗非小细胞肺癌(NSCLC)恶性胸腔积液的临床疗效。方法将50例NSCLC恶性胸腔积液的患者随机分为两组,采用胸腔穿刺术置入中心静脉导管引流胸腔积液,待排尽胸腔积液后,对照组给予胸腔灌注博莱霉素,实验组在对照组的基础上给予患者局部热疗,比较两组治疗情况、毒副反应及生活质量改善情况。结果两组患者治疗后,实验组患者的生活质量KPS评分及控制胸水的总有效率均明显高于对照组(P0.05),且不良反应明显少于对照组(P0.05)。结论博莱霉素联合局部热疗治疗NSCLC恶性胸腔积液具有协同作用,值得临床推广。     

山莨菪碱、普鲁卡因联合氟尿嘧啶治疗恶性胸腔积液疗效观察

目的 观察山莨菪碱、普鲁卡因联合氟尿嘧啶治疗恶性胸腔积液的疗效和不良反应.方法 20例恶性胸腔积液患者随机分为观察组和对照组,两组抽尽胸腔积液后,观察组胸腔注入山莨菪碱、普鲁卡因和氟尿嘧啶,对照组胸腔仅注入氟尿嘧啶.隔日1次,共用4次后观察疗效.结果 观察组总有效率90%,对照组总有效率50%,两组比较差异有统计学意义(P＜0.05).结论 山莨菪碱、普鲁卡因联合氟尿嘧啶治疗恶性胸腔积液疗效满意值得临床推广.     

博莱霉素、丝裂霉素、香菇多糖治疗恶性胸腔积液的临床研究

目的比较三种不同药物治疗恶性胸腔积液的有效性及副作用。方法选取2012年7月到2014年6月,恶性胸腔积液患者93例,先行胸腔中心静脉置管穿刺及积液引流后,采用向腔内注射博莱霉素、丝裂霉素、香菇多糖三种药物治疗恶性胸腔积液;B超评价治疗效果;为减轻不良反应,增加患者的耐受度,注射前注入2%利多卡因5 ml。结果博莱霉素组与香菇多糖组有效率分别为84.37%与87.1%,两组间没有显著性差异(P0.05),丝裂霉素有效率为50%,与博莱霉素组及香菇多糖组有显著差异(P0.05)。结论香菇多糖与博莱霉素在治疗恶性胸腔积液中有很好的治疗效果,优于丝裂霉素,而且香菇多糖副作用相对较少。     

胸腔内注射香菇多糖联合顺铂治疗肺癌并发恶性胸腔积液的观察

目的 观察香菇多糖联合顺铂胸腔内注射治疗肺癌并发恶性胸腔积液的疗效和不良反应.方法 选择肺癌并发恶性胸腔积液行胸腔闭式引流患者52例,观察组24例行胸腔内注射顺铂和香菇多糖,对照组28例单用顺铂,每周1次.结果 观察组有效率为75.0％,高于对照组的53.6％,两组比较差异有统计学意义(P＜0.05);观察组生活质量改善率为66.7％,高于对照组的50.0％,两组比较差异有统计学意义(P＜0.05).观察组不良反应较对照组轻.结论 香菇多糖联合顺铂胸腔内注射治疗肺癌并发恶性胸腔积液,疗效肯定,不良反应轻.     

胸腔内注入顺铂联合胞必佳治疗恶性胸腔积液疗效比较

目的探讨胸腔内注入顺铂（DDP）联合胞必佳治疗恶性胸腔积液疗效。方法恶性胸腔积液38例患者，随机分为两组，治疗组顺铂联合胞必佳胸腔内注入；对照组：单用顺铂胸腔内注入，观察疗效及药物毒副反应。结果顺铂联合胞必佳组有效率达80％，而单用顺铂组有效率达44％，差异有显著性（P〈0、01）。结论胸腔内联合注入顺铂（DDP）和胞必佳治疗恶性胸腔积液疗效明显。     

胸腔注入沙培林联合羟基喜树碱治疗恶性胸腔积液的疗效观察

目的探讨胸腔注入沙培林联合羟基喜树碱治疗恶性胸腔积液的疗效。方法78例有明确病理诊断的恶性胸腔积液患者,经胸腔埋管引流术排尽胸液后,按随机化原则分为两组。治疗组沙培林联合羟基喜树碱胸腔注入,对照组仅注入羟基喜树碱。观察两组疗效、不良反应、生活质量及生存率。结果治疗组总有效率90％、病变进展率5％,对照组总有效率37％、病变进展率25％;两组比较差异有统计学意义（P均〈0．05）。治疗组治疗后Kamofasky评分及1、2年生存率较对照组显著提高,差异有统计学意义（P均〈0．05）。结论应用沙培林联合羟基喜树碱胸腔注入治疗恶性胸腔积液安全有效。     

CD4＋CD25＋调节T细胞在平阳霉素胸膜固定术中的意义

目的探讨外周血及胸水CD4＋CD25＋调节T细胞（Treg）在平阳霉素（PYM）胸膜固定术中的变化及临床意义。方法23例肺癌并发恶性胸腔积液（MPE）患者给予PYM胸膜固定术,对固定术前及术后48h外周血及胸水采用流式细胞术观察Treg变化。结果23例患者治疗4周后,有效14例,无效9例,有效率60．87％。有效组男11例,女3例,无效组男6例,女3例,两组给药前年龄、KPS评分、Treg在血及胸水中比较均无差异。术后患者血及胸水Treg较术前明显减低（血Treg：P=0．019;胸水Treg：P=0．039）。有效组给药后血Treg降低显著（P=0．010）,胸水Treg降低不显著（P=0．092）;无效组血和胸水Treg降低均不明显。结论PYM胸膜固定术可有效控制MPE,其疗效与PYM显著减少血Treg,促进炎症反应有关。     

Th1/Th2细胞因子与平阳霉素治疗恶性胸腔积液疗效的相关性

目的探讨胸水及血浆中Th1/Th2细胞因子与平阳霉素（PYM）治疗恶性胸腔积液（MPE）疗效的关系。方法 24例非小细胞肺癌并发MPE患者均行胸腔闭式引流术,并给予胸膜腔内注射PYM24～32mg治疗。应用双抗体夹心酶联免疫吸附测定法（ELISA）法检测治疗前后胸水及外周血中干扰素-γ（IFN-γ）、肿瘤坏死因子-α（TNF-α）和白介素-4（IL-4）的浓度。一个月后根据WHO标准对MPE患者进行疗效评价。然后根据疗效将24例患者分为有效组和无效组,比较各组治疗前后胸水和外周血标本中IFN-γ、TNF-α和IL-4浓度的变化。结果有效组胸水中IFN-γ和TNF-α浓度在注药后24h和72h均显著高于注药前（P〈0.05）,而IL-4浓度在注药后72h较注药前出现下降趋势,有统计学意义（P〈0.05）。无效组胸水中IFN-γ、TNF-α和IL-4浓度在注药前后无显著差异（P〉0.05）。结论 PYM可刺激IFN-γ、TNF-α增多以及IL-4减少,以促进胸膜炎症形成胸膜粘连。胸膜腔内Th1细胞因子升高和Th2细胞因子减少与PYM胸膜固定术疗效有关。     

单核细胞趋化蛋白-1、癌胚抗原和C-反应蛋白在平阳霉素胸膜固定术中的变化及意义

目的 观察胸膜腔内注射平阳霉素(PYM)后胸腔积液(胸水)中单核细胞趋化蛋白-1(MCP-1)-1、癌胚抗原(CEA)和C-反应蛋白(CRP)水平的变化,探讨PYM胸膜固定术的机制.方法 2009年10月至2010年8月对31例恶性胸腔积液患者胸膜腔内注射PYM,检测注药前及注药后6 h、24 h、48 h胸水中MCP...     

Efficacious pleurodesis with OK-432 and doxorubicin against malignant pleural effusions.

Malignant pleural effusion develops frequently in patients with advanced lung cancer. Chemical pleurodesis is the most effective palliative treatment for these patients. The efficacy of pleurodesis using both OK-432, a preparation of Streptococcus pyogenes, and doxorubicin for 20 patients with cytology-proven malignant pleural effusion associated with lung cancer was evaluated. After complete removal of pleural effusion, OK-432 and 30 mg of doxorubicin were injected via an inserted chest tube. Treatment was terminated when the volume of daily drainage reached <200 mL. If the daily volume remained >200 mL, an additional OK-432 was administered every 3 days. In total, 16 patients (80%) revealed a complete response, two patients (10%) revealed a partial response, and no response was seen in two patients. Eighteen patients with complete or partial responses did not show subsequent reaccumulation of pleural effusion after pleurodesis. The chest tube remained in place for an average of 6.4 days, draining a mean of 2,854 mL. The main side-effects were fever and pain that were easily treated with nonsteroidal anti-inflammatory drugs. Pleurodesis using both OK-432 and doxorubicin showed high efficacy for controlling malignant pleural effusions caused by lung cancer.     

Combination chemotherapy in patients with malignant pleural effusions from non-small cell lung cancer : cisplatin, ifosfamide, and irinotecan with recombinant human granulocyte colony-stimulating factor support

OBJECTIVES: Malignant pleural effusions develop frequently in patients with non-small cell lung cancer (NSCLC), and the prognosis for these patients is very poor. We evaluated the role of systemic chemotherapy for patients with malignant pleural effusions from NSCLC. METHODS: We analyzed 34 patients who were found to have malignant pleural effusions in the course of diagnosis of 118 patients enrolled in three consecutive clinical trials on advanced NSCLC assessing combination chemotherapy of cisplatin, ifosfamide, and irinotecan with recombinant human granulocyte colony-stimulating factor support. The objective response in the malignant pleural effusion was evaluated by CT scans every course with the response criteria of the Japan Lung Cancer Society. RESULTS: All patients had adenocarcinoma. The pleural effusion showed a complete response in 13 patients, a partial response in 7 patients, and no response in 14 patients. In the assessment of the efficacy of the treatment for the measurable primary or metastatic lesions, there was a partial response in 25 patients, no change in 8 patients, and progressive disease in 1 patient. The response rate in pleural effusions was 58.8%, and overall response in mensurable lesions was 73.5%. The median time to response and duration of response for pleural effusions were 54 days and 151 days, respectively. The median survival time and 1-year survival rates were 362 days and 48.5%, respectively. CONCLUSIONS: Both the response rate and survival data in this retrospective study suggest a high degree of activity of this combination chemotherapy in patients with malignant pleural effusions from NSCLC.     

A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis

Background and objective: Talc is an effective and widely used agent for chemical pleurodesis. However, limited availability and high cost hamper the routine use of talc in resource poor countries. In this study, we compared the efficacy and safety of iodopovidone with that of cosmetic talc, for chemical pleurodesis. Methods: Patients with recurrent pleural effusions and/or spontaneous pneumothorax were prospectively randomized to undergo pleurodesis with cosmetic talc (5 g) or iodopovidone (20 mL of a 10% solution) by tube thoracostomy. The cosmetic talc was pretested for impurities (asbestos‐free) and particle size (20–60 µm), using energy dispersive analysis by X‐ray and scanning electron microscopy. The success rate (complete or partial), time to pleurodesis and safety of these two agents was compared. Results: Pleurodesis was performed in 73 patients (39 with iodopovidone, 34 with cosmetic talc; 56 men, 17 women; mean age 51.7 years; 38 pleural effusions, 35 pneumothoraces). A complete response was obtained in all patients with pneumothorax in both the iodopovidone and talc groups. Among patients with pleural effusions, a complete response was observed in 16/19 and 15/19 patients in the iodopovidone and talc groups, respectively. A partial response was observed in two additional patients from each group. The time to pleurodesis was similar in the two groups. Minor side‐effects (fever, chest pain) were observed with similar frequencies in the two groups. None of the patients experienced hypotension or ARDS. Conclusions: Iodopovidone and cosmetic talc are equally efficacious and safe agents for chemical pleurodesis.     

Differential Sensitivity to Alcohol Reinforcement in Groups of Men at Risk for Distinct Alcoholism Subtypes

The present study examines the relationship of familial and personality risk factors for alcoholism to individual differences in sensitivity to the positively and negatively reinforcing properties of alcohol. Sixteen sons of male alcoholics with multigenerational family histories of alcoholism (MFH) and 11 men who self-report heightened sensitivity to anxiety (HAS) were compared with 13 age-matched family history negative, low anxiety sensitive men (FH-LAS) on sober and alcohol-intoxicated response patterns. We were interested in the effects of alcohol on specific psychophysiological indices of "stimulus reactivity," anxiety, and incentive reward. Alcohol significantly dampened heart rate reactivity to aversive stimulation for the MFH and HAS men equally, yet did not for the FH-LAS group. HAS men evidenced idiosyncrasies with respect to alcohol-induced changes in electrodermal reactivity to avenive stimulation (an index of anxiety/fear-dampening), and MFH men demonstrated elevated alcohol-intoxicated resting heart rates (an index of psychostimulation) relative to the FH-LAS men. The results are interpreted as reflecting a sensitivity to the "stimulus reactivity-dampening" effects of alcohol in both high-risk groups, yet population-specific sensitivities to the fear-dampening and psychostimulant properties of alcohol in the HAS and MFH groups, respectively.     

Aluminum-dependent regulation of intracellular silicon in the aquatic invertebrate Lymnaea stagnalis

Silicon is essential for some plants, diatoms, and sponges but, in higher animals, its endogenous regulation has not been demonstrated. Silicate ions may be natural ligands for aluminum and here we show that, in the freshwater snail (Lymnaea stagnalis), intracellular silicon seems specifically up-regulated in response to sublethal aluminum exposure. X-ray microanalysis showed that exposure of snails to low levels of aluminum led to its accumulation in lysosomal granules, accompanied by marked up-regulation of silicon. Increased lysosomal levels of silicon were a specific response to aluminum because cadmium and zinc had no such effect. Furthermore, intra-lysosomal sulfur from metallothionein and other sulfur-containing ligands was increased after exposure to cadmium and zinc but not aluminum. To ensure that these findings indicated a specific in vivo response, and not ex vivo formation of hydroxy-aluminosilicates (HAS) from added aluminum (555 microg/liter) and water-borne silicon (43 microg/liter), two further studies were undertaken. In a ligand competition assay the lability of aluminum (527 microg/liter) was completely unaffected by the presence of silicon (46 microg/liter), suggesting the absence of HAS. In addition, exogenous silicon (6.5 mg/liter), added to the water column to promote formation of HAS, caused a decrease in lysosomal aluminum accumulation, showing that uptake of HAS would not explain the loading of aluminum into lysosomal granules. These findings, and arguments on the stability, lability, and kinetics of aluminum-silicate interactions, suggest that a silicon-specific mechanism exists for the in vivo detoxification of aluminum, which provides regulatory evidence of silicon in a multicellular organism.     

Induction of hyaluronic acid synthase 2 (HAS2) in human vascular smooth muscle cells by vasodilatory prostaglandins

Hyaluronic acid (HA) is a prominent constituent of the extracellular matrix of atherosclerotic vascular lesions in humans known to modulate vascular smooth muscle phenotype. The regulation of HA synthesis by vasodilatory prostaglandins was analyzed in human arterial smooth muscle cells (SMCs). The prostacyclin analogue, iloprost (100 nmol/L), markedly increased pericellular formation of HA coats and HA secretion into the cell culture medium in human arterial SMCs (8.7+/-1.6-fold). Expression of HA synthase 2 (HAS2) was determined by semiquantitative RT-PCR and found to be strongly upregulated at concentrations of iloprost between 1 and 100 nmol/L after 3 hours. Furthermore, endogenous cyclooxygenase-2 (COX2) activity was required for basal expression of HAS2 mRNA in SMCs in vitro. Total HA secretion in response to iloprost was markedly decreased by RNA interference (RNAi), specific for HAS2. In addition, siRNA targeting HAS2 strongly increased the spreading of human SMCs compared with mock-transfected cells. HAS2 mRNA levels were also stimulated by a selective prostacyclin receptor (IP) agonist, cicaprost (10 nmol/L), prostaglandin E(2) (10 nmol/L), and the EP(2) receptor agonist, butaprost (1 micromol/L). Induction of HAS2 mRNA and HA synthesis by prostaglandins was mimicked by stable cAMP analogues and forskolin. In human atherectomy specimens from the internal carotid artery, HA deposits and COX2 expression colocalized frequently. In addition, strong EP(2) receptor expression was detected in SMCs in HA-rich areas. Therefore, upregulation of HAS2 expression via EP(2) and IP receptors might contribute to the accumulation of HA during human atherosclerosis, thereby mediating proatherosclerotic functions of COX2.