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Multicenter, prospective, observational study of a novel technique for preoperative pulmonary nodule localization.

术前肺结节定位新技术的多中心、前瞻性、观察性研究。

  • 影响因子:1.52
  • DOI:10.1016/j.jtcvs.2019.10.148
  • 作者列表:"Fan L","Yang H","Yu L","Wang Z","Ye J","Zhao Y","Cai D","Zhao H","Yao F
  • 发表时间:2020-08-01
Abstract

OBJECTIVES:Minimally invasive surgery provides an ideal method for pathologic diagnosis and curative intent of small pulmonary nodules (SPNs); however, the main problem with thoracoscopic resection is the difficulty in locating the nodules. The goal of this study was to determine the safety and feasibility of a new localization technique tailored for SPNs. METHODS:A computed tomography (CT)-guided technique, which has a tri-colored suture and claw with 4 fishhook-shaped hooks, was designed to localize SPN preoperatively. Then a multicenter, prospective study was conducted to evaluate the safety and feasibility of this device. The primary endpoints included safety (asymptomatic/symptomatic pneumothorax or parenchymal hemorrhage, and unanticipated adverse effects) and success rate (precise placement and device fracture, displacement, or dislodgement). The secondary endpoints included feasibility (duration of the localization procedure and device fracture or fault) and patient comfort (pain). RESULTS:A total of 90 SPNs were localized from 80 patients. Overall, no symptomatic complications requiring medical intervention, with the exception of asymptomatic pneumothorax (n = 7 [7.8%]) and lung hemorrhages (n = 5 [5.6%]), were observed. The device was successfully placed without dislodgment or movement in 87 of 90 lesions (96.7%). The median nodule size was 0.70 cm (range, 0.30-1.0 cm). The median duration of the procedure was 15 minutes (range, 7-36 minutes). No patient complained of notable pain during or after the procedure. CONCLUSIONS:This new device for SPNs is safe, and has a high success rate, feasibility and good tolerance.

摘要

目的: 微创手术为肺小结节 (spn) 的病理诊断和治疗提供了理想的方法; 然而,胸腔镜切除的主要问题是结节的定位困难。本研究的目标是确定为spn量身定制的新定位技术的安全性和可行性。 方法: 设计了一种计算机断层扫描 (CT) 引导技术,该技术具有三色缝线和带有4个鱼钩形钩的爪,用于术前定位SPN。然后进行了一项多中心,前瞻性研究,以评估该装置的安全性和可行性。主要终点包括安全性 (无症状/症状性气胸或脑实质出血,以及未预料到的不良反应) 和成功率 (精确放置和装置骨折,移位或移位)。次要终点包括可行性 (定位程序的持续时间和设备断裂或故障) 和患者舒适度 (疼痛)。 结果: 80例患者共定位90个spn。总体而言,除了无症状的气胸 (n = 7 [7.8%]) 和肺出血 (n = 5 [5.6%]) 之外,没有观察到需要医疗干预的症状性并发症。在90个病变中的87个 (96.7%) 中,该装置成功放置而没有移位或移动。中位结节大小为0.70厘米cm (范围,0.30-1.0厘米cm)。手术的中位持续时间为15分钟 (范围,7-36分钟)。没有患者在手术期间或手术后抱怨明显的疼痛。 结论: 该装置安全可靠,成功率高,可行性好,耐受性好。

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影响因子:6.93
发表时间:2020-01-01
DOI:10.1002/ijc.32419
作者列表:["Milosevic V","Kopecka J","Salaroglio IC","Libener R","Napoli F","Izzo S","Orecchia S","Ananthanarayanan P","Bironzo P","Grosso F","Tabbò F","Comunanza V","Alexa-Stratulat T","Bussolino F","Righi L","Novello S","Scagliotti GV","Riganti C"]

METHODS::Malignant pleural mesothelioma (MPM) is a tumor with high chemoresistance and poor prognosis. MPM-initiating cells (ICs) are known to be drug resistant, but it is unknown if and how stemness-related pathways determine chemoresistance. Moreover, there are no predictive markers of IC-associated chemoresistance. Aim of this work is to clarify if and by which mechanisms the chemoresistant phenotype of MPM IC was due to specific stemness-related pathways. We generated MPM IC from primary MPM samples and compared the gene expression and chemo-sensitivity profile of IC and differentiated/adherent cells (AC) of the same patient. Compared to AC, IC had upregulated the drug efflux transporter ABCB5 that determined resistance to cisplatin and pemetrexed. ABCB5-knocked-out (KO) IC clones were resensitized to the drugs in vitro and in patient-derived xenografts. ABCB5 was transcriptionally activated by the Wnt/GSK3β/β-catenin/c-myc axis that also increased IL-8 and IL-1β production. IL-8 and IL-1β-KO IC clones reduced the c-myc-driven transcription of ABCB5 and reacquired chemosensitivity. ABCB5-KO clones had lower IL-8 and IL-1β secretion, and c-myc transcriptional activity, suggesting that either Wnt/GSK3β/β-catenin and IL-8/IL-1β signaling drive c-myc-mediated transcription of ABCB5. ABCB5 correlated with lower time-to-progression and overall survival in MPM patients treated with cisplatin and pemetrexed. Our work identified multiple autocrine loops linking stemness pathways and resistance to cisplatin and pemetrexed in MPM IC. ABCB5 may represent a new target to chemosensitize MPM IC and a potential biomarker to predict the response to the first-line chemotherapy in MPM patients.

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影响因子:2.09
发表时间:2020-01-01
DOI:10.1016/j.jiph.2019.05.013
作者列表:["Nishimura A","Yamaguchi H","Ito Y","Tokumoto S","Toyoshima D","Kasai M","Maruyama A"]

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胸膜疾病方向

胸膜疾病包括原发于胸膜的疾病,主要指胸膜间皮瘤,也包括胸膜腔内的异常情况,如脓胸、 血胸、胸腔积液等。

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