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Frontiers in Immunology 2021Malignant tumors accompanied with malignant pleural effusion (MPE) often indicate poor prognosis. The therapeutic effect and mechanism of intrapleural injection of...
BACKGROUND
Malignant tumors accompanied with malignant pleural effusion (MPE) often indicate poor prognosis. The therapeutic effect and mechanism of intrapleural injection of anti-programmed cell death protein 1 (PD1) on MPE need to be explored.
METHODS
A preclinical MPE mouse model and a small clinical study were used to evaluate the effect of intrapleural injection of anti-PD1 antibody. The role of immune cells was observed flow cytometry, RNA-sequencing, quantitative PCR, western blot, immunohistochemistry, and other experimental methods.
RESULTS
Intrathoracic injection of anti-PD1 monoclonal antibody (mAb) has significantly prolonged the survival time of mice (P = 0.0098) and reduced the amount of effusion (P = 0.003) and the number of cancer nodules (P = 0.0043). Local CD8+ T cells participated in intrapleural administration of anti-PD1 mAb. The proportion of CD69+, IFN-γ+, and granzyme B+ CD8+ T cells in the pleural cavity was increased, and the expression of TNF-α and IL-1β in MPE also developed significantly after injection. Local injection promoted activation of the CCL20/CCR6 pathway in the tumor microenvironment and further elevated the expression of several molecules related to lymphocyte activation. Clinically, the control rate of intrathoracic injection of sintilimab (a human anti-PD1 mAb) for 10 weeks in NSCLC patients with MPE was 66.7%. Local injection improved the activity and function of patients' local cytotoxic T cells (CTLs).
CONCLUSIONS
Intrapleural injection of anti-PD1 mAb could control malignant pleural effusion and the growth of cancer, which may be achieved by enhancing local CTL activity and cytotoxicity.
Topics: Animals; Antibodies, Monoclonal; Carcinoma, Lewis Lung; Carcinoma, Non-Small-Cell Lung; Cell Line, Tumor; Humans; Injections; Lung Neoplasms; Male; Mice, Inbred C57BL; Pleural Cavity; Pleural Effusion, Malignant; Programmed Cell Death 1 Receptor; T-Lymphocytes, Cytotoxic; Tumor Microenvironment; Mice
PubMed: 34966384
DOI: 10.3389/fimmu.2021.760683 -
Annals of Translational Medicine Sep 2020() is a common pathogenic bacterium which causes pleural empyema, and infection of is often associated with biofilm. The aim of this study was to establish a model of...
BACKGROUND
() is a common pathogenic bacterium which causes pleural empyema, and infection of is often associated with biofilm. The aim of this study was to establish a model of rabbit empyema infected by to determine whether it causes the formation of biofilm in the pleural cavity. Furthermore, we investigated the effect of cyclic diguanosine monophosphate (c-di-GMP) on biofilm formation in this empyema model.
METHODS
Twenty rabbits were used and randomly divided into five groups: PAO1, PAO1Δ, and PAO1/p infection groups, and Luria-Bertani (LB) broth and turpentine control groups. A drainage catheter was implanted into the pleural cavity through thoracentesis. The three infection groups were respectively infected with PAO1, PAO1Δ, and PAO1/p strains, which caused empyema. The two control groups were injected with LB or turpentine. After 4 days of infection, we sacrificed the rabbits. We evaluated the pathology of pleura through hematoxylin-eosin staining. Colony count and crystal violet assay were used to analyze the biofilm formation on the surface of catheters. Scanning electron was used to observe the biofilm on the surface of the pleura. Peptide nucleic acids-fluorescence in situ hybridization (PNA-FISH) was used to observe the biofilm in the fibrinous deposition.
RESULTS
By the PNA-FISH assay, biofilms were observed in the fibrinous deposition of the three infection groups. The red fluorescence area of the PAO1Δ infection group was larger than that of the PAO1 and PAO1/p - infection groups. Through electron microscopy, we observed that PAO1 strains were embedded in an electron-dense extracellular matrix on the surface of pleural tissue, and appeared to be biofilm-like structures. For the crystal violet assay, the optical density values of different groups were significantly different: PAO1Δ > PAO1 > PAO1/p > control groups (P<0.05).
CONCLUSIONS
To the best knowledge of the authors, this is the first study to report forming biofilm in a novel animal model of pleural empyema. In addition, c-di-GMP signaling molecules played an important role in biofilm formation in the pleural cavity.
PubMed: 33240995
DOI: 10.21037/atm-20-6022 -
Mediastinum (Hong Kong, China) 2024The hemiclamshell incision is a combination of partial median sternotomy and anterolateral thoracotomy, allowing excellent exposure of mediastinum, one pleural cavity...
The hemiclamshell incision is a combination of partial median sternotomy and anterolateral thoracotomy, allowing excellent exposure of mediastinum, one pleural cavity and the neck. It can be used for superior sulcus tumors with mediastinal involvement or to resect bulky mediastinal lesions or lesions requiring cervical, mediastinal and pleural exposition. Although the vast majority of mediastinal lesions can now be approached by minimally invasive techniques, the hemiclamshell incision still plays a pivotal role in the case of bulky lesions involving cervical, mediastinal and pleural cavities. In the case of cardiac or great vessel involvement, the procedure should be performed in experienced high-volume centers with the availability of cardio-pulmonary bypass, extra-corporeal membrane oxygenator or venous shunts. Although the vast majority of mediastinal lesions can now be approached by minimally invasive techniques, the hemiclamshell incision still plays a pivotal role in the case of bulky lesions involving cervical, mediastinal and pleural cavities. It consists of a combination of subtotal median vertical sternotomy and antero-lateral thoracotomy in the 4 intercostal space, providing excellent exposure of the neck, mediastinum and one pleural cavity. The objective of this paper is to describe the standard steps for performing a hemiclamshell incision by using modern devices and technology which contribute to make this procedure easier, faster and safer.
PubMed: 38322192
DOI: 10.21037/med-23-36 -
Cancer Science Dec 2012Multi-walled carbon nanotubes have a fibrous structure similar to asbestos and induce mesothelioma when injected into the peritoneal cavity. In the present study, we...
Multi-walled carbon nanotubes have a fibrous structure similar to asbestos and induce mesothelioma when injected into the peritoneal cavity. In the present study, we investigated whether carbon nanotubes administered into the lung through the trachea induce mesothelial lesions. Male F344 rats were treated with 0.5 mL of 500 μg/mL suspensions of multi-walled carbon nanotubes or crocidolite five times over a 9-day period by intrapulmonary spraying. Pleural cavity lavage fluid, lung and chest wall were then collected. Multi-walled carbon nanotubes and crocidolite were found mainly in alveolar macrophages and mediastinal lymph nodes. Importantly, the fibers were also found in the cell pellets of the pleural cavity lavage, mostly in macrophages. Both multi-walled carbon nanotube and crocidolite treatment induced hyperplastic proliferative lesions of the visceral mesothelium, with their proliferating cell nuclear antigen indices approximately 10-fold that of the vehicle control. The hyperplastic lesions were associated with inflammatory cell infiltration and inflammation-induced fibrotic lesions of the pleural tissues. The fibers were not found in the mesothelial proliferative lesions themselves. In the pleural cavity, abundant inflammatory cell infiltration, mainly composed of macrophages, was observed. Conditioned cell culture media of macrophages treated with multi-walled carbon nanotubes and crocidolite and the supernatants of pleural cavity lavage fluid from the dosed rats increased mesothelial cell proliferation in vitro, suggesting that mesothelial proliferative lesions were induced by inflammatory events in the lung and pleural cavity and likely mediated by macrophages. In conclusion, intrapulmonary administration of multi-walled carbon nanotubes, like asbestos, induced mesothelial proliferation potentially associated with mesothelioma development.
Topics: Animals; Asbestos, Crocidolite; Cell Proliferation; Lung; Macrophages, Alveolar; Male; Mesothelioma; Nanotubes, Carbon; Pleural Cavity; Rats; Rats, Inbred F344
PubMed: 22938569
DOI: 10.1111/cas.12005 -
Multimedia Manual of Cardiothoracic... Jan 2018Surgical staging of lung and pleural cancers is crucial for planning treatment and assessing prognosis. In some cases, we need to explore both the mediastinum and the...
Surgical staging of lung and pleural cancers is crucial for planning treatment and assessing prognosis. In some cases, we need to explore both the mediastinum and the pleural cavity to confirm or rule out tumor dissemination. The combination of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and thoracoscopy through a single transcervical incision allows the surgeon to widen the range of the exploration and improve the staging for lung and pleural cancers. VAMLA consists of complete removal of the mediastinal fat and lymph nodes of the subcarinal space, the right paratracheal and pretracheal areas, and the left paratracheal space. Once this mediastinal tissue is removed, the right mediastinal pleura can be identified and incised. A 30o thoracoscope is then inserted through the video-mediastinoscope into the pleural cavity to obtain samples of pleural fluid and biopsies of the parietal pleura and lung nodules, if present. In the case of left-sided thoracoscopy the access route to the left pleural cavity is anterior to the aortic arch, as for extended cervical mediastinoscopy. The combination of VAMLA and thoracoscopy is useful for exploring the mediastinum and the pleural space from a single incision and in the same surgical setting as the transcervical approach.
Topics: Biopsy; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Mediastinoscopy; Mediastinum; Neoplasm Staging; Pleural Cavity; Pleural Neoplasms; Thoracic Surgery, Video-Assisted; Thoracoscopy; Video-Assisted Surgery
PubMed: 29384599
DOI: 10.1510/mmcts.2018.004 -
Thorax Nov 1980Patients with oesophagopleural fistula after a pneumonectomy present a difficult therapeutic problem. There are two types of presentation, early and late. We report...
Patients with oesophagopleural fistula after a pneumonectomy present a difficult therapeutic problem. There are two types of presentation, early and late. We report three cases in addition to the 49 previously published. All three patients developed their fistulae after right-sided pneumonectomy (one month, four years, and 21 years respectively) and presented with the features of an empyema. The existence of an oesophagopleural fistula can be demonstrated by the discovery of food particles in the pleural aspirate, by direct visualisation during oesophagoscopy after instilling methylene blue into the pleural cavity, by barium swallow, or by identification of helium in the pleural space after swallowing a mouthful of helium. After the initial treatment of empyema we believe that surgical repair of the oesophagopleural fistula is the treatment of choice.
Topics: Adult; Esophageal Fistula; Female; Fistula; Humans; Male; Pleural Diseases; Pneumonectomy
PubMed: 7221985
DOI: 10.1136/thx.35.11.865 -
Annals of the American Thoracic Society Nov 2022
Topics: Humans; Steel; Retrospective Studies; Cohort Studies; Surgeons; Pleural Cavity
PubMed: 36318081
DOI: 10.1513/AnnalsATS.202207-644ED -
International Journal of Molecular... Jul 2018Pleural tuberculosis is one of the most frequent forms of extra-pulmonary tuberculosis observed in patients infected with Tumor Necrosis Factor (TNF) is a crucial...
Pleural tuberculosis is one of the most frequent forms of extra-pulmonary tuberculosis observed in patients infected with Tumor Necrosis Factor (TNF) is a crucial cytokine needed to control tuberculosis infection that remains a leading cause of morbidity and mortality worldwide. TNF blockade compromises host immunity and may increase the risk of reactivation of latent infection resulting in overt pulmonary, pleural and extra-pulmonary tuberculosis. While TNF signaling is mainly considered pro-inflammatory, its requirement for the anti-inflammation process involved in the resolution of infection and tissue repair is less explored. Our study analyzes the role of TNF and TNF receptors in the control of the inflammatory process associated with (BCG)-induced pleurisy. This study shows that the absence of TNF causes exacerbated inflammation in the pleural cavity of BCG-infected mice which is controlled by the transmembrane TNF (tmTNF) expression. The lack of TNF is associated with an impaired cellular expression and shedding of TNFR2 in the pleural cavity. The presence of tmTNF restores the normal expression of TNFR2 on myeloid cells during BCG-induced pleurisy. We also show that absence of TNFR1 affects the expression of TNFR2 on pleural cells and inflammation in the pleural cavity of BCG-infected mice. In conclusion, tmTNF but not soluble TNF prevents pleural cavity inflammation leading to attenuation and the resolution of the inflammatory process caused by mycobacterial pleurisy in association with the expression of TNFR2 on myeloid cells.
Topics: Animals; Cytokines; Disease Models, Animal; Humans; Inflammation; Mice; Mice, Inbred C57BL; Mice, Knockout; Mycobacterium bovis; Pleural Cavity; Receptors, Tumor Necrosis Factor; Tuberculosis, Pleural; Tumor Necrosis Factor-alpha
PubMed: 29973541
DOI: 10.3390/ijms19071959 -
Lung India : Official Organ of Indian... 2019
PubMed: 31031353
DOI: 10.4103/lungindia.lungindia_445_18 -
International Journal of Surgery Case... Aug 2023Echinococcus granulosus causes hydatid disease. The most affected organ is the liver which is followed by the lungs. The pleural cavity being the primary location of...
INTRODUCTION AND IMPORTANCE
Echinococcus granulosus causes hydatid disease. The most affected organ is the liver which is followed by the lungs. The pleural cavity being the primary location of hydatid cysts is rare and should be discussed further. This paper documents a rare case of primary pleural hydatidosis which can present with a merely isolated cough followed by dyspnea. The diagnosis and surgical treatment along with post-operative medications are vital in this case.
CASE PRESENTATION
We present a case of a 45-year-old who suffered from a cough for more than one week which did not subside after taking medications. This symptom was followed by dyspnoea for which an X-ray was done which showed left-sided pleural effusion, a complication of pleural hydatidosis. Computed tomography showed multiple cysts in the pleural cavity which confirmed the diagnosis of primary pleural hydatidosis as the cysts were not present in any other sites. Blood work revealed eosinophilia which is significant in parasitic diseases. A left posterolateral thoracotomy was performed, and the cysts were surgically removed. Additionally, empyemectomy and pleurectomy were done. The patient was then treated with anti-parasitic therapy and was advised to get X-rays during the follow-up visits. The X-rays were normal and indicated that there was no disease recurrence.
CLINICAL DISCUSSION
Echinococcus granulosus is a parasitic worm that causes hydatid disease. The primary location is the liver. A diagnosis of intrathoracic but extrapulmonary disease, which involves the presence of hydatid cysts in the pleura, heart, pericardium, mediastinum, chest wall, and diaphragm, is difficult in individuals lacking a primary cyst in a common location (Isitmangil et al., 2003; Saeedan et al., 2020).
CONCLUSION
This case implies the significance of a cough of more than a week that is not relieved by medications. This should be carefully evaluated and followed in cases that have a rare diagnosis requiring surgery. A diagnosis of primary pleural hydatidosis with left-sided pleural effusion and atelectasis with mediastinal shift to the right side was made which was treated with a surgical procedure.
PubMed: 37517250
DOI: 10.1016/j.ijscr.2023.108533