1363 Oesophago-Pleural Fistula After Pneumonectomy; A Systematic Review

Introduction Oesophago-pleural fistula (OPF) is an infrequent but highly complex complication of pneumonectomy with a mortality of up to 63%. There is a paucity of data on the optimal treatment strategy. Method Systematic review was conducted in line with PRISMA guidance concerning OPF following pneumonectomy. Demographic, operative and management data were analysed. Results 30 full manuscripts of the 76 abstracts were included in the analysis. Data was limited to case reports or small series. In total, information for 58 patients was included. Median age was 59 years, with a median follow up time was 18 months. Most authors adopted sepsis control with chest drainage and pleural lavage and the mean number of interventions was 1.6. Overall mortality was 31% (18/58). There was no significant difference between the time to presentation following left (29.2+/-39.28 months) and right pneumonectomy (66.24+/-110.62) (p = 0.2271) nor any significant difference between successful outcomes following intervention for OPF after left (11/14) compared to right pneumonectomy (31/41) (p = 0.8219) or 90-day mortality (p = 0.4571). However, 26% of patients had synchronous broncho-pleural fistula and 90-day mortality was significantly higher in these patients (6/15 vs 6/43. p = 0.0395). 25 patients who underwent additional pericardial, oesophageal or a nodal resection or intervention at the time of pneumonectomy had a significantly reduced mean time to presentation with OPF (21.49+/-60.15 vs. 84.99+/-114.31. p = 0.0148) and a higher 90-day mortality (8/25 vs 3/32. P = 0.0414). Conclusions Major heterogeneity of management hinders the introduction of standardised guidance of post-pnuemonectomy OPF. An MDT approach involving Oesophago-gastric and Cardio-Thoracic Surgery is vital.

Serjania marginata Casar. hydroalcoholic extract reduced cytokine and inflammatory parameters in experimental models of inflammation and infection in mice

This study investigated the antimycobacterial, anti-inflammatory and antihyperalgesic effects of EESM in in vitro and in vivo models. EESM (0.98–1000 µg/ml) was evaluated in in vitro against Mycobacterium tuberculosis, M. bovis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus epidermidis. The EESM oral administration (p.o.) (30, 100 and 300 mg/kg) and dexamethasone subcutaneous injection (s.c.) (1 mg/kg) were tested against the carrageenan-induced inflammatory paw edema and pleurisy in Swiss mice. The EESM (30 and 100 mg/kg, p.o.) and dexamethasone (1 mg/kg, s.c.) were tested against the CFA-induced paw inflammation and M. bovis (bacillus Calmette-Guerin - BCG)-induced pleurisy in C57bL6 mice. The minimum inhibitory concentration (MIC) of EESM in the presence of M. tuberculosis was 62.4 µg/ml. The values of MIC of EESM in the presence S. epidermidis, K. pneumoniae were 1000 µg/mL while EESM did not interfere with against P. aeruginosa growth. EESM significantly inhibited paw edema/mechanical hyperalgesia in carrageenan induced paw inflammation and leukocytes migration/proteins exudation in carrageenan-induced pleurisy model. In the BCG-induced pleurisy model, the daily treatment for 7 days, with EESM inhibited the levels of IL-1β in blood and in pleural exudate. The EESM did not alter the mycobacterial growth in the cell culture from pleural lavage, spleen and liver samples collected from BCG-treated animals. The EESM significantly inhibited the persistent edema and mechanical hyperalgesia induced by CFA. This study confirms the EESM anti-inflammatory property and showed that EESM has high potency in inducing inhibition of mycobaterial growth and low potency or no effects in relation to other microorganisms.

Extracellular Vesicle-Associated miRNAs as a Biomarker for Lung Cancer in Liquid Biopsy

Extracellular vesicles are cell-derived membranous vesicles that are secreted into biofluids. Emerging evidence suggests that EVs play an essential role in the pathogenesis of many diseases by transferring proteins, genetic material, and small signaling molecules between cells. Among these molecules, microRNAs (miRNAs), a type of small noncoding RNA, are one of the most important signals and are involved in various biological processes. Lung cancer is one of the leading causes of cancer-related deaths worldwide. Early diagnosis of lung cancer may help to reduce mortality and increase the 5 years survival rate and thereby reduce the associated socioeconomic burden. In the past, EV-miRNAs have been recognized as biomarkers of several cancers to assist in diagnosis or prognosis. In this review, we discuss recent findings and clinical practice for EV-miRNAs of lung cancer in several biofluids, including blood, bronchoalveolar lavage fluid (BALF), and pleural lavage.

Pleural invasion, epidermal growth factor receptor mutation and carcinoembryonic antigen level affect pleural lavage cytology-positive status in non-small-cell lung cancer

OBJECTIVES Pleural invasion (pl) is strongly associated with the pleural lavage cytology (PLC) status. We analysed tumours with pl and evaluated the relationship between the PLC status and pl. METHODS We retrospectively reviewed 428 surgically treated patients who had been diagnosed with non-small-cell lung cancer with pl and had their PLC status examined between 2000 and 2016. We investigated the influence of a PLC-positive status on the prognosis and searched for the factors predictive of a PLC-positive status. RESULTS Seventy-eight (18%) patients were PLC positive. The recurrence-free survival of PLC-positive patients was significantly worse than that of PLC-negative patients in pl1 and pl2, but not in pl3 (5-year recurrence-free survival rate, PLC positive versus PLC negative: pl1, 22.0% vs 60.0%, P = 0.002; pl2, 30.4% vs 59.7%, P = 0.015; pl3, 50.0% vs 59.6%, P = 0.427). A multivariable analysis showed that the degree of pl (pl2–3 versus pl1) [odds ratio (OR) 5.34, P < 0.001] was an independent predictive factor for PLC positivity. Epidermal growth factor receptor (EGFR) mutation positivity (OR 5.48, P = 0.042) and carcinoembryonic antigen (CEA) ≥5 ng/ml (OR 3.78, P = 0.042) were associated with a PLC-positive status in patients with pl2–3. We found that the PLC-positive rate in patients with pl2–3 was 35.6%; however, if the tumour was EGFR mutation positive and had CEA ≥5 ng/ml, the PLC-positive rate increased to 77%. CONCLUSIONS If a tumour was suspected of being pl2–3 and had EGFR mutation positivity and CEA ≥5 ng/ml, the PLC-positive rate was extremely high. Clinical trial registration number Hyogo Cancer Center, G-138.