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Sentinel lymph nodes (SLNs) are the first station of lymph nodes that extend from the breast tumor to the axillary lymphatic drainage. The pathological status of these LNs can predict that of the entire axillary lymph node. Therefore, the accurate identification of SLNs is necessary for sentinel lymph node biopsy (SLNB) to replace axillary lymph node dissection (ALND). The quality of life and prognosis of breast cancer patients are related to proper surgical treatment after the precise identification of SLNs. Some of the SLN tracers that have been identified include radioisotope, nano-carbon, indocyanine green (ICG), and methylene blue (MB). However, these tracers have certain limitations, such as pigmentation, radiation dangers, and the requirement for costly detection equipment. Ultrasound contrast agents (UCAs) have good specificity and sensitivity, and thus can compensate for some shortcomings of the mentioned tracers. This technique is also being applied to SLNB in patients with breast cancer, and can even provide an initial judgment on SLN status. Contrast-enhanced ultrasound (CEUS) has the advantages of high distinguishability, simple operation, no radiation harm, low cost, and accurate localization; therefore, it is expected to replace the traditional biopsy methods. In addition, it can significantly enhance the accuracy of SLN localization and shorten the operation time.
Subject(s)
Humans , Female , Sentinel Lymph Node/pathology , Breast Neoplasms/pathology , Quality of Life , Sentinel Lymph Node Biopsy/methods , Ultrasonography/methods , Lymph Nodes/surgeryABSTRACT
The management of the central nervous system (CNS) disorders is challenging, due to the need of drugs to cross the blood‒brain barrier (BBB) and reach the brain. Among the various strategies that have been studied to circumvent this challenge, the use of the intranasal route to transport drugs from the nose directly to the brain has been showing promising results. In addition, the encapsulation of the drugs in lipid-based nanocarriers, such as solid lipid nanoparticles (SLNs), nanostructured lipid carriers (NLCs) or nanoemulsions (NEs), can improve nose-to-brain transport by increasing the bioavailability and site-specific delivery. This review provides the state-of-the-art of
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Objective@#To systematically evaluate the diagnostic value of optical imaging combined with indocyanine green (ICG)-guided sentinel lymph node (SLN) biopsy in gastric cancer, and to identify potential factors that would influence diagnostic accuracy.@*Methods@#Study was carried out by searching the electronic database of PubMed, Embase, Medline, Web of Science, and the Cochrane Library with keywords as "gastric/stomach" and "cancer/carcinoma/tumor/tumour/adenocarcinoma/neoplasm" and "sentinel lymph node" and "near-infrared/NIR or fluorescent imaging" and "indocyanine green/ICG" . Literature inclusion criteria: (1) gastric cancer clinical stage was cT0-3; (2) clinical stage determined by at least 2 kinds of imaging modalities; (3) optical imaging (near-infrared or fluorescence imaging) combined with ICG-guided SLN biopsy; (4) prospective study to predict lymph node metastasis; (5) intraoperative or postoperative pathology for all lymph nodes removed; (6) patients number in the literature >10 cases. Exclusion criteria: (1) patients with a history of ICG allergy or chemoradiotherapy; (2) previous history of endoscopic mucosal resection or endoscopic submucosal dissection; (3) patients with a variety of gastrointestinal tumor; (4) case reports, conference abstracts, clinical guidelines, editorials, reviews, meta-analysis and correspondence letters; (5) in vitro or animal experiments; (6) insufficient diagnostic efficacy data. The meta-analysis was performed in the Stata12.0 software using the "bivariate mixed-effects model" combined with the "midas" command to pool the data. Information such as true positive value, false positive value, false negative value, and true negative value of each included articles were extracted. The literature quality assessment map was drawn to describe the overall quality of the articles; the heterogeneity analysis was performed with the forest map, with P<0.01 considered as statistical significance; the funnel plot was used to describe publication bias, with P<0.1 considered as statistically significant. Area under curve (AUC) of summary receiver operator characteristic (SROC) was used to describe the diagnostic accuracy and the AUC closer to 1 indicated higher diagnostic accuracy. If there was heterogeneity (I2>50%) among studies, regression analysis and subgroup analysis were performed. P<0.05 was considered as statistically significant.@*Results@#A total of 15 studies (1020 patients) were included. The optical imaging contained near-infrared (NIR) and fluorescent imaging (FI). The diagnostic value of optical imaging combined with ICG-guided SLN biopsy in gastric cancer was as follows: the pooled sensitivity (Sen) was 0.95 (95% CI: 0.82 to 0.99), specificity (Spe) was 1.00 (95% CI: 0.92 to 1.00), positive likelihood ratio (PLR) was 30.39 (95% CI: 9.14 to 101.06), negative likelihood ratio (NLR) was 0.05 (95% CI:0.01 to 0.20), diagnostic odds ratio (DOR) was 225.54 (95% CI: 88.81 to 572.77), AUC was 1.00 (95% CI: 0.99 to 1.00), threshold value was sensitivity=0.95 (95% CI: 0.82 to 0.99) and specificity=1.00 (95% CI: 0.92 to 1.00). Deeks method revealed DOR funnel plot of SLN biopsy was not asymmetrical obviously with significant difference (P=0.01), which indicated remarkable publishing bias. Meta-subgroup analysis showed that compared to FI, NIR imaging had higher sensitivity (0.98 vs. 0.73); compared to 0 minutes, optical imaging performed 20 minutes after ICG injection had higher sensitivity (0.98 vs. 0.70); compared to mean detected number of SLN of 4, mean detected number≥4 had higher sensitivity (0.96 vs. 0.68); compared to HE stain, immunohistochemistry + HE had higher sensitivity (0.99 vs. 0.84); compared to subserous injection of ICG, submucosa injection of ICG had higher sensitivity (0.98 vs. 0.40); compared to injection of 5 g/L ICG, 0.5 g/L and 0.05 g/L had higher sensitivity (0.98 vs. 0.83); compared to cT2-3 tumor, early stage (cT1) tumor had higher sensitivity (0.96 vs. 0.72); compared to ≤ enrolled 26 cases in the study, > 26 cases had higher sensitivity (0.96 vs. 0.65); compared to papers before 2010, papers after 2010 had higher sensitivity (0.97 vs. 0.81); whose differences were all significant. Sensitivity differences between mean tumor diameter of ≤30 cm and >30 cm, open surgery and laparoscopic surgery, lymph node regional dissection and retrieved dissection were not significant (all P>0.05).@*Conclusions@#Optical imaging combined with ICG-guided SLN biopsy is clinically feasible, and especially suitable for early gastric cancer. However, the ICG being used in current studies may be overdosed. Higher sensitivity may be achieved from NIR imaging when compared with FI method.
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In recent years, research about sentinel lymph node mapping in endometrial cancer surgery has developed quickly. Several clinical studies indicate that sentinel lymph node mapping in early endometrial cancer can improve detectable rate and decrease the false-negative rate. However, the technology is still controversial. Therefore, further study is needed to assess the role of sentinel lymph node mapping in endometrial cancer. This review mainly focused on the current clinical practice of sentinel node mapping technique in endometrial cancer, and the existing problems and controversies.
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The objective of present investigation was to prepare & evaluate solid lipid nanoparticle (SLN) based topical gel of non- steroidal anti-inflammatory drug (NSAID) etoricoxib for the treatment of arthritis which would attenuate the gastrointestinal related toxicities associated with oral administration. SLN were formulated by melt emulsification and solidification at low temperature method using stearic acid & tween 80. All the formulation were subjected to particle size, particle size distribution, zeta potential, scanning electron microscopy, crystallinity study by DSC and in-vitro release studies. It has been observed that, the high lipid concentration containing formulation have higher entrapment as compare to other two formulation. The SLN- dispersion shows 70.766% entrapment & zeta potential of the formulation were -25.6 which indicates the stability of formulation. The In Vitro drug release rate of gel was evaluated using Modified franz diffusion cell containing dialysis membrane with phosphate buffer pH 7.4 as the receptor medium. The in-vitro release was carried out in comparison with a carbopol gel & hydroxypropylmethylcellulose (HPMC) gel. The permeability parameters steady-state flux (Jss) was significantly increased in SLN-F3C (carbopol) formulation as compared with SLN-F3HPMC (hydroxypropyl methylcellulose) formulation. It was concluded that the Etoricoxib loaded SLN based gel formulation containing carbopol was suitable for topical application and shows much better result of anti-inflammatory activity.
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OBJECTIVE: To prepare capsaicin-solid lipid nanoparticles (CAP-SLNs) and study their physical and chemical properties. Then, the CAP-SLNs were modified with chitosan (CTS) and the pharmacokinetics across colon of rats was studied in vivo. METHODS: CAP-SLNs were prepared by emulsion-solvent evaporation method. The mean size, encapsulation efficiency and drug loading of the nanoparticles were investigated. RESULTS: The average diameter of CAP-SLNs was (118.89 ±25.0) nm, the encapsulation efficiency was (38.56 ±2.6)%, and the drug-loading was (6.17 ±0.21)%. After colon-specific delivery in rats, the AUC0.360 min(243. 63 ±61.46) mg · min · L-1 and ρmax(1.23 ±0.18) mg · L-1 of CTS-CAP-SLNs were 1.81-fold and 1.95-fold higher than CAP. CONCLUSION: It is simple and feasible to prepare CAP-SLNs by emulsion-solvent evaporation method. The pharmacokinetic parameters in rats are improved remarkably compared with CAP.
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The HIV/AIDS pandemic is an increasing global burden with devastating health-related and socioeconomic effects. The widespread use of antiretroviral therapy has dramatically improved life quality and expectancy of infected individuals. But currently available drug regimens and dosage forms are not good enough to eradicate HIV. Suboptimal adherence, toxicity, drug resistance and viral reservoirs make the lifelong treatment of HIV infection challenging. Along with some other organs, highly vascularized and secured with blood-brain barrier (BBB), brain acts as a great reservoir for the HIV virus. But all the available drug delivery techniques are not capable of bypassing the BBB and deliver anti-HIV drugs to the brain. In this review, all the brain delivery techniques available till date has been reviewed and recent noble ideas for delivering anti-HIV drugs to brain has been discussed.
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Objective: To optimize the formulation parameters of solid lipid nanoparticles (SLN) of Silymarin by Box-Behnken experimental design. Methods: A three-factor and three-level Box-Behnken experimental design was employed using emulsion evaporation-low temperature solidification technique to prepare SLN with Silymarin as model drug. Response surface methodology was used to investigate the factors affecting entrapment efficiency (EE), drug loading (DL), and particle size. Binomial mathematical model-optimized formulation was established with EE, DL, and particle size as response values. Results: The optimal formulation was as follows: the amount of glycerol monostearate was 5.05%, the concentration of Poloxamer 188 was 7.25%, and the amount of drug was 15%. Conclusion: The Box-Behnken experimental design could be used to optimize the SLN of silymarin.
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There are a lot of feasibility studies, using sentinel lymph node biopsy SLNB instead of Alex lymph node dissection (ALND), having got a conseusus that SLNB is a safe and useful method in the treatment of breast cancer. But in clinical practice, there are much false negative rate (FNR) which need to be carefully dealt with for SLNB. In order to diminish the FNR, how many nodes should be the perfect number to lower the FNR? If positive detection was found in the SLN, should ALND always be needed? And when micro metastasis was found in the post operation HE staining? Does it need further treatment? We make a review to discuss those matters.
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OBJECTIVE: To prepare Berberine hydrochloride solid lipid nanoparticles(BH-SLN). METHODS: BH-SL-N was prepared by conventional rotary-evaporated film-ultrasonication method. Based on the single-factor experiment, BH-SLN was prepared using orthogonal design for optimization of formulation and technology. The quality of the obtained BH-SLN was evaluated. RESULTS:BH-SLN had even and regular appearance with a mean diameter of 60.5 nm,Zeta potential of —29.7 mV,drug loading of 8.69%, and entrapment ratio of 97.58%. CONCLUSION: The entrapment ratio of BH-SLN is high and the stability is good for BH-SLN prepared by conventional rotary-evaporated film-ultrasonication method, and the method is reliable.
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Objective To introduce a new design of interlocking system which is easy in use, makes the distal fracture fragments well aligned and rigidly fixated, reduces exposure to radiation for the surgeon and patient, and allows for a decrease in operating time. Methods The new interlocking system was designed to be a self-locking nail with bevels (b-SLN). According to the bevel principle, the axial force of the nail should be turned into a transverse force so as to control the transverse nail's movement. 10 dry-bone simples were made into the fracture model of the middle-femur to test the prototype nail. The retention of the nail in the intramedullary cavity was evaluated by the radiogram. The mechanical properties of a simulated model of single leg loading were tested on the instron-1342 type MTS. Results The prototype nail performed well as designed. The process was stable and reliable. The retention in the intramedullary cavity was fine. The shearing force between the transverse nail and main nail was enough to cut anything around them. The mechanical properties of b-SLN were similar to those of the Grosse-Kempf nail, better than auto fork compress locked intramedullary nail, and much better than MHUA nail and Ender's nail. Conclusions The structure of b-SLN is simple and reliable. There is no focus-point under stress. Its biomechanic properties are satisfactory. It is easy to use with no need of fluoroscopes in the operating theatre.
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Purpose:To explore the possibility of non-sent inel lymph node (NSN) metastases in early breast carcinoma patients with positi ve sentinel lymph node (SLN) and its clinical significance. Methods:The incidence and related clinical factors of NSN metas tases were analyzed in 84 early breast carcinoma patients with positive sentinel lymph node, who underwent radical mastectomy. Results:The metastatic NSN was identified in 41 of the 84 pati ents with positive sentinel lymph node (48.8%), the incidence of NSN metastases was related to primary tumor size, SLN metastatic focus size and HER-2 expressi on status, the incidence rate of NSN metastases is proportional to the size of t he primary tumor and metastatic SLN focus, patients with positive HER-2 expres sion have a high NSN metastases rate. Conclusions:The early breast carcinoma patients with
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Object To study the mechanism of triptolide solid lipid nanoparticle (TP-SLN) for decreasing liver toxicity of triptolide (TP). Methods With ig three doses of TP-SLN to mice for 60 d, the A LT, AST activities in serum and superoxide dismutase (SOD), glutathione peroxida se (GSH-Px) activites and malondialdehyde (MDA) contents in liver were determin ed. Results The activities of ALT, AST, SOD, GSH-Px and conten t of MDA between experimental group and blank group did not have remarkable diff e rence. However, the activites of ALT, AST, SOD, GSH-Px for the middle- (20 ?g /kg) and high-dose (30 ?g/kg) group were higher and the contents of MDA were lower than the experimental group. Conclusion TP-SLN can decrease the liver toxicity of TP.