SiO2/hyaluronic acid nanoparticles carry CaO2, DOX and p53 plasmid to effectively achieve ion interference/chemical/gene multimodal therapy of lung cancer.

Monotherapy of lung cancer shows limited therapeutic effects due to its poorly targeted enrichment and low bioavailability. Using nanomaterials as carriers to form drug delivery systems has become a popular method to improve the targeting of anticancer drug therapy and patients' safety. However, the uniformity of the loaded drugs and the unsatisfactory effects are still the bottleneck in this field up to now. This study aims to construct a novel nanocomposite carrying 3 different types of anticancer drugs to enhance treatment efficacy. Herein, mesoporous silica (MSN) with high loading rate was constructed by dilute sulfuric acid thermal etching as the framework. Hyaluronic acid (HA) was loaded with CaO2, p53 and DOX to construct nanoparticle complexes-SiO2@CaO2@DOX@P53-HA. First, MSN was proved to be a porous sorbent with a mesoporous structure through BET analysis. The images obtained from the uptake experiment clearly show the gradual enrichment of the DOX and Ca2+ within the target cell. For in vitro experiments, the pro-apoptotic effects of SiO2@CaO2@DOX@P53-HA significantly increased compared to that of the single-agent group at different time points. Furthermore, in the tumor-bearing mouse experiment, the tumor volume was remarkably inhibited in the SiO2@CaO2@DOX@P53-HA group compared to that in the single-agent group. By observing the pathological sections of the euthanized mice, it is obvious that the tissues of the mice treated with the nanoparticles were more intact. Based on these beneficial results, it is believed that multimodal therapy is a meaningful treatment strategy for lung cancer.

CHRNA1 promotes the pathogenesis of primary focal hyperhidrosis.

The aim of the study was to elucidate the involvement of cholinergic receptor nicotinic alpha 1 subunit (CHRNA1) in the pathogenesis of primary focal hyperhidrosis (PFH). The hyperhidrosis mouse model was constructed using pilocarpine injection. The expression levels of CHRNA1 in sweat gland tissues of PFH patients and hyperhidrosis mice were compared using Western blots and quantitative real-time PCR (qRT-PCR) analyses. Sweat secretion in hyperhidrosis mice treated with small-interfering RNA (siRNA) targeting CHRNA1 (si-CHRNA1) or non-specific siRNA were compared. Sweat secretory granules in the sweat gland cells of hyperhidrosis mice were examined using transmission electron microscopy. The serum level of acetylcholine was measured using enzyme-linked immunosorbent assay, while markers associated with PFH, including Aquaporin 5 (AQP5) and Calcium Voltage-Gated Channel Subunit Alpha1 C (CACNA1C), were assessed using immunohistochemical assay and Western blots. Brain-derived neurotrophic factor (BDNF) and Neuregulin 1 (NRG-1) in sympathetic ganglia axons of hyperhidrosis mice were quantified using Western blots. CHRNA1 up-regulation is a characteristic of the sweat glands of PFH patients and Hyperhidrosis mice. Silencing CHRNA1 decreased sweat secretion and the number of sweat secretory granules of hyperhidrosis mice. Serum acetylcholine, as well as AQP5 and CACNA1C expression in the sweat glands, was reduced by siCHRNA1. BDNF1 and NRG-1 levels in the sympathetic ganglia axons were also attenuated by siCHRNA1 treatment. CHRNA1 up-regulation is a potential biomarker of PFH and downregulating CHRNA1 could alleviate the symptoms of PFH through inactivating the sympathetic system.

Involvement of activin a receptor type 1 (ACVR1) in the pathogenesis of primary focal hyperhidrosis.

The pathogenesis of primary focal hyperhidrosis (PFH) is still not clear. PFH is thought to be a genetic disease. Whether activin A receptor type 1 (ACVR1) is involved in the pathogenesis of PFH is unknown. In this study, the expression of ACVR1 in sweat glands of patients with PAH was detected by western blot and immunofluorescence. The primary sweat gland cells obtained from primary axillary hyperhidrosis (PAH) patients were transfected with acvr1 vector. Cell proliferation, apoptosis and cell cycling of gland cells were measured after transfection with acvr1 vector. The mRNA and protein expression of aquaporin 5 (AQP5) and Na:K:2Cl Cotransporter 1 (NKCC1/SLC12A2) were detected. Our data showed that ACVR1 expression in axillary sweat gland tissue of PAH patients was significantly higher than that of normal control group. The function of ACVR1 was further investigated in the gland cells obtained from PAH patients. Compared with NC group, ACVR1 overexpression significantly promoted the proliferation of sweat gland cells and inhibited the apoptosis of sweat gland cells. Meanwhile, ACVR1 overexpression significantly reduced the percentage of cells in G0/G1 and G2/M phases, and increased the percentage of cells in S phase. In addition, ACVR1 overexpression significantly promoted the expression of AQP5 and NKCC1 at both mRNA and protein levels. Together, ACVR1 expression is related to PFH and ACVR1 overexpression can promote the proliferation of sweat gland cells and inhibit apoptosis by promoting the expression of AQP5 and NKCC1.

Transareolar single-port endoscopic thoracic sympathectomy with a flexible endoscope for primary palmar hyperhidrosis: a prospective randomized controlled trial.

BACKGROUND: Transareolar single-port endoscopic thoracic sympathectomy (ETS) with a flexible endoscope has rarely been reported. This study assessed the performance of this novel minimally invasive technique for primary palmar hyperhidrosis (PPH). METHODS: From January 2019 to September 2019, 118 males with severe PPH requiring single-port and bilateral ETS were randomly allocated to undergo transareolar ETS using a flexible endoscope (group A, n=58) or transaxillary ETS using a 5 mm thoracoscope (group B, n=60). RESULTS: Both groups had similar patient characteristics. All procedures were performed successfully, with no mortality or conversion to open surgery. All patients had dry and warm palms immediately after surgery. Compared with group B, group A had a significantly shorter median incision length [5.1 (5.0-5.2) vs. 10.9 (10.8-11.9) mm; P<0.001], and significantly lower median postoperative pain score [1 (1.0-2.0) vs. 3 (3.0-4.0); P<0.001]. There were no differences between the two groups in operative time, palmar temperature increase, and transient postoperative sweating. After complete follow-up, group A had a significantly higher median cosmetic score than group B [4.0 (3.0-4.0) vs. 3.0 (3.0-3.0); P<0.001]. There were no differences between the two groups regarding symptom resolution, compensatory hyperhidrosis, and satisfaction score. No patient reported residual pain or symptom recurrence. CONCLUSIONS: Transareolar single-port ETS with a flexible endoscope is safe, effective, and minimally invasive with a small incision, minimal pain, and excellent cosmetic results. This novel procedure is suitable for routine treatment of PPH in males.

The complete chloroplast genome sequence of Populus simonii, a medicinal plant for anti-lung cancer activity.

Lung cancer is one of the most common malignant tumors. It is clinically divided into two types: small cell lung cancer and non-small cell lung cancer. Populus simonii distributed in East Asia region including China used as traditional medicine, which is an important medicinal plant for anti-lung cancer activity. The complete chloroplast genome sequence of P. simonii was characterized from Illumina pair-end sequencing. The chloroplast genome of P. simonii was 156,559 bp in length, containing a large single-copy region (LSC) of 84,825 bp, a small single-copy region (SSC) of 47,561 bp, and two inverted repeat (IR) regions of 16,494 bp. The overall GC content is 36.70%, while the corresponding values of the LSC, SSC, and IR regions are 34.5%, 30.0%, and 42.0%, respectively. The genome contains 131 complete genes, including 86 protein-coding genes (68 protein-coding gene species), 37 tRNA genes (29 tRNA species), and 8 rRNA genes (4 rRNA species). The neighbour-joining phylogenetic analysis showed that P. simonii and P. qamdoensis clustered together as sisters to other Populus species.

Simplified synchronous disconnection of pulmonary arteries and veins for right upper lobectomy.

BACKGROUND: Video-assisted thoracoscopic lobectomy with lymphadenectomy is considered one of the most effective treatments for early non-small cell lung cancer. We developed a novel approach for lobectomy in patients with right upper lung cancer through simplified synchronous disconnection of pulmonary arteries and veins. This study aimed to evaluate the feasibility, efficacy, safety, and cost-effectiveness of this minimally invasive technique in managing right upper lobectomy. PATIENTS AND METHODS: From March 2016 to September 2017, 62 patients with right upper lung cancer underwent lobectomy via simplified synchronous disconnection of pulmonary arteriovenous by video-assisted thoracoscopic surgery. All patients were followed up for 6-12 months after the procedure through clinic visits or telephone/e-mail interviews. RESULTS: Of the 62 patients (mean age, 57.2 ± 8.7 years), 28 were men (45.2%) and 34 (54.8%) were women. All procedures were successfully performed by thoracoscopy, with a mean operating time of 66.2 ± 9.0 min. The mean blood loss was 40.3 ± 19.5 mL. Only 1 (1.61%) patient required blood transfusion. The mean number of endoscopic linear stapling devices used was 2.6 ± 0.7. The mean number of lymph nodes harvested was 16.0 ± 1.6. Postoperative pneumonia was encountered in 4 (6.45%) patients. There was no postoperative mortality. The mean length of hospital stay was 5.3 ± 1.3 days. Six-month follow-up revealed an excellent clinical result and degree of satisfaction. CONCLUSIONS: Simplified synchronous disconnection of pulmonary arteries and veins is a feasible, economical, safe, and effective therapeutic procedure for right upper lung carcinoma. This novel procedure shows promise as a viable surgical approach for right upper lobectomy.

Sequential treatment strategy for malignant pleural effusion in non-small cell lung cancer with the activated epithelial grow factor receptor mutation.

With the advent of molecularly targeted therapy, it is necessary to reconsider the strategy for malignant pleural effusion in non-small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations. The aim of this study was to evaluate the efficacy of a two-line sequential treatment strategy in this patient subgroup. First-line treatment was gefitinib (250 mg/day) until disease progression. Second-line treatment was thoracoscopic talc pleurodesis followed by chemotherapy. Primary endpoints were the overall response and progression-free survival rates after first-line treatment, and the overall survival rate after first- and second-line treatment. Secondary endpoints were the success rate of thoracoscopic talc pleurodesis and gefitinib toxicity. Among the 76 patients enrolled, 61 (80%) were female and the median age was 62 years. The overall response rate after first-line treatment was 92.1% and median progression-free survival was 15 months. The success rate for thoracoscopic talc pleurodesis in 33 patients was 94%. Median follow-up was 35 months. Median overall survival was 39 months. The 1- and 3-year overall survival rates were 86.4% and 46.1%, respectively. The two-line sequential treatment strategy enhanced survival. These preliminary findings provide an insight into novel therapeutic models for malignant pleural effusion in NSCLC harbouring EGFR mutations.

Transareolar pulmonary bullectomy for primary spontaneous pneumothorax.

BACKGROUND: Conventional 3-port video-assisted thoracoscopic surgery is the classic approach for the diagnosis and treatment of primary spontaneous pneumothorax. Transareolar pulmonary bullectomy rarely has been attempted. This study aimed to evaluate the feasibility and safety of this novel minimally invasive technique in managing primary spontaneous pneumothorax. METHODS: From January 2013 to December 2014, a total of 112 male patients with primary spontaneous pneumothorax underwent transareolar pulmonary bullectomy by use of a 5-mm thoracoscope. RESULTS: All procedures were performed successfully, with a mean operating time of 26.5 minutes. The mean length of transareolar incision for the main operation was 2.0 ± 0.2 cm, the mean length of incision for the camera port was 0.6 ± 0.1 cm, and the mean postoperative cosmetic score was 3.0 ± 0.8. All patients regained consciousness rapidly after surgery. One hundred seven patients (95.5%) were discharged on postoperative day 2 or 3, with the remainder discharged on postoperative day 4 or 5. Postoperative complications were minor. At 6 months postoperatively, there was no obvious surgical scar on the chest wall, and no patient complained of postoperative pain. No recurrent symptoms were observed. One-year follow-up revealed an excellent cosmetic result and degree of satisfaction. CONCLUSIONS: Transareolar pulmonary bullectomy is a safe and effective therapeutic procedure for primary spontaneous pneumothorax caused by pulmonary bullae. The incision is hidden in the areola with excellent cosmetic effects. This novel procedure shows promise as a treatment of primary spontaneous pneumothorax.

Nonintubated Needlescopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis: A Randomized Controlled Trial.

BACKGROUND: Conventional endoscopic thoracic sympathectomy (ETS) is usually performed with 5-mm thoracoscope under general anesthesia with endotracheal intubation. Needlescopic thoracic sympathectomy under total intravenous anesthesia without intubation has rarely been attempted. This randomized controlled trial assesses the feasibility and safety of this minimally invasive therapeutic procedure in managing primary palmar hyperhidrosis. METHODS: From July 2012 to July 2014, 221 patients with severe primary palmar hyperhidrosis underwent bilateral ETS and were randomly allocated to group A or group B. Patients in group A (n=108) underwent nonintubated ETS using a needle endoscope, whereas those in group B (n=113) underwent traditional transaxillary single-port ETS using a 5-mm thoracoscope. RESULTS: ETS was successfully performed in all patients. The palms of all patients became dry and warm immediately after surgery. The mean resuscitation time was significantly shorter in nonintubated patients than in intubated patients (P<0.01). Postoperative sore throat occurred in 37 patients in group B, whereas none of the patients in group A complained about sore throat after surgery (P<0.01). The mean incision length was 5.1±0.1 mm with needle endoscope and 11.0±0.8 mm with traditional thoracoscope (P<0.01). The mean postoperative pain score was 1.1±0.8 in group A and 3.2±0.8 in group B (P<0.01). The mean cost of anesthesia was considerably lower in nonintubated patients than in intubated patients (P<0.01). Follow-up was 100% completed. The mean cosmetic scores were higher in group A than in group B (P<0.01). Residual pain occurred in 2 patients in group A and in 18 patients in group B (P<0.01). CONCLUSIONS: Nonintubated needlescopic thoracic sympathectomy is a safe, effective, and minimally invasive therapeutic procedure, which has the advantages of a smaller incision with less pain, shorter resuscitation time, and better cosmetic results.

Nonintubated transareolar single-port thoracic sympathicotomy with a needle scope in a series of 85 male patients.

BACKGROUND: Traditional endoscopic thoracic sympathicotomy is usually performed through an axillary incision with 5-mm thoracoscope under general anesthesia with endotrachea intubation. Nonintubated transareolar single-port thoracic sympathicotomy with a needle scope has rarely been attempted. The objective of this study is to evaluate the feasibility and safety of this minimally invasive technique in managing primary palmar hyperhidrosis (PPH). METHODS: From May 2012 to May 2014, a total of 85 male patients with severe PPH underwent transareolar single-port thoracic sympathicotomy by use of a 2-mm needle scope under total intravenous anesthesia without endotrachea intubation. RESULTS: All procedures were successfully performed with a mean operating time of 13.5 min. The palms of all patients became dry and warm as soon as the sympathetic chain was cut off. There were no sore throat, and all the patients regained consciousness rapidly after surgery. Eighty-two patients (96.5 %) were discharged from the hospital on the first postoperative day. The postoperative complications were minor, and no patients developed Horner's syndrome. At 6 months postoperatively, there is no obvious surgical scar on the chest wall, and none of the patients complained about postoperative pain. Compensatory sweating appeared in 31 patients. No recurrent symptoms were observed in our study. One-year follow-up revealed an excellent cosmetic result and degree of satisfaction. CONCLUSIONS: Nonintubated transareolar single-port needlescopic thoracic sympathicotomy is a safe, effective and minimally invasive therapeutic procedure, which can be performed in routine clinical practice for male PPH patients.

Minimally Invasive Esophagectomy in the Lateral-prone Position: Experience of 226 Cases.

BACKGROUND: An open esophagectomy for esophageal cancer is a severely invasive procedure. Minimally invasive esophagectomy (MIE) has emerged as an effective alternative to open techniques. Conventionally, a thoracoscopic procedure is performed either in the left lateral decubitus position or in the prone position. Both positions have their disadvantage during the mobilization of the esophagus. In this study, we applied a novel position: the left lateral-prone position in the throacoscopic phase of MIE; we also describe the details of the technique and its feasibility, and present the initial results of this large-volume series. METHOD: We performed 226 cases of MIEs for esophageal cancer successfully from February 2008 to September 2014. All patients received thoracoscopic mobilization of the esophagus, followed by larparoscopic mobilization of the stomach and cervical anastomosis (McKeown or 3-field lymphadenectomy dissection esophagectomy). The throacoscopic part was performed in the left lateral-prone position. Perioperative data and the surgical outcome were studied retrospectively. RESULT: Of the 226 patients, 131 were men (57.9%) and 95 (42.1%) were women, with a median age of 64.5 years. All procedures were completed by thoracoscopy and laparoscopy, except 3 cases of conversion to open thoracotomy and 2 conversions to open laparotomy. Two-field lymphadenectomy was performed in 89 patients. Three-field lymphadenectomy was performed in 137 patients. Only 6 (2.7%) patients required blood transfusion. Postoperative morbidity was encountered in 78 (34.5%) patients, and anastomotic leak occurred in 9 cases (4.0%). Vocal cord paralysis was found in 11 cases (4.9%). The mean number of lymph nodes harvested was 21. The 30-day postoperative mortality rate was 1.3% (n=3). The mean length of hospital stay was 12.7 days. CONCLUSIONS: MIE in the lateral-prone position is technically less demanding and provides better technical safety, with good oncological effectiveness. This positioning is a feasible and appropriate alternative for minimally invasive surgery of esophageal carcinoma.

Nation wide epidemiological survey of primary palmar hyperhidrosis in the People's Republic of China.

OBJECTIVE: To investigate the prevalence and epidemiological characteristics of primary palmar hyperhidrosis (PPH) among adolescents in PR China. METHODS: A nationwide survey was performed, including all seven geological areas of Mainland China. Stratified cluster sampling was performed, and a cross-sectional epidemiological survey was applied via questionnaire among 10,000 college students in each geological area. RESULTS: The prevalence rate of PPH was 2.08%. The prevalence in female adolescents was slightly higher than the prevalence in male adolescents (2.29 vs. 1.94%). The prevalence of PPH in coastal areas was higher than the prevalence of PPH in inland areas (2.81 vs. 1.53%). The peak age of onset is 7-15 years, accounting for 97.3% of the PPH population. Positive family history was found in 25.40% of PPH cases. In addition to palms, axillae and soles can also be affected. CONCLUSIONS: PPH affects a larger group of individuals than previously reported. More measures should be taken to enhance the recognition, diagnosis, and treatment of PPH.

[Transaxillary concealing single incision endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis: a novel surgical approach].

OBJECTIVE: To evaluate the cosmetic effect and safety of transaxillary concealing single incision endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis (PH). METHODS: Retrospective study was conducted for 326 PH cases undergoing transaxillary concealing single incision endoscopic thoracic bilateral sympathectomy during January 2009 and March 2011. RESULTS: All operations were successfully performed without severe complication and mortality. No conversion into open technique was necessary. The mean unilateral operative duration was 5.8 (5-8) min. It was calculated from the time of skin incision to the application of dressing over wound. The mean follow-up period was 25 (8-38) months. All patients achieved excellent cosmetic effects with undetectable incision. CONCLUSION: Transaxillary concealing single incision endoscopic thoracic sympathectomy is a safe and effective procedure for treating primary PH. Incision is undetectable with excellent cosmetic effect. It is worthy of wider popularization.

Prevention of chylothorax complicating extensive esophageal resection by mass ligation of thoracic duct: a random control study.

BACKGROUND: Chylothorax after esophagectomy remains a devastating postoperative complication. Prophylactic mass ligation of the thoracic duct during the extensive resection of esophageal cancer is used to prevent the chylothorax, but there are few published data about its effect. This randomized controlled study was designed to evaluate the preventive effect of thoracic duct mass ligation on postoperative chylothorax. METHODS: Six hundred fifty-three patients undergoing transthoracic esophagectomy for cancer were randomly assigned to two groups: 328 patients received esophagectomy (preservation group) and 325 patients received thoracic duct mass ligation during esophagectomy (prevention group). The patients in whom chylothorax developed were identified and occurrence rates of chylothorax were compared between the two groups. The management and outcome of postoperative chylothorax was also recorded. RESULTS: Patients' demographic details were similar between the two groups. No major or minor intraoperative or postoperative complications related to prophylactic thoracic duct mass ligation were recorded. Chylothorax occurred in 8 patients, giving an incidence of 1.2%. In the preservation group, chylothorax occurred in 7 patients (2.1%), and in the prevention group, 1 case of chylothorax was found (0.3%). The incidence of postoperative chylothorax was significantly lower in the prevention group. Among the 8 cases of postoperative chylothorax, 6 patients made an uneventful recovery, but the other 2 patients died of complications (mortality rate, 25%). CONCLUSIONS: The technique of intraoperative thoracic duct mass ligation proved safe and effective. It minimized the risk of postoperative chylothorax in patients who underwent transthoracic esophagectomy for cancer.

[Trans-areola single port endoscopic thoracic sympathectomy for the treatment of palmar hyperhidrosis: a new surgical approach].

OBJECTIVE: To evaluate the cosmetic effects and safety profiles of trans-areola single port endoscopic thoracic sympathectomy. METHODS: A retrospective study was conducted for 45 males and 7 females with palmar hyperhidrosis undergoing trans-areola single port endoscopic thoracic bilateral sympathectomy during April and June 2011. RESULTS: All operations were successfully performed without severe morbidity and mortality. No conversion to open technique was necessary. The mean unilateral operative duration was 6 minutes (range: 5 - 8). The time was calculated from the time of skin incision to that of dressing application over wound. The mean hospitalization duration was 2.2 days (range: 2 - 3). The mean follow-up period was 2.8 months (range: 1 - 7). All patients achieved excellent cosmetic effects. No incision scar was found. CONCLUSION: Trans-areola single port endoscopic thoracic sympathectomy is a safe and effective therapeutic procedure for primary palmar hyperhidrosis. The incision is undetectable with excellent cosmetic effects. The trans-areola route is a new ideal and promising approach for endoscopic thoracic sympathectomy.

[Video-assisted thoracoscopic extended thymectomy for myasthenia gravis: report of 62 cases].

OBJECTIVE: To evaluate the clinical value of video-assisted thoracoscopic extended thymectomy for myasthenia gravis(MG). METHODS: Sixty-two MG cases underwent video-assisted thoracoscopic extended thymectomy. The operative extension included thymus tissue and adipose tissue in anterior superior mediastinum. RESULTS: All operations were performed successfully. The mean operating duration, mean intraoperative blood loss and mean postoperative hospital stay was 98 ± 26 minutes, 60 ± 29 ml and 8.2 ± 2.5 days respectively. All cases were followed up for 5 to 48 months. Among them, 20 (32.3%) patients achieved a complete relief, 32 (51.6%) had their improved symptoms, 8 (12.9%) remained stable and 2 (3.2%) became worse. And the overall relief rate was 83.9%. CONCLUSION: Video-assisted thoracoscopic extended thymectomy is both feasible and reliable for MG with the advantages of a minimal trauma and a rapid recovery.

Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser Doppler blood flow.

BACKGROUND: Limiting the extent of sympathectomy in palmar hyperhidrosis was recently recognized as an effective method to minimize the incidence and severity of troublesome compensatory sweating. However, the levels at which transection should be performed remain controversial. In this study, we proposed that the level of ablation varies and should be adjusted for each individual patient. Guided by palmar skin temperature and laser Doppler blood flow, we try to find the correct target level in each case. METHODS: Fifty patients with severe primary palmar hyperhidrosis received bilateral endoscopic thoracic sympathectomy. Different levels of transection from T4 to T2 were performed step by step until the successful extirpation was implied by the intraoperative monitoring. The results of the operations were studied. All patients were followed up and evaluated for symptom resolution, postoperative complication, levels of satisfaction, and severity of compensatory sweating. RESULTS: Of a total of 100 lateral procedures, 76 laterals (76%) ended the procedure at the T4 level, 23 laterals (23%) ended the procedure at the T3 level, and 1 lateral (1%) ended the procedure at the T2 level. The postoperative complication was minor, and no Horner's syndrome was detected. The rate of symptom resolution was 100% and no recurrence was found. The satisfaction rate was 92%, and the incidence of mild, moderate, and severe compensatory sweating were 12%, 8%, and 6%, respectively. CONCLUSIONS: Concerning the sympathectomy for palmar hyperhidrosis, there is a possibility that the level of the transection varies and should be adjusted for each individual patient. Intraoperative monitoring of temperature and blood flow may be a useful tool in establishing a kind of standardized reference for finding the correct target level.

Endoscopic thoracic sympathectomy for palmar hyperhidrosis: a randomized control trial comparing T3 and T2-4 ablation.

BACKGROUND: Compensatory sweating is a major and troublesome complication noted frequently after sympathectomy in patients with primary palmar hyperhidrosis. This randomized clinical trial was projected to measure the impact of limited denervation on compensatory sweating while performing endoscopic thoracic sympthectomy. METHODS: Two hundred thirty-two patients with primary palmar hyperhidrosis were randomly allocated to either a T3 sympathectomy treatment, called group T3, or a T2-4 sympathetic treatment, called group T2-4. The patients underwent bilateral sympathetic ablation at corresponding levels. All patients were followed up and evaluated for comparison of symptom resolution, postoperative complication, levels of satisfaction, and severity of compensatory sweating between the two groups. RESULTS: Sex, age, family history, and distribution of sweating were similar in both groups. The postoperative complications were minor, and Horner's syndrome was not detected in either group. The frequency of mild and moderate compensatory sweating was not significantly different between the two groups, but the incidence of severe compensatory sweating was significantly lower after T3 sympathectomy (3% versus 10%). As for satisfaction rate, group T3 was superior to group T2-4 (96.6% versus 89.6%). The rate of symptom resolution was 100%, and no recurrence was found in either group. CONCLUSIONS: The single-level sympathetic denervation under thoracoscopy is a safe and effective procedure to treat primary palmar hyperhidrosis. This method reduces the incidence of severe compensatory sweating postoperatively without compromising the patient's satisfaction.

Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People's Republic of China.

OBJECTIVE: To investigate the prevalence and epidemiological characteristics of primary palmar hyperhidrosis (PPH) among adolescents in Fuzhou City of PR China. METHODS: Stratified cluster sampling was carried out and a cross-sectional epidemiological survey by questionnaire was applied among 13,000 college and high school students. RESULTS: The prevalence rate of PPH was 4.59% affecting both sexes equally. The peak age of onset is 6-16 years, accounting for 95.6% of the PPH population. Positive family history was found in 15.3% PPH cases. Besides palms, axillae and soles can be also affected. CONCLUSIONS: PPH affects a larger group of individuals than previously reported. More measures should be taken to enhance the recognition, diagnosis, and treatment of PPH.

Epidemiological survey of primary palmar hyperhidrosis in adolescents.

BACKGROUND: Despite recent advances in recognition and treatment of primary palmar hyperhidrosis (PPH), the epidemiological survey has hardly been conducted. The aim of this study was to investigate the prevalence and epidemiological characteristics of primary PPH among adolescents in three cities of southeast China. METHODS: Stratified-cluster sampling was carried out and cross-sectional epidemiological survey by questionnaire was applied among 33 000 college and high school students. RESULTS: The prevalence rate of PPH was 4.36% affecting both sexes equally. Prevalence rate of severe PPH was 0.27%. The average age of onset was 12.27 +/- 2.12 years. The peak age of onset was 6 - 16 years, accounting for 97.2% of PPH population. Positive family history was found in 17.9% PPH cases. Besides palms, axillae and soles can be also affected. CONCLUSIONS: PPH affects a larger group of individual than previously reported. More measures should be taken to enhance the recognition, diagnosis, and treatment of PPH.