Background:Primary focal hyperhidrosis (PFH) significantly impacts patients' physical and mental health, yet its underlying mechanisms remain unclear. Methods:This study involved 80 healthy controls and 60 patients each with primary palmar (PPH), craniofacial (PCH), or axillary hyperhidrosis (PAH). Peripheral blood mononuclear cells (PBMCs) were analyzed via flow cytometry to assess Th17 and Treg cell populations. Cytokine levels were measured in patient serum using ELISA, while sweat gland tissue from PAH patients underwent gene expression analysis. A pilocarpine-induced mouse model of hyperhidrosis was used to test SR2211, a RORγ inverse agonist. Results:PFH patients exhibited a disrupted Th17/Treg balance, with increased Th17 and decreased Treg cells across all subtypes compared to controls. Elevated IL-17 and IL-6 and reduced IL-10 and TGF-β1 levels were observed in PFH serum. Sweat glands showed increased RORγt and decreased FOXP3 expression. In mice, SR2211 treatment reduced sweat secretion, secretory granules, and serum acetylcholine. It also lowered Th17 infiltration, serum IL-17/IL-6, and IL-17A expression in sweat glands. Discussion:PFH is associated with a Th17/Treg immune imbalance. SR2211 alleviated hyperhidrosis and Th17-related inflammation in mice, highlighting the potential of targeting the RORγ-Th17 axis as a therapeutic strategy for PFH.

To explore the feasibility and safety of using indocyanine green combined with autologous blood and methylene blue for the localization of small pulmonary nodules in thoracoscopic wedge resection. Patients who met the inclusion criteria underwent CT-guided percutaneous lung puncture injection of localization agents to locate pulmonary nodules at our center from November 2023 to September 2024. Under thoracoscopy, pulmonary nodules were visualized, and wedge resection was performed. The feasibility was preliminarily verified by evaluating whether the localization agent concentrated around the nodules and help surgeons successfully completed wedge resection under marker guidance. The safety was verified by the incidence of adverse reactions during puncture and surgery. A total of 272 patients were included, comprising 110 males and 162 females, with an average age of 50.60 (14.17) years. In all cases except the first four, the localization agent concentrated around the nodules, achieving precise localization of pulmonary nodules. Nodules were found in all resected tissues, with negative margins. In 4 patients, excessive localization agent dosage caused marker diffusion and pleural staining. The overall localization success rate was 98.53%, and when the injection volume of the localization agent was 0.2–0.5 mL, the localization success rate was 100.0%. All cases successfully completed thoracoscopic wedge resection, and nodule lesions were found with negative margins. Indocyanine green combined with autologous blood and methylene blue for the localization of small pulmonary nodules is safe and feasible in lung wedge resection.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

The dependence of ACh-stimulated calcium transients on AQP5 and Na-K-2Cl cotransporter 1 (NKCC1) expression may be involved in the development of primary focal hyperhidrosis (PFH).

目的 评估原发性手汗症(primary palmar hyperhidrosis,PPH)患者胸腔镜下胸交感神经切断术(endoscopic thoracic sympathicotomy,ETS)术后生活质量(quality of life,QOL)并分析其影响因素.方法 纳入2017年1月-2018年1月福建医科大学附属第一医院成功接受ETS(仅T3水平胸交感神经切断)治疗的PPH患者243例,其中男118例、女125例,平均年龄(21.99±6.31)岁.采用世界卫生组织生活质量测定量表评估ETS前后患者的QOL.通过建立性别、年龄、体重指数、代偿性多汗(compensatory hyperhidrosis,CH)、手掌干燥的线性回归模型,研究QOL变化与各因素间的关系.结果 ETS术后QOL总分高于术前(63.01±4.58 vs.48.11±1.95,P＜0.05).术后合并CH与阴性组比较,QOL总分改变情况降低4.662.CH的程度每升高1级,QOL总分改变情况降低3.449.术后合并胸部CH、背部CH与阴性组比较,QOL总分改变情况均降低,其中随着CH的严重程度每升高1级,QOL总分改变情况分别降低1.804、2.400.结论 ETS不仅能改善手掌异常多汗症状,而且能显著提高QOL.重度胸背部CH是影响患者QOL的重要因素.

Abstract Primary palmar hyperhidrosis (PPH) is a pathologic condition of excessive sweating on hands that has adverse impacts on patients’ social activity, professional life, and psychological state. Endoscopic thoracic sympathicotomy (ETS) is by far the treatment choice for PPH with the most stable and durable curative effects, but special attention should be given to the side effects of the surgery, especially compensatory hyperhidrosis (CH). This consensus is the second version of the Chinese Expert Consensus on the Surgical Treatment of PPH by the China Expert Committee on Palmar Hyperhidrosis (CECPH), which was published 10 years ago. This consensus emphasizes the need for special attention and careful assessment of the patients’ feelings, as well as their emotional and mental state, and emphasizes that distress due to palmar sweating and the desire for treatment are prerequisites for diagnosis. It also provides a more nuanced delineation of CH and reviews all new attempts to prevent and treat this side effect. New evidence of the epidemiology, pathogenesis of PPH, and indications for surgery were also assessed or recommended.

Molecularly targeted drugs are flourishing in the clinical treatment of non-small cell lung cancer (NSCLC). However, the treatment of a single drug (such as Gefitinib (Geb)) had defects such as poor pharmacokinetics, insufficient drug delivery, and considerable toxic side effects, which greatly affect its therapeutic efficacy against NSCLC. To solve these issues, this study developed a new nanocomposite heterogeneous platform (MSNs@Ag@Geb-FA) that combined photothermal therapy and molecular targeted therapy. The high specific surface area empowered mesoporous silicon dioxide (SiO2) heterostructure the ability to efficiently load Ag photothermal agents and anti-tumor drug Geb. Meanwhile, a favorable pH response (degradation of residual MnO2) achieved the controlled release of Ag and Geb. Besides, the targeting and endocytosis properties of nano drugs were greatly improved through the modification of folic acid (FA). Both in vivo and in vitro experiments authenticated that this nanocomposite heterogeneous platform could effectively integrate the multiple tumor suppressor properties of Ag nanoparticles and cooperate with Geb to hasten A549 cell apoptosis, thereby achieving a favorable anti-tumor effect. This heterogeneous structure of the nanocomposite heterogeneous platform could provide an effective strategy for the treatment of NSCLC.

系统回顾我国20年来有关手汗症微创治疗临床与基础系列研究证据,针对当前手汗症微创治疗的热点问题和难点问题进行深入探讨,对手汗症的定义、临床表现、诊断标准与分级、手术适应证与禁忌证、手术方法及并发症的处理,尤其是对术后代偿性多汗(compensatory hyperhidrosis,CH)等领域形成新的共识.肯定胸腔镜下胸交感神经切断术(endoscopic thoracic sympathicotomy,ETS)仍是当前治疗手汗症最有效且值得推广的方法,CH为最常见的副作用.为了降低CH发生率,减轻患者困扰,提高患者满意度,指南特别强调:重视术前谈话和告知、充分与患者沟通、谨慎选择患者、杜绝手术适应证扩大化、优化手术术式等策略是防治CH的关键.详细介绍各种降低CH发生率方法的利与弊.为规避手术风险、重视围手术期的处理、进一步提高手术疗效提供一份权威性指导性文件.

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.

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.

目的 探讨人工气胸辅助单孔胸腔镜胸腺切除术在胸腺肿瘤患者中的应用.方法 选择我院2016年9月～2018年12月行人工气胸辅助单孔胸腔镜胸腺切除术的28例胸腺肿瘤患者为实验组,选取同期行人工气胸辅助胸腔镜(三孔)胸腺切除术的38例胸腺肿瘤患者为对照组.实验组行人工气胸辅助单孔胸腔镜胸腺切除术,对照组行人工气胸辅助胸腔镜(三孔)胸腺切除术.比较两组患者的手术时间、术中出血量、术后引流液量、术后住院时间.结果 两组患者的手术时间、术中出血量、术后住院时间、术后胸管放置时间、病理类型、放置26F引流管所占比例比较,差异无统计学意义(P＞0.05).实验组术后24 h的视觉模拟疼痛评分低于对照组,差异有统计学意义(P＜0.05).两组患者术后均恢复好,无并发症,无术中和术后死亡.术后随访6～18个月,无患者复发.结论 人工气胸辅助单孔胸腔镜胸腺切除术应用于胸腺肿瘤患者是可行、安全的.

BACKGROUND:This study aimed to evaluate the clinical efficacy and safety of endoscopic thoracic sympathicotomy and to explore strategies to decrease the incidence of transfer hyperhidrosis (TH). METHODS:From January 2003 to July 2016, 10,275 patients with primary palmar hyperhidrosis underwent endoscopic thoracic sympathicotomy in 15 different institutions. We carried out a retrospective analysis of these patients who were grouped into group A, those with nonretained R2 (R2, R2-3, or R2-4 ablation), and group B, those with retained R2 (single R3 or R4 ablation). RESULTS:All procedures were performed successfully. Both hands of all patients became warm and dry immediately after endoscopic thoracic sympathicotomy. Pneumothorax occurred in 146 patients, and 39 patients had intraoperative bleeding. Follow-up was carried out from 6 months to 13 years. A total of 531 patients (5.2%) were lost to follow-up. The effective rate for primary palmar hyperhidrosis was 100%. Palmar hyperhidrosis recurred in 73 patients (0.7%). Transfer hyperhidrosis appeared in 7,678 patients (78.8%). For groups A and B, the incidence of TH was 80.4% and 78.5%, respectively (P > .05), but the incidence of grade III+IV TH in group B (1.6%) was less than that in group A (4.8%; P < .001). CONCLUSION:Endoscopic thoracic sympathicotomy is a minimally invasive, safe, and effective therapeutic method for primary palmar hyperhidrosis. Although the overall incidence of TH is high, the incidence of grade III to IV TH can be decreased by reserving R2, lowering the level of thoracic sympathicotomy, and single severing of R3 or R4.

实践证明，胸腔镜胸交感神经切断术（ endoscopic thoracic sympathicotomy or sympathotomy ，ETS）是治疗原发性手汗症（ primary palmar hyperhidrosis ， PPH ）的安全有效的方法［1］。 ETS 术毕手掌立即干燥无汗，不仅有效率高，而且部分患者伴发的腋汗和足汗也减轻或消失，更无发生严重并发症的报道，手术当日或次日便可出院，且切口隐蔽美观。更为明确的是，ETS术后可使之前严重影响患者生活、工作和社交的尴尬完全摆脱，故而ETS受到广大青年患者的青睐。

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 (250mg/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.

Objective To analyze the efficacy of endoscopic thoracic sympathotomy ( ETS) in the treatment of primary palmar hyperhidrosis (PPH). Methods From January 2003 to January 2013, we performed ETS to treat 2206 patients with PPH.We carried out a retrospective summary and analysis of clinical data of Group A ( non-reserved R2, R2 -R4 ablation ) and Group B (reserved R2, R3 or R4 ablation). Results All the operations were performed under thoracoscope , and no severe complications or mortality were found .Transient postoperative palmar sweating manifested in 25 patients within 1 week after surgery , which was resolved spontaneously within 1-2 weeks.Long-term follow-ups for 1-8 years (median, 4.5 years) were obtained for all the 2206 patients. All the patients had warm and dry palm and face at discharge , and the effective rate was 100%.Among them, 41.8% of patients experienced decreased axillary sweating and 29.3% of patients experienced decreased plantar sweating .Three patients experienced gustory hperhidrosis during 1 -2 months after operation , and the symptoms disappeared spontaneously after 1 year.Five cases experienced recurrent palmar hyperhidrosis 9 months to 5 years after operation , all of which were cured by reoperation . The compensatory hyperhidrosis (3 grades) was changed to transfer hyperhidrosis (TH), with patients divided into 4 grades, including 944 cases (42.8%) with GradeⅠor mild symptoms, 750 cases (34.0%) with GradeⅡor moderate symptoms, 42 cases (1.9%) with Grade Ⅲor severe symptoms, and 18 cases (0.8%) with Grade Ⅳ or extremely severe symptoms ( also known as incapacitating hyperhidrosis, IH).The overall rate of TH was 79.5%(1754/2206).All these 18 cases of IH were followed up for 1 -8 years (median,4.5 years), with only two cases improved.The satisfaction in therapeutic effect was 94.2%(487/517) in Group A, which was significantly lower than that in Group B [98.1%(1657/1689),Z=-4.704,P=0.000].The quality of life was significantly higher in Group B than that in Group A (Z=-5.425,P=0.000). Conclusions ETS is a safe and effective method of minimally invasive treatment for PPH.Reserving R2 during surgery and lowering the thoracic sympathotomy level (single ablation of R3 or R4) can significantly reduce the incidence of Grade Ⅲ-ⅣTH.Regarding the harmful effect of Grade ⅣIH, the indications of surgery are restrict.

Objectives: Transareolar single-port needlescopic thoracic sympathectomy under intravenous anesthesia without intubation has rarely been attempted in managing primary palmar hyperhidrosis (PPH). The objective of this study is to evaluate the feasibility and safety of this minimally invasive technique. Materials and Methods: From May 2012 to May 2015, 168 male patients with severe PPH underwent single-port endoscopic thoracic sympathectomy (ETS) and were randomly allocated to groups A or B. Patients in group A underwent nonintubated transareolar ETS with a 2-mm needle endoscope, while those in group B underwent intubated transaxillary ETS with a 5-mm thoracoscope. Results: All procedures were performed successfully. 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. Postoperative sore throat occurred in 4 patients in group A and in 32 patients in group B (P<.01). The mean incision length was significantly shorter in group A than in group B. The mean postoperative pain scores were markedly higher in group B than in group A. The mean cost of anesthesia was considerably lower in nonintubated patients than in intubated patients. The mean cosmetic scores were higher in group A than in group B (P<.01). Conclusions: Nonintubated transareolar single-port ETS with a needle endoscope is a safe, effective, and minimally invasive therapeutic procedure, which allows a smaller incision with less pain and excellent cosmetic results. This novel procedure can be performed in a routine clinical practice for male patients with severe PPH.

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).

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.

Background: The expression of aquaporin 5 (AQP5) in human axillary sweat glands has never been studied so far. Objective: To detect the expression of AQP5 in axillary sweat glands of patients with primary focal hyperhidrosis (PFH) relative to control subjects. Methods: The morphological characteristics and the number of sweat coils in axillary sweat glands were compared between two groups by using transmission electron microscopy. The expression of AQP5 was detected by immunohistochemistry, Western blot analysis, and real-time transcription polymerase chain reaction. Results: There were no significant differences between the two groups in terms of morphological characteristics and the number of sweat coils in axillary sweat glands. The expressions of AQP5 protein and AQP5 mRNA were significantly higher in the patient group than in the control group. Conclusion: AQP5 is involved in the secretion of human axillary sweat glands. The overexpression of AQP5 in sweat glands is probably one pathogenetic mechanism underlying PFH.