Long Sudarshan Kriya Yoga enhances cardiovascular and respiratory synchronization: An observational study.

BACKGROUND: Sudarshan Kriya Yoga (SKY - a rhythmic cyclic breathing) is known to produce several physiological changes in human body. Earlier it has been reported that SKY improves cardiovascular modulations, namely increase in heart rate variability. OBJECTIVE: To observe the synchronization in oscillatory modulations in cardiac autonomic tone and ventilatory exchange during Long Sudarshan Kriya Yoga (LSKY). LSKY is a sequential combination of pranayama in ujjayi breath, bhastrika, and cyclic rhythmic breathing followed by yog-nidra. METHODS: Regular LSKY practitioners from the Art of Living community with more than two years of experience participated in the study (n = 22; age 40.09 ± 12.68). The Electrocardiogram (ECG), respiration, oxygen saturation, and concentrations of oxygen and carbon-di-oxide from exhaled air were recorded before and during LSKY. The time domain parameters of heart rate variability (HRV) were calculated from ECG. All parameters were compared and correlated at each stage of LSKY. RESULTS: Highly significant reciprocal correlation was found between HRV parameters and respiration rate during LSKY. Both O2 consumption and CO2 production increased significantly during three stages of pranayama and decreased towards the end of cyclic breathing. We also saw increased SPO2 simultaneously. CONCLUSION: The autonomic parameters exhibited reciprocal response to respiratory rate and correlated well to the ventilatory parameters. Further during LSKY we observed enhanced synchronization. In conclusion the LSKY has a potential to influence cardiorespiratory parameters for improving the performance of both systems. LSKY - enhances oscillations in HRV that resets the autonomic system, indicative of better cardiac health and prepares body for better metabolic response. Such changes are capable of inducing resilience along with physiological, psychological relaxation and emotional well-being.

Effects of Sudarshan KriyaYoga and Advanced Meditation Program on Genetic Expression of Pro-inflammatory and Antioxidants Genes.

Background Stress leads to immune system dysregulation and dyshomeostasis at the gene level. Mind-body practices are known to influence genomic expression, leading to better health and quality of life. Objective To assess the effect of Advanced Meditation Program (AMP) on the mRNA expression of pro-inflammatory and antioxidative genes among those already practicing Sudarshan Kriya Yoga (SKY). Methods A total of 97 healthy volunteers participated in the study, distributed into two groups. The Group I SKY practitioners attended a four-day AMP (50 participants with an average age of 38.8 ± 11.9 consisting of 37 females and 13 males); they are first-time participants of the AMP. Group II SKY practitioners, on the other hand, consisted of 47 participants with an average age of 36.4 ± 9.3 with 43 females and four males. At day 0, day 5, and day 90, the mRNA expression of pro-inflammatory genes, namely interleukin (IL) 1ß, IL6, and the tumor necrosis factor (TNF), and the expression of antioxidative genes, namely superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx) was observed. The data were analysed in two phases due to the emergence of coronavirus disease 2019 (COVID-19): (i) pre-COVID-19 and (ii) during COVID-19. Results In the pre-COVID-19 data set, IL1ß, IL6, and TNF were found to have decreased in both groups. There is a significant increase in the expression of SOD and catalase in Group I and a decrease in Group II by day 90. During COVID-19, pro-inflammatory genes increased in Group I and had no significant change in Group II. All three antioxidant genes had decreased expression by day 90 in Group I; SOD decreased in Group II. Interpretation and conclusions Reduced expression of pro-inflammatory genes and increase in the expression of antioxidative genes during the pre-COVID-19 time suggest that the practice of SKY and added AMP may enhance antioxidative defense and may reduce the chance of getting diseases related to inflammation in the body.

Effect of fetal liver condition media derived cytokines(IL-6 and Flt-3) on human bone marrow stem cells colony formation.

Earlier research from our laboratory demonstrated the presence of stimulatory activity of different growth factors in the fetal liver (FL) extracts when collected in a medium known as fetal liver conditioned medium (FLCM) using Enzyme-linked Immunosorbent Assay (ELISA). In the present study, we have assessed two other cytokines viz. IL-6 and FMS like tyrosine kinase-3 (Flt-3) with the help of bioneutralization assay. FLCM was prepared by incubating fetal liver cells with Iscove's Modified Dulbecco's Medium (IMDM) containing 10% fetal bovine serum (FBS) and 10% Phytohemagglutinin and collected after 24hrs, 48hrs, 72 hrs. and on the 7th day of incubation. Clonal cultures were established for 1 X 105 normal bone marrow (BM) mononuclear cells (NBM MNC) per plate with methylcellulose medium containing cytokines SCF and EPO. Mean Colony forming units-granulocytes, erythrocytes, macrophages, megakaryocytes (CFU-GEMM) were assessed with and without the addition of FLCM. It was found that FLCM enhanced the number of colonies made by NBM MNCs. Further, cytokines IL-6 and Flt-3, present in FLCM, were bioneutralized with respective anti-cytokine antibodies. Neutralized FLCM was evaluated for the colony-forming potential of CFU-GEMM colonies. The maximum reduction of 42% was seen with 20 ng/ml of anti-IL-6 antibody. Maximum suppression up to 20% was observed with 0.7 ng/ml of anti Flt-3 antibody for CFU-GEMM colonies. Presence of cytokines IL-6 and Flt-3 in FL extracts and their colony stimulatory activity suggests that fetal liver infusion (FLI) may be a valuable alternative for managing BM recovery in certain clinical conditions such as AA.

In vitro expansion of fetal liver hematopoietic stem cells.

Fetal liver hematopoietic stem and progenitor cells (HSPCs) have been considered appropriate for the management of aplastic anemia owing to their proliferative potential. Bone marrow recovery was possible in some cases; the engraftment potential of these cells, however was unsatisfactory, possibly due to the availability of a smaller number of these cells from a single fetus. The present study explores how we can expand fetal liver hematopoietic stem cells under in vitro conditions. We isolated mononuclear cells from fetal liver and hematopoietic stem cells were identified and analyzed by cell surface marker CD34. CD34+ fetal liver HSPCs cells were separated by magnetic cell sorting positive selection method. HSPCs (CD34+) were cultured by using 5 cytokines, stem cell factor (SCF), granulocyte macrophages-colony stimulating factor (GM-CSF), interleukin-6 (IL-6), Fms-related tyrosine kinase 3 (FLT-3) and erythropoietin (EPO), in 4 different combinations along with supplements, in serum-free culture media for 21 days. Cell viability continued to be greater than 90% throughout 21 days of culture. The cells expanded best in a combination of media, supplements and 5 cytokines, namely SCF, FLT-3, IL6, EPO and GM-CSF to yield a large number of total (CD34+ & CD34-) cells. Even though the total number of nucleated cells increased in culture significantly, levels of CD34 antigen expression declined steadily over this period.

Effect of Sudarshan Kriya Yoga (SKY) on daytime and situational sleep propensity in novice practitioners: a prospective cohort study.

OBJECTIVES: Hectic, late-night lifestyle has reduced 90 min sleep in 20% adults resulting in insomnia and excessive daytime sleepiness (EDS). We assess the scope of Sudarshan Kriya Yoga (SKY), a 4-component, breathing process in reducing EDS, generally and situationally. METHODS: This is a prospective, controlled study involving randomized subjects without any sleep-wake cycle anomalies and prior experience in SKY. Subjects (n=52) performed 30 min of SKY for 6 days/week for 8 weeks, while controls (n=53) performed sitting activity and Suryanamaskar for 4-weeks each. Epworth Sleepiness Scale (ESS) was used to measure EDS at 0, 4, and 8 weeks. RESULTS: SKY group showed significant ESS score improvements between 0-4 weeks and 4-8 weeks of 1.22 (p=0.0001) and 1.66 (p=0.001) respectively. Controls however failed to improve with score differences of 0.02 (p=0.892) and 0.02 (p=0.8212) respectively. SKY group showed significant ESS score improvement over controls at 4-weeks (difference=1.74; p=0.013) and 8-weeks (difference eight; p=0.0001). Improvement was most for obese people and those sitting in a halted car. CONCLUSIONS: Improvement in subjects' nighttime sleep and daytime wakefulness in SKY practitioners can be attributed to polyvagal theory. Increased heart rate variability (HRV) alterations and sympathetic hyperarousal in chronic insomnia; and cholinergic and GABAergic dysregulation in anxiety disorders are countered by regulated vagal nerve stimulation post SKY. Our study establishes effectivity of SKY in reducing EDS (total and situational), provides a clinical correlation for prior polysomnographic evidence and paves way for larger trials directed towards SKY prescriptions for insomnia.

High-Frequency Cerebral Activation and Interhemispheric Synchronization Following Sudarshan Kriya Yoga as Global Brain Rhythms: The State Effects.

CONTEXT: Respiration is known to modulate neuronal oscillations in the brain and is measured by electroencephalogram (EEG). Sudarshan Kriya Yoga (SKY) is a popular breathing process and is established for its significant effects on the various aspects of physiology and psychology. AIMS: This study aimed to observe neuronal oscillations in multifrequency bands and interhemispheric synchronization following SKY. SETTINGS AND DESIGN: This study employed before- and after-study design. SUBJECTS AND METHODS: Forty healthy volunteers (average age 25.45 ± 5.75, 23 males and 17 females) participated in the study. Nineteen-channel EEG was recorded and analyzed for 5 min each: before and after SKY. Spectral power for delta, theta, alpha, beta, and gamma frequency band was calculated using Multi-taper Fast Fourier Transform (Chronux toolbox). The Asymmetry Index was calculated by subtracting the natural log of powers of left (L) hemisphere from the right® to show interhemispheric synchronization. STATISTICAL ANALYSIS: Paired t-test was used for statistical analysis. RESULTS: Spectral power increased significantly in all frequency bands bilaterally in frontal, central, parietal, temporal, and occipital regions of the brain after long SKY. Electrical activity shifted from lower to higher frequency range with a significant rise in the gamma and beta powers following SKY. Asymmetry Index values tended toward 0 following SKY. CONCLUSIONS: A single session of SKY generates global brain rhythm dominantly with high-frequency cerebral activation and initiates appropriate interhemispheric synchronization in brain rhythms as state effects. This suggests that SKY leads to better attention, memory, and emotional and autonomic control along with enhanced cognitive functions, which finally improves physical and mental well-being.

Assessment of Cardiac Autonomic Tone Following Long Sudarshan Kriya Yoga in Art of Living Practitioners.

OBJECTIVE: The breathing processes are known to modulate cardiac autonomic tone and improve psychological status. We investigated cardiac autonomic tone following long Sudarshan Kriya Yoga (SKY) using heart rate variability (HRV) and skin conductance level (SCL). METHODS: Thirty healthy volunteers (age 28.3 ± 8.4 years; 23 M: 7 F) participated in the study. Electrocardiogram (ECG) and SCL were recorded for 5 min each, before and after long SKY. Long SKY is a combination of pranayama and cyclic rhythmic breathing and is performed by following the guided audio instructions. HRV analysis was used for the assessment of cardiac autonomic tone. Time and frequency domain parameters of HRV were calculated by using RR interval of ECG. SCL was acquired using Galvanic skin response (GSR) amplifier of PowerLab in microSeimens (µS). RESULTS: Time domain parameters of HRV, including mean RR interval (p = 0.000), respiratory sinus arrhythmia (RSA) (p = 0.037), standard deviation of all NN intervals (SDNN) (p = 0.013), NN50 count divided by the total number of all NN intervals (pNN50) (p = 0.004), and square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD) (p = 0.002) increased, and mean heart rate decreased (p = 0.000) following long SKY. In frequency domain analysis, power of low-frequency (LF) component (p = 0.010) and LF/HF ratio (p = 0.008) decreased significantly, whereas power of high frequency (HF) significantly increased (p = 0.010). SCL decreased following long SKY, although it did not attain statistical significance. CONCLUSIONS: The results suggest that long SKY induces significant oscillations in cardiac autonomic tone. Parasympathetic activity increases and sympathetic activity decreases and sympathovagal balance improves following long SKY. Decrease in sympathetic activity is also demonstrated by decrease in conductance although it did not reach statistical significance. From this study it can be concluded that long SKY has a beneficial effect on cardiac autonomic tone, and psychophysiological relaxation. It may serve as a tool to improve HRV, which is the marker of cardiovascular health.

Effect of controlled breathing exercises on the psychological status and the cardiac autonomic tone: Sudarshan Kriya and Prana-Yoga.

OBJECTIVE: The objective of the study was to observe the effect of controlled breathing exercises including Sudarshan Kriya (SK) and Prana-Yoga (PY) on the psycho-physiological status. METHODS: The study group included 60 healthy volunteers (M:30, F:30) in the age group of 18 to 30 years (21.3 ± 3.2 yrs), randomly divided in to three groups of 20 subjects each--(1) The SK group (2) the PY group and the (3) Control group. The psycho-physiological data was collected at the following four time interventions: Baseline, 6th, 60th and the 150th day. Psychological assessment was done using questionnaires and for the autonomic tone quantification Heart Rate Variability (HRV) analysis was done using the standard lead II electrocardiogram recordings. In a post-hoc analysis each group was further sub divided in to the following two patterns, based on the baseline values of normalized Low Frequency (LF) power (cutoff 64 ms2): (i) Pattern A-Subjects with low level LF power, and (ii) Pattern B- subjects with high level LF power. RESULTS: The stress management skills have shown significant increase in SK group but not in PY and Control group. Subjects of SK, PY, and control group showed significant increase in LF value and LF:HF ratio for pattern A and significant decrease for pattern B. Plotted LF value for pattern A & B in SK and PY practitioners showed convergence, coming to a mean value over the period of 150 days. The LF:HF ratio curve plotted over time for pattern A & B showed convergence in SK group only. No such convergence in LF value & LF/HF ratio for pattern A & B was seen in control group. CONCLUSION: In conclusion, Sudarshan Kriya positively modifies stress coping behavior and initiates appropriate balance in cardiac autonomic tone.

Role of sudarshan kriya and pranayam on lipid profile and blood cell parameters during exam stress: A randomized controlled trial.

BACKGROUND: Yoga is a science practiced in India over thousands of years. It produces constituent physiological changes and has sound scientific basis. AIM: Since exam stress modifies lipid profile and hematological parameters, we conducted an investigation on the effect of sudarshan kriya (SK and P) program on these parameters. MATERIALS AND METHODS: Blood samples of 43 engineering students were collected at four intervals namely baseline (BL), exam stress (ES), three and six weeks practice of SK and P during exam stress. Lipid profile and hematological parameters were measured at all four intervals. RESULTS: ES elevated total cholesterol (TC), triglycerides (TGL) and very low density lipoprotein (VLDL) levels. Hematological parameters affected by ES included neutrophil, lymphocytes, platelet count, packed cell volume (PCV) and mean cell volume (MCV). Three and six weeks practice of SK and P reduced the elevated lipid profile, hematological parameters and improved lymphocyte levels. CONCLUSION: Our study indicates that SK and P practice has the potential to overcome ES by improving lipid profile and hematological parameters.

Mutations in ABL kinase domain are associated with inferior progression-free survival.

Imatinib mesylate is currently the drug of choice for all phases of chronic myeloid leukemia (CML). Despite the initial high rates of hematological and cytogenetic responses, many patients develop resistance. We prospectively studied 40 patients with CML with primary cytogenetic resistance to imatinib mesylate. A semi-nested reverse transcriptase-PCR approach was used for amplification of the ABL kinase domain, which was then subjected to direct sequencing for the detection of point mutations. Expression of BCR-ABL transcripts was quantified using the real-time Taqman assay, and BCR-ABL gene amplification was detected using fluorescence in situ hybridization. Twelve different point mutations were detected in 18/40 (45%) patients. Five patients had mutations in the P-loop region and 13 had mutations in other regions of the BCR-ABL kinase domain. Progression-free survival at 2 years was inferior for patients with mutations compared to those without mutations (72% vs. 95%, p < 0.0045). The BCR-ABL fusion gene was over-expressed in five patients (5/18); the mean BCR-ABL/ABL ratio was 75.38 vs. 28.72 for imatinib responders, p < 0.001. Amplification of the BCR-ABL fusion gene was detected in 4/40 (10%) patients. Point mutation was the major mechanism of primary cytogenetic resistance to imatinib mesylate in the present study. Patients with mutations had inferior progression-free survival compared to those without mutations. Regular monitoring for the presence of point mutations in the ABL kinase region may identify such patients early, with an opportunity to intervene.

Response to Imatinib mesylate in chronic myeloid leukemia patients with variant BCR-ABL fusion transcripts.

Chronic myeloid leukemia patients with different BCR-ABL transcripts might respond differently to Imatinib mesylate. This prompted us to study BCR-ABL transcripts in chronic myeloid leukemia (CML) patients and their correlation with response to Imatinib. Eighty-seven chronic phase CML patients (median age, 35 years; range, 13-62 years; M/F, 59:28) were included in this study; 57 patients had received interferon-alpha and/or hydroxyurea, and 30 were previously untreated. All patients received Imatinib mesylate (Gleevec) 400 mg daily. Complete hematological remission rate and major cytogenetic response (CGR) rates were 99% and 72%, respectively. B3a2 transcript was present in 53% of patients, b2a2 in 39%, and both transcripts in 8% of patients. Twenty of 34(59%) patients with b2a2 type achieved complete CGR compared to 15 of 53 (28%) patients with b3a2, p = 0.04. Among 24 patients with minor or no CGR, six (25%) had b2a2 compared to 18 (75%) b3a2 type, p = 0.04. Expression of BCR-ABL/ABL% was higher in b3a2 patients compared to b2a2, p = 0.120. Pre-treatment characteristics-mean spleen size (6.6 vs. 6.4 cm, p = 0.868), mean hemoglobin (G/dl; 12.0 vs. 11.8, p = 0.690), mean WBC count (83 x 10(9) vs. 77 x 10(9)/L, p = 0.923), and mean platelets counts (360x10(9) vs. 340 x 10(9)/L, p = 0.712)-were not significantly different in the b3a2 vs. b2a2 transcripts groups. Our preliminary findings suggest that CML patients with b2a2 BCR-ABL transcript might have higher CGRs to Imatinib mesylate (Gleevec).

Gene expression profiling in practitioners of Sudarshan Kriya.

BACKGROUND: The rapid pace of life, eating habits, and environmental pollution have increased stress levels and its related disorders. The complex molecular response to stress is mediated by stress genes and a variety of regulatory pathways. Oxidative stress is internal damage caused by reactive oxygen species. Increasing evidence suggests that chronic psychosocial stress may increase oxidative stress, which in turn may contribute to aging, and etiology of coronary diseases, cancer, arthritis, etc. Psychophysiological concomitants of meditation have been extensively researched, but there are very little data available on biochemical activity leading to relieving stress by causing a relaxation response by Sudarshan Kriya (SK). SK is a breathing technique that involves breathing in three different rhythms. It is preceded by Ujjayi Pranayam (long and deep breaths with constriction at the base of throat) and Bhastrika (fast and forceful breaths through nose along with arm movements). METHODS: Forty-two SK practitioners and 42 normal healthy controls were recruited for our study. The practitioners had practiced SK for at least 1 year. Selected normal healthy controls did not perform any conventional physical exercise or any formal stress management technique. Whole blood was used for glutathione peroxidase estimation and red blood cell lysate was used for superoxide dismutase activity assay and for glutathione estimation. White blood cells were isolated from fresh blood and assayed for gene expression using reverse transcriptase-polymerase chain reaction. The parameters studied are antioxidant enzymes, genes involved in oxidative stress, DNA damage, cell cycle control, aging, and apoptosis. RESULTS: A better antioxidant status both at the enzyme activity and RNA level was seen in SK practitioners. This was accompanied by better stress regulation and better immune status due to prolonged life span of lymphocytes by up-regulation of antiapoptotic genes and prosurvival genes in these subjects. CONCLUSIONS: Our pilot study provides the first evidence suggesting that SK practice may exert effects on immunity, aging, cell death, and stress regulation through transcriptional regulation.

Primary pulmonary rhabdomyosarcoma in adults: case report and review of literature.

A 38-year-old man, a chronic smoker, presented to us with a large left upper lobe mass lesion and left-sided pleural effusion. After resection, a residual mass remained. On histopathologic examination, a diagnosis of pleiomorphic rhabdomyosarcoma stage III of the lung was made. Chemotherapy using IRS (Intergroup Rhabdomyosarcoma Study) IV protocol with radiation therapy (RT) at week 9 was planned. The tumor progressed within 6 weeks of chemotherapy to involve the diaphragm and the pericardium (inoperable disease). Chemotherapy was abandoned, and we referred the patient to receive RT, which the patient refused; and he died of progressive disease 1 month later. The poor response to chemotherapy suggests that alternative treatment modalities including RT/second-look surgery or novel chemotherapeutic strategies should be tried in such a case.

Multifocal osteosarcoma involving unusual sites.

We report a rare case of multifocal osteosarcoma (MFOS) with involvement of skeleton, lung, bone marrow, and soft tissues, presenting with paraparesis, cranial nerve palsies, subcutaneous nodules, anemia, and thrombocytopenia. MFOS with involvement of unusual sites presents problems in diagnosis and has a poor prognosis. The literature on 11 cases of MFOS with extraosseus, extrapulmonary involvement reported previously has been reviewed.

Small cell lung cancer: an update on therapeutic aspects.

Small cell lung cancer comprises approximately 20% of all lung cancers and continues to be a difficult management issue. More than two-thirds of cases present with extensive disease, which has spread beyond the himithorax and regional ipsilateral nodes. While response rates to chemotherapy are relatively high, durable responses are rare, and long-term survival rates are anecdotal. Although many attempts have been made to develop new therapies, a combination of etoposide with either cisplatin or carboplatin remains the most widely used first-line therapy for extensive disease. For those with limited disease, chemotherapy with concomitant radiotherapy (given with the first or second cycles of chemotherapy) is considered the standard of care. Over the last decade, several new drugs and targeted agents have been identified with the aim to improve outcome of this malignancy. In this review we highlight recent developments in the management of this tumour.

Evaluation of the effect of Withania somnifera root extracts on cell cycle and angiogenesis.

In the Indian System of Medicine, the medicinal plant, Withania somnifera Dunal (Solanaceae) finds application for numerous ailments including cancer. This study explores the mechanism(s) underlying this property. The hydroalcoholic extract of the roots (WS) was partitioned between chloroform (WS-chloroform) and water (WS-water). Further, WS-chloroform was fractionated (A1-A12) by reverse-phase column chromatography and their withanolide content was quantified by high-performance liquid chromatography (HPLC). Preliminarily, the anti-proliferative activity of all the extracts and fractions was screened against human laryngeal carcinoma (Hep2) cells by microculture tetrazolium assay (MTT). Two extracts (WS and WS-chloroform) and three fractions (A4, A5 and A6) negatively affected Hep2 viability at the concentration of 25 microg/ml and these were further investigated pharmacologically. Flow cytometry revealed cell cycle block and accumulation of hypoploid (sub G1) cells as the mode of anti-proliferative activity of all but A4. Their anti-angiogenic potential was investigated by a chickchorio-allantoic membrane (CAM) wherein a significant inhibition (p<0.0001) of vascular endothelium growth factor (VEGF), induced neovascularization was recorded. The effect was confirmed in vivo by mouse sponge implantation method. These findings suggest that the roots of Withania somnifera possess cell cycle disruption and anti-angiogenic activity, which may be a critical mediator for its anti-cancer action.

Chemotherapy alone vs. chemotherapy plus high dose multiple antioxidants in patients with advanced non small cell lung cancer.

OBJECTIVE: In vitro and animal studies suggest that antitumor effect of chemotherapeutic agents may be enhanced by antioxidants. Therefore, we initiated a clinical study to test the efficacy of high-dose multiple antioxidants (vitamins C, E and beta carotene) as an adjunct to chemotherapy (paclitaxel and carboplatin) in non-small-cell lung cancer. METHODS: 136 patients of stage IIIb and stage IV NSCLC were randomized to receive chemotherapy (paclitaxel and carboplatin) alone (chemotherapy arm, n = 72) or chemotherapy in combination with ascorbic acid 6100 mg/day, dl-alpha-tocopherol (vitamin E) 1050 mg/day and beta-carotene 60 mg/day (combination arm, n = 64). Survival were calculated by the Kaplan-Meier method and compared using the log-rank test. RESULTS: An overall response rate (RR) of 33% was observed in chemotherapy arm with 24 patients showing a partial response (PR) and none showing a complete response (CR). In combination arm the overall RR was 37% with 24 patients showing PR and two showing CR. The median survival times in chemotherapy arm and combination arm were nine and 11 months respectively. The overall survival (OS) rates in chemotherapy arm and combination arm at one year were 32.9% and 39.1%, and at two years, 11.1% and 15.6% respectively. None of these differences were statistically significant (p = 0.20). Toxicity profiles were similar in both arms. CONCLUSIONS: These results do not support the concern that antioxidants might protect cancer cells from the free radical damage induced by chemotherapy. Larger trials are needed to demonstrate whether high-dose multiple antioxidants in conjunction with chemotherapy increase the response rates and/or survival time in advanced lung cancer.

Effect of rhythmic breathing (Sudarshan Kriya and Pranayam) on immune functions and tobacco addiction.

Stress, a psychophysiological process, acts through the immune-neuroendocrine axis and affects cellular processes of body and immune functions, leading to disease states including cancer. Stress is also linked to the habit of tobacco consumption and substance abuse, which in turn also leads to diseases. Sudarshan Kriya (SK) and Pranayam (P), rhythmic breathing processes, are known to reduce stress and improve immune functions. Cancer patients who had completed their standard therapy were studied. SK and P increased natural killer (NK) cells significantly (P <0.001) at 12 and 24 weeks of the practice compared to baseline. Increase in NK cells at 24 weeks was significant (P <0.05) compared to controls. There was no effect on T-cell subsets after SK and P either in the study group or among controls. SK and P helped to control the tobacco habit in 21% of individuals who were followed up to 6 months of practice. We conclude that the inexpensive and easy to learn and practice breathing processes (SK and P) in this study demonstrated an increase in NK cells and a reduction in tobacco consumption. When confirmed in large and randomized studies, this result could mean that the regular practice of SK and P might reduce the incidence and progression of cancer.

Acute basophilic leukemia with t(8;21).

Acute basophilic leukemia (ABL) is a rare form of leukemia. The diagnostic criteria have recently been described. Morphological evidence for basophilic lineage is required for its classification. However the criteria for remission status and standard therapy is not established. Here we have described an atypical case of ABL and reviewed the literature to high light issues regarding diagnosis and management, which need further discussion.

POEMS syndrome: experience with fourteen cases.

The POEMS syndrome, also known as Crow-Fukase disease, is a rare multisystem disorder, which may take several years to evolve fully. The combination of symptoms and signs is highly complex and some of the features are detected at sub-clinical level requiring high level of suspicion. The clinical data on POEMS is still evolving with only a few case reports from India. Herein, we report a series of 14 cases with POEMS syndrome at our centre over the past 8 years, which were analysed retrospectively for their clinical features, response to therapy and treatment outcome. Presence of plasma cell dyscrasia (PCD) was essential for inclusion in this study. Confirmation of PCD was done by positive "M" spike in serum and/or urine, bone marrow plasmacytosis or presence of plasmacytoma on biopsy. In addition, the diagnosis of POEMS syndrome needed the presence of at least two of the following features: polyneuropathy, organomegaly, endocrinopathy and/or skin changes. Patients were excluded from study if there was a secondary cause of polyneuropathy like amyloidosis, drugs like vincristine, nerve root or spinal cord compression. Two patients had complete form (all five features) of the syndrome, whereas 12 had incomplete form. Median age was 48 years (range 32-65). Peripheral neuropathy was seen in 13 (92.85%) cases, organomegaly 10 (71.42%), endocrinal involvement 7 (50%) and skin changes 9 (64.28%). An association with Castleman's disease and vasculitis was also noted. With different chemotherapy protocols, all treated patients (n = 12), had significant symptomatic improvement with or without objective improvement at median follow up of 48 months (range 6-120). In conclusion, high level of suspicion is required to detect this rare entity.