Mallampati Score Is an Independent Predictor of Active Oxygen Therapy in Patients with COVID-19.

Mallampati score has been identified and accepted worldwide as an independent predictor of difficult intubation and obstructive sleep apnea. We aimed to determine whether Mallampati score assessed on the first patient medical assessment allowed us to stratify the risk of worsening of conditions in patients hospitalized due to COVID-19. A total of 493 consecutive patients admitted between 13 November 2021 and 2 January 2022 to the temporary hospital in Pyrzowice were included in the analysis. The clinical data, chest CT scan, and major, clinically relevant laboratory parameters were assessed by patient-treating physicians, whereas the Mallampati score was assessed on admission by investigators blinded to further treatment. The primary endpoints were necessity of active oxygen therapy (AOT) during hospitalization and 60-day all-cause mortality. Of 493 patients included in the analysis, 69 (14.0%) were in Mallampati I, 57 (11.6%) were in Mallampati II, 78 (15.8%) were in Mallampati III, and 288 (58.9%) were in Mallampati IV. There were no differences in the baseline characteristics between the groups, except the prevalence of chronic kidney disease (p = 0.046). Patients with Mallampati IV were at the highest risk of AOT during the hospitalization (33.0%) and the highest risk of death due to any cause at 60 days (35.0%), which significantly differed from other scores (p = 0.005 and p = 0.03, respectively). Mallampati IV was identified as an independent predictor of need for AOT (OR 3.089, 95% confidence interval 1.65−5.77, p < 0.001) but not of all-cause mortality at 60 days. In conclusion, Mallampati IV was identified as an independent predictor of AOT during hospitalization. Mallampati score can serve as a prehospital tool allowing to identify patients at higher need for AOT.

Electromagnetic Fields Modify Redox Balance in the Rat Gastrointestinal Tract.

Objective: The aim of the study was to assess the influence of electromagnetic fields with divergent physical properties on the prooxidative and antioxidative balances in homogenates of the tongue, salivary glands, esophagus, stomach, and small and large intestines of rats. Material and Methods: Forty rats were randomly divided into four equal groups, namely, a control group, a group exposed to low-frequency electromagnetic fields (LF-EMFs; frequency: 50 Hz; intensity: 10 kV/m; magnetic induction: 4.3 pT), a group exposed to radiofrequency electromagnetic fields (RF-EMFs) emitted by mobile phones (frequency: 900 MHz), and a group exposed simultaneously to LF-EMFs and RF-EMFs emitted by mobile phones. After 28 consecutive days of the experiment, the following pro- and antioxidative markers were assessed in the gastrointestinal tract homogenates: superoxide dismutase (SOD) and its two isoenzymes (Mn-SOD, Cu,Zn-SOD) catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), glutathione S-transferase (GST), total antioxidative capacity (TAC), total oxidative status (TOS), and malondialdehyde (MDA). Results: In rats exposed to LF-EMFs, higher concentrations of the markers of prooxidant processes, MDA or TOS, were observed in the salivary glands, esophagus, and small intestine homogenates in comparison with the control group. Additionally, in the group of rats opposite to the control, antioxidant activity was observed. The main differences included a higher activity of Cu,Zn-SOD in homogenates of the tongue, salivary glands, and esophagus as well as decreased activity of CAT in homogenates of the tongue, esophagus, and small intestine. In animals exposed to RF-EMFs, the concentration of TOS was higher in the large intestine than in control rats. The main difference of antioxidant activity was presented by decreased Cu,Zn-SOD in homogenates of the salivary glands, stomach, small and large intestine as well as CAT in homogenates of the tongue, esophagus, stomach, and small and large intestine. Moreover, in rats exposed simultaneously to LF-EMFs and RF-EMFs, a lower concentration of TOS was observed. Antioxidant activity was presented by a decreased activity of CAT in homogenates of the tongue, esophagus, stomach, and small and large intestine in comparison to the control group. Conclusion: Among those applied in the study, electromagnetic fields of a low-frequency caused the most significant disturbances of oxidative stress in the rat gastrointestinal tract.

Monitoring PDT effects in basal cell carcinoma treatment using thermal imaging.

BACKGROUND: One of the most frequent type of malignant skin lesion (almost 95 percent of all skin tumours) is basal cell carcinoma (BCC). It is often treated by radiotherapy using ionizing radiation as well by photodynamic therapy (PDT) which is a selective method directed only on cancer cells and well tolerated by patients. MATERIALS AND METHODS: Eight male patients of the Department and Clinic of Internal Diseases, Angiology and Physical Medicine in Bytom, Medical University of Silesia, in Katowice, Poland suffering from basal cell carcinoma were monitored by thermovision during the photodynamic therapy. All lesions were diagnosed as superficial were confirmed by histopathological examination. RESULTS: The dynamics of changes observed in the isotherm area during the therapy can provide physicians with additional information. The significant increase of observed isotherm area in comparison to the lesion area diagnosed by a physician was confirmed, which may be connected with the increased metabolism processes occurring in the tissue surrounded the lesion. CONCLUSION: The obtained results based on the temperature gradient changes in the lesion vicinity area may bring some new information describing the range of biochemical and physiological processes occurring during photodynamic therapy.

Clinical Trials and Basic Research in Photodynamic Diagnostics and Therapies from the Center for Laser Diagnostics and Therapy in Poland.

The purpose of this review is to present an overview of the development of photodiagnostic and photodynamic therapy (PDD and PDT) techniques in Poland. The paper discusses the principles of PDD, including fluorescent techniques in determining precancerous conditions and cancers of the skin, digestive tract, bladder and respiratory tract. Methods of PDT of cancer will be discussed and the current state of knowledge as well as future trends in the development of photodynamic techniques will be presented, including the possibility of using photodynamic antimicrobial therapy. Research pioneers in photodynamic medicine such as Thomas Dougherty are an inspiration for the development of methods of PDD and PDT in our Clinic. The Center for Laser Diagnostics and Therapy in Bytom, Poland, promotes the propagation of PDD and PDT through the training of clinicians and raising awareness among students in training and the general public. Physicians at the Center are engaged in photomedical research aimed at clinical implementation and exploration of new avenues in photomedicine while optimizing existing modalities. The Center promotes dissemination of clinical results from a wide range of topics in PDD and PDT and serving as representative authorities of photodynamic medicine in Poland and Europe.

Can fluorescence and autofluorescence imaging be useful in diagnosis of basal cell cancer? Proposition of algorithms.

BACKGROUND: The most common non-melanoma skin carcinomas (NMSC) are basal cell carcinomas (BCC). Autofluorescence study may allow a non-invasive distinction of neoplastic lesions from benign lesions, whereas fluorescence spectroscopy enables qualification of the patient for possible photodynamic or surgical treatment. The aim of the study is to assess the suitability of autofluorescence and fluorescence imaging in the diagnosis of the stage of advancement, and the morphological type of changes in basal cell carcinoma of the skin. METHODS: A group of 382 patients with 430 skin lesions of basal cell carcinoma were subjected to an autofluorescence study and a spectral imaging using a spectral camera. The acquired spectra and fluorescence images were analyzed using the Image Pro-Plus 5.0.2 software. An analysis of fluorescence intensity profiles in the long and short axis of the studied changes was carried out. RESULTS: The fluorescence emission observed in BCC lesions with an area of ​​up to 3 cm2 showed a statistically significantly higher level of intensity in comparison to changes in lesions exceeding 3 cm2 (#p < 0.05, ## p < 0.01). In the autofluorescence evaluation, we observed significant differences in the mean values of the Numerical Colour Value (NCV) depending on the size of the area of skin occupied by skin lesions. Based on the spatial and profile assessment of the types of BCC lesions a proposed algorithm for identifying changes was developed. Analysis of green fluorescence intensity profiles, analogous to fluorescence profiles analysis, allowed to propose an algorithm of autofluorescence evaluation in the diagnosis of BCC. CONCLUSIONS: Autofluorescence and fluorescence imaging allow assessment of the extent of neoplastic infiltration and distinguish types of skin lesions with BCC. The determined diagnostic algorithms may be an effective diagnostic solution in the diagnosis of skin lesions of this nature.

Does the Numerical Colour Value (NCV) correlate with preneoplastic and neoplastic colorectal lesions?

BACKGROUND: White light endoscopy (WLE) is the gold standard for detection of colorectal cancer. Autofluorescence endoscopy (AFE) is among the novel methods expected to increase the sensitivity and specificity of endoscopic diagnosis. The main objective of the study was to determine the diagnostic efficacy of AFE for the detection of preneoplastic and neoplastic colorectal lesions and to identify high-grade neoplasia using Numerical Colour Value (NCV). METHODS: This retrospective study included 188 patients with colorectal mucosal lesions diagnosed on WLE and assessed using AFE; they were included in the study if a complete patient record was available (description of visualized colorectal lesions, NCV and histopathology report). The NCV was compared with the histological result. RESULTS: Histology revealed 38 hyperplastic colon polyps, 77 low-grade dysplastic lesions, 17 high-grade dysplastic lesions, 24 adenocarcinomas and 32 inflammatory lesions. The mean NCVs of high-grade dysplasia (HGD) and adenocarcinoma were 2.24 ±â€¯0.22 and 2.73 ±â€¯0.16, respectively, significantly higher than the NCV of hyperplastic colon polyps (0.95 ±â€¯0.06), low-grade dysplasia (LGD) (1.27 ±â€¯0.05) and inflammatory lesions (1.26 ±â€¯0.17). The NCV cut-off value for HGD and adenocarcinoma was set at 1.7. The sensitivity, specificity, PPV (positive predictive value) and NPV (negative predictive value) were 95.2%, 87.9%, 97.5%, 84.8%, respectively. CONCLUSION: Our study showed that AFE could provide useful diagnostic information regarding preneoplastic and neoplastic colorectal lesions. Additionally, the NCV significantly correlated with the histopathology results.

The effect of ALA-PDT under normoxia and cobalt chloride (CoCl2)-induced hypoxia on adhesion molecules (ICAM-1, VCAM-1) secretion by colorectal cancer cells.

BACKGROUND: The most fundamental problem in cancer biology research is to understand the mechanisms of cancer cell resistance to oncological therapies. Literature reports emphasize the important role of adhesion molecules: intercellular adhesion molecule 1 and vascular cell adhesion molecule 1 (ICAM-1 and VCAM-1) in cancer progression and resistance to treatment. Photodynamic therapy (PDT) could become the component of a personalized approach to colorectal cancer, therefore we examined the effects of ALA (δ-aminolevulinic) acid PDT in normoxia and under cobalt chloride (CoCl2)-induced hypoxia on ICAM-1 and VCAM-1 secretion by colorectal cancer cells. METHODS: Human colorectal cancer cells of different malignant potential SW480 and SW620 were used in the experiment. Cell lines were treated ALA, in order to achieve conditions comparable to in vivo hypoxia, CoCl2 was added, then cells were irradiated both in normoxia and in hypoxia-like conditions. Cell viability was assessed using the LDH and MTT assays and apoptosis. ICAM-1 and VCAM-1 concentrations were determined with the Bio - Plex ProTM Assay and System. RESULTS: The experiment revealed that ALA PDT under normoxia and CoCl2-induced hypoxia had no significant effect on ICAM-1 and VCAM-1-dependent adhesion of colorectal cancer cells. The secretion of ICAM-1 by SW480 ell line was more pronounced compared to ICAM-1 secretion by SW620 cells. CONCLUSION: Determination of tumor marker levels and especially adhesion molecules involved in metastatic spread is necessary. Our experiment reveals, that ALA PDT in normoxia and CoCl2-induced hypoxia has no effect on adhesion molecules secretion by colon cancer cells in vitro.

Whole-Body Cryostimulation as an Effective Method of Reducing Oxidative Stress in Healthy Men.

BACKGROUND: Whole-body cryostimulation (WBC) is the therapeutic exposure of the total human body (without underwear) to a very low temperature (below -100°C) for 120-180 s. Currently, WBC is used more frequently not only in the treatment of patients suffering from various diseases, but also by healthy people as a wellness method. OBJECTIVES: The aim of this research is to evaluate the impact of WBC procedures on oxidative stress parameters in healthy men. MATERIAL AND METHODS: The study involved 32 healthy male subjects who were randomly divided into 2 groups: 16 men exposed to WBC procedures with subsequent kinesiotherapy (WBC group) and 16 men exposed only to kinesiotherapy procedures (KT group). Depending on the group, the subjects were exposed to 10 daily WBC procedures lasting 3 min, with a subsequent 60-min of kinesiotherapy, or exclusively to kinesiotherapy. In subjects from both groups, a day before the beginning of a cycle of treatment and a day after its completion, the level of selected indicators of oxidative stress and non-enzymatic antioxidants, as well as the activity of antioxidant enzymes in serum, plasma and erythrocyte lysates were determined. RESULTS: In the WBC group subjects, we recorded a statistically significant decrease in the concentrations of most of the parameters of oxidative stress with an accompanying increase in plasma concentrations of non-enzymatic antioxidants (total antioxidant status and uric acid). We recorded no significant changes in the activities of antioxidant enzymes (plasma total superoxide dismutase (SOD) and its isoenzymes SOD-Mn and SOD-ZnCu, erythrocyte catalase, glutathione peroxidase and glutathione reductase). CONCLUSIONS: The results we obtained confirmed that WBC decreases oxidative stress in healthy men.

Proposal of thermal imaging application in photodynamic therapy-Preliminary report.

There are many different skin lesions that manifest a skin temperature gradient. Basal cell carcinoma (BCC) is the most frequently occurring type of malignant skin lesion (almost 95% of all skin tumors). BCC is sometimes treated by using photodynamic therapy which is very well tolerated by patients and provides good results, especially in superficial skin layer lesions. The results of our studies showed significant changes in the area of temperature gradient due to photodynamic therapy. It seems that the ability to acquire knowledge of such area changes may provide additional useful information to physicians. The increase of observed isotherm area in comparison to lesion size on the skin was a few times higher. It may suggest the range of areas where the metabolism processes take place. Due to the accumulation of photosensitivity only in tumor cells, we theorize that such a large region of increased metabolism observed during therapy may be connected with a larger range of tumor cells than was previously predicted through diagnosis. However, it should be noted that the region can be much bigger due to the existing heat transfer. The results obtained have a potential meaning in describing the range of chemical and physiological processes occurring during photodynamic therapy.

The role of fluorescence diagnosis in clinical practice.

Fluorescence diagnosis is a fast, easy, noninvasive, selective, and sensitive diagnostic tool for estimation of treatment results in oncology. In clinical practice the use of photodynamic diagnosis is focused on five targets: detection for prevention of malignant transformation precancerous changes, detection of neoplasmatic tissue in the early stages for fast removal, prevention of expansion and detection of recurrence of the cancer, monitoring therapy, and the possibility of excluding neoplasmatic disease. In this article, selected applications of fluorescence diagnosis at the Center for Laser Diagnostics and Therapy in Bytom, Poland, for each of these targets are presented.

Clinical evaluation of twenty cases of heterotopic gastric mucosa of upper esophagus during five-year observation, using gastroscopy in combination with histopathological and microbiological analysis of biopsies.

AIM OF THE STUDY: Heterotopic gastric mucosa of the upper esophagus (HGMUE) may be connected with disorders of the upper gastrointestinal tract, exacerbated by Helicobacter pylori. Furthermore, HGMUE may be the origin of malignant progression to cervical esophageal carcinoma. MATERIAL AND METHODS: In this work, 20 patients with diagnosed heterotopic gastric mucosa of the upper esophagus (HGMUE) were subjected to 5-year follow-up to determine the extent and structure of histopathological changes within HGMUEs, as well as HGMUE dysplasia and metaplasia, and risk of their malignant transformation. As a diagnostic tool to describe localization, form, size and surface feature of HGMUEs, endoscopy was used. At the same time, the biopsies were collected for histopathological and microbiological analysis. RESULTS: In examined patients, HGMUEs were associated with inflammation, chronic gastritis, hiatus hernia, duodenal bulb erosion and ulcer and infection of H. pylori. Intestinal metaplasia and low grade dysplasia were also indicated. During 5 years of observation, both the clinical and histopathological image of diagnosed HGMUEs was stable. The patients with detected presence of H. pylori were treated with triple or quadruple therapy. These results show that HGMUEs may be associated with severe complications in the gastrointestinal tract, such as infection by H. pylori, hiatus hernia or duodenal ulcer. Although dysplasias and metaplasias found in diagnosed HGMUEs were not very numerous and relatively stable both clinically and histopathologically, at the present stage of the study we cannot exclude the possibility of HGMUE malignant transformation.

Does the temperature gradient correlate with the photodynamic diagnosis parameter numerical colour value (NCV)?

BACKGROUND: Photodynamic diagnosis (PDD) as well as thermovision belong to the category of non-invasive optical diagnosis techniques. Among many different skin cancer diseases, basal cell carcinoma (BCC) is the most frequently occurring one (almost 95% of all skin tumours). In contrast, seborrhoeic keratosis represents almost 70% of benign skin tumours. In this paper we present infrared thermography as an additional method, combined with PDD, to show the differentiation between these two skin mutations. METHODS: The photodynamic diagnosis studies were performed by using the autofluorescence diagnosis system Xillix Onco. As an additional non-invasive diagnosis technique, thermovision studies were performed. Thermal imaging was done by using a Thermovision Camera A40M with a sensitivity of 0.07K. The thermograms of the chosen areas were performed in a special room with a temperature of 22.5±1°C. All patients were treated in the Chair and Clinic of Internal Diseases, Angiology and Physical Medicine in Bytom. Thirteen skin lesions were studied: 9 diagnosed as basal cell carcinoma and 4 as seborrhoeic keratosis. All skin lesions were confirmed in histopathological examinations. RESULTS AND CONCLUSIONS: The results of the studies revealed significant differences in skin thermal mapping between patients suffering from basal cell carcinoma and seborrhoeic keratosis. It appears that benign skin lesions are characterised by a lower mean temperature than the surrounding healthy skin. To the contrary, cancerous skin mutations appeared on the thermal map at a higher mean temperature. Thermal images for the chosen skin lesions and temperature parameters derived from the thermograms are contiguous with the photodynamic diagnosis results and may give some additional diagnostic information.

Comparison of cryotherapy and photodynamic therapy in treatment of oral leukoplakia.

Oral leukoplakia is a pre-malignant lesion of the oral mucosa. The aim of this study is to compare the curative effects of photodynamic therapy and cryotherapy in the treatment of oral leukoplakia. The first group, treated by photodynamic therapy (δ-aminolevulinic acid (ALA), 630-635 nm wavelength), consisted of 48 patients suffering from leukoplakia. The second group consisted of 37 patients treated using cryotherapy. Analyses and comparisons of the complete responses, recurrences, numbers of procedures and adverse effects after both PDT and cryotherapy were obtained. In the first group, a complete response was obtained in 35 patients (72.9%), with thirteen recurrences observed (27.1%) over a six-month period. In the second group, a complete response was obtained in 33 patients (89.2%), and recurrence was observed in nine patients (24.3%). Photodynamic therapy and cryotherapy appear to be comparative methods of treatment that may both serve as alternatives for the traditional surgical treatment of oral leukoplakia. The advantages of PDT are connected with minimally invasive and localized character of the treatment and with not damage of collagenous tissue structures, therefore normal cells will repopulate these arrangements. PDT is more convenient for patients, less painful, and more esthetic.

Autofluorescence endoscopy with "real-time" digital image processing in differential diagnostics of selected benign and malignant lesions in the oesophagus.

BACKGROUND: Oesophageal papilloma and Barrett's oesophagus are benign lesions known as risk factors of carcinoma in the oesophagus. Therefore, it is important to diagnose these early changes before neoplastic transformation. METHOD: Autofluorescence endoscopy is a fast and non-invasive method of imaging of tissues based on the natural fluorescence of endogenous fluorophores. The aim of this study was to prove the diagnostic utility of autofluorescence endoscopy with digital image processing in histological diagnosis of endoscopic findings in the upper digestive tract, primarily in the imaging of oesophageal papilloma. RESULTS: During the retrospective analysis of about 200 endoscopic procedures in the upper digestive tract, 67 cases of benign, precancerous or cancerous changes were found. White light endoscopy (WLE) image, single-channel (red or green) autofluorescence images, as well as green and red fluorescence intensities in two modal fluorescence image and red-to-green (R/G) ratio (Numerical Colour Value, NCV) were correlated with histopathologic results. The NCV analysis in autofluorescence imaging (AFI) showed increased R/G ratio in cancerous changes in 96% vs. 85% in WLE. Simultaneous analysis with digital image processing allowed us to diagnose suspicious tissue as cancerous in all of cases. Barrett's metaplasia was confirmed in 90% vs. 79% (AFI vs. WLE), and 98% in imaging with digital image processing. In benign lesions, WLE allowed us to exclude tissue as malignant in 85%. Using autofluorescence endoscopy R/G ratio was increased in only 10% of benign changes causing the picture to be interpreted as suspicious, but when both methods were used together, 97.5% were cases excluded as malignancies. Mean R/G ratios were estimated to be 2.5 in cancers, 1.25 in Barrett's metaplasia and 0.75 in benign changes and were statistically significant (p=0.04). CONCLUSION: Autofluorescence imaging is a sensitive method to diagnose precancerous and cancerous early stages of the diseases located in oesophagus. Especially in two-modal imaging including white light endoscopy, autofluorescence imaging with digital image processing seems to be a useful modality of early diagnostics. Also in observation of papilloma changes, it facilitates differentiation between neoplastic and benign lesions and more accurate estimation of the risk of potential malignancy.

Twenty years of experience with PDD and PDT in Poland--review.

This article is a review of laboratory and clinical research undertaken in Poland in PDD and PDT over the past 20 years. These are divided into two parallel research areas. The first is based on clinical trials where new modalities of photosensitizer synthesis, molecular mechanisms of PDT and other aspects are investigated. The second is concerned with clinical aspects of PDD and PDT in both pre-neoplastic and malignant disease. In Poland there were 2 National Congresses in 2006 and 2008 with 100 and 400 participants respectively. One of the oldest centers of Photodynamic Diagnostics and Therapy is located in Bytom. For about 10 years it has led clinical research in Poland with PDD and PDT in such medical disciplines as dermatology, gastroenterology, laryngology, pulmonology, gynecology, and orthopedics.

The role of autofluorescence diagnostics in the oral mucosa diseases.

BACKGROUND: Laser-induced fluorescence diagnostics (LIFE) can be used as an imaging system of precancerous and neoplasmatic lesions of oral mucosa. LIFE system utilizes healthy and neoplasmatically changed tissue in autofluorescence, without using any fluorescence substances. Neoplasmatic lesions are visible in pseudo colors, healthy tissue as a shade of green color and abnormal tissue as a shade of red color. All visible colors have different intensity. Color intensity is relevant to the grade of dysplasia, carcinoma progress and is called numerical color value (NCV). AIM: The aim of our study was to find correlation between autofluorescence diagnostics with NCV assessment and type of histopathological diagnostics of specimen biopsy. PATIENTS AND METHODS: Fourteen patients participated in our study. Lesions were located in different intraoral areas. The most common location was: buccal, gingival and mandibular mucosa. Patients were examined using laser induced fluorescence diagnostics (400-750 nm wavelength) with NCV using OncoLIFE system. Then the specimen biopsy from the lesion was taken and histopathological examination was performed. RESULTS: We have noted different NCV and dependence of NCV on histopathological grade. CONCLUSION: Diagnostics using white-light imaging with LIFE imaging is not only a significant faster method and a better diagnostics of preneoplasmatic and neoplasmatic lesions, but also there is a correlation between NCV and histopathological grade. The farther investigations are necessary to prove these preliminary findings.