Trimodality Treatment of Superior Sulcus Non-Small Cell Lung Cancer: An Institutional Series of 47 Consecutive Patients.

OBJECTIVES: Treatment of superior sulcus tumors (SST) using concurrent chemoradiation followed by surgery is a current standard. However, due to the rarity of this entity, clinical experience in its treatment remains scarce. Here, we present the results of a large consecutive series of patients treated with concurrent chemoradiation followed by surgery at a single academic institution. MATERIALS AND METHODS: The study group included 48 patients with pathologically confirmed SST. The treatment schedule consisted of preoperative 6-MV photon-beam radiotherapy (45-66 Gy delivered in 25-33 fractions over 5-6.5 weeks) and concurrent two cycles of platinum-based chemotherapy. Five weeks after completion of chemoradiation, pulmonary and chest wall resection was performed. RESULTS: From 2006 to 2018, 47 of 48 consecutive patients meeting protocol criteria underwent two cycles of cisplatin-based chemotherapy and concurrent radiotherapy (45-66 Gy) followed by pulmonary resection. One patient did not undergo surgery due to brain metastases that occurred during induction therapy. The median follow-up was 64.7 months. Chemoradiation was well tolerated, with no toxicity-related deaths. Twenty-one patients (44%) developed grade 3-4 side effects, of which the most common was neutropenia (17 patients; 35.4%). Seventeen patients (36.2%) had postoperative complications, and 90-day mortality was 2.1%. Three- and five-year overall survival (OS) were 43.6% and 33.5%, respectively, and three- and five-year recurrence-free survival were 42.1% and 32.4%, respectively. Thirteen (27.7%) and 22 (46.8%) patients had a complete and major pathological response, respectively. Five-year OS in patients with complete tumor regression was 52.7% (95% CI 29.4-94.5). Predictive factors of long-term survival included age below 70 years, complete resection, pathological stage, and response to induction treatment. CONCLUSIONS: Chemoradiation followed by surgery is a relatively safe method with satisfactory outcomes.

The red-light emitting diode irradiation increases proliferation of human bone marrow mesenchymal stem cells preserving their immunophenotype.

PURPOSE: For effective clinical application of human bone marrow mesenchymal stem cells (hBM-MSCs), the enhancement of their proliferation in vitro together with maintaining the expression of their crucial surface antigens and differentiation potential is necessary. The present study aimed to investigate the effect of light-emitting diode (LED) irradiation on hBM-MSCs proliferation after two, five, or nine days post-irradiation. MATERIALS AND METHODS: The hBM-MSCs were exposed to the LED light at 630 nm, 4 J/cm2, and power densities of 7, 17, or 30 mW/cm2. To assess the cell proliferation rate in the sham-irradiated and irradiated samples the cells metabolic activity and DNA content were determined. The number of apoptotic and necrotic cells in the samples was also evaluated. The expression of the crucial surface antigens of the hBM-MSCs up to nine days after irradiation at 4 J/cm2 and 17 mW/cm2 was monitored with flow cytometry. Additionally, the potential of hBM-MSCs for induced differentiation was measured. RESULTS: When the metabolic activity was assayed, the significant increase in the cell proliferation rate by 31 and 50% after the irradiation with 4 J/cm2 and 17 mW/cm2, respectively, was observed at day five and nine when compared to the sham-irradiated cells (p < .05). Similarly, DNA content within the irradiated hBM-MSCs increased by 31 and 41% at day five and nine after the irradiation with 4 J/cm2 and 17 mW/cm2 in comparison to the sham-irradiated cells. LED irradiation did not change the expression of the crucial surface antigens of the hBM-MSCs up to nine days after irradiation at 4 J/cm2 and 17 mW/cm2. At the same experimental conditions, the hBM-MSCs maintain in vitro their capability for multipotential differentiation into osteoblasts, adipocytes, and chondrocytes. CONCLUSION: Therefore, LED irradiation at a wavelength of 630 nm, energy density 4 J/cm2, and power density 17 mW/cm2 can effectively increase the number of viable hBM-MSCs in vitro.

Yttrium-Doped Iron Oxide Nanoparticles for Magnetic Hyperthermia Applications.

Magnetic nanoparticles of Fe3O4 doped by different amounts of Y3+ (0, 0.1, 1, and 10%) ions were designed to obtain maximum heating efficiency in magnetic hyperthermia for cancer treatment. Single-phase formation was evident by X-ray diffraction measurements. An improved magnetization value was obtained for the Fe3O4 sample with 1% Y3+ doping. The specific absorption rate (SAR) and intrinsic loss of power (ILP) values for prepared colloids were obtained in water. The best results were estimated for Fe3O4 with 0.1% Y3+ ions (SAR = 194 W/g and ILP = 1.85 nHm2/kg for a magnetic field of 16 kA/m with the frequency of 413 kHz). The excellent biocompatibility with low cell cytotoxicity of Fe3O4:Y nanoparticles was observed. Immediately after magnetic hyperthermia treatment with Fe3O4:0.1%Y, a decrease in 4T1 cells' viability was observed (77% for 35 µg/mL and 68% for 100 µg/mL). These results suggest that nanoparticles of Fe3O4 doped by Y3+ ions are suitable for biomedical applications, especially for hyperthermia treatment.

Single-step synthesis of Er3+ and Yb3+ ions doped molybdate/Gd2O3 core-shell nanoparticles for biomedical imaging.

Nanostructures as color-tunable luminescent markers have become major, promising tools for bioimaging and biosensing. In this paper separated molybdate/Gd2O3 doped rare earth ions (erbium, Er3+ and ytterbium, Yb3+) core-shell nanoparticles (NPs), were fabricated by a one-step homogeneous precipitation process. Emission properties were studied by cathodo- and photoluminescence. Scanning electron and transmission electron microscopes were used to visualize and determine the size and shape of the NPs. Spherical NPs were obtained. Their core-shell structures were confirmed by x-ray diffraction and energy-dispersive x-ray spectroscopy measurements. We postulated that the molybdate rich core is formed due to high segregation coefficient of the Mo ion during the precipitation. The calcination process resulted in crystallization of δ/ξ (core/shell) NP doped Er and Yb ions, where δ-gadolinium molybdates and ξ-molybdates or gadolinium oxide. We confirmed two different upconversion mechanisms. In the presence of molybdenum ions, in the core of the NPs, Yb3+-[Formula: see text] (∣2F7/2, 3T2〉) dimers were formed. As a result of a two 980 nm photon absorption by the dimer, we observed enhanced green luminescence in the upconversion process. However, for the shell formed by the Gd2O3:Er, Yb NPs (without the Mo ions), the typical energy transfer upconversion takes place, which results in red luminescence. We demonstrated that the NPs were transported into cytosol of the HeLa and astrocytes cells by endocytosis. The core-shell NPs are sensitive sensors for the environment prevailing inside (shorter luminescence decay) and outside (longer luminescence decay) of the tested cells. The toxicity of the NPs was examined using MTT assay.

Photodynamic Therapy As a Promising Method Used in the Treatment of Oral Diseases.

Photodynamic therapy (PDT) consists of three elements: photosensitizer, light and oxygen. The photosensitizer has the property of selective accumulation in abnormal or infected tissues without causing any damage to the healthy cells. This innovative therapeutic method has already been successfully adapted in many fields of medicine, e.g. dermatology, gynecology, urology and cancer therapy. Dentistry is also beginning to incorporate photodisinfection for treatment of the oral cavity. The antibacterial and fungicidal properties of the photosensitizer have been used to achieve better results in root canal treatment, periodontal therapy and the eradication of candidiasis in prosthodontics. The aim of this article is to discuss the effectiveness of photodynamic methods in the diagnosis and therapy of selected oral diseases. Scientific data and published papers regarding the antibacterial properties of PDT will be subjected to analysis. Photodynamic therapy will be discussed as an alternative treatment protocol in oncology, endodontics, periodontology and other fields of dentistry.

Early results of a trimodality treatment for superior sulcus tumors.

INTRODUCTION: Superior sulcus tumors are a unique form of lung cancer. Preoperative concurrent radio- and chemotherapy improves the results of treating these lung tumors. AIM: The study aimed to assess the early results of a trimodality treatment for superior sulcus tumors. MATERIAL AND METHODS: Fifty-six superior sulcus tumors patients were operated on between 2006 and 2013. Data from 25 patients undergoing preoperative chemoradiotherapy were analyzed. Fifteen men and 10 women were treated (mean age: 59 years). All patients experienced pain in the pectoral girdle of the chest. RESULTS: Nineteen patients received preoperative chemoradiotherapy consisting of 2 chemotherapy cycles with cisplatin (a different number of cycles was administered in 6 cases) and irradiation at a mean dose of 51.2 Gy (30-60 Gy) in 25 fractions (25-30 fractions). All patients underwent upper lobectomy. Twenty-two patients underwent chest wall resection, whereas 3 patients underwent extrapleural excision of the infiltrate without rib resection. Stages IIB and IIIB were diagnosed in 15 and 10 patients, respectively. In 9 samples, no neoplastic features were found, 9 showed individual neoplastic lesions, and in 7 most tumor cells were necrotized. The R1 resection was noted in 2 patients. Mean hospitalization time was 13 days. No perioperative deaths were noted. CONCLUSIONS: The trimodality treatment for superior sulcus tumors is a safe method. Perioperative mortality and the number of complications observed among patients treated with this method are similar to those observed in one-phase surgery. In over half of the patients, chemoradiotherapy resulted in complete or nearly complete remission of the neoplasm.

Complications after using the Airtraq laryngoscope for a predicted difficult intubation.

Although standard management of an expected difficult intubation is based on fibre-optic techniques, the application of optical laryngoscopes such as Airtraq is gaining widespread acceptance. We here describe a case where an intubation attempt with the Airtraq laryngoscope was not only unsuccessful, but negatively influenced subsequent use of a flexible fibroscopic approach.

Prognostic value of the apoptotic index analysed jointly with selected cell cycle regulators and proliferation markers in non-small cell lung cancer.

In a previous small series of surgically treated non-small cell lung cancer patients (NSCLC), we found that higher apoptotic index (AI) negatively influenced survival (Dworakowska D, Jassem E, Jassem J, Karmolinski A, Dworakowski R, Wirth T, et al. Clinical significance of apoptotic index in non-small cell lung cancer: correlation with p53, mdm2, pRb and p21WAF1/CIP1 protein expression. J Cancer Res Clin Oncol 2005; 131:617-623.). In this study we attempted to verify our previous finding in larger group of 170 NSCLC cases, additionally correlating AI to selected cell cycle regulators as well as a proliferation marker. Apoptosis was assessed with the use of the TUNEL technique, whereas the expression of p53, pRb, mdm2, p21(WAF1/CIP1), cyclin D1 and PCNA were assessed immunohistochemically. The mean and the median AI was 12 and 8, respectively. The expression of p53, pRb, mdm2, p21(WAF1/CIP1) proteins and cyclin D1 was found in 47%, 71%, 37%, 65% and 40% of cases, respectively. The mean and the median PCNA labeling index (PCNA LI) was 34 and 35, respectively. AI was not correlated with any patient characteristic or other tumor markers. In uni- and multivariate analysis AI, analysed separately or jointly with cell cycle regulators and PCNA LI, did not influence disease-free or over-all survival. However, patients with "very high AI/very high PCNA LI" had a particularly poor prognosis (P=0.001). Patients with "very low AI/negative pRb" phenotype survived for a shorter time in comparison to others (P=0.04). In addition, patients with the highest PCNA LI had a worse outcome in comparison to patients with the lowest PCNA LI (P=0.04), especially those with concomitant p53 protein expression (P=0.026) or lacking pRb protein expression (P=0.04). This study demonstrates that joint analysis of several factors involved in apoptosis, proliferation and cell cycle regulation, but not AI alone, might provide additional prognostic information in NSCLC patients.

Catecholamine excretion and circadian blood pressure profile in patients with pheochromocytoma.

Circadian blood pressure (BP) rhythm is often disturbed in patients with secondary forms of hypertension. The aim of the present article was to investigate changes in circadian BP profile parameters using two-step statistical approach by Fourier analysis in relation to day and night urinary catecholamine excretion in 35 patients with pheochromocytoma (mean age 42+/-19 years). Twenty-four-hour ambulatory BP measurements (ABPM) were obtained using the SpaceLabs 90,207 monitor. Daytime and night-time urine collection was obtained in all patients to determine circadian catecholamine excretion. Fourier analysis was applied to estimate measures of BP circadian rhythm in ABPM, including the highest (Max) and lowest (Min) systolic (SBP) and diastolic (DBP) BP values, norad (ampSBP, ampDBP), and early acrophase (APSBP, APDBP). The Fourier indices of circadian BP rhythm were: MaxSBP 153+/-28 mm Hg, MaxDBP 99+/-16 mm Hg, MinSBP 117+/-17 mm Hg, MinDBP 69+/-11 mm Hg, ampSBP 18+/-8 mm Hg, ampDBP 14+/-5 mm Hg, APSBP 10+/-5 (h), and APDBP 11+/-3 (h). Urine noradrenaline (NA), adrenaline (A), and dopamine (DA) excretion during the day (d) and night (n) were: dNA 103.5+/-89.8 microg/14 h, nNA 52+/-70.8 microg/10 h, dA 13.2+/-17.9 microg/14 h; nA 6.13+/-9.6 microg/10 h, dD 181.8+/-87.3 microg/14 h, and nD 89.3+/-59.8 microg/10 h. A positive correlation was observed between urine dNa excretion and MaxDBP (r=0.37, P<0.05), and urine nNA and urine dA excretion were correlated with APDBP (r=0.47, r=0.35, respectively, both P<0.05). Thus, in addition to the effect on mean 24-h BP values, catecholamines released by tumor may also disturb circadian BP rhythm in patients with pheochromocytoma.

[Effect of neoadjuvant chemotherapy on complications in patients undergoing surgical treatment for non small cell lung cancer]. / Wplyw przedoperacyjnej chemioterapii na powiklania po leczeniu operacyjnym chorych na niedrobnokomórkowego raka pluca.

Neoadjuvant chemotherapy before resection is being the standard of care for stage IIIA non-small cell lung cancer in many institutions. The risk of complications in patients undergoing thoracotomy after induction chemotherapy remain controversial. We reviewed our experience. From 1998 to 2003, 29 patients underwent pulmonary resection after induction chemotherapy for advanced non-small cell lung cancer. Pneumonectomies were performed for 16 (55.2%) patients (2 right sleeve pneumonectomy and 1 pneumonectomy with wedge excision of tracheal carina), lobectomies for 11 (37.9%) patients (3 right upper sleeve lobectomy), segmentectomies for 1 (3.45%) patient and explorative thoracotomy for 1 (3.45%) patient. There were 3 (10.3%) postoperative deaths, all after right pneumonectomy; 2 caused by pneumonia of the left lung, 1 caused by pulmonary embolism in patient after re-thoracotomy for hemothorax. The postoperative complications included pneumonia in 2 patients, postoperative bleeding in 2, hemothorax in 1, prolonged intubation in 1, vocal cord paralysis in 2, cardiac arrhythmia in 2, atelectasis in 1 and residual air space in 1, resulting in 41,4% morbidity. Most of complications occurred after right pneumonectomy (45.5%). The mortality of patients who had received induction chemotherapy was higher than that of a comparative group of 1529 who underwent lung resection or only exploration without induction chemotherapy during the same period, and the difference was significant (10.3% vs 4.1%; p = 0.01). Morbidity differences were. not significant (p = 0.94).

[Predictive value of plasma interleukin 1, interleukin 6, interleukin 8 and C-reactive protein (CRP) in patients with myocardial infarction]. / Rokownicze znaczenie osoczowego stezenia interleukiny 1, interleukiny 6, interleukiny 8 oraz CRP w zawale serca.

Long-term risk of mortality in patients with myocardial infarction is thought to be linked with plasma concentrations of proinflammatory cytokines and CRP (markers of inflammation). The aim of our study was to analyze plasma levels of interleukin (IL) 1, interleukin 6, interleukin 8 and C-reactive protein (CRP) in patients with myocardial infarction. One hundred and seven (107) patients with myocardial infarction hospitalized at the Cardiac Care Unit of St. Elizabeth's Sisters' Hospital in Warsaw and a control group of 10 subjects were enrolled in our study. The samples of peripheral venous blood were withdrawn from the patients on 2nd and 7th of infarction and plasma levels of IL-1, IL-6, IL-8 and CRP were determined. The patients were followed-up for a year. The analysis of survivals and deaths caused by acute coronary syndrome allowed to determine the predictive value of IL-1, IL-6, IL-8 and CRP in myocardial infarction. Twenty-two (22) of the total 107 patients died of acute coronary syndrome during one-year follow-up. Plasma IL-6 and CRP levels were higher in non-survivors as compared to the levels of IL-6 and CRP in living subjects, whereas plasma levels of IL-1 and IL-8 were comparable in both groups. IL-6 and CRP proved to be of predictive value in patients with myocardial infarction during one-year follow-up. It has also been found that plasma IL-6 level correlates with plasma CRP concentration and that there is a positive correlation between the former and CK-MB levels. IL-6 and CRP levels were higher in patients with Q wave infarction in comparison with non-Q wave infarction. Plasma levels of IL-1 and IL-8 have not been found to be good predictors of death during 12-month follow-up.