Pulmonary resection for malignant tumors

Resection of malignant tumors in the lung represents greater than 70% of thoracic surgeries. The continuous evolution of new surgical techniques and management of malignant diseases have improved the clinical outcomes of survival and quality of life. The aim of this thesis is to review important clinical aspects of the surgical resection of malignant tumors in the lung. Study I A prospective population-based cohort assessment of the relation between preoperative baseline self-reported SF-36 questionnaire data and long-term survival after thoracic procedures. The study included 249 patients planned for thoracic surgery at Karolinska University Hospital, Stockholm, Sweden, between 2006 and 2008. During an 8.0-year (median) follow-up, 48% of patients died. Patients with a physical component summary score less than the reference experienced significantly higher mortality rates compared with those of patients with lower mental component summary scores (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.34–3.06, p = 0.001) and (HR, 1.32; 95% CI, 0.84–3.06, p = 0.233), respectively. Study II A population-based cohort study of 184 patients who underwent pulmonary metastasectomy for colorectal cancer at Karolinska University Hospital between January 1, 2004, and December 31, 2015. The median follow-up was 3.2 years, and 36% (66/184) of patients died. Five-year overall survival was 60% (95% CI, 50%–68%), and carcinoembryonic antigen levels were the only statistically significant prognostic factor of mortality (age- and sex-adjusted, [HR, 2.46; 95% CI, 1.15–5.26, p = 0.020]). Study III A nationwide cohort study to investigate overall survival after surgical resection of pulmonary metastases of colorectal cancer in Sweden and to assess the discriminatory power of a recently suggested risk-prediction model. This study, which used the Swedish national quality register for thoracic surgery (ThoR), included 756 patients who underwent surgery between 2009 and 2015. Five-year overall survival was 56%, and the median follow-up was 2.9 years. Study IV Evaluation of early and late clinical outcomes after video-assisted thoracic surgery (VATS) and thoracotomy-lobectomy for non-small cell lung cancer of a cohort of patients in Sweden. The study used the ThoR register and included patients (n = 285) who underwent VATS lobectomy at Karolinska University Hospital and patients (n = 1316) who underwent thoracotomy lobectomy at other hospitals in Sweden between 2012 and 2015. Study V A study of a nationwide cohort conducted in Sweden to determine if the weekday of surgery influenced the long-term survival of patients listed in the ThoR register who underwent surgery for lung cancer between 2009 and 2015

Unique transcriptional and protein-expression signature in human lung tissue-resident NK cells

Human lung tissue-resident NK cells (trNK cells) are likely to play an important role in host responses towards viral infections, inflammatory conditions and cancer. However, detailed insights into these cells are still largely lacking. Here we show, using RNA sequencing and flow cytometry-based analyses, that subsets of human lung CD69(-)CD16(-) NK cells display hallmarks of tissue-residency, including high expression of CD49a, CD103, and ZNF683, and reduced expression of SELL, S1PR5, and KLF2/3. CD49a(+)CD16(-) NK cells are functionally competent, and produce IFN-gamma, TNF, MIP-1 beta, and GM-CSF. After stimulation with IL-15, they upregulate perforin, granzyme B, and Ki67 to a similar degree as CD49a(-) CD16(-) NK cells. Comparing datasets from trNK cells in human lung and bone marrow with tissue-resident memory CD8(+) T cells identifies core genes co-regulated either by tissue-residency, cell-type or location. Together, our data indicate that human lung trNK cells have distinct features, likely regulating their function in barrier immunity.Peer reviewe

Tissue-specific transcriptional imprinting and heterogeneity in human innate lymphoid cells revealed by full-length single-cell RNA-sequencing

The impact of the microenvironment on innate lymphoid cell (ILC)-mediated immunity in humans remains largely unknown. Here we used full-length Smart-seq2 single-cell RNA-sequencing to unravel tissue-specific transcriptional profiles and heterogeneity of CD127+ ILCs across four human tissues. Correlation analysis identified gene modules characterizing the migratory properties of tonsil and blood ILCs, and signatures of tissue-residency, activation and modified metabolism in colon and lung ILCs. Trajectory analysis revealed potential differentiation pathways from circulating and tissue-resident na\uefve ILCs to a spectrum of mature ILC subsets. In the lung we identified both CRTH2+ and CRTH2− ILC2 with lung-specific signatures, which could be recapitulated by alarmin-exposure of circulating ILC2. Finally, we describe unique TCR-V(D)J-rearrangement patterns of blood ILC1-like cells, revealing a subset of potentially immature ILCs with TCR-δ rearrangement. Our study provides a useful resource for in-depth understanding of ILC-mediated immunity in humans, with implications for disease

Influenza A Virus Infection Induces Hyperresponsiveness in Human Lung Tissue-Resident and Peripheral Blood NK Cells

NK cells in the human lung respond to influenza A virus- (IAV-) infected target cells. However, the detailed functional capacity of human lung and peripheral blood NK cells remains to be determined in IAV and other respiratory viral infections. Here, we investigated the effects of IAV infection on human lung and peripheral blood NK cells in vitro and ex vivo following clinical infection. IAV infection of lung- and peripheral blood-derived mononuclear cells in vitro induced NK cell hyperresponsiveness to K562 target cells, including increased degranulation and cytokine production particularly in the CD56brightCD16− subset of NK cells. Furthermore, lung CD16− NK cells showed increased IAV-mediated but target cell-independent activation compared to CD16+ lung NK cells or total NK cells in peripheral blood. IAV infection rendered peripheral blood NK cells responsive toward the normally NK cell-resistant lung epithelial cell line A549, indicating that NK cell activation during IAV infection could contribute to killing of surrounding non-infected epithelial cells. In vivo, peripheral blood CD56dimCD16+ and CD56brightCD16− NK cells were primed during acute IAV infection, and a small subset of CD16−CD49a+CXCR3+ NK cells could be identified, with CD49a and CXCR3 potentially promoting homing to and tissue-retention in the lung during acute infection. Together, we show that IAV respiratory viral infections prime otherwise hyporesponsive lung NK cells, indicating that both CD16+ and CD16− NK cells including CD16−CD49a+ tissue-resident NK cells could contribute to host immunity but possibly also tissue damage in clinical IAV infection

Media and USF Students\u27 Perception of Terrorism

This study examined the influence of mass media on students\u27 perceptions of terrorism by applying the situational theory of publics (Grunig & Hunt, 1984). Behavior is the consequence of perception of reality. But perception of reality is not always consistent with the reality itself. Because of the important role of the media in shaping perceptions, terrorist organizations rely on it to spread fear and advance their political goals beyond the people directly affected by their attacks. The media not only spreads the news of an attack, it contributes significantly to formulating and disseminating the message of terrorist organizations. This study explores University of South Florida (USF) students\u27 perceptions of terrorism, and the role of mass media in shaping such perceptions. It also examines assumptions, asks pertinent questions, and seeks answers by conducting a survey of college students. The findings of this study support the basic premise of the situational theory of publics and contribute to better understanding of how media influences perceptions of terrorism. The findings of this study and future studies on the same subject might be used to better educate students, and inform communication professionals about methods to increase awareness about the U.S. position on terrorism

Expansions of adaptive-like NK cells with a tissue-resident phenotype in human lung and blood

Human adaptive-like "memory" CD56(dim)CD16(+) natural killer (NK) cells in peripheral blood from cytomegalovirus-seropositive individuals have been extensively investigated in recent years and are currently explored as a treatment strategy for hematological cancers. However, treatment of solid tumors remains limited due to insufficient NK cell tumor infiltration, and it is unknown whether large expansions of adaptive-like NK cells that are equipped for tissue residency and tumor homing exist in peripheral tissues. Here, we show that human lung and blood contains adaptive-like CD56(bright)CD16(-) NK cells with hallmarks of tissue residency, including expression of CD49a. Expansions of adaptive-like lung tissue-resident NK (trNK) cells were found to be present independently of adaptive-like CD56(dim)CD16(+) NK cells and to be hyperresponsive toward target cells. Together, our data demonstrate that phenotypically, functionally, and developmentally distinct subsets of adaptive-like NK cells exist in human lung and blood. Given their tissue-related character and hyperresponsiveness, human lung adaptive-like trNK cells might represent a suitable alternative for therapies targeting solid tumors.Peer reviewe

Influenza A Virus Infection Induces Hyperresponsiveness in Human Lung Tissue-Resident and Peripheral Blood NK Cells

NK cells in the human lung respond to influenza A virus-(IAV-) infected target cells. However, the detailed functional capacity of human lung and peripheral blood NK cells remains to be determined in IAV and other respiratory viral infections. Here, we investigated the effects of IAV infection on human lung and peripheral blood NK cells in vitro and ex vivo following clinical infection. IAV infection of lung- and peripheral blood-derived mononuclear cells in vitro induced NK cell hyperresponsiveness to K562 target cells, including increased degranulation and cytokine production particularly in the CD56(bright)CD16(-) subset of NK cells. Furthermore, lung CD16(-) NK cells showed increased IAV-mediated but target cell-independent activation compared to CD16(+) lung NK cells or total NK cells in peripheral blood. IAV infection rendered peripheral blood NK cells responsive toward the normally NK cell-resistant lung epithelial cell line A549, indicating that NK cell activation during IAV infection could contribute to killing of surrounding non-infected epithelial cells. In vivo, peripheral blood CD56(dim)CD16(+) and CD56(bright)CD16(-) NK cells were primed during acute IAV infection, and a small subset of CD16(-) CD49a(+)CXCR3(+) NK cells could be identified, with CD49a and CXCR3 potentially promoting homing to and tissue-retention in the lung during acute infection. Together, we show that IAV respiratory viral infections prime otherwise hyporesponsive lung NK cells, indicating that both CD16(+) and CD16(-) NK cells including CD16(-)CD49a(+) tissue-resident NK cells could contribute to host immunity but possibly also tissue damage in clinical IAV infection.Peer reviewe

Bitter taste receptor agonists mediate relaxation of human and rodent vascular smooth muscle.

Taste-sensing type 2 receptors (TAS2Rs) have been implicated in extraoral functions. Airway smooth muscle expresses TAS2Rs and is strongly relaxed by TAS2R agonists. We hypothesised that TAS2R agonists might affect vascular smooth muscle as well. Moreover, the general pharmacological profile of TAS2R agonists, which are used to investigate the functions of TAS2R׳s, are undefined. The aim of this study was to pharmacologically characterise the effects of five prototype TAS2R agonists in vascular smooth muscle. Responses to the TAS2R agonists were investigated in guinea-pig aorta and taenia coli, mouse aorta (wild-type and caveolin-1(-/-) mice) and human pulmonary arteries. Chloroquine, denatonium, dextromethorphan, noscapine and quinine, agonists for TAS2R3, TAS2R4, TAS2R10 and TAS2R14, induced strong endothelium-independent relaxations (responses between 82-96% of maximal relaxations) in phenylephrine pre-contracted guinea-pig aorta that persisted in the presence of L-type Ca(2+) and KCa1.1-channel blockers. Experiments in guinea-pig taenia coli revealed that denatonium and quinine also inhibited relaxations to phenylephrine, indicating antagonism of α-adrenoceptors. Only chloroquine and noscapine mediated relaxations when the guinea pig aorta was pre-contracted by U-46619 or PGF2α. Relaxations to chloroquine and noscapine after U-46619 pre-contractions were however markedly impaired in aortae from caveolin-1(-/-) mice. Chloroquine and noscapine mediated relaxations of human pulmonary arteries that expressed also mRNA for TAS2R3, TAS2R4, TAS2R10 and TAS2R14, at levels similar to that of the α1A adrenoceptor. Notwithstanding whether TAS2Rs are involved or not, TAS2R agonists have profound effects on vascular smooth muscle. Chloroquine and noscapine are of special interest as their effects cannot be accounted for by conventional pathways

Immunoprofiling Reveals Novel Mast Cell Receptors and the Continuous Nature of Human Lung Mast Cell Heterogeneity

Background: Immunohistochemical analysis of granule-associated proteases has revealed that human lung mast cells constitute a heterogeneous population of cells, with distinct subpopulations identified. However, a systematic and comprehensive analysis of cell-surface markers to study human lung mast cell heterogeneity has yet to be performed.Methods: Human lung mast cells were obtained from lung lobectomies, and the expression of 332 cell-surface markers was analyzed using flow cytometry and the LEGENDScreen (TM) kit. Markers that exhibited high variance were selected for additional analyses to reveal whether they were correlated and whether discrete mast cell subpopulations were discernable.Results: We identified the expression of 102 surface markers on human lung mast cells, 23 previously not described on mast cells, of which several showed high continuous variation in their expression. Six of these markers were correlated: SUSD2, CD49a, CD326, CD34, CD66 and HLA-DR. The expression of these markers was also correlated with the size and granularity of mast cells. However, no marker produced an expression profile consistent with a bi- or multimodal distribution.Conclusions: LEGENDScreen analysis identified more than 100 cell-surface markers on mast cells, including 23 that, to the best of our knowledge, have not been previously described on human mast cells. The comprehensive expression profiling of the 332 surface markers did not identify distinct mast cell subpopulations. Instead, we demonstrate the continuous nature of human lung mast cell heterogeneity