183 research outputs found
Breakthroughs in lung cancer management
In the present issue of Anales del Sistema Sanitario de Navarra, Rico et al summarize the progress in key areas of the radiotherapeutic strategies to fight against advanced lung cancer1. Progress in radiotherapy strategies for lung cancer management has been remarkable in the last decade. We will devote some comments in the present editorial to these achievements. Nevertheless, radiotherapy (RT) has been only one of the many areas that have benefited from successful basic, translational and clinical research in lung cancer during the last decade. In the following paragraphs, we will very briefly mention some of these breakthroughs and seminal achievements that have improved the survival prospects of lung cancer patients in the decade from 2010 to 2020
Radiologic features of small pulmonary nodules detected in initially negative screening CT examinations: a step towards personalized screening strategies?
Results of the National Lung Screening Trial (NLST)
have invigorated the discussion around performing lung
cancer screening using low-dose computed tomography
(LDCT) of the chest. The NLST trial demonstrated a
clear benefit of LDCT screening in reducing lung cancer
and all-cause mortality, by showing reduced lung cancer
mortality in high-risk individuals by about 20%, and allcause mortality by 6.7%, compared to a control group of
subjects receiving chest radiographs
Adrenomedullin expression in a rat model of acute lung injury induced by hypoxia and LPS
Adrenomedullin
(ADM) is upregulated independently by hypoxia and LPS, two key
factors in the pathogenesis of acute lung injury (ALI). This study
evaluates the expression of ADM in ALI using experimental models
combining both stimuli: an in vivo model of rats treated with LPS and
acute normobaric hypoxia (9% O2) and an in vitro model of rat lung
cell lines cultured with LPS and exposed to hypoxia (1% O2). ADM
expression was analyzed by in situ hybridization, Northern blot,
Western blot, and RIA analyses. In the rat lung, combination of
hypoxia and LPS treatments overcomes ADM induction occurring
after each treatment alone. With in situ techniques, the synergistic
effect of both stimuli mainly correlates with ADM expression in
inflammatory cells within blood vessels and, to a lesser extent, to cells
in the lung parenchyma and bronchiolar epithelial cells. In the in vitro
model, hypoxia and hypoxia LPS treatments caused a similar strong
induction of ADM expression and secretion in epithelial and endothelial
cell lines. In alveolar macrophages, however, LPS-induced
ADM expression and secretion were further increased by the concomitant
exposure to hypoxia, thus paralleling the in vivo response. In
conclusion, ADM expression is highly induced in a variety of key
lung cell types in this rat model of ALI by combination of hypoxia and
LPS, suggesting an essential role for this mediator in this syndrom
Effects of acute hypoxia and lipopolysaccharide on nitric oxide synthase-2 expression in acute lung injury
The potential role of nitric oxide synthase-2 (NOS2) in acute lung
injury (ALI) has gained increasing attention. This study evaluates
the effects of hypoxia, an important feature of ALI, on NOS2 expression
in a rat model of ALI caused by exposure to hypoxia and LPS.
Exposure to hypoxia alone had no effect on the expression of NOS2
in rat lungs. LPS treatment resulted in a significant increase in NOS2
in the lungs, which was further enhanced by concomitant exposure
to hypoxia. Immunohistochemical analysis and in situ hybridization
showed no changes in the expression of NOS2 in lung resident cells
under any conditions. The increase in NOS2 levels is mainly due to
the influx of NOS2-expressing inflammatory cells. By morphologic
analysis, these inflammatory cells were identified as neutrophils,
lymphocytes, and monocytes. In vitro experiments of lung epithelial
and endothelial cell lines showed no detectable expression of NOS2
with any of the treatments. In a macrophage cell line, LPS-induced
NOS2 expression was not affected by the concomitant exposure to
hypoxia. In conclusion, LPS increases NOS2 expression in rat lungs
through the recruitment of NOS2-producing leukocytes. Simultaneous
exposure to LPS and hypoxia results in a greater influx of inflammatory
cells that further enhances NOS2 expression
Preliminary Experience With the Use of Electromagnetic Navigation for the Diagnosis of Peripheral Pulmonary Nodules and Enlarged Mediastinal Lymph Nodes
Electromagnetic navigation is a new technique that can be
used with bronchoscopy to obtain samples of small peripheral
nodular lesions and enlarged mediastinal lymph nodes. It is
very versatile in that it enables both transbronchial biopsies
and fine-needle aspiration to be performed. We describe
2 cases in which navigation with the superDimension/
Bronchus system combined with traditional diagnostic
techniques facilitated a definitive diagnosis by bronchoscopy.
Electromagnetic navigation can obviate the need for more
invasive diagnostic procedures such as surgery, thus saving
time and money and avoiding complications
Effects of Small-Sided Games vs. Interval Training in Aerobic Fitness and Physical Enjoyment in Young Elite Soccer Players
The purpose of this study was to compare the effects of Small-Sided Games (SSG) vs. Interval Training (IT) in soccer training on aerobic fitness and physical enjoyment in youth elite soccer players during the last 8 weeks of the season. Seventeen U-16 male soccer players (age = 15.5 ? 0.6 years, and 8.5 years of experience) of a Spanish First Division club academy were randomized to 2 different groups for 6 weeks: SSG group (n = 9) and IT group (n = 8). In addition to the usual technical and tactical sessions and competitive games, the SSG group performed 11 sessions with different SSGs, whereas the IT group performed the same number of sessions of IT. Players were tested before and after the 6-week training intervention with a continuous maximal multistage running field test and the counter movement jump test (CMJ). At the end of the study, players answered the physical activity enjoyment scale (PACES). During the study, heart rate (HR) and session perceived effort (sRPE) were assessed. SSGs were as effective as IT in maintaining the aerobic fitness in elite young soccer players during the last weeks of the season. Players in the SSG group declared a greater physical enjoyment than IT (P = 0.006; ES = 1.86 ? 1.07). Coaches could use SSG training during the last weeks of the season as an option without fear of losing aerobic fitness while promoting high physical enjoyment.publishersversionPeer reviewe
Trasplante pulmonar
A lung transplant is usually the final therapeutic
option for patients with respiratory insufficiency. In
spite of the many advances in immunology and the
management of complications, mortality and morbidity
associated with this transplant are far higher than
with others. Acute rejection is an almost universal
problem in the first year, while obliterative bronchitis
reduces long term survival. Respiratory infections
also play a significant role in the complications associated
with lung transplants due to the constant
exposure of the graft to the outside. However, the
success of this therapeutic option, which basically
depends on a suitable selection of donor and recipient,
are evident, above all with respect to quality of
life
Use of Gene Therapy in a Subcutaneous Murine Model of Lung Cancer
OBJECTIVE: To assess the effectiveness of in vivo gene
therapy to treat subcutaneous tumors generated from murine
lung cancer cells.
MATERIAL AND METHODS: C57BL/6 mice received
subcutaneus injections of 5Ă—105 cells from the murine Lewis
lung cancer cell line. By 10 days, subcutaneous tumors of
approximately 5 mm diameter were formed. At that point,
treatment was provided by intratumor injection of a
replication-defective recombinant adenovirus carrying the
gene for thymidine kinase (AdCMV-Tk) or interleukin (IL)
12 (AdCMV-IL12), or by injection of syngeneic dendritic
cells previously transduced with adenovirus containing the
IL-12 gene (DC-IL12). Control groups were treated with
saline or adenovirus containing the gene for β-galactosidase
(AdCMV-LacZ), which functions as a reporter gene and
does not have a therapeutic effect. The number of animals in
each group ranged from 14 to 25 in experiments using
adenovirus and from 10 to 12 in experiments using dendritic
cells. Tumor size was followed for 3 weeks in the case of
treatment with adenovirus and 4 weeks for treatment with
dendritic cells.
RESULTS: A significant reduction in subcutaneous tumor
growth was observed in the groups treated with AdCMVTk,
AdCMV-IL12, and DC-IL12 compared with control
groups treated with saline or AdCMV-LacZ. The difference
was statistically significant from day 7 of treatment in the
AdCMV-Tk group, from day 9 in the AdCMV-IL12 group,
and from day 10 in the DC-IL12 group, and in all cases it
was maintained until the end of the follow-up period.
CONCLUSIONS: Gene therapy with AdCMV-Tk, AdCMVIL12,
or DC-IL12 is effective in our model of subcutaneous
tumors arising from cells of the Lewis lung cancer cell line.
The treatment leads to a significant reduction in tumor
growth compared with control groups
Hyperleptinaemia, respiratory drive and hypercapnic response in obese patients
Leptin is a powerful stimulant of ventilation in rodents. In humans, resistance
to leptin has been consistently associated with obesity. Raised leptin levels
have been reported in subjects with sleep apnoea or obesity-hypoventilation
syndrome. The aim of the present study was to assess, by multivariate analysis,
the possible association between respiratory centre impairment and levels of
serum leptin. In total, 364 obese subjects (body mass index >or=30 kg.m(-2))
underwent the following tests: sleep studies, respiratory function tests,
baseline and hypercapnic response (mouth occlusion pressure (P(0.1)), minute
ventilation), fasting leptin levels, body composition and anthropometric
measures. Subjects with airways obstruction on spirometry were excluded. Out of
the 346 subjects undergoing testing, 245 were included in the current analysis.
Lung volumes, age, log leptin levels, end-tidal carbon dioxide tension,
percentage body fat and minimal nocturnal saturation were predictors for baseline
P(0.1). The hypercapnic response test was performed by 186 subjects; log leptin
levels were predictors for hypercapnic response in males, but not in females.
Hyperleptinaemia is associated with a reduction in respiratory drive and
hypercapnic response, irrespective of the amount of body fat. These data suggest
the extension of leptin resistance to the respiratory centre
Outpatient Management of Malignant Pleural Effusion Using a Tunneled Pleural Catheter: Preliminary Experience
Inpatient management of malignant pleural effusion
includes the placement of a conventional thoracostomy tube
for drainage and talc slurry pleurodesis and/or a surgical
approach consisting of video-assisted thoracoscopic talc
insufflation. Both techniques require prolonged hospital
stays of up to 1 week. Unfortunately, life expectancy in
patients with this disease does not usually exceed 6 months,
and so the primary aim of any palliative intervention
intended to improve quality of life should be to avoid
hospital admissions and to relieve pain as far as possible.
Of the few outpatient alternatives to hospital management
the most frequently used is repeated thoracentesis. We
describe the outpatient management of malignant pleural
effusion by placement of a tunneled pleural catheter in a
patient with stage IIIB lung adenocarcinoma. In our
opinion, the use of this catheter offers a viable alternative to
conventional therapy and is better tolerated
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