Locally advanced pancreatic cancer — new therapeutic challenges

The overall survival rate of patients with pancreatic ductal adenocarcinoma remains extremely poor, and the only potentially curative treatment is radical surgery. There are three subgroups among the patients: primary resectable, metastatic and locally advanced pancreatic cancer. The term of locally ad advanced pancreatic cancer includes borderline resectable pancreatic cancer (BRPC) and unresectable pancreatic cancer (URPC). As in the case of BRPC, the strategy of induction treatment may convert the inoperable tumour into a resectable one. As in the case of URPC, the optimal standard of treatment is unknown. Recent advances in systemic treatment such as FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, oxaliplatin) and gemcitabine plus nab-paclitaxel as well as the optimisation of local treatment such as stereotactic radiotherapy (SBRT — stereotactic body radiation therapy) should be incorporated into future trials dedicated for BRPC and URPC

Miejscowo zaawansowany rak trzustki — nowe wyzwania terapeutyczne

Gruczolakorak trzustki charakteryzuje się wybitnie niekorzystnym rokowaniem, a jedyną szansą na wyleczenie nadal pozostaje radykalne leczenie chirurgiczne. Wśród chorych można wyodrębnić grupę pierwotnie operacyjną, grupę z uogólnieniem procesu nowotworowego oraz grupę z procesem miejscowo zaawansowanym. Termin „miejscowo zaawansowany rak trzustki” obejmuje grupę pacjentów z granicznie resekcyjnym rakiem trzustki (BRPC — borderline resectable pancreatic cancer) oraz grupę pacjentów z definitywnie nieresekcyjnym rakiem trzustki (URPC —unresectable pancreatic cancer). W przypadku BRPC zastosowanie skutecznego leczenia indukcyjnego może doprowadzić do przeprowadzenia radykalnego leczenia chirurgicznego. W przypadku URPC optymalny sposób postępowania nie jest ustalony. Postępy w zakresie systemowego leczenia raka trzustki, takie jak FOLFIRINOX (5-fluorouracyl, leukoworyna, irynotekan, oksaliplatyna) lub gemcytabina plus nab-paklitaksel oraz próby optymalizacji leczenia miejscowego, takie jak stereotaktyczna radioterapia (SBRT — stereotactic body radiation therapy), powinny być wykorzystane do protokołów badań klinicznych leczenia zarówno BRPC, jak i URPC

Assessment of changes in a viewshed in the Western Carpathians landscape as a result of reforestation

A viewshed analysis is of great importance in mountainous areas characterized by high landscape values. The aim of this research was to determine the impact of reforestation occurring on former pasturelands on changes in the viewshed, and to quantify changes in the surface of glades. We combine a horizontal and a vertical approach to landscape analysis. The changes in non-forest areas and the viewshed from viewpoints located in glades were calculated using historical cartographic materials and a more recent Digital Elevation Model and Digital Surface Model. An analysis was conducted using a Visibility tool in ArcGIS. The non-forest areas decreased in the period 1848–2015. The viewshed in the majority of viewpoints also decreased in the period 1848–2015. In the majority of cases, the maximal viewsheds were calculated in 1879/1885 and 1933 (43.8% of the analyzed cases), whereas the minimal ones were calculated in 2015 (almost 57.5% of analyzed cases). Changes in the viewshed range from 0.2 to 23.5 km2 with half the cases analyzed being no more than 1.4 km2. The results indicate that forest succession on abandoned glades does not always cause a decline in the viewshed. Deforestation in neighboring areas may be another factor that has an influence on the decline

Long-term observation of the patient after CABG with asymptomatic high-grade aortic regurgitation – a clinical case study

Introduction: The aortic valve regurgitation (AR) is a heart defect consisting of the retrograde flow of blood from the aorta to the left ventricle due to the improper closure of the aortic valve leaflets. It occurs approximately in 13% of men and 8.5% of women, and the incidence increases with age. A crucial issue in regards to a patient with asymptomatic AR, especially of a high degree, is determination of the time of qualification for invasive treatment. Aim: To draw attention to the necessity of holistic approach to a patient with asymptomatic high-grade aortic regurgitation. Moreover, the complications of delayed implementation of invasive treatment were discussed. Case report: A clinical case of a 62-year-old patient with a history of coronary artery bypass grafting and with AR – stage II, accidentally detected two years later in a control echocardiogram, was presented. Despite gradual progress of regurgitation, none of the disturbing symptoms were noted, whereas cardiac parameters were systematically monitored using ECG, ECHO and CT imaging. Beta blockers, ACE inhibitors, loop diuretics and aspirin were used as conservative treatment. After 10-year transthoracic echocardiographic follow-up due to progression of AR and development of heart failure, the patient was qualified to surgical replacement of the aortic valve. This procedure significantly improved the patient's quality of life. Summary: The key element in the treatment of chronic asymptomatic AR is the individualization of the therapy. An essential role is played by appropriate pharmacotherapy, precise monitoring using transthoracic echocardiography, which is recommended as the first-line imaging strategy. Delaying in the implementation of surgical treatment may result in failure of the therapy and the onset of serious complications

The Assessment of Hydrogeosites in the Fann Mountains,Tajikistan as a Basis for Sustainable Tourism

Despite the fact that the Fann Mountains are among the most popular tourist destinations in Tajikistan, they are still in the first stage of tourism development. This represents a great opportunity for the implementation of the principles of sustainable tourism, which will avoid the mistakes associated with the uncontrolled tourism development currently observed in other mountain areas of the world. The aim of this article is to demonstrate, using the example of the Fann Mountains, how hydrogeosites in mountain areas can be valorised for the needs of cognitive tourism. The valorisation methods used in previous research to this point have focused on the evaluation of the objects themselves. This study additionally takes into account features of the surroundings of hydrogeostations, such as the visibility range, the vertical development of the view, and the diversity of the landscape. The conducted value assessments of the sites and their surroundings show that in both internal and external assessments the highest values were achieved by lakes and wetlands. This means that the evaluation of the surroundings has a strong influence on the results obtained and the choice of hydrogeotourism attractions

Rak przełyku — opis przypadku klinicznego wraz z przeglądem piśmiennictwa

W niniejszym opisie przypadku przedstawiono sposoby efektywnego leczenia przyczynowego i objawowego miejscowo zawansowanego, a następnie uogólnionego płaskonabłonkowego raka szyjnego odcinka przełyku, z uwzględnieniem dostępnych metod terapii (radiochemioterapia, chemioterapia). Pomimo bardzo wydłużonego okresu od diagnozy do rozpoczęcia leczenia terapia umożliwiła uzyskanie zadowalającej kontroli choroby oraz przeżycia całkowitego

The association of the IL−1β−31IL-1\beta-31 polymorphism and the development of neuroinfections

Introduction. Inflammation of the meninges can have various clinical courses, from mild, self-limiting in some viral neuroinfections to severe, sometimes ending in death. The pro-inflammatory cascade and defects in the inhibitors of the inflammatory response play an important prognostic role. Single nucleotide polymorphisms (SNPs) of the genes encoding cytokines, influence the severity of the inflammatory response. Aim. The aim of this study was to evaluate the effect of selected polymorphisms of proinflammatory cytokines $IL-1\beta$, $TNF-\alpha$ and IL-8 on the development of neuroinfections. Material and Methods. We evaluated the laboratory results of 30 patients treated for bacterial and viral meningitis and compared those to 30 healthy volunteers. The following 4 variants were analyzed for occurrence of genetic polymorphism in patients with meningitis versus the control group: $IL-1\beta$ 3953, $IL-1\beta-31$, $TNF-\alpha$ -308, and IL-8 781. Then, we assessed the association between these genetic polymorphisms and the inflammatory response during the course of meningitis. Results and Conclusions. We observed that polymorphism of the $IL-1\beta-31$ signifi cantly differs between patients and healthy subjects, the $IL-1\beta$ -31AA polymorphism existed only in healthy individuals (p < 0.001). The WBC count was dependent on the $TNF-\alpha$ -308 polymorphism with a statistically signifi cant difference (p = 0.021) occurring among persons with variants AA and AG. In conclusion the study showed that the presence of the AA genotype of $IL-1\beta-31$ polymorphism may have a protective effect on the development of meningitis. This polymorphism was not observed in any patient with meningitis

Ocena bezpieczeństwa i efektywność jabłczanu sunitynibu w przerzutowych guzach neuroendokrynnych trzustki (NEN G1/G2) w zależności od liczby i rodzaju wcześniejszych linii terapeutycznych — doniesienie wstępne

Introduction: The objective of this paper was to assess the safety and efficacy of sunitinib malate in patients with well-differentiated metastatic pancreatic neuroendocrine neoplasms (PNENs) who relapsed on standard therapy.Material and methods: Overall, eight patients with well-differentiated pancreatic neuroendocrine tumours/neoplasm (NET/NEN G1/G2, Ki-67 &lt; 20%), who had relapsed on a standard therapy approach, were treated. All had non-resectable, progressive disease. All received therapy using a standard dose of sunitinib malate. Adverse events were evaluated using NCI-CTC AE v. 3.0.Results: Of the eight patients, seven had non-secretor and single secretor tumour (gastrinoma). Partial remission (PR) was noted in three patients (one after a single therapeutic line, two after two lines), five patients had stabilisation (SD) — including three individuals after three lines, one patient after two lines and another after a single line. Haematological adverse events: leukopenia (25%) — occurred in one patient after three lines and in one patient after two lines; anaemia (25%) — in one patient after three lines and in one patient after one therapeutic line. Mucocutaneous lesions were noted in 37.5% of patients after 2–3 lines of treatment. All of them experienced fatigue syndrome irrespective of the number of therapies. The majority of the patients simultaneously received somatostatin analogues, which did not exacerbate the toxicity profile. The median progression-free survival time (PFS) was 11 months.Conclusions: Sunitinib may be considered as a fairly well-tolerated and effective therapeutic option in progressive non-resectable PNEN patients in the second and subsequent lines of treatment, irrespective of the types of treatment previously applied. (Endokrynol Pol 2014; 65 (6): 472–478)Wstęp: Celem pracy była ocena bezpieczeństwa oraz analiza skuteczności jabłczanu sunitynibu u chorych z przerzutowymi wysokozróżnicowanymi guzami neuroendokrynnymi trzustki (PNET) w drugiej i kolejnych liniach leczenia.Materiał i metody: Analizie poddano 8 pacjentów z wysoko zróżnicowanymi guzami neuroendokrynnymi trzustki (NEN G1/G2, Ki-67 &lt; 20%), u których wystąpiła progresja choroby i otrzymali sunitynib. Wszyscy chorzy byli w stadium nieoperacyjnym. Sunitynib był podawany w standardowej dawce. Działania niepożądane oceniono na podstawie kryteriów NCI-CTC AE v. 3.0.Wyniki: Leczono 8 pacjentów; 7 guzów nieaktywnych hormonalnie i 1 o typie gastrinoma. Częściową remisję (PR) uzyskano u 3 chorych (1 po 1 linii terapeutycznej, 2 — po 2 liniach), 5 chorych miało stabilizację (SD) — w tym 3 było po 3 liniach, 1 po 2 liniach i 1 po 1 linii terapeutycznej. Powikłania hematologiczne: leukopenia (25%) — wystąpiły u 1 pacjenta po 3 liniach i u 1 pacjenta po 2 liniach; niedokrwistość (25%) — u 1 pacjenta po 3 liniach i u 1 pacjenta po 1 linii terapeutycznej. U 37,5% chorych wystąpiły zmiany skórno-śluzówkowe po 2–3 liniach leczenia. U 100% chorych obserwowano zespół zmęczenia niezależnie od liczby terapii. Większość chorych jednocześnie otrzymywała SSA, co nie pogorszyło profilu toksyczności. Mediana czasu wolnego od progresji PFS (progression free survival) – wyniosła 11 miesięcy.Wnioski: Sunitynib może być rozważany, jako dość dobrze tolerowana, skuteczna opcja terapeutyczna u chorych z nieresekcyjnymi PNET w drugiej oraz kolejnych liniach leczenia, niezależnie od rodzaju uprzednio zastosowanych metod. (Endokrynol Pol 2014; 65 (6): 472–478

Application of the clustering technique to multiple nutritional factors related to inflammation and disease progression in patients with inflammatory bowel disease

Diet and nutritional status affect intestinal inflammation in patients with inflammatory bowel disease (IBD). The aim of this study was to use a cluster analysis to assess structural similarity between different groups of parameters including short-chain fatty acid (SCFA) levels in stool as well as hematological and inflammatory parameters (such as serum C-reactive protein (CRP) and proinflammatory and anti-inflammatory cytokines). We also assessed similarity between IBD patients in terms of various biochemical features of disease activity and nutritional status. A total of 48 participants were enrolled, including 36 patients with IBD and 12 controls. We identified four main meaningful clusters of parameters. The first cluster included all SCFAs with strong mutual correlations. The second cluster contained red blood cell parameters and albumin levels. The third cluster included proinflammatory parameters such as tumor necrosis factor-α, CRP, platelets, and phosphoric, succinic, and lactic acids. The final cluster revealed an association between zonulin and interleukins IL-10, IL-17, and IL-22. Moreover, we observed an inverse correlation between IL-6 and body mass index. Our findings suggest a link between nutritional status, diet, and inflammatory parameters in patients with IBD, which contribute to a better adjustment of the nutritional treatment