Hyperthermia in cervical cancer – current status

BackgroundThis article reviews the salient features of recent results of clinical studies. It puts a special emphasis on technical aspects, mechanisms of action together with radiotherapy and chemotherapy and points out areas for additional investigation.AimTo present the current state of knowledge on hyperthermia (HT) and to highlight its role in the treatment of cervical cancer.Materials and methodsThe literature on the clinical use of combined hyperthermia for cervical cancer was analyzed. Clinical outcomes together with the technical aspects and the role of HT were also evaluated.ResultsClinically randomized trials have demonstrated benefit including survival with the addition of hyperthermia to radiation or chemotherapy in the treatment of cervical cancer without significant acute or late morbidities. The technological advances have led to an effective and safer treatment delivery, thermal treatment planning, thermal dose monitoring and online adaptive temperature modulation.ConclusionsDue to rapid development over the last decade of hyperthermia systems and new studies at the basic science and clinical level, the perception of hyperthermia as a part of multimodality treatment in cervical cancer has been changed. However, there is still a need for multicentre randomized clinical trials

Effects of lubrication, specimen preparation and tool coating on the friction behavior of commercially pure titanium at elevated temperature

Titanium forming processes are often limited by severe adhesive wear as a result of poor friction conditions. This can be partially remedied with careful selection of lubricant, billet preparation and tool coating, but the optimal combination of these factors is not known. A full factorial ring compression experiment, with grade 2 commercially pure titanium rings deformed at 300 °C, was conducted to study the effect of each of these factors over three levels. The change in internal diameter was compared to a set of calibration curves generated by an FEA simulation of the process in order to determine the friction coefficient during each trial. A robust statistical analysis methodology was used to isolate and evaluate the effect of varying each factor. The choice of lubricant was found to be the most statistically significant factor by a considerable margin, followed by the method of billet preparation, with tool coating found to be insignificant. Of the lubricants tested, the graphite-based lubricant resulted in the lowest friction, followed by the WS2- and MoS2-based lubricants. Sandblasted billet surfaces resulted in similar friction to as-machined surfaces, whereas those subjected to micro-arc oxidation performed notably worse. For reducing friction during warm forming of titanium, a graphite-based lubricant is therefore recommended, with tool coating and billet surface preparation unlikely to provide significant further improvement

Monocyte Chemoattractant Protein-1− 2518 A/G Single Nucleotide Polymorphism Might Be Associated with Renal Disease and Thrombocytopenia of SLE

There is conflicting evidence on the contribution of the MCP-1 −2518 A>G (rs 1024611) polymorphism to SLE incidence and clinical manifestations. We examined the prevalence of the MCP-1 −2518 A>G polymorphism in SLE patients (n = 199) and controls (n = 250) in Poland. We did not observe a significant difference in the distribution of MCP-1 −2518 A>G polymorphic variants in patients with SLE and healthy individuals. However, we found an association between the GG versus AG and AA genotypes as well as the AG and GG versus AA genotypes with renal manifestations of SLE OR = 3.614 (1.123–11.631, P = 0.0345) and OR = 2.297 (1.301–4.057, P = 0.0046), respectively. We also observed that the MCP-1 AG and GG -genotypes contribute to the occurrence of thrombocytopenia in SLE patients OR = 2.618 (1.280–5.352, P = 0.0089). Our observations indicate that either MCP-1 −2518 G variant can be associated with some clinical findings in patients with SLE

Does conformal therapy improve dose distribution in comparison to old techniques in teleradiotherapy of cervical cancer patients?

SummaryBackgroundThe use of a combined modality approach – chemotherapy and radiation therapy – in the treatment of patients with cervical cancer is associated with significant toxicity, mainly haematological and gastrointestinal. Conformal radiotherapy has the potential to deliver an adequate dose to the target structures while sparing the normal tissue. Both the radiation dose to the small bowel and the volume are factors known to influence the risk of complications.AimThe aim of this study was to determine whether the implementation of conformal modality can reduce the volume of normal tissue included in the RT field.Methods and Materials14 cervical cancer patients (FIGO IIB and IIIB) treated with conformal radiotherapy concurrently with cisplatin (40 mg/m2) administration once a week were analyzed. According to ICRU 50 recommendations target volumes and the organs at risk were contoured on CT slices. For the gross tumour volume (GTV) the tumour of the uterus and cervix was traced. The clinical target volume (CTV) was defined as the vessels and lymph nodes from the obturator level to the aortic bifurcation, presacral region, and upper 1/3 of the vagina. The margin for planning target volume (PTV) was added. The normal tissue region included the small bowel, large bowel and bladder. Using a 3D system and multi-leaf collimator a four-field treatment plan was performed for each patient. All 14 patients were treated with radiotherapy using these conformal 3D plans. Additionally (just for study purposes) for each patient we prepared two simpler plans with (1) two-field: anterior-posterior (A-P) and posterior-anterior (P-A); and (2) four-field box techniques. Dose-volume histograms of target volumes and organs at risk were calculated for each three plans for every patient and compared. Analysis of variance was performed to compute the statistical significance.ResultsThere is no statistical difference between doses received by target volumes – in each plan PTV is covered by the 95% isodose. Significantly different volumes of critical organs were included in the treatment field, depending on radiotherapy technique (conformal 3D method vs AP–PA two-field method): rectum 96.82% vs 38.23%, bowels 61.37% vs 30.79%.ConclusionThese data suggest that implementation of conformal radiotherapy can reduce the irradiated volume in all the contoured critical organs, especially the bowels, compared to old techniques

Should we affraid of induced cancer in group of patients after radical radiotherapy of prostate cancer?

Radiotherapy is one of the basic methods of radical treatment of prostate cancer. Because of that getting to know all factors of post-radiation complications, and in consequence the possibility to limit them, is one of the challenges of contemporary radiotherapy.One of the potential complications associated with radiation treatment is radiation-induced cancer. Despite a whole range of epidemiological analyses there is still lacking a fully credible model that would allow one to estimate the magnitude of risk of inducing such cancers. The last decades have seen the entry into clinical practice of technologically advanced methods of radiation therapy, such as the 3DCRT and IMRT. As the previous epidemiological analyses refer mainly to older radiation techniques, there is still a lack of credible data estimating the risk of inducing secondary cancers for new techniques, and in particular IMRT. It should be emphasized that IMRT allows one to escalate the dose, which may contribute to the improvement of radiotherapy effectiveness. From this there follows a new problem to be solved in future, i.e. how the escalation of the dose may influence the magnitude of risk of radiation carcinogenesis.The problem of carcinogenesis may concern the group of younger patients for whom long survival is very likely, and the competitive edge of RT relative to surgery, in particular in the aspect of late complications, has to be thoroughly justified

Zastosowanie hodowli i multiplex PCR w diagnostyce drobnoustrojów wywołujących zapalenie pochwy u kobiet z rakiem szyjki macicy

Background: Bacterial vaginosis (BV) and vaginitis in cervical cancer patients might becaused by mixed aerobic, anaerobic, and atypical bacteria. Since genital tract infections can be complicated, early and accurate identification of causal pathogens is vital. Objectives:The purpose of this study was i) to determinate if currently used aerobic culture methods are sufficiently sensitive to identify pathogens that can appear in the cervix of women after cancer treatment; ii) to investigate if molecular methods can improve the diagnostic process of BV and vaginitis, as well as broaden the range of detectable pathogens that would otherwise be difficult to cultivate. Methods: A one-year hospital-based study was conducted in 2011/2012. Cervical swabs from 130 patients were examined by microbiological culture and multiplex PCR. Results: Swab samples were positive for 107 and 93 women by microbiological culture and multiplex PCR, respectively. The most common bacteria isolated from culture were: Escherichia coli, Enterococcus faecalis, Streptococcus agalactiae, and Staphylococcus aureus, and using the molecular technique were: Gardnerella vaginalis, Bacteroides fragilis, Ureoplasma ureoliticum/parvum, Mobiluncus curtisii and Atopobium vaginae. Conclusions: Multiplex PCR might contribute to the diagnosis of genital tract infections and it broadens the number of detectable microorganisms responsible for BV. Combination of these two methods may become the basis for standardized diagnosis of BV and vaginitis.Bakteryjne zapalenie pochwy u pacjentów chorych na raka szyjki macicy może być spowodowane przez bakterie beztlenowe, tlenowe i atypowe. Ponieważ infekcje narządów płciowych mogą doprowadzić do poważnych komplikacji, wczesna i odpowiednia identyfikacja źródła infekcji jest bardzo ważna. Cel pracy: 1) określenie, czy obecnie używane metody hodowli tlenowej w pracowni mikrobiologicznej są wystarczające do identyfikacji patogenów, które mogą pojawić się w szyjce macicy po leczeniu nowotworowym; 2) zbadanie, czy molekularne metody mogą polepszyć diagnostykę bakteryjnych zapaleń pochwy i zwiększyć zakres wykrywanych patogenów o te, które są trudne w hodowli. Metodyka: Materiałem do badań były wymazy z szyjki macicy, pobrane od 130 kobiet z nowotworem szyjki macicy hospitalizowanych w Wielkopolskim Centrum Onkologii w latach 2011-2012. Identyfikacji mikroorganizmów dokonano tradycyjną metodą hodowlaną i metodą molekularną- multiplex PCR. Wyniki: Hodowla mikrobiologiczna zdiagnozowała 107 pozytywnych przypadków, zaś multiplex PCR- 93. Najczęściej izolowanymi patogenami metodą mikrobiologiczną były: Escherichia coli, Enterococcus faecalis, Streptococcus agalactiae i Staphylococcus aureus, a techniką molekularną: Gardnerella vaginalis, Bacteroides fragilis, Ureoplasma ureoliticum/parvum, Mobiluncus curtisii i Atopobium vaginae. Wnioski: Multiplex PCR mógłby pomóc w diagnostyce infekcji narządów płciowych i powiększyć zakres wykrywanych mikroorganizmów. Połączenie tych dwóch technik może stanowić podstawę standaryzacji diagnostyki zapalenia dróg rodnych kobiet

E-learning practice at medical universities in Poland in the perspective of the SARS-CoV-2 pandemic

The epidemiological situation resulting from the SARS-CoV-2 pandemic caused the Polish universities to fully switch to distance education in March 2020. Medical e-learning has not yet been broadly implemented into the education process. Therefore, examples of successful e-learning implementations or the organization of the process of medical e-learning offer a valuable source of knowledge today, which is needed immediately. The article presents e-learning practices at the Polish medical universities during the SARS-CoV-2 epidemic during the period from March to September 2020, covering seven universities in Poland that offer medical and health studies. The organization and implementation of e-learning classes is presented, including knowledge evaluation practices, providing example decisions issued by university rectors, on which the teaching process was based. A detailed presentation of the schools’ organizational units or workgroups that played an important role in the process of coordination of measures supporting e-education is also included. The article also presents a description of the software applications, utilities, and services used at the schools in the course of the process of online education. Below are some examples of specific such implementations in selected university courses

Odczucia chorych na nowotwór narządu rodnego, u których zastosowano różne metody brachyterapii

Brachytherapy using ałterloading system with low and medium dose (LDR/MDR) or high dose (HDR) radioactive sources is the method of treatment of uterine cervix or endometrium cancer, applied at the Greatpoland Oncology Centre.PurposeThe work was aimed at carrying out an analysis of the psychological response and behaviour in patients in the course of brachytherapy.Materials and methodsThe study comprised 86 women, including 56 patients with the cancer of the uterine cervix and 30 patients with the cancer of the endometrium. Forty-eight women from both groups investigated were treated with LDR brachytherapy and 38 women were administered HDR brachytherapy. The methods used in the study were psychological interview and observation.ResultsSixty-tive (76%) patients gained their intormation about the applied treatment methods from other patients. This intormation was mainly based on the patients’ own psychological response (feelings or perception), rather than on scientific knowledge. By comparing both methods of treatment 76 patients (88%) would have chosen to undergo the HDR brachytherapy due to the short time of its application. Eighty-three (97%) patients reported anxiety betore the first and second application of HDR and LDR. Ali patients considered brachytherapy as the most difficult, although acceptable, time in the course of treatment.Conclusions1. Brachytherapy, until started, gives rise to considerable degree of anxiety. 2. Both LDR and HDR techniques are believed to be difficult, but very effective. 3. The HDR technique, compared with the LDR/MDR techniques, due to the short time of its application is more acceptable be patients.W Wielkopolskim Centrum Onkologii (WCO) jedną z metod leczenia nowotworów szyjki macicy lub błony śluzowej macicy jest brachyterapia metodą afterloading przy użyciu źródeł promieniotwórczych o niskiej i średniej (LDR/MDR) lub wysokiej (HDR) mocy.CelCelem pracy było przeanalizowanie odczuć i zachowań chorych w trakcie brachyterapii.Materiał i metodyBadaniem objęto 86 kobiet, w tym 56 chorych na raka szyjki macicy i 30 na raka błony śluzowej macicy. Czterdzieści osiem kobiet z obu analizowanych grup zostało poddanych brachyterapii LDR, a 38 – HDR. Metodą badania była rozmowa psychologiczna i obserwacja.WynikiDla 65 (76%) chorych źródłem informacji na temat stosowanych metod leczenia były najczęściej inne chore. Pozyskiwana wiedza opierała się na własnych odczuciach pacjentek, a nie na informacji naukowej. Porównując obie metody leczenia 76 pacjentek (88%) zdecydowanych byłoby poddać się brachyterapii metodą HDR, ze względu na krótki czas trwania aplikacji. Osiemdziesiąt trzy chore (97%) opisywały swój niepokój przed pierwszą i drugą aplikacją HDR i LDR. Wszystkie chore oceniały brachyterapię jako najtrudniejszy etap leczenia, jednakże możliwy do zaakceptowania.Wnioski1. Brachyterapia jest metodą leczenia, która do momentu poddania się jej budzi znaczne obawy. 2. Obie metody (LDR i HDR) odbierane są przez pacjentki jako trudne, ale w ich przekonaniu bardzo skuteczne. 3. Metoda HDR, w porównaniu z metodą LDR/MDR, jest przez chore bardziej akceptowana z uwagi na krótki czas aplikacji

Pharmacological stroke prevention in the elderly with atrial fibrillation in Poland : results of PolSenior study

Introduction: Atrial fibrillation (AF) is the most frequent clinically significant arrhythmia, especially common in the elderly. As it is known, AF is associated with increased risk of stroke. Little is known about pharmacological cardiovascular prevention in the elderly with AF in Poland. Objectives: The purpose of the study was to evaluate the frequency of pharmacological stroke prevention among the elderly with AF in Poland and its association with clinical characteristics and concomitant cardiovascular risk factors. Patients and methods: The analysis included elderly (≥65 years) participants of the PolSenior study performed in years 2008-2012. Results: The study group consisted of 4979 people (mean age: 79.3 8.7 years). Among them, there were 875 patients (18.7%) with documented history of AF. Pharmacological prevention with the use of vitamin K antagonists (VKA) was applied by 117 (13.4%) of the elderly with AF, including 15 (1.7%) on dual therapy. Additionally, 386 (45.3%) subjects with AF were using oral antiplatelet therapy (OAPs), mostly aspirin. Acenocoumarol was much more often used than warfarin. New oral anticoagulant drugs (NOACs) were not used at all. Only personal income was associated with the use of VKA. No significant correlation was found for the age, sex, place of residence and level of education

Secondary prevention of stroke in elderly people in Poland—Results of PolSenior study

Background and purpose The purpose of the study was to evaluate the frequency of use of oral antiplatelet (OAP) and anticoagulant (OAC) drugs as secondary stroke prevention among older people in Poland and its association with sociodemographic factors, place of residence, and concomitant cardiovascular risk factors. Material and methods The study group consisted of 426 subjects with a history of a previous stroke (mean age of 81.5±8.2 years), participants of multicentre, population-based PolSenior study. Results Among the study group, 261 people (61.3%) used at least one drug as a secondary prevention. OAPs were regularly used by 237 people (55.6%), and OACs—by 25 people (5.9%). The most often used drug was acetylsalicylic acid. Ticlopidine was more frequently used than clopidogrel, and acenocoumarol was used more often than warfarin. Among all of the concomitant cardiovascular risk factors, congestive heart failure was mostly associated with OAP treatment, and a history of atrial fibrillation—with OAC treatment. Use of drugs did not depend on age, sex, place of residence (rural or urban), level of education and personal income, but it was associated with the region where the respondents lived. Conclusions Secondary cardiovascular preventive therapy in Poland is used too rarely in older people after stroke, and it especially concerns anticoagulant therapy in those with a history of atrial fibrillation. Structured educational programmes should be developed in Poland to improve usage of secondary preventive therapy in the elderly