Chemotherapy for advanced non-small-cell lung cancer: Role of paclitaxel and gemcitabine

Objective. To review the role of chemotherapy in advanced non-small-cell lung cancer, focusing on cisplatin-based regimens and two new drugs: paclitaxel and gemcitabine. Data sources. Medline search of the relevant English literature. Study selection. Open and randomised comparative (phases II and III) studies, and meta-analyses of cytotoxic drugs/regimens used to treat advanced non-small-cell lung cancer. Data extraction. The following factors were studied and compared: symptomatic response rates; tumour response rates; median survival time and 1-year survival rates; and side effects of cisplatin-, paclitaxel-, and gemcitabine-based regimens. Data synthesis. Using cisplatin-based chemotherapy achieves significant relief of disease-related symptoms of advanced non-small-cell lung cancer and a slight improvement in the median survival time (by approximately 1.5 months). New cytotoxic drugs that are effective and have good safety profiles include paclitaxel and gemcitabine. When used as single agents, these two drugs give response rates of approximately 25%. When used with cisplatin/carboplatin, response rates increase to 45% to 62% and 1-year survival rates increase to 40% to 60%. Conclusion. Paclitaxel, gemcitabine, and other drugs such as decetaxel and vinorelbine are promising new chemotherapeutic agents in the treatment of advanced non-small-cell lung cancer. These drugs can palliate disease symptoms and improve the median survival time. The optimal dose and treatment schedules, however, are yet to be defined.published_or_final_versio

Peritoneal implantation of ureter in cadaveric renal transplant

Case reportWe report here a case of complication of peritoneal implantation of ureter in cadaveric renal transplant. The patient presented with anuria and delayed graft function. The diagnosis was suspected upon physical examination and radiological investigation. The complication was managed with reimplantation of the ureter into the bladder and the patient recovered with good graft function. We discuss this case, review the literature on this rare complication, and share our suggestions on how it can be prevented.published_or_final_versio

Purpurin suppresses Candida albicans biofilm formation and hyphal development

published_or_final_versio

Long-term results of endoscopic-assisted cranionasal resection for olfactory neuroblastoma - single centre experience of fourteen patients

postprin

Classifying Generalization: Paradigm War or abuse of Terminology?

Lee and Baskerville (2003) attempted to clarify the concept of generalization and classify it into four types. In Tsang and Williams (2012) we objected to their account of generalization as well as their classification and offered repairs. Then we proposed a classification of induction, within which we distinguished five types of generalization. In their (2012) rejoinder, they argue that their classification is compatible with ours, claiming that theirs offers a ‘new language.’ Insofar as we resist this ‘new language’ and insofar as they think that our position commits us to positivism and the rejection of interpretivism, they conclude both that our classification is more restrictive than theirs and also that we embrace ‘paradigmatic domination.’ Lee and Baskerville\u27s classification of generalization is based on a distinction between theoretical and empirical statements. Accordingly we will first clarify the terms ‘theoretical statement’ and ‘empirical statement.’ We note that they find no fault with our classification of induction, we restate our main objections to their classification that remain unanswered and we show that their classification of generalizing is in fact incompatible with ours. We argue that their account of generalization retains fatal flaws, which means it should not be relied upon. We demonstrate that our classification is not committed to any paradigm and so we do not embrace ‘paradigmatic domination.

Lymphangioleimyomatosis: the Hong Kong experience

published_or_final_versio

Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection

We aimed to explore the diagnostic accuracy of various mediastinal measurements in determining acute nontraumatic thoracic aortic dissection with respect to posteroanterior (PA) and anteroposterior (AP) chest radiographs, which had received little attention so far. We retrospectively reviewed 100 patients (50 PA and 50 AP chest radiographs) with confirmed acute thoracic aortic dissection and 120 patients (60 PA and 60 AP chest radiographs) with confirmed normal aorta. Those who had prior history of trauma or aortic disease were excluded. The maximal mediastinal width (MW) and maximal left mediastinal width (LMW) were measured by two independent radiologists and the mediastinal width ratio (MWR) was calculated. Statistical analysis was then performed with independent sample t test. PA projection was significantly more accurate than AP projection, achieving higher sensitivity and specificity. LMW and MW were the most powerful parameters on PA and AP chest radiographs, respectively. The optimal cutoff levels were LMW = 4.95 cm (sensitivity, 90 %; specificity, 90 %) and MW = 7.45 cm (sensitivity, 90 %; specificity, 88.3 %) for PA projection and LMW = 5.45 cm (sensitivity, 76 %; specificity, 65 %) and MW = 8.65 cm (sensitivity, 72 %; specificity, 80 %) for AP projection. MWR was found less useful and less reliable. The use of LMW alone in PA film would allow more accurate prediction of aortic dissection. PA chest radiograph has a higher diagnostic accuracy when compared with AP chest radiograph, with negative PA chest radiograph showing less probability for aortic dissection. Lower threshold for proceeding to computed tomography aortogram is recommended however, especially in the elderly and patients with widened mediastinum on AP chest radiograph. © 2012 The Author(s).published_or_final_versio

Purpurin Triggers Caspase-Independent Apoptosis in Candida dubliniensis Biofilms

Candida dubliniensis is an important human fungal pathogen that causes oral infections in patients with AIDS and diabetes mellitus. However, C. Dubliniensis has been frequently reported in bloodstream infections in clinical settings. Like its phylogenetically related virulent species C. albicans, C. Dubliniensis is able to grow and switch between yeast form and filamentous form (hyphae) and develops biofilms on both abiotic and biotic surfaces. Biofilms are recalcitrant to antifungal therapies and C. Dubliniensis readily turns drug resistant upon repeated exposure. More than 80% of infections are associated with biofilms. Suppression of fungal biofilms may therefore represent a viable antifungal strategy with clinical relevance. Here, we report that C. dubliniensis biofilms were inhibited by purpurin, a natural anthraquinone pigment isolated from madder root. Purpurin inhibited C. dubliniensis biofilm formation in a concentration-dependent manner; while mature biofilms were less susceptible to purpurin. Scanning electron microscopy (SEM) analysis revealed scanty structure consisting of yeast cells in purpurin-treated C. dubliniensis biofilms. We sought to delineate the mechanisms of the anti-biofilm activity of purpurin on C. Dubliniensis. Intracellular ROS levels were significantly elevated in fungal biofilms and depolarization of MMP was evident upon purpurin treatment in a concentration-dependent manner. DNA degradation was evident. However, no activated metacaspase could be detected. Together, purpurin triggered metacaspase-independent apoptosis in C. dubliniensis biofilms.published_or_final_versio

Multicentre phase II trial of taxotere and cisplatin in advanced non-small cell lung cancer

Session - Respiratory & Critical Care Medicine: no. G-RC-10published_or_final_versio

Gastro-oesophageal reflux in bronchiectasis

published_or_final_versio