Analysis of prognostic factors and efficacy of surgical treatment for non-small cell lung cancer: department of surgery NTLDRI (1998-1999)

Introduction: Surgical resection is the mainstay of curative treatment for non-small cell lung cancer. Material and methods: A retrospective analysis of the efficacy of this treatment, based on 431 patients operated from 1998 to 1999 in the Department of Surgery of the National Tuberculosis and Lung Diseases Research Institute, was accomplished. In 218 cases (51%) lobectomy was performed, in 21 cases (5%) - bilobectomy, in 188 cases (44%) - pneumonectomy and in 4 cases (1%) - wedge resection. The pIA stage was diagnosed in 70 cases (16%), pIB - in 112 (26%), pIIA - in 22 (5%), pIIB - in 110 (26%), pIIIA - in 88 (20%), pIIIB - in 13 (3%) and pIV - in 16 (4%). Results: The five-year survival rate for the whole group was 49.1%. Statistical analysis revealed better survival in patients younger than 50 (p = 0.03), in women (p = 0.01, HR = 0.63) and in cases with less extensive surgery, i.e. lobectomy, (p < 0.05). Long-term survival was significantly dependent on the disease stage (p < 0.005). Five-year survival of patients in stage IA was 81.7%, IB - 62.2%, IIA - 59.1%, IIB - 38%, IIIA - 21.3%, IIIB - 8.3% and IV - 8.3%. Tumour status (p < 0.005) and histological subtype (p < 0.005) had a significant influence on long-term survival. Five-year survival of patients with squamous cell carcinoma was 53.4%, with adenocarcinoma - 38.3%, with large cell carcinoma - 37.5%, with carcinoid - 94.7% and with other types of cancer - 39.1%. The decreased preoperative Hb level (p < 0.005, HR = 1.52), as well as blood transfusion in postoperative period (p = 0.03), were negative prognostic factors. Significantly worse prognosis was observed in the cases of R1 or R2 categories (p = 0.01) and M1 category (p < 0.005). Additionally, in multivariate Cox analysis, a decreased FEV1 lower than 80% (HR = 1.46) was a negative prognostic factor, and lack of symptoms, except cough (HR = 0.73), was a positive one. Conclusions: Univariate analysis revealed several factors worsening prognosis: male sex, age older than 50 years, lowered preoperative Hb concentration, extended surgery, advanced stage, adenocarcinoma and large cell carcinoma, T status, N status, R status, M status and blood transfusion in postoperative period. In multivariate Cox analysis lowered preoperative Hb concentration, decreased FEV1 lower than 80% pred., extended surgery (pneumonectomy), advanced stage and adenocarcinoma were negative prognostic factors. Female sex and lack of symptoms, except coughing were positive prognostic factors.Wprowadzenie: Postępowanie chirurgiczne stanowi podstawową metodę leczenia niedrobnokomórkowego raka płuca.Materiał i metody: W pracy przeprowadzono retrospektywną analizę skuteczności tego leczenia w grupie 431 chorych operowanych w Klinice Chirurgii Instytutu Gruźlicy i Chorób Płuc w Warszawie w latach 1998-1999. W 218 (50%) przypadkach wykonano lobektomię, w 21 (5%) - bilobektomię, w 188 (44%) - pneumonektomię, a w 4 (1%) - resekcję klinową. U 70 (16%) chorych rozpoznano stadium zaawansowania pIA, u 112 (26%) - pIB, u 22 (5%) - pIIA, u 110 (26%) - pIIB, u 88 (20%) - pIIIA, u 13 (3%) - pIIIB i u 16 (4%) - pIV. Wyniki: Wskaźnik 5-letniego przeżycia dla całej grupy wynosił 49,1%. Analiza statystyczna wykazała wyższy odsetek odległych przeżyć w grupie wiekowej do 50. rż. (p = 0,03), u płci żeńskiej (p = 0,01, HR = 0,63), w przypadku mniej rozległego zabiegu (lobektomia) (p < 0,005). Wskaźniki odległych przeżyć wykazywały znamienną zależność od stadium zaawansowania choroby nowotworowej (p < 0,005). Pięcioletnie przeżycie pacjentów w stadium IA wynosiło 81,7%, IB - 62,2%, IIA - 59,1%, IIB - 38%, IIIA - 21,3%, IIIB - 8,3% oraz IV - 8,3%. Typ histopatologiczny miał również znamienny wpływ na odległe przeżycia chorych (p < 0,005). Pięcioletnie przeżycie chorych na raka płaskonabłonkowego wynosiło 53,4%, na raka gruczołowego - 38,3%, na raka wielkokomórkowego - 37,5%, na rakowiaka - 94,7%, a na pozostałe typy raka - 39,1%. Wskaźnik odległego przeżycia zależał znamiennie od cechy T (p < 0,005). Obniżone wyjściowe stężenie hemoglobiny (p < 0,005, HR = 1,52) oraz przetoczenie masy erytrocytarnej w okresie pooperacyjnym (p = 0,03) były niekorzystnymi czynnikami rokowniczymi. Znamiennie gorsze rokowanie wykazano w przypadku cechy R1 lub R2 (p = 0,01) oraz cechy M1 (p < 0,005). Dodatkowo, w analizie wielowymiarowej Coxa wartość FEV1 poniżej 80% (HR = 1,46) była zmienną negatywnie wpływającą na odległe przeżycie, a brak objawów klinicznych choroby, z wyjątkiem kaszlu (HR = 0,73) - zmienną wpływającą korzystnie. Wnioski: W analizie jednowymiarowej wyłoniono następujące czynniki ryzyka: płeć męska, wiek powyżej 50. rż., obniżone stężenie Hb, zabieg operacyjny o poszerzonym zakresie, zaawansowane stadium, utkanie raka gruczołowego i wielkokomórkowego, cecha T, N, R i M oraz przetoczenie ME w okresie pooperacyjnym. Analiza wielowymiarowa Coxa wykazała następujące negatywne czynniki prognostyczne: obniżone wyjściowe stężenie Hb, wartość FEV1 poniżej 80%, zabieg operacyjny o poszerzonym zakresie (pneumonektomia), zaawansowane stadium raka, utkanie raka gruczołowego oraz następujące korzystne rokowniczo czynniki: płeć żeńska i brak objawów klinicznych, z wyjątkiem kaszlu

A Dichotomy of Sport Sponsorships: Does the Nature of Competition Among Sponsors Matter?

In this paper, we argue that the firm value implications of sport sponsorships for sponsors may depend on the competitive environment during the bidding process for different types of sponsorships. More specifically, we contend that the bidding environment for professional football (soccer) kit sponsorships represents a form of common value auction, while the bidding environment for corporate logo sponsorships on teams’ shirts does not. As common value auctions are prone to winner’s curse, the firm value implications should be different for kit sponsorship announcements than for shirt sponsorship announcements. Our results suggest that shareholders indeed perceive the value derived from kit and shirt sponsorships differently, resulting in the predicted distinction in their impact on sponsors’ firm value. This study sheds light on conflicting results on firm value implications of sport sponsorships in the prior literature and provides rich areas for future research

Characterisation and OSL dating of modern fluvial sediments in the lower Vistula River: testing the zeroing assumption

In this study recent sediments of the lower Vistula River were investigated to determine the relationship between the structure and texture specific features and the possibility of their zeroing. The samples of recent fluvial deposits were collected from the lower Vistula River at two sites in Toruń and Ciechocinek. Sand bars newly emerged from the river were selected for testing. The coarse quartz grains were separated for OSL measurements. The single-aliquot regenerative (SAR) technique was applied for measuring equivalent doses from multigrain aliquots. The obtained dose estimates were found to be very low, proving the reliability of OSL zeroing assumption. The dose rates were estimated by gamma-ray spectrometry, demonstrating homogeneity of the radiation field. These results related to fossil sediments of that type confirm their suitability for the OSL dating method

Loneliness among surgical patients - measuring levels of loneliness using De Jong Gierveld Loneliness Scale and Revised UCLA Loneliness Scale

Objective: Loneliness is a state that most people will experience during their lifetime. In order to raise awareness of loneliness and its complexity, we attempted to measure the span of loneliness among the surgical patients hospitalized in the Department of Surgery in the 4th Military Teaching Hospital in Wroclaw.&nbsp; The aim of this study was to establish correlations between loneliness, measured using and four other variables: age, gender, nutritional state and quality of life of surveyed patients. Material and methods: A total of 100 patients in the Surgery Department in the 4 th Military Teaching Hospital in Wroclaw, Poland, were enrolled.&nbsp; The Mini-Nutritional Assessment (MNA) questionnaire was used to assess their nutritional status; the World Health Organization Quality of Life Scale (WHO-QoL-BREF) was used to assess their quality of life; the De Jong Gierveld Loneliness Scale (DJGLS) and Revised UCLA Loneliness Scale (R-UCLA) were used to assess their loneliness level. Results:The WHO-QoL-BREF showed that patients’ quality of life (QoL) self-perception was between average and good, health self-perception was average as well. Lowest score of QoL was found in the physical domain whereas the highest was found in the social domain. The MNA showed that 8% of the study group was malnourished, 49% at risk of malnutrition and 43% displayed a normal nutritional status. 49% of the study group experience loneliness during study by DJGLS. A significant positive correlation between loneliness status and QoL was observed in physical health self-perception (r=0,226, p=0,024). Negative correlation was found between loneliness and QoL in psychological, social and environmental domains (p&lt;0,001). &nbsp; Conclusions: Loneliness has a significant negative impact on the quality of life.Sex, age and nutritional status can not be predictors of patient’s loneliness. More than half of patients were in a disturbing nutrition state. &nbsp

Hypoxia-induced fatty acid transporter translocation increases fatty acid transport and contributes to lipid accumulation in the heart

AbstractProtein-mediated LCFA transport across plasma membranes is highly regulated by the fatty acid transporters FAT/CD36 and FABPpm. Physiologic stimuli (insulin stimulation, AMP kinase activation) induce the translocation of one or both transporters to the plasma membrane and increase the rate of LCFA transport. In the hypoxic/ischemic heart, intramyocardial lipid accumulation has been attributed to a reduced rate of fatty acid oxidation. However, since acute hypoxia (15min) activates AMPK, we examined whether an increased accumulation of intramyocardial lipid during hypoxia was also attributable to an increased rate of LCFA uptake as a result AMPK-induced translocation of FAT/CD36 and FABPpm. In cardiac myocytes, hypoxia (15min) induced the redistribution of FAT/CD36 from an intracellular pool (LDM) (−25%, P<0.05) to the plasma membranes (PM) (+54%, P<0.05). Hypoxia also induced an increase in FABPpm at the PM (+56%, P<0.05) and a concomitant FABPpm reduction in the LDM (−24%, P<0.05). Similarly, in intact, Langendorff perfused hearts, hypoxia induced the translocation of a both FAT/CD36 and FABPpm to the PM (+66% and +61%, respectively, P<0.05), with a concomitant decline in FAT/CD36 and FABPpm in the LDM (−24% and −23%, respectively, P<0.05). Importantly, the increased plasmalemmal content of these transporters was associated with increases in the initial rates of palmitate uptake into cardiac myocytes (+40%, P<0.05). Acute hypoxia also redirected palmitate into intracellular lipid pools, mainly to PL and TG (+48% and +28%, respectively, P<0.05), while fatty acid oxidation was reduced (−35%, P<0.05). Thus, our data indicate that the increased intracellular lipid accumulation in hypoxic hearts is attributable to both: (a) a reduced rate of fatty acid oxidation and (b) an increased rate of fatty acid transport into the heart, the latter being attributable to a hypoxia-induced translocation of fatty acid transporters

Altered Peroxisome-Proliferator Activated Receptors Expression in Human Endometrial Cancer

Peroxisome proliferator-activated receptors (PPARs) belong to a family of nuclear hormone receptors acting as transcriptional factors, recently involved also in carcinogenesis. Present study was undertaken to evaluate the presence and subcellular localization of different PPAR isoforms (α, β, γ) in healthy endometrial tissue (n = 10) and endometrial carcinoma (FIGO I, endometrioides type, G1, n = 35). We sought to analyze PPARs mRNA content as well as protein immunohistochemical expression that was further quantified by Western Blot technique. For both PPARα and PPARβ, protein expression was significantly higher in endometrial cancers compared to normal endometrial mucosa. In opposite, PPARγ protein expression was lower in endometrial cancer cells. In each case, immunohistochemical reaction was confined to the perinuclear and/or nuclear region. At the transcriptional level, the content of mRNA of all PPAR subunits did not follow the protein pattern of changes. These results provide evidence for altered PPAR's protein expression and disregulation of posttranslational processes in endometrial cancers

Pulmonary epithelioid haemangioendothelioma - interferon 2-alpha treatment - case report

W pracy przedstawiono przypadek 62-letniej chorej, otyłej palaczki tytoniu (10 paczko/lat), przyjętej do Instytutu Gruźlicy i Chorób Płuc w Warszawie w celu diagnostyki stwierdzanych w badaniu radiologicznym klatki piersiowej dobrze wysyconych cieni okrągłych. Zmiany te były widoczne w badaniach radiologicznych od 5 lat, jednak w ostatnim okresie uległy zdecydowanemu powiększeniu. Chora leczyła się z powodu nadciśnienia tętniczego, cukrzycy insulinoniezależnej oraz łuszczycy z zajęciem skóry. W chwili przyjęcia uskarżała się na kaszel z niewielkim odkrztuszaniem śluzowej wydzieliny i okresowe bóle kostno-stawowe. W badaniu przedmiotowym stwierdzono zmiany skórne o charakterze łuszczycowym, niewielkie obrzęki na kończynach dolnych oraz palce pałeczkowate. Odczyn tuberkulinowy był dodatni. W badaniu tomograficznym klatki piersiowej wykazano obecność częściowo uwapnionych guzków o średnicy około 1 cm zlokalizowanych głównie w dolnych i środkowych polach płucnych bez powiększenia węzłów chłonnych wnęk i śródpiersia. Badaniem histologicznym wycinków uzyskanych drogą biopsji otwartej płuca stwierdzono obecność w obrębie pęcherzyków i naczyń płucnych nacieku nowotworu pochodzenia naczyniowego. Komórki tego guza wykazywały obecność antygenów: czynnika VIII, CD31 i CD34, co pozwoliło postawić rozpoznanie haemangioendothelioma epithelioides płuc. Po 6 miesiącach od biopsji otwartej płuca doszło do istotnej progresji choroby, co było powodem podjęcia próby leczenia interferonem 2-alfa. W trakcie leczenia zaobserwowano nieznaczną regresję zmian, a przez następne 6 miesięcy stabilizację choroby.A 62-year-old, obese woman, smoking 10 pack/year was admitted to the National Tuberculosis and Lung Diseases Research Institute to diagnose small, round opacities revealed by routine chest X-ray examination. These lesions had been observed for 5 years. The patient had been treated for psoriasis, hypertension, and insulin-independent diabetes. On admission she was in good condition, complaining of a slight productive cough as well as intermittent osteoarticular pain. Physical examination revealed cutaneous psoriatic lesions, slight edema of the lower limbs, and clubbed fingers. Tuberculin test was positive. Chest Computer Tomography scanning showed partially calcified nodules (up to 1cm in diameter) located in the middle and base areas of both lungs. No evidence of hilar nor mediastinal lymph node enlargement was seen. Lung specimens displayed intraalveolar and intravascular growth of neoplastic cells. Immunohistochemical expression of Factor VIII, CD31 and CD34 antigens was present. Pulmonary epithelioid haemangioendothelioma was diagnosed. After 6 months of observation, progression of the disease was shown. Interferon alpha treatment was introduced. During the therapy, a slight regression of pulmonary changes was noticed and since then stabilization of the disease was observed