130 research outputs found

    Czynniki molekularne w indywidualizacji leczenia systemowego niedrobnokom贸rkowego raka p艂uca - odleg艂a przysz艂o艣膰 czy tera藕niejszo艣膰?

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    Indywidualizacja stosowania terapii systemowych, w tym chemioterapii w zaawansowanym niedrobnokom贸rkowym raku p艂uca (NDRP), staje si臋 faktem. Do niedawna rozpoznanie histopatologiczne, stopie艅 zaawansowania nowotworu oraz stan sprawno艣ci chorych decydowa艂y o wyborze metody leczenia. Jednak taki spos贸b kwalifikacji chorych wi膮za艂 si臋 z du偶ym odsetkiem niepowodze艅 terapii. Wiadomo obecnie, 偶e czynniki molekularne mog膮 decydowa膰 o skuteczno艣ci leczenia. Do niekorzystnych czynnik贸w predykcyjnych w leczeniu zwi膮zkami platyny nale偶y wysoka ekspresja enzymu rozpoznaj膮cego miejsca uszkodzenia DNA w kom贸rkach nowotworowych - ERCC1. Oporno艣膰 na gemcytabin臋 warunkuje wysoka aktywno艣膰 enzymu naprawy DNA - RRM1. Alkaloidy vinca oraz taksoidy nie hamuj膮 podzia艂贸w kom贸rki, je艣li we wrzecionie kariokinetycznym wyst臋puje klasa III β-tubuliny. Analogi kwasu foliowego (pemetreksed) hamuj膮 syntez臋 puryn i pirymidyn, ale tylko w kom贸rkach o niskiej ekspresji enzym贸w zale偶nych od folan贸w, takich jak syntaza tymidylowa. Niepodwa偶alna jest korzystna rola obecno艣ci mutacji w eksonach 19 i 21 genu EGFR. Natomiast dyskusyjny jest obecnie wp艂yw powielenia liczby kopii genu EGFR w kom贸rkach nowotworowych na skuteczno艣膰 niekt贸rych lek贸w ukierunkowanych molekularnie, na przyk艂ad inhibitor贸wi kinazy tyrozynowej EGFR. Trwaj膮 badania nad wp艂ywem st臋偶enia cz膮steczek adhezji mi臋dzykom贸rkowej (ICAM) i naczyniowo-艣r贸db艂onkowego czynnika wzrostu (VEGF) w surowicy krwi na efekt dzia艂ania leku antyangiogennego - bewacyzumabu. Oznaczenia niekt贸rych z czynnik贸w predykcyjnych (np. mutacje w genie EGFR) ju偶 wkr贸tce b臋d膮 wykorzystane w rutynowej diagnostyce podczas kwalifikacji do leczenia. W przypadku innych metod wyst臋puj膮 du偶e trudno艣ci zwi膮zane z problemami w uzyskaniu miarodajnych i powtarzalnych wynik贸w u wszystkich chorych. Synteza nowych lek贸w oraz post臋p w wykrywaniu silnych czynnik贸w predykcyjnych ju偶 dzisiaj zaowocowa艂y wyd艂u偶eniem czasu i popraw膮 jako艣ci 偶ycia chorych. Onkol. Prak. Klin. 2010; 6, 2: 62-72The individualization of systemic therapy in advanced non-small cell lung cancer (NSCLC) becomes fact. Recently, chosen of therapy's methods were depended on histopathological diagnosis, stage of disease and patients' performance status. However, the percentage of patients with resistance to chemotherapy was high. Currently, it was shown that molecular factors may determine treatment efficacy. The high expression of excision repair cross complementing group 1 (ERCC1) enzyme, which recognizes DNA damage, is unfavorable predictive factors in platinium-based therapy. High activity of subunit M1 of ribonucleotide reductase (RRM1) is connected with the resistance to gemcitabine treatment. Among the all mechanisms regarding the resistance to anti-tubulin agents (vinca alkaloids and taxanes), the overexpression of class III β-tubulin is of particular interest. Folate analogous - pemetrexed - works by inhibiting enzymes (thymidylate synthase, dihydrofolate reductase and glycinamide ribonucleotide formyltransferase) used in purine and pyrimidine synthesis. The favourable role of EGFR gene mutations during therapy with the tyrosine kinase domain inhibitors is unquestionable. However, the predictive role of EGFR gene amplification in these therapies is receding into the background. The level of ICAM and VEGF in serum as well as polymorphism of VEGF, ICAM and IL-8 genes could be practical predictive factors for bevacizumab therapy. Presently, the estimation of several predictive factors (e.g. mutation in EGFR gene) is used in routine diagnostic during qualification into specific treatment in lung cancer. Although, still is the paucity of reliable and repeatedly molecular methods to estimate the predictive, genetic factors. Currently, the prolongation of overall survival of patients with NSCLC is connected with both: new therapeutic agent synthesis as well as with predictive factors detection. Onkol. Prak. Klin. 2010; 6, 2: 62-7

    The quality of life of farmers with chronic obstructive pulmonary disease (COPD)

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    Introduction and objective COPD is a medical state characterized by chronically poor airflow, and typically worsens over time. Farmers have an increased risk of COPD because of being exposed to ammonia, hydrogen sulfide, inorganic dust, and organic dust. The quality of life of the ill depends on biomedical as well as psychosocial factors, the impact of which has not been a frequent subject of studies among COPD patients. The aim of the study was to indicate the factors that have negative and positive influence on the quality of life of farmers suffering from COPD. Material and Methods The study was conducted among 84 farmers treated for COPD in the Department of Pneumology, Oncology and Allergology of the Medical University in Lublin, Poland. The differences between the farmers concerned: severity of the disease, level of education and income, frequency of smoking tobacco and drinking alcohol, kinds of support they receive from their families, and the level of depression and anxiety experienced by the patients. Results The study revealed that most patients suffered from depressive and anxiety disorders, and the level of depression higher among the patients who smoked more. Lack of family support had significant influence on exacerbation of the patient鈥檚 depressive and anxiety symptoms. Patients who had recently experienced a critical situation presented with more severe COPD symptoms, lower quality of life and a higher level of depression. Higher income of the patients had positive influence on their quality of life. Farmers addicted to alcohol suffered from a higher level of anxiety

    The role of computed tomography in the diagnosis of lung cancer - a case report

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    Introduction Lung cancer has been the main oncological problem in the world for years. It is extremely important to use appropriate diagnostic methods that enable its detection and implementation of appropriate treatment. Aim The presented case shows the advantage of computed tomography over chest X-ray (X-ray) in visualizing neoplastic changes in the lungs. Case Study The paper presents a description of a patient diagnosed with centrally located advanced lung adenocarcinoma with a strong expression of PD-L1 qualified for treatment with pembrolizumab. Results and Discussion Presented case confirms that X-ray is less sensitive, especially in the case of centrally located tumors. Therefore, the emergence of a new cough in a smoker or ex-smoker should raise concerns related to lung cancer despite a normal X-ray image. The central location of the tumor may cause dramatic course of the symptoms. In the presented case, a sudden significant deterioration of the condition was observed due to atelectasis of the entire lung. Haemoptysis observed during hospitalization was another symptom of centraly located tumor mass. Conclusions In conclusion, the history of cigarette smoking, presence of typical symptoms should provide an in-depth diagnosis of lung cancer, despite normal X-ray. Diagnostic procedures include computed tomography in the first place. The course of centrally localized disease may change rapidly during on first cycle of treatment. Due to the possibility of serious complications of the ongoing neoplastic disease, the patient should be under constant medical supervision

    Czynniki biochemiczne i genetyczne w diagnostyce i prognozowaniu przebiegu chor贸b nowotworowych

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    Pomimo rozwoju nauki, coraz doskonalszych technik diagnostycznych, nowych terapii opartych na lekach dzia艂aj膮cych wybi贸rczo na kom贸rki nowotworowe, nowotwory z艂o艣liwe stanowi膮 po chorobach uk艂adu kr膮偶enia najcz臋stsz膮 przyczyn臋 zgon贸w. W Polsce w 2006 roku na nowotwory z艂o艣liwe zachorowa艂o ponad 120 tysi臋cy os贸b. Do najcz臋stszych przyczyn zgonu z powodu schorze艅 nowotworowych w艣r贸d m臋偶czyzn nale偶膮: rak p艂uca, prostaty, jelita grubego, trzustki oraz bia艂aczki. Natomiast u kobiet s膮 to: rak p艂uca, piersi, uk艂adu rozrodczego, jelita grubego i trzustki. Polska zajmuje ostatnie miejsce pod wzgl臋dem skuteczno艣ci leczenia nowotwor贸w w艣r贸d kraj贸w Unii Europejskiej. Jest to spowodowane wieloma czynnikami, kt贸re cz臋sto nak艂adaj膮 si臋 na siebie. Zaliczy膰 tu nale偶y mi臋dzy innymi niewiedz臋 lub lekcewa偶enie pierwszych objaw贸w choroby, zbyt p贸藕no rozpocz臋ty proces diagnostyczny, uwarunkowania ekonomiczne oraz utrudnienia administracyjne. Historyczne poj臋cie markera nowotworowego oznacza biochemiczn膮 substancj臋 wybi贸rczo uwalnian膮 przez kom贸rki guza do kr膮偶enia, kt贸ra mo偶e by膰 nast臋pnie wykryta w surowicy krwi lub innych p艂ynach cia艂a w celu klinicznego monitorowania procesu nowotworowego. Z biegiem lat termin ten zosta艂 rozszerzony o cechy charakteryzuj膮ce tkanki czy kom贸rki nowotworowe (ekspresja receptor贸w, enzym贸w, mutacje w onkogenach i genach supresorowych, aberracje chromosomalne). Idealny marker nowotworowy jest substancj膮 normalnie niewyst臋puj膮c膮 w organizmie, kt贸rej wykrycie odzwierciedla obecno艣膰, progresj臋 lub regresj臋 tocz膮cego si臋 procesu nowotworowego (antygeny swoiste dla nowotworu powsta艂e w wyniku mutacji koduj膮cych je gen贸w). Du偶膮 warto艣膰 diagnostyczn膮 maj膮 tak偶e antygeny wsp贸lne wyst臋puj膮ce na kom贸rkach nowotworowych oraz gametach i kom贸rkach 艂o偶yska. Najcz臋艣ciej jednak oznacza si臋 antygeny r贸偶nicowania (swoiste dla tkanek, z kt贸rych wywodzi si臋 nowotw贸r (np. CYFRA 21.1) oraz powszechnie wyst臋puj膮ce, kt贸rych st臋偶enie u chorych z procesem nowotworowym jest znamiennie wy偶sze ni偶 u os贸b zdrowych. W tej grupie znajduj膮 si臋 tak偶e antygeny embrionalno-nowotworowe, podlegaj膮ce ekspresji podczas rozwoju p艂odowego, kt贸re u doros艂ych mog膮 pojawi膰 w wyniku proces贸w naprawczych lub nowotworowych (np. antygen karcynoembrionalny [CEA] i α-fetoproteiny [AFP]). Przy obecnym stanie s艂u偶by zdrowia w Polsce (braku odpowiednich rozwi膮za艅 strukturalnych, ograniczonego zaufania lekarzy do nowych metod diagnostycznych oraz uwarunkowa艅 ekonomicznych) w najbli偶szym czasie diagnostyka molekularna nowotwor贸w (zw艂aszcza guz贸w litych) mo偶e napotyka膰 na du偶e trudno艣ci. Nie dotyczy to rutynowo oznaczanych marker贸w, takich jak CA 125, CA 19.9 czy PSA, nale偶膮cych jednak do antygen贸w powszechnie wyst臋puj膮cych. Istnieje jednak nadzieja szybkiego wdro偶enia bada艅 molekularnych w oznaczaniu czynnik贸w predykcyjnych w kwalifikacji chorych do terapii ukierunkowanych molekularnie. Forum Medycyny Rodzinnej 2010, tom 4, nr 2, 122-13

    Polymorphism of the ACE gene and the risk of obstructive sleep apnoea

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    WST臉P: Zesp贸艂 obturacyjnego bezdechu w czasie snu (obturacyjny bezdech 艣r贸dsenny, OB艢) charakteryzuje si臋 pojawianiem nawracaj膮cych epizod贸w bezdech贸w lub sp艂yce艅 oddychania. W艣r贸d gen贸w kandydat贸w, wp艂ywaj膮cych na ryzyko wyst膮pienia OB艢 wymienia si臋 geny, kt贸rych polimorfizmy wp艂ywaj膮 na rozw贸j chor贸b o podobnej patogenezie co OB艢: APOE, geny dla leptyny i receptora leptyny, TNFA1, ADRB2 oraz ACE (gen dla enzymu konwertuj膮cego angiotensyn臋). Dotychczas opisano zale偶no艣膰 pomi臋dzy polimorfizmem genu ACE a chorobami sercowo-naczyniowymi, a jego wp艂yw na zachorowanie na OB艢 jest dyskusyjny. Celem pracy by艂o zbadanie wp艂ywu polimorfizmu insercyjno/delecyjnego (I/D) genu ACE na ryzyko zachorowania na OB艢.MATERIA艁 I METODY: Badaniem obj臋to grup臋 55 chorych, kt贸rzy zg艂aszali si臋 w celu rozpocz臋cia terapii CPAP. Grup臋 kontroln膮 stanowi艂o 50 os贸b, kt贸re nie zg艂asza艂y zaburze艅 snu. Rozpoznanie ustalano na podstawie wyniku polisomnografii (wg klasyfikacji AASM) i warto艣ci punktowej Skali Senno艣ci Epworth. DNA izolowano z leukocyt贸w krwi obwodowej za pomoc膮 zestawu Qiagen DNA mini Kit. Polimorfizm genu ACE oceniano na podstawie d艂ugo艣ci fragment贸w produkt贸w reakcji PCR w 偶elu agarozowym.WYNIKI: Nie wykazano statystycznie istotnych r贸偶nic w rozk艂adzie poszczeg贸lnych genotyp贸w genu ACE w grupie chorych z OB艢 i w grupie kontrolnej. Wykazano natomiast, 偶e allel D wyst臋powa艂 istotnie rzadziej w grupie chorych na OB艢 ni偶 w grupie kontrolnej (蠂虏 = 4,25, p = 0,04). Ponadto, nosiciele allela I mieli trzykrotnie wi臋ksze ryzyko wyst膮pienia OB艢 (HR = 2,748, 95% CI = 1,029鈥7,340, p < 0,05).WNIOSKI: Analiza polimorfizmu genu ACE mo偶e by膰 przydatna w ocenie ryzyka wyst膮pienia OB艢 u os贸b klinicznie predysponowanych do rozwoju tej choroby.INTRODUCTION: Obstructive sleep apnoea/hypopnea syndrome (OSA) is characterized by obstruction of the upper airway during sleep, resulting in repetitive breathing pauses accompanied by oxygen desaturation and arousal from sleep. Among the candidate genes affecting the risk of OSA, genes whose polymorphisms influence the development of diseases with similar pathogenesis such as OSA could be listed: APOE, genes for leptin and leptin receptor, TNFA1, ADRB2 and ACE (gene for angiotensin-converting enzyme). Until now there has been a confirmed relationship between ACE gene polymorphism and cardiovascular diseases, but its effect on the incidence of OSA is debatable. The aim of this study was to investigate the effect of ACE gene insertion/deletion (I/D) polymorphism on the risk of OSA.MATERIAL AND METHODS: Fifty-five patients with confirmed diagnose of OSA and qualified to CPAP therapy entered the study. The control group included 50 subjects who did not complain of any sleep related symptoms. Diagnose of OSA was set on the basis of full overnight polysomnography together with Epworth Sleepiness Scale according to American Academy of Sleep Medicine guidelines. DNA was isolated from peripheral blood leukocytes with Qiagen DNA mini Kit. ACE gene polymorphism was determined in genomic DNA using allele specific polymerase chain reaction. Different sizes of PCR products were observed on agarose gel electrophoresis.RESULTS: There were non-significant differences in the frequency of ACE genotypes. However, allele D had significantly lower prevalence in the study group than in the control group. (蠂虏 = 4.25 p = 0.04). Moreover, I allele carriers had a threefold greater risk of developing OSA (HR = 2.748, 95% CI = 1.029鈥7.340, p < 0.05).CONCLUSIONS: Analysis of ACE gene polymorphism might be useful to determine the risk of developing OSA in clinically predisposed patients

    Cervical tubercular lymphadenitis accompanying with pulmonary tuberculosis 鈥 a case report

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    Tuberculosis (TB) is still one of the major public health problems worldwide. TB is an infectious disease caused by Mycobacterium tuberculosis. It typically affects the lungs (pulmonary tuberculosis), but may also occur in other sites (extrapulmonary tuberculosis). Cervical tubercular lymphadenitis is one of the most common localizations of extrapulmonary tuberculosis [1,2]. We present a case of a 57-year old man with a history of 3-month weakness and swollen, bilaterally inflamed cervical lymph nodes. Cervical tubercular lymphadenitis accompanying with pulmonary tuberculosis was diagnosed. Moreover, we carry out the differential diagnosis of the cervical lymphadenopathy

    The presence of HER2 exon 20 insertion in patients with central nervous system metastases from non-small lung cancer 鈥 a potential application in classification for therapy

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    聽WST臉P: HER2 (ErbB2/neu) jest bia艂kiem nale偶膮cym do rodziny receptor贸w HER (EGFR, HER2, HER3 i HER4), posiadaj膮cych w swej cz臋艣ci wewn膮trzkom贸rkowej aktywno艣膰 kinazy tyrozynowej. Nadekspresja EGFR i HER2 wyst臋puje w wielu typach nowotwor贸w, ale to mutacje w genach koduj膮cych te receptory uwra偶liwiaj膮 chorych na niedrobnokom贸rkowego raka p艂uca (NSCLC) na dzia艂anie inhibitor贸w kinaz tyrozynowych EGFR i HER2.MATERIA艁 I METODY: Wykorzystano technik臋 PCR oraz analiz臋 d艂ugo艣ci fragment贸w amplifikowanego DNA w celu zidentyfikowania u 150 chorych insercji 12 par zasad w obr臋bie eksonu 20 genu HER2 w przerzutach NDRP do m贸zgu.WYNIKI: W guzie z wykryt膮 mutacj膮 HER2 nie stwierdzono mutacji EGFR ani BRAF. Insercja w eksonie 20 genu HER2 zosta艂a wykryta u 77-letniego niepal膮cego m臋偶czyzny chorego na niskozr贸偶nicowanego raka gruczo艂owego (0,67% wszystkich chorych oraz 1,5% chorych na raka gruczo艂owego). U tego chorego nie zidentyfikowano innych nieprawid艂owo艣ci genetycznych.WNIOSKI: W literaturze opisano, 偶e u chorych posiadaj膮cych mutacj臋 w genie HER2 mog膮 okaza膰 si臋 skuteczne inhibitory specyficzne w stosunku do kinaz tyrozynowych obu receptor贸w: EGFR i HER2 (np. afatynib). Dlatego te偶 identyfikacja nowych mutacji kieruj膮cych w kom贸rkach NSCLC wydaje si臋 kluczem do w艂a艣ciwej kwalifikacji do terapii ukierunkowanych molekularnie.聽INTRODUCTION: HER2 (ErbB2/neu) is a member of the ErbB family of four structurally related receptors of tyrosine kinase activity. Overexpression of ErbB-1 (EGFR) and HER2 is found in many human cancers, but the presence of these genes mutations determines the effectiveness of EGFR and HER2 tyrosine kinase inhibitors in the therapy of non-small cell lung cancer (NSCLC).MATERIAL AND METHODS: To search for insertions of the HER2 gene in exon 20 in 150 brain metastases of non-small cell lung cancer patients, we used a PCR technique based on analysis of amplified DNA fragment lengths. We also compared the HER2 mutational status with clinicopathologic features and the presence of EGFR and BRAF mutations.RESULTS: HER2 mutation was present in one male, non-smoking patient with low differentiated adenocarcinoma (0.67% of all patients and 1.5% of patients with adenocarcinoma). The mutations of EGFR and BRAF genes were not found in HER2-mutated patient.CONCLUSIONS: The literature data suggests that patients with HER2 mutations may be sensitive to tyrosine kinase inhibitors of both EGFR and HER2 receptors (e.g. afatinib). Therefore, the identification of new driver mutations in NSCLC can improve the quality of patient care by enabling the use of correct molecularly targeted therapies

    The value of topotecan in the second-line treatment of small-cell lung cancer. Preliminary report

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    Introduction: Small cell lung cancer (SCLC) is an aggressive malignancy with high propensity for early regional and distant metastases. Response rate to first-line chemotherapy is high but typically short-therm. All patients with extensive disease and majority with limited disease have recurrence of disease. The choice of second-line chemotherapy in case of progression depends on many factors, including type of first-line chemotherapy, response to treatment, progression-free survival and patients’ performance status. No standard second-line treatment has been established until recently. Monotherapy with topotecan is widely used in second-line treatment especially in patients in poor performance status. Material and methods: The aim of the study was to evaluate the results of monotherapy with topotecan. We also determined the predictive markers which could affect the therapeutic effect of topotecan. The examined group consisted of 42 patients with extensive stage of SCLC. Cox regression model was used to establish adverse factors, which were prognostic for overall survival of our patients divided into two groups according to administrated chemotherapy: 21 topotecan-treated and 21 standard chemotherapy-treated. Six variables that gave a maximum hazard ratio (HR) were used in the final model, e.g.: the age above 65 (HR = 2.35), anemia (HR = 1.83) and poor performance status (HR = 1.51). These variables scored the points according to their prognostic significance and HR. Results: In Kaplan-Meier analysis, in the group of patients treated with topotecan, the higher survival probability was noted for patients scored below 10 points than for patients scored above 10 points. The prognostic scale was not useful for patients with other scheme of chemotherapy. Five partial responses (24%) in topotecan-treated patients were noted. Conclusions: Precise qualification of patients to topotecan monotherapy in second-line treatment may be effective to prolong survival and increase the percentage of SCLC patients with objective response.Wst臋p: Drobnokom贸rkowy rak p艂uca (DRP) jest nowotworem z艂o艣liwym o du偶ej agresywno艣ci oraz wysokim potencjale wzrostu i tworzenia przerzut贸w. Odpowied藕 na leczenie pierwszej linii uzyskuje si臋 cz臋sto, lecz jest ona zwykle kr贸tkotrwa艂a. Nawr贸t choroby wyst臋puje u niemal wszystkich chorych w stadium choroby rozleg艂ej i u wi臋kszo艣ci chorych w stadium choroby ograniczonej. Wyb贸r chemioterapii drugiej linii zale偶y od wielu czynnik贸w, w tym od pierwotnie zastosowanych lek贸w i uzyskanej odpowiedzi, czasu od zako艅czenia pierwszego leczenia do progresji oraz stanu sprawno艣ci chorego. Najcz臋艣ciej w leczeniu drugiej linii stosuje si臋 schemat chemioterapii, za pomoc膮 kt贸rego uzyskano d艂ugotrwa艂膮 remisj臋 w pierwszej linii leczenia. Coraz cz臋艣ciej w leczeniu drugiej linii wykorzystuje si臋 monoterapi臋 topotekanem, szczeg贸lnie u chorych w z艂ym stanie sprawno艣ci. Materia艂 i metody: Celem autor贸w pracy by艂a ocena wynik贸w monoterapii topotekanem oraz okre艣lenie wp艂ywu czynnik贸w predykcyjno-rokowniczych na skuteczno艣膰 terapii. Badaniami obj臋to 42 chorych na DRP w uog贸lnionym stadium. W grupie 21 chorych stosowano monoterapi臋 topotekanem, natomiast u pozosta艂ych chorych inne schematy chemioterapii. Za pomoc膮 testu wzgl臋dnego ryzyka wed艂ug Coxa udowodniono, 偶e najwi臋kszy wp艂yw na skr贸cenie ca艂kowitego prze偶ycia maj膮 mi臋dzy innymi: wiek powy偶ej 65 lat (HR = 2,35), wyst膮pienie niedokrwisto艣ci (HR = 1,83) oraz z艂y stan sprawno艣ci (HR = 1,51). Stworzono skal臋 predykcyjno-rokownicz膮, kt贸ra obj臋艂a 6 czynnik贸w wypunktowanych w zale偶no艣ci od warto艣ci ryzyka wzgl臋dnego. Wyniki: Prawdopodobie艅stwo prze偶ycia chorych leczonych topotekanem by艂o nieistotnie wy偶sze (p = 0,097) w grupie chorych, kt贸rzy uzyskali mniej ni偶 10 punkt贸w w por贸wnaniu z grup膮 chorych z punktacj膮 10 i wi臋cej punkt贸w wed艂ug zaproponowanej skali. Skala ta okaza艂a si臋 nieprzydatna w prognozowaniu przebiegu DRP u chorych otrzymuj膮cych inn膮 chemioterapi臋. Obiektywn膮 odpowied藕 na leczenie topotekanem uzyskano u 5 chorych (24%). Wnioski: Precyzyjna kwalifikacja do monoterapii topotekanem mo偶e przynie艣膰 wyd艂u偶enie czasu 偶ycia i umo偶liwi膰 uzyskanie wy偶szego odsetka odpowiedzi w艣r贸d leczonych chorych

    Exacerbation of symptoms of rheumatoid arthritis in the course of immunotherapy of non-small cell lung cancer - an analysis of medical cases and a review of the literature

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    Background: Lung cancer has been at the forefront of cancers with the highest incidence and mortality rates. Nowadays, there are available more effective forms of treatment such as immunotherapy. In the case of cancer cells expressing the PD-L1 receptor, pembrolizumab, atezolizumab and nivolmab are of particular use. While these drugs have the great benefit of stabilizing the disease, they are not without side effects, especially inflammatory changes in the joints. The aim of the study is to show the risk of immunotherapy in the form of exacerbation of inflammatory symptoms in patients with rheumatoid arthritis (RA) as a concomitant disease. Case report: Lung cancer (PD-L1 +) was diagnosed in three patients with a history of RA. After meeting the criteria of the drug program, the patients started molecularly targeted therapy with pembrolizumab and atezolizumab. The applied treatment brought a great benefit in the form of stabilization the neoplastic disease. Over time an exacerbation of inflammatory changes within the joints was noted, which significantly impeded everyday functioning in two patients. Due to this situation, immunotherapy was discontinued. Conlusions: Studies show that as many as 1/4 of patients treated with PD-L1 inhibitors experience side effects related to the autoimmune system. In the case of people suffering from RA, the use of immunotherapy may intensify inflammatory changes and increase pain, which significantly reduce the quality of life. Therefore, the risk of RA exacerbation as a side effect of biological therapy for lung cancer treatment should be popularized. This awareness will enable quick intervention and minimize the number of interrupted immunotherapies

    Natriuretic peptides and their usefulness in clinical practise

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    Natriuretic聽peptides聽are聽peptic聽hormones聽produced聽by聽atrial聽and聽ventricular聽myocytes, and by聽endothelium聽of聽blood聽vessels,聽that聽take聽part in聽homeostatic聽control聽of聽water聽and聽sodium聽levels, but聽also聽potassium聽transport,聽lipolysis聽in聽adipocytes聽and聽blood聽pressure聽regulation.聽聽聽Three聽different聽natriuretic聽peptides聽are聽distinguished:聽atrial聽natriuretic聽peptide聽(ANP), b-type聽natriuretic聽peptide聽(BNP) and c-type聽natriuretic聽peptide聽(CNP).聽Those聽peptides聽are聽responsible聽mostly聽for聽water-sodium聽homeostasis聽and聽regulation聽of聽blood聽pressure.聽Levels聽of聽natriuretic聽peptides聽increase聽significantly聽in聽diseases聽and聽disorders聽such聽as聽congestive聽heart聽failure聽and聽pulmonary聽hypertension,聽that聽is聽why聽natriuretic聽peptides聽were聽found聽useful聽in聽diagnosis聽and monitoring of聽said聽diseases. In聽clinical聽practise, BNP and NT-proBNP聽levels聽are聽mostly聽used.聽聽
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