Immunosuppressive properties of human PD-1 + , PDL-1 + and CD80 + dendritic cells from lymph nodes aspirates of lung cancer patients.

Dendritic cells (DCs) play a pivotal role in the homeostasis of the immune system. The tumor microenvironment impairs the proper function of DCs. The immunomodulatory properties of DCs in lung cancer are of interest. In the present study, we analysed DCs subsets and immune cells with the expression of immunomodulatory molecules: PD-1 and PD-L1 and co-stimulatory molecule CD80 in metastatic, non-metastatic lymph nodes (LNs) and peripheral blood (PB). LNs aspirates were obtained during the EBUS/TBNA procedure of 29 patients with primary lung cancer. The cells were analyzed by flow cytometry. We reported a higher percentage of DCs in the metastatic than in the non-metastatic LNs and the PB (0.709% vs. 0.166% vs. 0.043%, p < 0.0001). The proportions of PD-1 + , PD-L1 + and CD80 + DCs were higher in the metastatic LNs than in the non-metastatic ones. A higher proportion of regulatory DCs (DCregs) was found in the metastatic ones than in the non-metastatic LNs (22.5% vs. 3.1%, p = 0.0189). We report that DCs cells show increased expression of PD-1, PD-L1 and CD80 molecules that can interact with T lymphocytes. It can be assumed that mature DCs infiltrating metastatic LNs can develop into DCregs, which are involved in the suppression of anti-tumor response.

Fas-positive lymphocytes are associated with systemic inflammation in obstructive sleep apnea syndrome.

PURPOSE: Obstructive sleep apnea syndrome (OSAS) is associated with alterations in immune system which may lead to serious complications. The aim of this study was to explore lymphocyte populations in OSAS with special attention to the Fas-positive cells. METHODS: Fifty-one patients with confirmed OSA and 20 healthy subjects were investigated. The OSA severity indices, data concerning comorbidities, and markers of inflammation and metabolic disorders were collected. Flow cytometry was used to analyze the lymphocyte profile and expression of Fas receptors (CD95). Concentration of adiponectin, IL-1ß, TNF-α, and sFas were measured. RESULTS: Proportions of Fas-positive cells in the pool of CD4+ and Fas-positive in the pool of CD8+ cells in the blood of patients were significantly increased when compared with healthy subjects (74.5% vs. 65.6% and 78.8% vs.70.9%, respectively, p < 0.05). No correlation with OSA severity was found. However, the proportion and number of Fas+ cells were elevated in obese patients, in non-smokers, and in patients suffering from COPD and hypertension. There were several significant relations of Fas+ cells with inflammatory markers of systemic inflammation. CONCLUSION: Lymphocytes with the expression of Fas receptor are associated with systemic inflammation in OSAS.

CD163 and CCR7 as markers for macrophage polarization in lung cancer microenvironment.

INTRODUCTION: M2 macrophages are predominant in the immune infiltrates of resected tumours, but little is known about macrophage phenotype in the local lung cancer environment, which may be evaluated by bronchoalveolar lavage fluid (BALF). AIM OF THE STUDY: To find differences between BALF from lung affected by cancer (clBALF) and hlBALF from the opposite, healthy lung, as a control, from the same patient, regarding their individual macrophage polarization and their correlation with IL-10 and TGF-ß. MATERIAL AND METHODS: Eighteen patients with confirmed lung cancer were investigated. Macrophage subtyping was performed by immunofluorescence with antibodies anti-CCR7 and CD163 (M1 and M2, respectively). RESULTS: We found five populations of macrophages: cells with a single reaction: only for CCR7+ or CD163+, a double reaction (CCR7+CD163+), cells with a stronger CD163 (CCR7lowCD163+), and cells with a stronger CCR7 (CCR7+CD163low). The main population in the clBALF was composed of cells with a phenotype similar to M2 (CCR7lowCD163+), while in the hlBALF the predominating phenotype was the one similar to M1 (CCR7+CD163low). The median proportion of TGF-ß1 concentration was higher in the clBALF and hlBALF supernatant than in the serum. CONCLUSIONS: In this study we confirmed the usefulness of the immunofluorescence method with CCR7 and CD163 in the evaluation of BALF macrophage polarization in lung cancer.

Achieving Thoracic Oncology data collection in Europe: a precursor study in 35 Countries.

BACKGROUND: A minority of European countries have participated in international comparisons with high level data on lung cancer. However, the nature and extent of data collection across the continent is simply unknown, and without accurate data collection it is not possible to compare practice and set benchmarks to which lung cancer services can aspire. METHODS: Using an established network of lung cancer specialists in 37 European countries, a survey was distributed in December 2014. The results relate to current practice in each country at the time, early 2015. The results were compiled and then verified with co-authors over the following months. RESULTS: Thirty-five completed surveys were received which describe a range of current practice for lung cancer data collection. Thirty countries have data collection at the national level, but this is not so in Albania, Bosnia-Herzegovina, Italy, Spain and Switzerland. Data collection varied from paper records with no survival analysis, to well-established electronic databases with links to census data and survival analyses. CONCLUSION: Using a network of committed clinicians, we have gathered validated comparative data reporting an observed difference in data collection mechanisms across Europe. We have identified the need to develop a well-designed dataset, whilst acknowledging what is feasible within each country, and aspiring to collect high quality data for clinical research.

Menopausal asthma-much ado about nothing? An observational study.

OBJECTIVE: Menopausal asthma is considered a distinct asthma phenotype. Our aim was to identify potential specific features of asthma in postmenopausal women in a cohort of Polish females. METHODS: Asthma severity and control, pulmonary function, exhaled nitric oxide (FENO), peripheral blood and induced sputum (IS) differential cell count were compared in three groups: women with premenopausal asthma (group 1), menopausal women with pre-existing asthma (group 2A) and menopausal women with asthma onset in the perimenopausal or menopausal period (group 2B). RESULTS: We enrolled 27 women to group 1, 13 to group 2A and 16 to group 2B. Asthma severity and control, blood eosinophil count and FENO did not differ among the groups. Menopausal women had a higher incidence of irreversible airway obstruction (84.6% in group 2A and 56.2% in group 2B vs. 22.2% in group 1, p < 0.001 and p = 0.03, respectively). The proportion of patients with sputum eosinophilia was highest in menopausal women with pre-existing asthma, although the difference did not reach statistical significance (88.9% in group 2A vs. 66.7% in group 2B and 65.0% in group 1, respectively, p = 0.86). CONCLUSIONS: Menopausal women with asthma are characterized by an increased incidence of irreversible airway obstruction regardless of disease duration. This may indicate that age may contribute to pulmonary function impairment in asthmatic women independently of their hormonal status at the time of asthma diagnosis. Our results failed to confirm the presence of specific asthma features which would allow to distinguish the phenotype of menopausal asthma.

Elevated regulatory T cells, surface and intracellular CTLA-4 expression and interleukin-17 in the lung cancer microenvironment in humans.

Regulatory T cells (Tregs) play an important role in the suppression of the immune response in lung cancer. Cytotoxic T-lymphocyte antigen 4 (CTLA-4) expressed on T lymphocytes is capable of downregulating cytotoxic T cells and is constitutively expressed on Tregs. Little is known about the population of Tregs with two forms of CTLA-4: surface (s) and intracellular (in) in the lung cancer environment. Th17 cells defined by production of IL-17 have pleiotropic functions in anticancer immune response. Our aim was to detect the elements of immune response regulation in lung cancer in three compartments: by analysis of bronchoalveolar lavage fluid (BALF) from the lung affected by cancer (clBALF), healthy symmetrical lung (hlBALF) and peripheral blood (PB) from the same patient. A total of 54 samples were collected. Tregs, (s)CTLA-4, (in)CTLA-4 were detected by flow cytometry with antibodies against CD4, CD25, Foxp3, CD127, CTLA-4, and concentration of IL-17 was estimated by ELISA. We observed a significantly higher proportion of Tregs in clBALF than in hlBALF or PB (8.5 vs. 5.0 vs. 5.1%, respectively, p < 0.05). The median proportion of (in)CTLA-4+ Tregs was higher in clBALF than in hlBALF or PB (89.0, 81.5, 56.0%, p < 0.05). IL-17 concentration was the highest in clBALF-6.6 pg/ml. We observed a significant correlation between the proportion of Tregs and (in)CTLA-4+ Tregs with IL-17A concentration in clBALF. We confirmed significant differences in the proportion of regulatory elements between cancerous lung and healthy lung and PB and the usefulness of BALF analysis in evaluation of immune response regulation in local lung cancer environment.

[Lung cancer and COPD - growing clinical problem]. / Rak pluca i przewlekla obturacyjna choroba pluc ­ narastajacy problem kliniczny.

A spread of the addiction of tobacco smoking is valued on near 1 billion of people in the world, that involves growing number of morbidity and mortality by the reason of smoke related diseases. Lung cancer and chronic obstructive pulmonary disease (COPD) are the most serious and incurable diseases which are leading to a permanent disability as well as to premature death. There are factors that naturally increase the vulnerability of an individual on the coincidence of above disorders, such as pathophysiological conditions, systemic inflammation, bronchitis, emphysema, respiratory obstructive disease and precise genetic predispositions for COPD and lung cancer. The harmful substances of the tobacco smoke are the causes of the development of diseases outside the group of respiratory disorders which affects the greater scope of comorbidity among this patient group in comparison to the normal population. The similarity of the clinical picture of lung cancer and COPD may cause numerous problems for a proper and prompt diagnosis and the implementation of the appropriate treatment. On the other hand, it is evident that the patients with COPD are carefully examined and often diagnosed with cancer while those who already suffer from cancer and undertake additional function testing are in 40-50% diagnosed with COPD. The coexistance of these two diseases influences the therapeutic procedure: COPD limits the possibilities of a radical lung cancer treatment which is determined by the general health condition and the respiratory system insufficiency as far as COPD patients are concerned. The knowledge of common pathogenesis both of cancer and COPD and the mutual relations between them shall positively affect the diagnostic and therapeutic process in the high-risk patient groups.

Macrophage polarization in interstitial lung diseases.

The role of bronchoalveolar lavage fluid (BALf) examination in differential diagnosis of interstitial lung diseases (ILD) was established. Currently, functional polarization into M1 (pro-inflammatory) and M2 (anti-inflammatory) subpopulations is emphasized. The aim of our study was to compare the proportion of M1 and M2 in BALf of patients with different ILD. BALf samples were collected from 75 ILD patients: sarcoidosis (SA, 36), hypersensitivity pneumonitis (HP, 10), non-specific interstitial pneumonia (NSIP, 8), idiopathic pulmonary fibrosis (IPF, 6) and other ILD (15). Phenotyping was performed by immunocytochemistry with anti-CD40 and CD163 antibodies (for M1 and M2, respectively). For both, CD40 and CD163, three populations of cells have been specified: small cells with strong (+++), large cells with weak (+) and cells with no (-) reaction. Due to lack of statistically significant differences between patients with HP, NSIP and IPF, they were classified into a common group and compared to the group of patients with sarcoidosis. The median proportion of macrophage population was as follows: for CD40: 61%, 35%, 2% in patients with SA and 49%, 47%, 3% in patients with other ILD and for CD163: 55%, 35%, 5% in SA and 53%, 43%, 1% in ILD patients, respectively. We found a significantly higher proportion of M1 in SA when compared with other ILD. Our study showed no evidence of defined polarization of alveolar macrophages in different types of interstitial lung diseases. However, we emphasized the role of CD40 positive cells in sarcoidosis and the role of CD163 positive cells in fibrotic diffuse lung diseases.

T, B, and NKT Cells in Systemic Inflammation in Obstructive Sleep Apnoea.

BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) brings risk of serious complications. The study objective was to assess elements of the cellular immune response in the course of OSAS. METHODS: Peripheral blood (PB) lymphocytes: T, B, NK, NKT-like, Th, Tc, and HLA DR+ T cells were evaluated by flow cytometry of 48 OSA patients; the concentration of adiponectin, interleukin 1ß, and TNFα was measured by ELISA method. The OSA complication score was developed and used for statistical analysis. RESULTS: The proportion of B cells and Th/Tc ratio were significantly lower in the BP of OSA patients when compared with control subjects (median 7.9 versus 10.9%, 0.9 versus 1.5, p < 0.05). The proportion of Tc, NK, NKT-like, and HLADR positive T cells were elevated in OSA patients when compared with healthy subjects (36.4 versus 26.8, 15.5 versus 8.5, 5.7 versus 3.0, and 8.4 versus 4.5%, p < 0.05, resp.) and were more pronounced in patients with metabolic syndrome. The grade of OSA complication score correlated with systemic inflammation markers and the proportion of B cells. The value of adiponectin/BMI ratio correlated significantly with SpO2 (r = 0.31, p < 0.05), CRP (r = -0.35, p < 0.05), TNFα concentration (r = -0.36, p < 0.05), and proportion of B cells (r = 0.32, p < 0.05). CONCLUSION: Lymphocytes B, Tc, NK, NKT-like, and adiponectin are involved in systemic immune response in OSA patients possibly predisposing them to cardiovascular and metabolic complications.

[Immune alterations in lung cancer - the new therapeutic approach]. / Zaburzenia odpowiedzi immunologicznej w raku pluca - nowy cel terapii.

Lung cancer is the main cause of cancer death worldwide. An advanced stage of the disease at the time of diagnosis, observed in the majority of cases, does not allow for introduction of radical treatment or makes the treatment ineffective. Lung cancer as a solid tumour with a very low antigenicity escapes immune surveillance, and cytotoxic cells attack. Cytotoxic lymphocytes play a key role in anticancer defence, but the population of these cells individually differs. Many suppressor and regulatory mechanisms inhibit the recognition of tumour antigens by dendritic and cytotoxic cell activation. The population of regulatory T cells (T regs) plays a crucial role in this inhibition of immune response. Their function depends on the expression of transcription factor Foxp3 and the presence of CTLA-4 molecules. The increased proportion of T regs and high expression of Foxp3 and CTLA-4 on lung cancer cells and tumour infiltrating lymphocytes were observed. Other components of immune response inhibition and tumour promotion are: Th17 cell population, M2 macrophage polarisation, the presence of myeloid derived suppressor cells (MDSCs) and a significantly elevated concentration of cytokines: TGF-b and IL-10 in the tumour microenvironment. The recognition of these mechanisms may have important therapeutic implications. Several types of agents which are capable of modulating the immune response have recently been used in many clinical trials conducted in lung cancer patients, some of them showing efficacy. Lung cancer immunotherapy has two main directions: the first goal is to improve the cytotoxic effect (for example by inhibition of CTLA-4, stimulation of dendritic cell function, inhibition of lymphocyte apoptosis), and the second way is the production of anti-cancer vaccines using known cancer antigens: MAGE A3, MUC1, EGF and TGF-b. Immunotherapy in lung cancer treatment has a character of personalised therapy - there is a need to specify the patient's immune status prior to treatment. The analysis of immune cells and mediators in the peripheral blood allows this, but the more valuable method seems to be bronchoalveolar lavage (BAL) examination with careful assessment of the tumour microenvironment.

Lung Cancer in Women-Sociodemographic, Clinical and Psychological Characteristics with Comparison to Men.

(1) Background: There is a difference in the course of lung cancer between women and men. Therefore, there is a need to evaluate various factors in the patient population treated in daily practice. The purpose of this study was to analyze the clinical, sociodemographic and psychological aspects of female lung cancer. To better express the results, we compared women and men. (2) Methods: Consecutive patients with a history of lung cancer treatment admitted to the outpatient oncology clinic (Department of Lung Cancer and Chest Tumours, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw) and the Department of Internal Medicine, Pulmonary Diseases and Allergy, were enrolled. We conducted analyses of the clinical, psychological and socioeconomic factors of women with lung cancer treated in everyday practice, including a comparison with a group of men. Demographic data were collected from a self-administered questionnaire. We used the Perceived Stress Scale (PSS-10) and Acceptance of Illness Scale (AIS) questionnaires for psychological evaluation. (3) Results: A total of 100 patients with confirmed primary lung cancer with a history of treatment were enrolled in the study (50 women and 50 men). We found a significantly shorter history of smoking in the group of women; at the same time, there were no differences in the reported incidence of COPD. Despite comparable results to men on the psychological questionnaire (PSS-10, AIS), women more often reported a willingness to be supported by a psychologist or psychiatrist due to lung cancer. However, they did not decide to consult them more often than men. Immunotherapy was a significantly less frequently used method in women. (4) Conclusions: We should be more active in finding out the willingness to consult a psychologist or psychiatrist among women with lung cancer. The diagnosis of COPD should be considered more often among women due to the lack of differences in the reported incidence of COPD between men and women, despite a clear contrast in the number of pack-years.

Unravelling the diagnostic pathology and molecular biomarkers in lung cancer.

The progress in lung cancer treatment is closely interlinked with the progress in diagnostic methods. There are four steps before commencing lung cancer treatment: estimation of the patient's performance status, assessment of disease stage (tumour, node, metastasis), recognition of histological subtype, and detection of biomarkers. The resection rate in lung cancer is <30% and >70% of patients need systemic therapy, which is individually adjusted. Accurate histological diagnosis is very important and it is the basis of further molecular diagnosis. In many cases only small biopsy samples are available and the rules for their assessment are defined in this review. The use of immunochemistry with at least thyroid transcription factor 1 (TTF1) and p40 is decisive in distinction between lung adenocarcinoma and squamous cell carcinoma. Molecular diagnosis and detection of known driver mutations is necessary for introducing targeted therapy and use of multiplex gene panel assays using next-generation sequencing is recommended. Immunotherapy with checkpoint inhibitors is the second promising method of systemic therapy with best results in tumours with high programmed death-ligand 1 (PD-L1) expression on cancer cells. Finally, the determination of a full tumour pattern will be possible using artificial intelligence in the near future.

[Bronchoalveolar lavage in lung cancer--diagnostic value and assessment of the anti-cancer immune response]. / Plukanie oskrzelowo-pecherzykowe w raku pluca--znaczenie w diagnostyce i ocenie odpowiedzi ukladu odpornosciowego.

Lung cancer is the most serious neoplasm worldwide. Despite significant progress in the treatment regimens and ongoing research development, lung cancer remains the first cause of cancer death in both sexes, and 5-year survival does not exceed 15%. The failure of host defense against this solid tumor is well known. The mechanisms of escaping from immune surveillance include, among others, changing of cancer cells' antigenicity, impaired function of antigen-presenting cells, enhancing apoptosis of tumor-infiltrating cytotoxic cells, and immune response inhibition by regulatory cells. To recognize these mechanisms well is very important in anti-cancer therapy. The small number of resectable cases of lung cancer causes very low availability of tumor environment examination. The cellular pattern and cytokine concentration in bronchoalveolar fluid (BALF), which can be performed during diagnostic bronchofiberoscopy, reflects the changes in tumor milieu. The character of BAL fluid qualifies this material for analysis by flow cytometry with precise evaluation of lymphoid cell phenotype and measurement of the surface and cytoplasmic molecules' regulatory properties. The results of previous studies have shown that the BAL fluid composition well characterized the local immune response in patients with lung cancer. However, many of the cases resulted from the influence of tobacco smoke, which is inextricably connected with cancer. Furthermore, BAL fulfills the diagnostic criteria in peripheral tumors and in disseminated malignant changes in the lung. We discuss the usefulness of this well-standardized method in the diagnosis of lung cancer and in the assessment of the local immune response prior to systemic treatment.

Coping styles with stress and its relations to psychiatric and clinical symptoms in patients with sarcoidosis: A latent profile analysis.

OBJECTIVE: Although stress and styles of coping with it can have a major impact on one's health and can determine the course and management of chronic diseases, no previous studies have evaluated coping strategies and their relation to emotional distress and clinical symptoms in sarcoidosis. METHODS: In two consecutive studies, we investigated differences in coping styles of sarcoidosis patients in comparison to healthy control subjects and the association of identified profiles to an objective measurement of disease (Forced Vital Capacity) and symptoms such as dyspnoea, pain, anxiety and depressive symptoms in 36 patients with sarcoidosis (study 1) and 93 patients with sarcoidosis (study 2). RESULTS: Across two studies we found that patients with sarcoidosis used emotion-focused and avoidant coping significantly less often than healthy individuals, and that in both groups the profile with dominant problem (task)-focus style was the most beneficial in terms of mental health. Further, the profile of sarcoidosis patients characterized by the lowest intensity of all coping strategies was found to be superior in terms of physical health status (dyspnoe, pain and FVC level). CONCLUSION: These findings suggest that successful management of sarcoidosis should include coping styles assessment and call for a multidisciplinary approach in diagnosis and treatment of sarcoidosis patients.

Flow Cytometric Analysis of Macrophages and Cytokines Profile in the Bronchoalveolar Lavage Fluid in Patients with Lung Cancer.

Macrophages play an important role in the suppression and activation of immune anti-cancer response, but little is known about dominant macrophage phenotype in the lung cancer environment, evaluated by bronchoalveolar lavage fluid (BALF). The aim of this study was to characterize macrophages in BALF from a lung affected by cancer (cBALF) and a healthy lung (hBALF) of the same patient regarding their individual macrophage polarization and selected cytokines profile. A total of 36 patients with confirmed lung cancer were investigated. Macrophages markers: CD206 CD163 CD80 CD86 CD40 CD45, Arginase-1, and CD68 were evaluated by flow cytometry. Cytokines (IL-1 RA, IL-6, IL-10, TNF-α, IL-1ß, IL-12, IL-23, and TGF-ß) profile was analyzed. There was higher median proportion of macrophages in Cbalf than in Hbalf. The population of macrophages presented immunophenotype: Ccd68+bright CD206+bright CD163+bright CD80+ CD86+ CD40+bright CD45+ cArginase+. We observed some trends in the expression of the analyzed antigens in clBALF and hlBLAF. The highest concentrations of IL-1RA and IL-6 were in Cbalf and Hbalf supernatant. There were the correlations between pro- and anti-inflammatory cytokines. The findings showed that macrophages include a diverse and plastic group with the presence of different antigens and cytokines, and determining the target phenotype is a complex and variable process.

IL-6 and IL-13 in induced sputum of COPD and asthma patients: correlation with respiratory tests.

BACKGROUND: IL-6 is strongly implicated in the development of chronic obstructive pulmonary disease (COPD). IL-13 is the well-documented central mediator in allergic asthma. IL-6 is attributed to the proinflammatory activities in COPD as well as asthma. In COPD patients exacerbation is increased by serum IL-6. The association of IL-13 as well as IL-6 with the impaired respiratory function of asthma patients remains controversial. OBJECTIVES: The aim of this study was to compare the concentration of IL-6 and IL-13 in the induced sputum of asthma and COPD patients, and to assess the possible association of these cytokines with the impairment of lung function. METHODS: Twenty-six subjects with COPD and 18 subjects with asthma were enrolled in this study. IL-6 and IL-13 levels were measured in induced sputum by ELISA and correlated with the results of respiratory tests. RESULTS: The induced sputum of COPD patients had a significantly higher IL-6 level than the sputum of asthma subjects while no significant differences were found in the levels of IL-13. There was a statistically significant negative correlation between IL-6 level and FEV(1) or FEV(1)/FVC in asthma patients (r = -0.59 and -0.54, respectively) and a negative correlation that did not reach statistical significance between IL-6 level and FEV(1), FEV(1)% or FVC in COPD subjects (r = -0.30, -0.30 and -0.38, respectively). There was no relationship between concentrations of IL-13 and impaired respiratory function. CONCLUSIONS: Our results confirmed that IL-6, but not of IL-13, is associated with respiratory disorders in both asthma and COPD patients.

[Sarcoidosis and tobacco smoking--clinical picture, diagnostic tests results and bronchoalveolar lavage fluid composition]. / Sarkoidoza a palenie tytoniu: obraz kliniczny, wyniki badan dodatkowych i sklad plynu z plukania oskrzelowo-pecherzykowego.

UNLABELLED: Sarcoidosis is a multiorgan granulomatous disease of unknown aetiology. Bronchoalveolar lavage (BAL) is approved in diagnostics of sarcoidosis. The aim of the study was to assess epidemiological data, demographic status, clinical picture of sarcoidosis patients and to correlate above-mentioned findings with smoking status. MATERIAL AND METHODS: The study included 101 patients hospitalized due to suspicion of pulmonary sarcoidosis. The results of clinical assessment and smoking status data were obtained by retrospective analysis of 78 confirmed sarcoidosis case records. RESULTS: Investigated group comprised 54 non-smokers (NS) and 24 smokers (S), including 9 (11.5%) active smokers (AS). Smokers were significantly younger than nonsmokers. Most of the smokers were males. The mean number of pack-years was 8.2. Respiratory symptoms occurred with similar frequency among non-smokers and smokers. The incidence of the Loefgren's syndrome was similar in S and NS . The pulmonary function tests results were comparable in both groups, however, the obstruction was more frequent among smokers. Composition of BAL fluid (BALf) differed significantly between S and NS. The total cell count was significantly higher among active smokers than among nonsmokers (29.3 +/- 19.2 x 10(6) vs 13.7 +/- 6.3 x 10(6)). Compared to non-smokers, smokers had higher number of macrophages and lower percentage of lymphocytes (11.3 +/- 11 x 10(6) vs 6.5 +/- 3.9 x 10(6), 29 +/- 19 vs 41 +/- 17%, respectively). CONCLUSIONS: A significantly lower proportion of smokers is observed among sarcoidosis patients than in general population. The influence of smoking on clinical picture and results of pulmonary function tests is not evident in sarcoidosis. However, tobacco smoking causes significant alteration in the composition of BALf, which should be taken into account in diagnostics of sarcoidosis.

[Clinical manifestation and radiological features of small cell lung cancer (SCLC)]. / Obraz kliniczny i radiologiczny drobnokomórkowego raka pluca.

INTRODUCTION: Small cell lung cancer (SCLC) includes 10-15% of primary lung tumors and it is very aggressive neoplasm. The aim of this study was to evaluate radiological and clinical features of SCLC and its spread. MATERIAL AND METHODS: The retrospective analysis included 31 patients (18 women, 13 men, mean age: 68.2 +/- 8.34 years).The extensive disease (ED) in most patients was present. 25 patients (80,6%) reported habitual cigarette smoking. Localization of primary tumor, metastases, clinical symptoms and main blood abnormalities were assessed. RESULTS: The most common locations of the primary tumor were: the lung hilus--15 (48.4%), the upper lobe of lung--6 (19.3%) and mediastinum--3 (9.7%). In most cases, mediastinal, subcarinal--both (41.9%) and hilus--(32.2%) lymph nodes were involved. Distant metastases were present in 20 patients (64.5%) at the moment of diagnosis. The most common locations of metastases were: liver--12 (60%), lungs--7 (35%), suprarenal glands--6 (30%), bones--3 (15%) and CNS--3 (15%). The most common symptoms were: cough (77.4%), weakness (51.6%), dyspnea (45.2%), chest pain (41.9%) and the weight loss (30%). Superior vena cava syndrome occurred in 4 patients (13%). The symptoms lasted an average 115 days, but the most persistent were: cough (216 days) and dyspnea (150 days). The main blood tests abnormalities were increased activities of: CRP (mean 63.4 mg/L), AspAT (65U), LDH (1852.7 U/l) and D-dimer (1892.5 microg/l). CONCLUSIONS: SCLC was mainly manifested in CT as central mass lung involving hilus or mediastinum. In most cases, distant metastases were present at the moment of diagnosis.

[Asthma as a psychosomatic disease. The causes, scale of the problem, connection with alexithymia and asthma control]. / Astma jako choroba psychosomatyczna. Przyczyny, skala problemu, zwiazek z aleksytymia i kontrola choroby.

INTRODUCTION: It is well known, that psychological factors may have an influence on evolution and course of asthma, however few information is available about the scale of a problem and the factors which are associated with the psychogenic asthma. The aim of the study was to estimate the coincidence of asthma and the psychosomatic diseases, to evaluate the impact of a stress and strong emotions on an asthma exacerbation and the level of alexithymia. The level of alexithymia was also compared with asthma control level. MATERIAL AND METHODS: The study was conducted among 54 (75.9% female) patients with diagnosed asthma (mean age 54.37 ± 14.52 yrs). Research was carried out at SP CSK Warsaw. Patients filled in a questionnaire consisting of: Asthma Control Test (ACT), list of factors which may cause asthma excerbation, Toronto Alexithymia Scale 26 (TAS-26, E. Scigala, T. Maruszewski translation). Patients took part in an interview gathering information about diagnosed diseases in which the presence of psychological or behavioural influences is thought to have played a major role in the etiology of physical disorders or disorders connected with stress but presented by the patient as somatic symptoms. Following diseases have been included: atopic dermatitis, depression, anorexia nervosa, irritable bowel syndrome, panic disorder (based on ICD-10 guidelines). Statistical analysis was conducted with SPSS 14.00 PL package, the level of statistical significance was p < 0.05. To check the relationship between the qualitative variables the non parametric test for independent samples was used. RESULTS: In 50% of cases patients with asthma had diagnosed at least one of following diseases: irritable bowel syndrome (n = 8), atopic dermatitis (n = 7), depression (n = 13), panic disorder (n = 9). Alexithymia was diagnosed in 11 cases (21.6%), relation between the level of alexithymia and stress and strong emotions was not found (χ² = 0,106, p > 0.05). Stress and/or strong emotions were marked as factors causing asthma exacerbation in 33 cases (61.1%). In the 72.5% of cases the asthma control was badly controlled, in 17.6% the asthma control was good, and in 9.8% the asthma control was complete. There was no connection between the asthma control and alexithymia (χ² = 0.358, p > 0.05). There was no relation between patients sex and the asthma control (χ² = 0.605; p > 0.05). CONCLUSION: The high level of alexithymia among the patients with asthma, frequent coincidence of asthma and psychosomatic diseases and the distinct influence of stress and strong emotions on causing asthma exacerbations, proven in this study, confirm that asthma may be considered as the psychosomatic disease.

[Factors influencing asthma course and the degree of control in the patients assessed with own questionnaire and Asthma Control Test (ACT)]. / Wplyw wybranych czynników na przebieg i kontrole astmyu chorych poddanych badaniu za pomoca ankiety wlasneji Testu Kontroli Astmy (ACT).

INTRODUCTION: Asthma treatment requires control and monitoring. According to Global Initiative For Asthma (GINA) asthma severity is described by degree of control. The aim of the present study was to compare self-patients' opinions about asthma control with Asthma Control Test (ACT) scores. Furthermore factors associated with asthma control were analyzed in the examined group of patients. Age, BMI, the length and the degree of asthma treatment, concomitant diseases, physical activity, exposition to the tobacco smoke, needs for education and self-control were assessed. MATERIAL AND METHODS: The study was based on a 36-point questionnaire that evaluated last two years of asthma duration, the reference data were obtained by objective evaluation with ACT. Fifty three patients, 37 women and 16 men, median age 54 years (24-80 years), from outpatients clinic were enrolled into the study. According to ACT score the patients (pts) were divided into 3 groups: 25 points - well controlled asthma (group 1), 20-24 points - partially controlled asthma (group 2) and less than 20 points - lack of asthma control (group 3). Kruskal-Wallis test and Chi-square test were used to compare the characteristics of subjects in different ACT groups. Pearson's test was used for assessment of correlation between different parameters. RESULTS: Twenty seven of 53 pts (51%) were treated with low dose of inhaled steroids and long acting beta-agonists (third degree of treatment according to GINA). During last two years the treatment was intensified in 37 pts (70%) due to exacerbation, and 19 of them (36%) were hospitalized in the course of exacerbation. Although 36 out of 53 pts (68%) claimed their asthma was fully controlled, ACT showed full control only in 5/53 (9%) of cases, partial control in 18/53 (34%), lack of control - in 30/53 (57%). Older age (p 〈 0.05) and longer duration of the disease (p 〈 0.01) were the factors significantly influencing lack of asthma control. A tendency towards worse asthma control was combined also with overweight and greater number of concomitant diseases (mainly coronary artery disease, diabetes and gastro-esophageal reflux). The presence of influenza vaccinations in medical history was associated with better asthma control (p = 0.05). CONCLUSIONS: A discrepancy between subjective assessment of asthma control and ACT score was observed in the examined group of patients. The frequency of asthma exacerbations (according to questionnaire) was describing the degree of asthma control more precisely than self-assessment. Older age and longer disease duration were combined with significantly worse asthma control. Better asthma control was combined with the presence of influenza vaccinations in medical history.