High Proportion of Arsenic Detected in Bronchoalveolar Fluid among Newly Diagnosed Lung Cancer in Jakarta Indonesia.

OBJECTIVE: This study aims to measure arsenic concentration in bronchoalveolar lavage fluid  (BALF ) of newly diagnosed lung cancer and its corelation with clinical profiles. METHODS: This study is a cross-sectional study to identify arsenic levels in newly diagnosed lung cancer patients. Bronchoalveolar lavage fluid was taken during the bronchoscopy. Arsenic concentration was measured using an ICP-EOS spectrometer. RESULTS: Forty-two subjects who met inclusion criteria were recruited in this study. Arsenic metals were detected among 40% of subjects with mean, highest, and lowest values are 0.38 µg/L, 0.5 µg/L, and 0.3 µg/L, respectively. There is no significant difference between arsenic level and patients' demographic and clinical data. CONCLUSION: Arsenic was detected in BALF in majority of newly diagnosed lung cancer patients. Despite the insignificant relationship between arsenic level and patients characteristic, this results is evidence of which arsenic metal exposure in lung cancer during their lifetime and should raise public health awareness regarding mitigating the source of exposure and its potential as lung carcinogenic agent.

Role of Flexible Bronchoscopy using Biopsy Forceps as the Initial Attempt for Headscarf Pin Aspiration Extraction.

Introduction: Flexible bronchoscopy is a less invasive procedure for extracting foreign bodies from the airways. However, studies on the extraction of headscarf pins are still very limited to determine the efficacy and safety of headscarf pin extraction using flexible bronchoscopy with biopsy forceps. Methods: This retrospective study was conducted at Persahabatan Hospital, Jakarta, Indonesia, on patients who had been treated in this hospital for headscarf pin extraction between January 2013 and February 2023. Fibreoptic bronchoscopy was performed under general anaesthesia. The pin was removed using Radial Jaw 4 mm single-use pulmonary biopsy forceps. The impacted sharp tip of the pin was freed first, and the proximal part of the pin body was gripped using biopsy forceps. Once a firm hold of the sharp end or the proximal part of the pin was secured, the bronchoscope and forceps were both slowly withdrawn under direct vision. Results: Thirty-two cases with headscarf pin aspiration were managed by fibreoptic bronchoscopy. A total of 12 patients (37.5%) came without any respiratory complaints; however, an equal number complained of cough and 6 cases (18.7%) of haemoptysis. All the cases in which the pins were visible in the airway were found with the round head down and the sharp tip oriented superiorly in the airway and impacted in the mucosa. Fibreoptic bronchoscopy extraction succeeded in 31 cases (96.8%). Only one case was converted to surgery. There were no major complications. Conclusion: Fibreoptic bronchoscopy with biopsy forceps under general anaesthesia is safe and effective for the removal of headscarf pin aspiration.

Pneumocystis jirovecii colonization in bronchoalveolar lavage among naïve non-small cell lung cancer from tertiary respiratory hospital in Jakarta, Indonesia.

INTRODUCTION: Pneumocystis jirovecii pneumonia (PJP) is a lung mycosis commonly found in immunocompromised patients (e.g., HIV patients); however, its role in solid cancer remains unclear. This study aims to identify Pneumocystis jirovecii colonization among naïve non-small-cell lung cancer (NSCLC) through bronchoalveolar lavage (BAL) and explore its correlation with clinical parameters. METHODOLOGY: This cross-sectional study recruited newly diagnosed naïve NSCLC patients who had not been given systemic treatments. We tested BAL from patients for P. jirovecii colonization with nested PCR targeting the mtLSU rRNA gene. Demographic and clinical characteristics were obtained from medical records, and the correlation between P. jirovecii colonization and clinicopathological data were analyzed. Kaplan-Meier analyses were done to evaluate survival. RESULTS: Among 56 newly diagnosed, naïve NSCLC patients enrolled, the prevalence of P. jirovecii colonization was 17.9% (10 subjects). There was no statistically significant difference in demographic and clinical characteristics between the P. jirovecii colonization group versus no colonization (p value > 0.05). The overall survival duration for both groups demonstrated no significant difference. CONCLUSIONS: This study demonstrated a relatively high prevalence of P. jirovecii colonization among BAL samples of naïve Indonesian NSCLC patients. Further study is needed to delineate its implications for the potential transmission source, lung cancer pathogenesis, and prognosis.

Gene transfer of thromboxane A(2) synthase and prostaglandin I(2) synthase antithetically altered tumor angiogenesis and tumor growth.

Cyclooxygenase, involved in tumor growth and angiogenesis, converts arachidonic acid to prostaglandin (PG)H(2), which is immediately converted to bioactive prostanoids including PGE(2), PGD(2), thromboxane (TX)A(2) and PGI(2). To test the hypothesis that changes in the prostanoid profile alter cancer growth, we transduced the retroviral vectors carrying TXA(2) synthase cDNA or PGI(2) synthase cDNA to colon-26 adenocarcinoma cells and subsequently inoculated each transformant to syngeneic BALB/c mice. Tumors derived from TXA(2) synthase transformants grew faster (280%, day 8, versus null-vector control; P < 0.05) and showed more abundant vasculature (204%, versus null-vector control; P < 0.01), whereas tumors from PGI(2) synthase transformants presented opposite effects. These effects by the transgenes were reversed by administration of specific inhibitors. These results suggest that the profile of downstream metabolites of cyclooxygenase in cancer cells can be a determinant for tumor development.

Adenovirus vector-mediated in vivo gene transfer of OX40 ligand to tumor cells enhances antitumor immunity of tumor-bearing hosts.

OX40 ligand (OX40L), the ligand for OX40 on activated CD4+ T cells, has adjuvant properties for establishing effective T-cell immunity, a potent effector arm of the immune system against cancer. The hypothesis of this study is that in vivo genetic engineering of tumor cells to express OX40L will stimulate tumor-specific T cells by the OX40L-OX40 engagement, leading to an induction of systemic antitumor immunity. To investigate this hypothesis, s.c. established tumors of three different mouse cancer cells (B16 melanoma, H-2b; Lewis lung carcinoma, H-2b; and Colon-26 colon adenocarcinoma, H-2d) were treated with intratumoral injection of a recombinant adenovirus vector expressing mouse OX40L (AdOX40L). In all tumor models tested, treatment of tumor-bearing mice with AdOX40L induced a significant suppression of tumor growth along with survival advantages in the treated mice. The in vivo AdOX40L modification of tumors evoked tumor-specific cytotoxic T lymphocytes in the treated host correlated with in vivo priming of T helper 1 immune responses in a tumor-specific manner. Consistent with the finding, the antitumor effect provided by intratumoral injection of AdOX40L was completely abrogated in a CD4+ T cell-deficient or CD8+ T cell-deficient condition. In addition, ex vivo AdOX40L-transduced B16 cells also elicited B16-specific cytotoxic T lymphocyte responses, and significantly suppressed the B16 tumor growth in the immunization-challenge experiment. All of these results support the concept that genetic modification of tumor cells with a recombinant OX40L adenovirus vector may be of benefit in cancer immunotherapy protocols.