3D mixed-reality visualization of medical imaging data as a supporting tool for innovative, minimally invasive surgery for gastrointestinal tumors and systemic treatment as a new path in personalized treatment of advanced cancer diseases.

BACKGROUND: The purpose of this study was to investigate the potential of a combination of 3D mixed-reality visualization of medical images using CarnaLife Holo (MedApp, Poland) system as a supporting tool for innovative, minimally invasive surgery/irreversible electroporation-IRA, Nano-Knife), microwave ablation (MWA)/for advanced gastrointestinal tumors. Eight liver and pancreatic tumor treatments were performed. In all of the patients undergoing laparoscopy or open surgery volume and margin were estimated by preoperative visualization. In all patients, neoplastic lesions were considered unresectable by standard methods. METHODS: Preoperative CT or MRI were transformed into holograms and displayed thanks to the HoloLens 2. During operation, the surgeon's field of view was augmented with a 3D model of the patient's relevant structures. RESULTS: The intraoperative hologram contributed to better presentation of tumor size and locations, more precise setting of needles used to irreversible electroporation and for determining ablation line in case of liver metastases. Surgeons could easily compare the real patient's anatomy to holographic visualization just before the operations. CONCLUSIONS: The combination of 3D mixed-reality visualization using CarnaLife Holo with IRA, MWA and next systemic treatment (chemotherapy) might be a new way in personalized treatment of advanced cancers.

Madelung's disease - progressive, excessive, and symmetrical deposition of adipose tissue in the subcutaneous layer: case report and literature review.

Madelung's disease is a rare disorder described for the first time in the year 1846 by Brodie. It is characterized by the occurrence of progressive, excessive, and symmetrical deposits of adipose tissue in the subcutaneous layer. Most often, these changes concern the neck, the nape of the neck, arms, and upper back, giving the patients a specific, pseudoathletic appearance. Madelung's disease is also known as multiple symmetrical lipomatosis, benign symmetrical lipomatosis, and Launois-Bensaude syndrome. The most commonly affected ones are men who drink alcohol in excessive amounts. The fat masses emerging in the course of the disease are painless but can lead to adverse repercussions. Patients may experience dysphagia, dysphonia, difficulty in breathing, and limited mobility of the neck. The reasons for the willingness to take up treatment are also often esthetic reasons. The disease is usually accompanied by numerous metabolic disorders. The etiology of the disease has not been sufficiently explained so far, which creates diagnostic and therapeutic difficulties. Currently used treatment is limited to surgical resection of the resulting lesions or liposuction. Unfortunately, the effectiveness of these activities is limited. Most patients experience recurrence after treatment. This paper discusses the essence of Madelung's disease, numerous aspects of etiology, the manner of diagnosis, and treatment based on current literature data.

Helicobacter pylori associated factors in the development of gastric cancer with special reference to the early-onset subtype.

Nowadays, gastric cancer is one of the most common neoplasms and the fourth cause of cancer-related death on the world. Regarding the age at the diagnosis it is divided into early-onset gastric carcinoma (45 years or younger) and conventional gastric cancer (older than 45). Gastric carcinomas are rarely observed in young population and rely mostly on genetic factors, therefore provide the unique model to study genetic and environmental alternations. The latest research on early-onset gastric cancer are trying to explain molecular and genetic basis, because young patients are less exposed to environmental factors predisposing to cancer. In the general population, Helicobacter pylori, has been particularly associated with intestinal subtype of gastric cancers. The significant association of Helicobacter pylori infection in young patients with gastric cancers suggests that the bacterium has an etiologic role in both diffuse and intestinal subtypes of early-onset gastric cancers. In this paper we would like to ascertain the possible role of Helicobacter pylori infection in the development of gastric carcinoma in young patients. The review summarizes recent literature on early-onset gastric cancers with special reference to Helicobacter pylori infection.

Preoperative radiotherapy and local excision of rectal cancer: Long-term results of a randomised study.

BACKGROUND AND PURPOSE: It is uncertain whether local control is acceptable after preoperative radiotherapy and local excision (LE). An optimal preoperative dose/fractionation schedule has not yet been established. MATERIAL AND METHODS: In a phase III study, patients with cT1-2N0M0 or borderline cT2/T3N0M0 < 4 cm rectal adenocarcinomas were randomised to receive either 5 × 5 Gy plus 1 × 4 Gy boost or chemoradiation: 50.4 Gy in 28 fractions plus 3 × 1.8 Gy boost and 5-fluorouracil with leucovorin bolus. LE was performed 6-8 weeks later. Patients with ypT0-1R0 disease were observed. Completion total mesorectal excision (CTME) was recommended for poor responders, i.e. ypT1R1/ypT2-3. RESULTS: Of 61 randomised patients, 10 were excluded leaving 51 for analysis; 29 in the short-course group and 22 in the chemoradiation group. YpT0-1R0 was observed in 66% of patients in the short-course group and in 86% in the chemoradiation group, p = 0.11. CTME was performed only in 46% of patients with ypT1R1/ypT2-3. The median follow-up was 8.7 years. Local recurrence incidences and overall survival at 10 years were respectively for the short-course group vs. the chemoradiation group 35% vs. 5%, p = 0.036 and 47% vs. 86%, p = 0.009. In total, local recurrence at 10 years was 79% for ypT1R1/T2-3 without CTME. CONCLUSIONS: This trial suggests that in the LE setting, both local recurrence and survival are worse after short-course radiotherapy than after chemoradiation. Because of the risk of bias, a confirmatory study is desirable. Lack of CTME is associated with an unacceptably high local recurrence rate.

The use of rifaximin in pre-operative period of patients with tumors of the gastrointestinal tract - a retrospective study (2013-2016).

ntroduction: One of the most important goals of preparing a patient for elective gastrointestinal cancer surgery is prevention of postoperative complications. The literature gives many ways to prepare for surgery, but only a few suggests that pre-operative use of rifaximin provides benefits in the form of fewer perioperative complications and reduces the severity of pain during this period. O bjective: The presented project is a retrospective analysis of the effectiveness of rifaximin in the prevention of perioperative complications in patients treated in the Unit of General Surgery with the Orthopedic and Urology in the Hospital of the Ministry of the Interior and Administration in Lublin, and a review of international literature in this subject. MATERIALS AND METHODS: A retrospective analysis of the results of pre-operative use of rifaximin was performed in 181 patients scheduled for rectal and colorectal cancer between 2013 and 2016 in the General Surgery Unit with the Orthopedic and Urology in the Hospital of the Ministry of Interior and Administration in Lublin. Patients undergoing urgent surgery were excluded from the study. Patients were divided into 2 groups. The first group of 139 patients - patients operated on for rectal and colorectal cancer in 2013 until 2015, in whom rifaximine was not used in the preoperative period. The second group is 42 patients, operated on in 2016, in which the rifaximin was used in the pre-operative period at a dose of 2x2 tablets (400 mg) per day, 12-hour interval, for 7 days before the planned operation. Additionally, a probiotic was administered for 7 days. Drugs were ordained at the Oncological Outpatient Clinic as part of the pre-hospitalization check. R esults: The use of rifaximin in the preoperative period in patients with colorectal cancer had an effect on shortening the time of post-operative hospitalization and reduced post-surgical pain in comparison with the control group. The analysis of the cynumber and intensity of surgical complications in both groups did not differ. C onclusions: Large studies on the influence of rifaximin on the development of colorectal cancer have not been published so far. Only single reports suggest that its use has a positive effect on the perioperative period of patients treated for colorectal cancer including rectum and our retrospective analysis confirms these observations.

Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders: a prospective multicentre study.

PURPOSE: To assess local control after preoperative radiation and local excision and to determine an optimal radiotherapy regimen. METHODS: Eighty-nine patients with G1-2 rectal adenocarcinoma <3-4 cm; unfavourable cT1N0 (23.6%), cT2N0 (62.9%) or borderline cT2/cT3N0 (13.5%) received 5 × 5 Gy plus 4 Gy boost (71.9%) or 55.8 Gy in 31 fractions with 5-FU and leucovorin (28.1%). Local excision (traditional technique 56.2%, transanal endoscopic microsurgery 41.6%, Kraske procedure 2.2%) was performed 6-8 weeks later. If patients were downstaged to ypT0-1 without unfavourable factors (good responders), this was deemed definitive treatment. Immediate conversion to radical surgery was recommended for remaining patients. RESULTS: Good response to radiation was seen in 67.2% of patients in the short-course group and in 80.0% in the chemoradiation group, p = 0.30. Local recurrence at 2 years (median follow-up) in good responders was 11.8% in the short-course group and 6.2% in the chemoradiation group, p = 0.53. In the total group, a lower rate of local recurrence at 2 years was observed in elderly patients (>69 years, median value) when compared to the younger patients; 8.3% vs. 27.7%, Cox analysis hazard ratio 0.232, p = 0.016. A total of 18 patients initially managed with local excision required conversion to abdominal surgery but either refused it or were unfit. In this group, local recurrence at 2 years was 37.1%. CONCLUSIONS: This study suggests an acceptable local recurrence rate after preoperative radiotherapy and local excision of small, radiosensitive tumours in elderly patients.

Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders.

BACKGROUND AND PURPOSE: To report an early analysis of prospective study exploring preoperative radiotherapy and local excision in rectal cancer. MATERIALS AND METHODS: Mucosa at tumour edges was tattooed. Patients with cT1-3N0 tumour <3-4 cm were treated with either 5x5Gy+4Gy boost (N=31) or chemoradiation (50.4Gy+5.4Gy boost, 1.8Gy per fraction+5-fluorouracyl and leucovorin; N=13). Thirteen patients from the short-course group were unfit for chemotherapy. The interval from radiation to full-thickness local excision was 6 weeks. The protocol called for conversion to a transabdominal surgery in case of ypT2-3 disease or positive margin. RESULTS: The postoperative complications requiring hospitalization were recorded in 9% of patients. The rate of pathological complete response was 41%. The rate of patients requiring conversion was 34%; however, 18% actually underwent conversion and the remaining 16% refused or were unfit. During the 14 months of median follow-up, local recurrence was detected in 7% of patients and all underwent salvage surgery. Of 19 patients in whom initially anterior resection was likely, 16% had abdominoperineal resection performed for a conversion or as a rescue procedure. CONCLUSION: Our study suggests that the short-course radiation prior to local excision is a treatment option for high-risk patients.

Induction of caspase 3 activity, bcl-2 bax and p65 gene expression modulation in human acute promyelocytic leukemia HL-60 cells by doxorubicin with amifostine.

The influence of amifostine alone and in combination with doxorubicin, cytarabine, and etoposide on the cell growth and on bcl-2, bax and p65 gene expression was investigated in human acute promyelocytic leukemia cell line HL-60. No or very little influence of the exposure of HL-60 cells to amifostine (10(-6) to 10(-2) M) on cell proliferation was shown. Proliferation of HL-60 cells exposed to doxorubicin, cytarabine, or etoposide dropped down with increasing doses of these drugs. Only in the case of doxorubicin, more effective inhibition of HL-60 cell growth was observed when combination of doxorubicin, cytarabine or etoposide with amifostine was used. Cytotoxic effect of cytarabine or etoposide was not reduced by amifostine. The lowering of the cytotoxic index (IC50) was observed only when HL-60 cells were preincubated with amifostine followed by doxorubicin treatment. IC50 was estimated as 2.1 x 10(-7) M and 0.9 x 10(-7) M for doxorubicin and doxorubicin with amifostine, respectively. This effect was accompanied by the induction of caspase 3 activity. HL-60 cells treated with doxorubicin alone showed about 35-fold increase in caspase 3 activity. The enzyme activity was stimulated by combination of doxorubicin with amifostine up to 94 times. Furthermore, the expression of bcl-2 and bax genes involved in apoptosis as well as tumor-associated p65 gene were determined. Semiquantitative reverse transcriptase polymerase chain reaction showed a decrease in bcl-2 and an increase in bax and p65 expression in HL-60 cells treated with doxorubicin in combination with amifostine when compared with the cells treated only with doxorubicin. Amifostine may potentiate doxorubicin therapeutic efficiency in human acute promyelocytic leukemia cells.

Uptake of radiolabelled endomorphins by experimental mammary adenocarcinoma.

BACKGROUND: The aim of this study was to examine the accumulation of endomorphin-1 (Tyr-Pro-Trp-Phe-NH2) and endomorphin- 2 (Tyr-Pro-Phe-Phe-NH2) labelled with radioiodine in tumour-bearing C3H/Bi mice. MATERIAL AND METHODS: Mice C3H/Bi bearing transplantable mammary adenocarcinoma were used as animal models to study the interaction between micro-opioid receptors and endomorphin-1 and 2. The expression of the micro-opioid receptor in the tumours was confirmed by cross-linking assay and by RT- PCR technique. RESULTS: The endomorphins showed relatively high tumour accumulation - about 5.2% of dose/g tissue for endomorphin-1 and about 3.8% for endomorphin-2. The ratio of tumour to muscle for endomorphin-2 reached the highest value (12.7) six hours after injection. For endomorhin-1 this ratio was the highest (7.5) three hours after injection. The cross-linking assay of [125I]-labelled peptides with membranes, isolated from the mouse adenocarcinoma, followed by electrophoresis and autoradiography revealed the presence of a radioactive complex with molecular weight of about 65 kDa. This complex was detectable by polyclonal antibodies raised against the N-terminal end of a micro-opioid receptor. The expression of gene encoding micro-opioid receptor on mouse mammary adenocarcinoma was further confirmed by RT-PCR technique. The binding studies with membranes of mouse mammary adenocarcinoma cells have shown significantly higher Bmax values for endomorphin-1 and endomorphin- 2 (806 and 671, respectively) than for morphiceptin (131), a well-known specific micro-opioid receptor ligand. CONCLUSIONS: Endomorphin-1 and 2 have shown a high affinity to the m-opioid receptor present in mouse mammary adenocarcinoma. However, endomorphin-2 showed more promising characteristics in biodistribution studies.

Effect of cancer procoagulant (CP) on the growth and adhesion of MCF-7 cells to vitronectin in vitro.

Cancer procoagulant (CP) is a cysteine protease produced by fetal and malignant tissues, activating in vitro blood coagulation factor X. It has been demonstrated that CP is able to stimulate blood platelet adhesion to fibrinogen and collagen. The pro-adhesive properties of CP could play an important role in metastatic spread of cancer as well as in primary tumor growth. Effects of anti-CP antibody on the growth of MCF-7 breast cancer cells and on the cells adhesion to vitronectin have been analyzed in vitro. Addition of polyclonal anti-CP antibody to MCF-7 cell culture resulted in 16-18% (P < 0.001) decrease in the cells viability as compared with the control (other antibody or no antibody in the culture). Preincubation of MCF-7 cells with anti-CP antibody reduced the cells adhesion to vitronectin. Further addition of purified CP (0.5-8 microg/ml) to the MCF-7 cells preincubated with anti-CP antibody resulted in complete recovery of adhesive properties of the cells. However, when high concentration (16 microg/ml) of CP was added to the sample, only partial recovery of the adhesive properties by the cells was observed. Results of the experiments support the hypothesis that CP is involved in the growth of cancer cells, but its pro-coagulative properties are of secondary importance. One of the possible mechanisms of the interactions between CP and malignant cell could be the regulation of the cell adhesion processes.

Induction of caspase 3 and modulation of some apoptotic genes in human acute promyelocytic leukemia HL-60 cells by carboplatin with amifostine.

The influence of carboplatin alone and carboplatin in combination with cytoprotective agent amifostine on the growth, caspase 3 activity and some apoptotic genes expression was investigated in vitro in human acute promyelocytic leukemia HL-60 cells. Proliferation of HL-60 cells exposed to carboplatin dropped down with increasing dose of the drug. This effect was slightly higher when carboplatin was used in combination with amifostine. The cytotoxic index (IC50) was estimated as 6.6 and 4.4 x 10(-4) M (after 24 h) and 3.3 and 2.5 x 10(-5) M (after 48 h) for carboplatin and carboplatin with amifostine, respectively. This effect was accompanied by induction of caspase 3 activity. HL-60 cells treated with carboplatin alone showed about 120-fold increase in caspase 3 activity. Combination of carboplatin with amifostine induced the enzyme activity up to 280 times. Furthermore, the expression of bcl-2, c-myc and bax genes involved in apoptosis as well as p65, which function in this process is unknown, were determined. Semi-quantitative RT-PCR showed a decrease in bcl-2 and an increase in bax, c-myc and p65 expression in HL-60 cells treated with carboplatin in combination with amifostine as compared to the cells treated only with carboplatin. We conclude that amifostine may potentiate carboplatin therapeutic efficiency towards human acute promyelocytic leukemia cells.