Surgical Outcomes in a Lung Cancer-Screening Program Using Low Dose Computed Tomography.

OBJECTIVE: Lung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. METHODS: We conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. RESULTS: Ninety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64±9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2±7.6mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n=39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n=17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%-98%) and 83% (95% CI: 65%-92%), respectively. CONCLUSION: Lung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.

Chronic rhinosinusitis is associated with prolonged SARS-CoV-2 RNA shedding in upper respiratory tract samples: A case-control study.

BACKGROUND: SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding amongst patient's basal clinical conditions. METHODS: We have evaluated all 513 patients attended in our hospital between 1 March and 1 July. We have selected all 18 patients with prolonged viral shedding and compared them with 36 sex-matched randomly selected controls. Demographic, treatment and clinical data were systematically collected. RESULTS: Global median duration of viral clearance was 25.5 days (n = 54; IQR, 22-39.3 days), 48.5 days in cases (IQR 38.7-54.9 days) and 23 days in controls (IQR 20.2-25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups. Chronic rhinosinusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (P < 0.001 and P = 0.003). The use of inhaled corticosteroids was also more frequent in case group (P = 0.007). Multivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI], 3.89-90.59; P < 0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values. CONCLUSION: We found that chronic rhinosinusitis and atopy might be associated with increased risk of prolonged viral shedding. If confirmed in prospective trials, this finding might have clinical implications for quarantine duration due to increased risk of pandemic spread.

Sleep disordered breathing and nocturnal hypoxemia are very prevalent in a lung cancer screening population and may condition lung cancer screening findings: results of the prospective Sleep Apnea In Lung Cancer Screening (SAILS) study.

OBJECTIVE: Obstructive sleep apnea (OSA) can influence the appearance and proliferation of some tumors. The Sleep Apnea In Lung Cancer Screening (SAILS) study (NCT02764866) evaluated the prevalence of OSA and nocturnal hypoxemia in a high-risk population enrolled in a lung cancer screening program. METHODS: This was a prospective study of the prevalence of OSA in a lung cancer screening program. Subjects met the National Lung Screening Trial (NLST) age and smoking criteria (age 55-75 years; pack-years >30). Participants in the study were offered annual screening with low-dose computed tomography (LDCT) and pulmonary function testing, as well as home sleep apnea testing (HSAT) and a sleep-specific questionnaire. Sleep study-related variables, symptoms, and epidemiologic data were recorded. RESULTS: HSAT was offered to 279 subjects enrolled in our lung cancer screening program. HSAT results were available for 236 participants (mean age 63.6 years; mean tobacco exposure: 45 pack-years), of whom 59% were male and 53% were active smokers. Emphysema (74%) and chronic obstructive pulmonary disease (COPD) (62%) were common and in most cases mild in severity. OSA, including moderate to severe disease, was very common in this patient population. AHI distributions were as follows: AHI <5 (22.5%); 5-15 (36.4%); 15-30 (23.3%); and >30 (17.8%). Nocturnal hypoxemia (T90) (p = 0.003), diffusing capacity for carbon monoxide (DLCO) (p = 0.01), tobacco exposure (p = 0.024), and COPD (p = 0.023) were associated with OSA severity. Positive screening findings (nodules ≥6 mm) were associated with nocturnal hypoxemia on multivariate analysis adjusted for confounders (OR = 2.6, 95% CI = 1.12-6.09, p = 0.027). CONCLUSION: Moderate to severe OSA is very prevalent in patients enrolled in a lung cancer screening program. Nocturnal hypoxemia more than doubles the risk of positive screening findings.

Broadband anti-Stokes white emission of Sr2CeO4 nanocrystals induced by laser irradiation.

The laser induced white emission (LIWE) from Sr2CeO4 nanocrystals upon irradiation with a focused IR laser beam was investigated. It was observed to be a threshold phenomenon with its intensity increasing exponentially with the excitation power density. This process was investigated under double laser beam simultaneous excitation in the UV range leading to Stokes emission in the visible range and in the IR range leading to anti-Stokes LIWE. With increasing LIWE intensity, the Stokes emission intensity strongly decreased. The LIWE is accompanied by efficient photocurrent generation depending on laser excitation density followed by multiphoton absorption and ionization processes. Photoimpedance measurements showed a sharp increase of the dielectric constant by several orders of magnitude in the Sr2CeO4 nanocrystals during the LIWE process demonstrating a metallic-like behaviour. The mechanisms of LIWE include multiphoton absorption and ionization that lead to the creation of a coupled pair of Ce3+ and Ce4+ ions that allow for the intervalence charge transfer (IVCT) emission transitions in the white light range. A strong decrease of absorption band intensity of Sr2CeO4 with increasing LIWE intensity confirms the creation of (Ce3+, Ce4+) pairs.

Diagnostic bronchoscopy: state of the art.

Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the development of a white light video bronchoscope with a miniature charge-coupled device built in its tip replacing the fibreoptics. White light flexible videobronchoscopy with its ancillary devices (forceps biopsy, bronchial brushing, bronchoalveolar lavage, bronchial washings and transbronchial needle aspiration) has long been the only established diagnostic bronchoscopic technique. With the advances in microtechnology over the past two decades, recent technical developments such as autofluorescence bronchoscopy and endoscopic ultrasound allow better evaluation of endobronchial, mediastinal and parenchymal lesions.

Hiperplasia adenomatosa atípica pulmonar. A propósito de un caso / Atypical Adenomatous Hiperplasia. Report of a case

La Hiperplasia adenomatosa atípica (HAA) es una entidad infrecuente en la población general. Se manifi esta en TC como un nódulo pulmonar en vidrio deslustrado sin componente sólido y persistente a pesar detratamiento antibiótico. Se presenta un caso de HAA, descubierto a raíz del programa de detección precoz de cáncer de pulmón de la Clínica Universitaria de Navarra. Se muestran los hallazgos en TC y AnatomíaPatológica, así como la correlación radio patológica. Se plantea el diagnóstico diferencial con otras entidades incluidas lesiones con potencial maligno (carcinoma bronquioloalveolar y adenocarcinoma de bajo grado). Se comenta el método empleado en el manejo de laslesiones nodulares en vidrio deslustrado en el contexto de este programa de detección precoz

Atypical adenomatose hyperplasia (HAA) is an infrequent pathology in general population. The CT fi ndings are ground glass opacity without solid component and persistent regardless antibiotic treatment. Wepresent a case of HAA, detected on program of early detection of lung cancer program of the Clínica Universitaria de Navarra. We show the CTand histology fi ndings, and radiopathologic correlation. The differential diagnosis must include other lesions with potential malignity (bronquioalveolarcarcinoma and low grade adenocarcinoma). We show themethod applied in ground glass opacities management in an early lung detection program context

Hiperplasia adenomatosa atípica pulmonar. A propósito de un caso / No disponible

La Hiperplasia adenomatosa atípica (HAA) es una entidad infrecuenteen la población general. Se manifi esta en TC como un nódulo pulmonaren vidrio deslustrado sin componente sólido y persistente a pesar detratamiento antibiótico. Se presenta un caso de HAA, descubierto a raízdel programa de detección precoz de cáncer de pulmón de la ClínicaUniversitaria de Navarra. Se muestran los hallazgos en TC y AnatomíaPatológica, así como la correlación radio patológica. Se planteael diagnóstico diferencial con otras entidades incluidas lesiones conpotencial maligno (carcinoma bronquioloalveolar y adenocarcinomade bajo grado). Se comenta el método empleado en el manejo de laslesiones nodulares en vidrio deslustrado en el contexto de este programade detección precoz(AU)

Atypical adenomatose hyperplasia (HAA) is an infrequent pathology ingeneral population. The CT fi ndings are ground glass opacity withoutsolid component and persistent regardless antibiotic treatment. Wepresent a case of HAA, detected on program of early detection of lungcancer program of the Clínica Universitaria de Navarra. We show the CTand histology fi ndings, and radiopathologic correlation. The differentialdiagnosis must include other lesions with potential malignity (bronquioalveolarcarcinoma and low grade adenocarcinoma). We show themethod applied in ground glass opacities management in an early lungdetection program context(AU)

Factors determining early adherence to a lung cancer screening protocol.

Lung cancer screening using computed tomography (CT) is effective in detecting early stage disease. However, concerns regarding adherence have been raised. The current authors conducted a retrospective observational study of 641 asymptomatic smokers enrolled in a lung cancer screening programme between 2000 and 2003. Adherent subjects were compared with nonadherent subjects with regard to lung function, sex, age, motivation for enrollment, smoking status, distance to the referral centre, family history of lung cancer, asbestos exposure, education, the presence and type of nodule(s) seen on initial CT, and exposure to a nursing intervention designed to improve adherence. Overall, early adherence to the study protocol was 65%. Multivariate analysis confirmed the importance of sex, proximity to the referral centre, the presence of noncalcified nodules, and the nursing intervention as factors conditioning adherence to the study protocol. Patients encouraged to participate in the study were more adherent, as were former smokers. Sex interactions were observed in multivariate analysis. The nursing intervention was significant for females, while abnormal lung function improved male adherence. Adherence to lung cancer screening is particularly good among females and subjects living near the referral centre. The present study suggests the need to develop new strategies, especially those targeting males and subjects with low risk perception, in order to improve adherence.

Hyperleptinaemia, respiratory drive and hypercapnic response in obese patients.

Leptin is a powerful stimulant of ventilation in rodents. In humans, resistance to leptin has been consistently associated with obesity. Raised leptin levels have been reported in subjects with sleep apnoea or obesity-hypoventilation syndrome. The aim of the present study was to assess, by multivariate analysis, the possible association between respiratory centre impairment and levels of serum leptin. In total, 364 obese subjects (body mass index >or=30 kg.m(-2)) underwent the following tests: sleep studies, respiratory function tests, baseline and hypercapnic response (mouth occlusion pressure (P(0.1)), minute ventilation), fasting leptin levels, body composition and anthropometric measures. Subjects with airways obstruction on spirometry were excluded. Out of the 346 subjects undergoing testing, 245 were included in the current analysis. Lung volumes, age, log leptin levels, end-tidal carbon dioxide tension, percentage body fat and minimal nocturnal saturation were predictors for baseline P(0.1). The hypercapnic response test was performed by 186 subjects; log leptin levels were predictors for hypercapnic response in males, but not in females. Hyperleptinaemia is associated with a reduction in respiratory drive and hypercapnic response, irrespective of the amount of body fat. These data suggest the extension of leptin resistance to the respiratory centre.

[Lung transplant]. / Trasplante pulmonar.

A lung transplant is usually the final therapeutic option for patients with respiratory insufficiency. In spite of the many advances in immunology and the management of complications, mortality and morbidity associated with this transplant are far higher than with others. Acute rejection is an almost universal problem in the first year, while obliterative bronchitis reduces long term survival. Respiratory infections also play a significant role in the complications associated with lung transplants due to the constant exposure of the graft to the outside. However, the success of this therapeutic option, which basically depends on a suitable selection of donor and recipient, are evident, above all with respect to quality of life.

Trasplante pulmonar / Lung transplant

El tranplante pulmonar suele ser la última opción terapéutica para pacientes con insuficiencia respiratoria. A pesar de los muchos avances en inmunología y el manejo de las complicaciones, la mortalidad y morbilidad asociadas a este trasplante son muy superiores a los demás. El rechazo agudo es casi un problema universal en el primer año, mientras que la bronquiolitis obliterante limita la supervivencia a largo plazo. Las infecciones respiratorias también cumplen un papel importante en las complicaciones asociadas al trasplante pulmonar por la constante exposición del injerto al medio exterior. No obstante, los éxitos de esta opción terapéutica que depende fundamentalmente de una correcta selección de donante y receptor, son evidentes, sobre todo en cuanto a calidad de vida se refiere

A lung transplant is usually the final therapeutic option for patients with respiratory insufficiency. In spite of the many advances in immunology and the management of complications, mortality and morbidity associated with this transplant are far higher than with others. Acute rejection is an almost universal problem in the first year, while obliterative bronchitis reduces long term survival. Respiratory infections also play a significant role in the complications associated with lung transplants due to the constant exposure of the graft to the outside. However, the success of this therapeutic option, which basically depends on a suitable selection of donor and recipient,are evident, above all with respect to quality of life

Complexation of the interferon inducer, bropirimine, with hydroxypropyl-beta-cyclodextrin.

Bropirimine (ABPP) is an orally active immunomodulator that increases endogenous alpha-interferon and other cytokines used clinically against carcinoma in situ of the bladder. The oral absorption of ABPP is poor because its low solubility in water. The purpose of this study is to develop a technological procedure useful to increase the water solubility of ABPP. To this end, the interaction of ABPP with several cyclodextrin derivatives-alpha-, beta-, gamma- and hydroxypropyl-beta-cyclodextrin with a degree of substitution 2.7 (HPbetaCD) was studied and the effect of the complexation process on the water solubility of the drug was evaluated. The best results were obtained with the hydroxypropyl derivative, HPbetaCD, that interacts in a 1:1 drug:cyclodextrin molar ratio. The inclusion complex ABPP-HPbetaCD was characterized in solution by nuclear magnetic resonance (1H-NMR). The solid inclusion complex was obtained by freeze-drying and characterized by differential scanning calorimetry (DSC), X-ray diffractometry and mass spectrometry. The dissolution rate of ABPP from the HPbetaCD solid inclusion complex was increased compared to the powdered drug but not differences were found between the complex and a physical mixture with a similar molar ratio. The increase of the dissolution rate of the drug can be attributed to the breakdown in solution of the drug dimers in the presence of the cyclodextrin and to the complex formation.

MRI findings in adenosquamous carcinoma of the gallbladder.

In this report, we present the MRI findings of adenosquamous carcinoma of the gallbladder, a rare type of gallbladder malignancy. MRI examination not only helped established the diagnosis but also accurately depicted the extent of involvement of the adjacent liver. The ability to image in multiple planes was also useful in assessing the anatomic location of the tumor and in determining that the patient could be treated with surgical resection.

Endometrial adenocarcinoma with choriocarcinomatous differentiation in an elderly virginal woman.

A 70-year-old virginal woman underwent hysterectomy and bilateral salpingo-oophorectomy for endometrial carcinoma. Gross examination of the surgical specimen showed normal ovaries and fallopian tubes, an enlarged uterus with several intramural leiomyomata, an endometrium completely carpeted by cancer, and, additionally, a necrotic and hemorrhagic nodular mass that protruded into the endometrial cavity. Histologic examination showed a widespread and superficially invasive, moderately differentiated endometrial adenocarcinoma that merged with a choriocarcinoma. Immunohistochemical studies showed cytoplasmic staining for human chorionic gonadotrophin in syncytiotrophoblast cells, cytotrophoblast-like cells and rare adenocarcinoma cells. A discussion of previously reported similar cases and possible mechanisms of dual differentiation in tumors, as well as comments on histogenesis are included.