Unresectable stage III non-small cell lung cancer: Insights from a Portuguese expert panel.

INTRODUCTION: The management of unresectable stage III non-small cell lung cancer (NSCLC) is clinically challenging and there is no current consensus on optimal strategies. Herein, a panel of Portuguese experts aims to present practical recommendations for the global management of unresectable stage III NSCLC patients. METHODS: A group of Portuguese lung cancer experts debated aspects related to the diagnosis, staging and treatment of unresectable stage III NSCLC in light of current evidence. Recent breakthroughs in immunotherapy as part of a standard therapeutic approach were also discussed. This review exposes the major conclusions obtained. RESULTS: Practical recommendations for the management of unresectable stage III NSCLC were proposed, aiming to improve the pathways of diagnosis and treatment in the Portuguese healthcare system. Clinical heterogeneity of patients with stage III NSCLC hinders the development of single standardised algorithm where all fit. CONCLUSIONS: A timely diagnosis and a proper staging contribute to the best management of each patient, optimizing treatment tolerance and effectiveness. The expert panel considered chemoradiotherapy as the preferable approach when surgery is not possible. Management of adverse events and immunotherapy as a consolidation therapy are also essential steps for a successful strategy.

Polymorphism in the pvcrt-o and pvmdr-1 genes of Plasmodium vivax associated with a better prognosis for malaria.

The early molecular identification of strains of Plasmodium vivax that have a worse prognosis is important to stratify the risk of complications and choice of conduct made by medical teams. Thus, the aim of the present study was to associate the presence of polymorphisms in the pvmdr-1 and pvcrt-o resistance genes of P. vivax in patients with better or worse prognosis. This cross-sectional epidemiological study was conducted based on data obtained from the records of 120 patients diagnosed with malaria in the Brazilian Amazon. The T958M and F1076L mutations of the pvmdr-1 gene had a frequency of 3.3 and 4.2%, respectively, and primo-infected patients had a 17 times greater chance of being infected with protozoa with the T958M mutation compared to patients with previous episodes. Regarding pvcrt-o, the C393T and T786C polymorphisms had a frequency of 14.2 and 3.3%, respectively, and self-declared white patients had a 3.1 times greater chance of being infected with protozoa with the C393T polymorphism. In addition, patients with this pvcrt-o polymorphism had lower concentrations of C-reactive protein, indicating a better prognosis. These data present clues of genetic indicators useful for assessing the virulence of the parasite and the prognosis of patients with vivax malaria.

Polymorphism in the pvcrt-o and pvmdr-1 genes of Plasmodium vivax associated with a better prognosis for malaria

@#The early molecular identification of strains of Plasmodium vivax that have a worse prognosis is important to stratify the risk of complications and choice of conduct made by medical teams. Thus, the aim of the present study was to associate the presence of polymorphisms in the pvmdr-1 and pvcrt-o resistance genes of P. vivax in patients with better or worse prognosis. This cross-sectional epidemiological study was conducted based on data obtained from the records of 120 patients diagnosed with malaria in the Brazilian Amazon. The T958M and F1076L mutations of the pvmdr-1 gene had a frequency of 3.3 and 4.2%, respectively, and primo-infected patients had a 17 times greater chance of being infected with protozoa with the T958M mutation compared to patients with previous episodes. Regarding pvcrt-o, the C393T and T786C polymorphisms had a frequency of 14.2 and 3.3%, respectively, and self-declared white patients had a 3.1 times greater chance of being infected with protozoa with the C393T polymorphism. In addition, patients with this pvcrt-o polymorphism had lower concentrations of C-reactive protein, indicating a better prognosis. These data present clues of genetic indicators useful for assessing the virulence of the parasite and the prognosis of patients with vivax malaria.

High power and low critical current density spin transfer torque nano-oscillators using MgO barriers with intermediate thickness.

Reported steady-state microwave emission in magnetic tunnel junction (MTJ)-based spin transfer torque nano-oscillators (STNOs) relies mostly on very thin insulating barriers [resulting in a resistance × area product (R × A) of ~1 Ωµm2] that can sustain large current densities and thus trigger large orbit magnetic dynamics. Apart from the low R × A requirement, the role of the tunnel barrier in the dynamics has so far been largely overlooked, in comparison to the magnetic configuration of STNOs. In this report, STNOs with an in-plane magnetized homogeneous free layer configuration are used to probe the role of the tunnel barrier in the dynamics. In this type of STNOs, the RF modes are in the GHz region with integrated matched output powers (P out ) in the range of 1-40 nW. Here, P o u t values up to 200 nW are reported using thicker insulating barriers for junctions with R × A values ranging from 7.5 to 12.5 Ωµm2, without compromising the ability to trigger self-sustained oscillations and without any noticeable degradation of the signal linewidth (Γ). Furthermore, a decrease of two orders of magnitude in the critical current density for spin transfer torque induced dynamics (J STT ) was observed, without any further change in the magnetic configuration.

Femtosecond control of electric currents in metallic ferromagnetic heterostructures.

The idea to use not only the charge but also the spin of electrons in the operation of electronic devices has led to the development of spintronics, causing a revolution in how information is stored and processed. A novel advancement would be to develop ultrafast spintronics using femtosecond laser pulses. Employing terahertz (10(12) Hz) emission spectroscopy and exploiting the spin-orbit interaction, we demonstrate the optical generation of electric photocurrents in metallic ferromagnetic heterostructures at the femtosecond timescale. The direction of the photocurrent is controlled by the helicity of the circularly polarized light. These results open up new opportunities for realizing spintronics in the unprecedented terahertz regime and provide new insights in all-optical control of magnetism.

The aggressiveness of cancer care in the last three months of life: a retrospective single centre analysis.

BACKGROUND: There is concern that terminally ill cancer patients are over treated with chemotherapy, even when such treatment is unlikely to palliate symptoms. The study objective was to evaluate the use of chemotherapy in the last three months of life in a cohort of adult patients with advanced solid tumours. METHODS: All adult patients with solid tumours who died in our hospital in 2003 and received chemotherapy for advanced cancer, were included. Detailed data concerning chemotherapy and toxicity, in the last three months of life, were collected from patients' clinical charts. RESULTS: A total of 319 patients were included. Median age was 61 years. Median time from diagnosis of metastatic disease to death was 11 months. The proportion of patients who received chemotherapy in the last three months of life was 66% (n = 211), in the last month 37% and in the last two weeks 21%. Among patients who received chemotherapy in the last three months of life, 50% started a new chemotherapy regimen in this period and 14% in the last month. There was an increased probability of receiving chemotherapy in the last three months of life in younger patients and in patients with breast, ovarian and pancreatic carcinomas. CONCLUSION: There was a large proportion of patients who received chemotherapy in the last three months of life, including initiation of a new regimen within the last 30 days. Thus, further study is needed to evaluate if such aggressive attitude results in better palliation of symptoms at the end of life.

Tuberculous mesenteric lymphadenitis mimicking pancreatic carcinoma.

Tuberculous mesenteric lymphadenitis is a rare clinical entity and non-surgical diagnosis of this condition remains a challenge. A 38-year-old Indian woman presented with a six-week history of epigastric pain, low-grade fever and anorexia. Upper endoscopy showed a gastric ulcer of the posterior wall of the stomach. On CT scan there was a 8 cm abdominal mass involving the pancreatic body and tail and the endoscopic ultrasonography was also compatible with a cystic pancreatic tumor which had eroded into the stomach. An exploratory laparotomy was performed and the diagnosis of tuberculous mesenteric lymphadenitis was confirmed by bacteriological and histological examinations. Medical therapy was started after surgery. At 18 months she is asymptomatic and abdominal CT scan is normal. Tuberculosis of mesenteric lymph nodes usually raises serious diagnostic problems. A high grade of suspicion is necessary in order to perform a pre-operative diagnosis.

Alveolar adenoma of the lung: further characterization of this uncommon tumour.

Alveolar adenoma of the lung is a poorly characterized, uncommon pulmonary lesion with proliferation of alveolar epithelium and septal mesenchyme. We describe the electron microscopy, immunohistochemistry and DNA flow cytometry in a case of alveolar adenoma in a 55-year-old woman. Alveolar adenoma appears to be a distinct benign neoplasm of the alveolar structures. Our findings further suggest that it is not a precursor of bronchioloalveolar carcinoma or other type II pneumocyte lesions of presumed malignant potential.

Glutathione S-transferase mu polymorphism and susceptibility to lung cancer in the Portuguese population.

Epidemiological studies have led to the suggestion that a genetic basis may exist in the individual variation in predisposition to cancer. Interindividual differences in human toxicological response to carcinogenic exposure have been attributed to heritable polymorphisms in metabolism, namely glutathione S-transferases (GSTs) coding for enzymes that are known to be detoxifiers of carcinogens. Within the human GST mu class, there is a specific isozyme that is frequently lacking. To check whether or not this association exists in the Portuguese population with lung cancer, we used polymerase chain reaction (PCR)-based genotyping to examine GSTM1 polymorphism (nulled and non-nulled) in 84 individuals as a control healthy population and a group of 98 lung cancer patients. In this study we were able to find a frequency of the GSTM1 phenotype among our healthy control subjects consistent with earlier genotyping studies in other Caucasoid populations. For the group of individuals with lung cancer as a whole, or in subsets of histological subtypes, our data for the Portuguese population did not show a positive correlation between the null allele and this neoplasm. In contrast, we found a slight increase in the frequency of the wild-type allele in our lung cancer group.