Should the dosage of propofol be higher and independent of immunosuppressive therapy in adult cystic fibrosis patients undergoing sedation during flexible video bronchoscopy?

OBJECTIVE

Flexible video bronchoscopy (FVB) performed under sedation is a useful procedure in adults with cystic fibrosis (CF). Propofol dosage for CF is poorly described, although it is of high importance for professionals. The study aimed to assess whether propofol dosage should be higher in adults CF undergoing sedation during FVB.

PATIENTS AND METHODS

50 adult CF and non-CF patients undergoing sedation during FVB were included. Clinical features of studied patients were assessed. In CF group spirometry, liver enzymes, inflammatory biomarkers, albumin, protein concentration, WBC were estimated. Propofol and fentanyl dosage was calculated. Multiple regression model was performed.

RESULTS

CF patients were characterized by a lower mean value of body weight and lower mean requirement of total propofol (135 mg in CF vs. 145 mg in non-CF). Calculated propofol dose per kg of body weight was significantly higher in CF (2.43 mg/kg vs. 2.04 mg/kg) and did not depend on the bronchopulmonary disease stage. Propofol dose per kg of body weight was predicted by CF status (CF vs. non-CF), sex, and age.

CONCLUSIONS

Adult CF patients not receiving immunosuppressive therapy require higher propofol dose per kg of body weight compared to non-CF, independently on bronchopulmonary disease stage showing a narrow therapeutic window for propofol in CF group.

Diagnostic value of plasma expression of microRNAs complementary to Drosha and Dicer in lung cancer patients

OBJECTIVE

Lung cancer (LC) is diagnosed mostly in advanced, non-operable stage, with poor prognosis. The analysis of microRNAs may be a useful tool for early and non-invasive detection of cancer. Dicer and Drosha are enzymes with an essential role for microRNA biogenesis. The aim of our study was to analyze the expression of miRNA-27a-3p, miRNA-31, miRNA-182, miRNA-195 with the ability to reciprocal regulation of Dicer and Drosha expression in lung cancer patients.

PATIENTS AND METHODS

The relative expression of microRNAs was detected by qPCR in plasma of 160 LC patients. The U-Mann Whitney test was used to compare the relative expression between particular groups of lung cancer patients and healthy individuals. The diagnostic value of microRNAs examination was analyzed using a receiver operating curve.

RESULTS

We demonstrated that the plasma levels of miRNA-27, miRNA-31 and miRNA-182 were significantly higher and miRNA-195 significantly lower in the whole group of LC patients and in patients with early stages of NSCLC, in comparison with healthy donors. ROC analysis showed that four studied microRNAs have a potential diagnostic value for early stages of NSCLC with AUC=0.95 for miRNA-27a (94% sensitivity and 81% specificity, p=0.0001), 0.71 for miRNA-31 (73% sensitivity and 61% specificity, p=0.001) 0.77 for miRNA-182 (70% sensitivity and 79% specificity, p=0.0001) and 0.82 for miRNA-195 (74% sensitivity and 80% specificity, p=0.0001).

CONCLUSIONS

We have proved that the expression of miRNA-27a-3p, miRNA-31, miRNA-182, and miRNA-195 in patients with LC is different from the expression of these molecules in healthy people. The examination of these microRNAs in plasma could be used in non-invasive lung cancer diagnosis.

Serum from patients with chronic obstructive pulmonary disease promotes proangiogenic behavior of the vascular endothelium

OBJECTIVE

It has been documented that COPD is a risk factor for lung cancer. In COPD patients, changes in lung angiogenesis - a critical process in the development of lung cancer - have been poorly investigated. We aimed to determine whether serum from COPD patients could promote the proangiogenic capabilities of endothelial cells in vitro.

PATIENTS AND METHODS

The research was carried out using sera from COPD patients and healthy volunteers, endothelial cells EA.hy926, and bronchial epithelial cells. The concentration of angiogenic molecules was quantified using ELISA tests. The proliferation and migration of EA.hy926 were tested using fluorescence-based methods. Tube formation was analyzed with a commercially available assay.

RESULTS

Sera from COPD patients and conditioned media generated by epithelial cells exposed to these sera stimulate proliferation, but not migration, of EA.hy926. This coincided with increased tube formation in both experimental regimens. The sera from COPD patients contained increased levels of CCL2, CCL21, and HGF, whereas the conditioned media generated by epithelial cells treated with these sera exhibited increased levels of CCL2, CCL21, CXCL8, FGF, and sICAM-1. The concentration of angiogenic markers in the sera and conditioned media, and their effect on the behavior of the endothelium were independent of smoking status (COPD and controls), stage of obstruction, and disease group (COPD).

CONCLUSIONS

The increased incidence of lung malignancy in COPD patients may be associated, at least to some extent, with the direct and indirect proangiogenic activity of their sera (via alterations in the secretome of epithelial cells).

Survival of Patients with Cystic Fibrosis Depending on Mutation Type and Nutritional Status

The purpose of the study was to evaluate the influence of nutrition and of the severity of mutation type on survival rate in cystic fibrosis (CF) patients. Data were longitudinally collected from 60 hospitalized adult CF patients, aged 18-50. The variables consisted of body mass index (BMI) ratio, Cole's BMI cut-off points, severity of mutation type, and survival rate of CF patients. We found that the mean BMI was strongly associated with the severity of mutation type and was significantly lower in patients with severe mutations of grade I and II. The mutation type significantly affected the patients' survival rate; survival was greater in patients with mild and undefined mutation types. The BMI and Cole's cut-off points also had a significant influence on survival rate. CF patients, who suffered from malnutrition and emaciation, had a shorter survival rate than those with proper nutritional status. In conclusion, the study findings confirmed a significant effect of nutritional status and of mutation type on survival rate of CF patients.

Regulatory T cells in malignant pleural effusions subsequent to lung carcinoma and their impact on the course of the disease

Tumors exert suppressive effects on the host immune system and tumor progression can be linked to functional impairments of immune cells. Regulatory T cells (Treg) are a subpopulation of T lymphocytes and play a key role in suppressing immune responses against autoimmune diseases and cancer. The aim of the study was to investigate the prevalence of Treg in malignant and benign pleural effusions and to evaluate the relationship between Treg frequency and disease advance. Pleural effusions from 76 patients were subjected to a routine laboratory diagnosis and analyzed by conventional cytology. Biological materials were divided into three groups: malignant pleural effusions with malignant cells, effusions from patients with malignancy but without malignant cells, and non-malignant pleural effusions. The frequency of Treg in malignant pleural effusions was significantly higher compared to non-malignant effusions. In general, the increase in Treg frequency was correlated with a decrease in the percentage of lymphocytes and an increase in T CD4+ and T CD4+ CD25+ cells. The highest percentage of Treg was observed among patients with the most advanced clinical stage of lung cancer in terms of size and location of a primary tumor, T4. A Kaplan-Meier survival analysis showed a statistically significant trend towards an adverse outcome for patients representing higher Treg counts. Overall, our results support the extraordinary potential of Treg control in future anticancer therapy.

Methylation of the DCLK1 promoter region in circulating free DNA and its prognostic value in lung cancer patients

INTRODUCTION

The possibility of detection of suppressor genes methylation in circulating free DNA (cf-DNA) of cancer patients and the lack of methylation in healthy individuals makes this epigenetic alternation an ideal diagnostic marker of neoplastic processes. Moreover, hypermethylation in several genes promoter was described as a biomarker of lung cancer. Methylation in the gene encoding doublecortin-like kinase 1 (DCLK1) is observed in patients with colorectal cancer and cholangiocarcinoma. However, there are no studies concerning DCLK1 methylation in lung cancer patients. The aims of the study was to evaluate the frequency of DCLK1 promoter methylation in cf-DNA of lung cancer patients and of healthy persons as well as the usefulness of this test for predicting the lung cancer course.

MATERIALS AND METHODS

DCLK1 methylation status was evaluated in DNA isolated from peripheral blood plasma from 65 lung cancer patients and 95 healthy individuals. After DNA bisulfitation, DCLK1 methylation was determined using the qMSP-PCR technique. Moreover, the presence of DCLK1 methylation was correlated with the overall survival (OS) probability of lung cancer patients.

RESULTS

DCLK1 promoter methylation was detected in 32 lung cancer patients (49.2 %) and 8 healthy individuals (8.4 %). The methylation of the region before transcription start site (TSS) and the region after TSS of DCLK1 gene was detected in 28 and 11 patients, respectively. In seven cases (10.8 %), the DCLK1 promoter methylation in both regions was reported simultaneously. The methylation was observed slightly frequently in patients with small cell lung cancer (75 % of SCLC patients). The median overall survival of patients with DCLK1 promoter methylation was lower than that of patients without DCLK1 gene modification (p = <0.001, HR = 4.235).

CONCLUSIONS

The evaluation of DCLK1 promoter region methylation may be useful in both early diagnosis and prediction of the course of lung cancer.

Impulse oscillometry in the diagnosis of airway resistance in chronic obstructive pulmonary disease

Spirometry is a standard lung function test for diagnosis and staging of chronic obstructive pulmonary disease (COPD). Impulse oscillometry (IOS) can be complementary to spirometry, especially in patients at advanced age and with physical or mental disorders who cannot be diagnosed through spirometry. The aim of this study was to compare IOS and spirometry in the assessment of airway obstruction in COPD. The study was conducted in 112 stable COPD patients, including 29 females and 83 males of the mean age of 69±11 years. The oscillometric evaluation included total (R5), peripheral (R5-R20), and negative reactance (X5), which were compared with the predicted forced expiratory volume in 1 s (FEV1%pred). The findings show a significantly negative correlation between FEV1%pred and the R5, R5-R20, and X5. COPD patients had increased R5, R5-R20, and X5. The severity of bronchial obstruction found by impulse oscillometry correlated well the spirometric assessment. IOS is a simple to perform test that may be helpful for functional examination of COPD patients.

Adipocytokines in sleep apnea syndrome

OBJECTIVE

Biomarkers of adipose tissue may affect glucose and lipid metabolism and present pro-inflammatory properties, thus could be involved in the pathobiochemistry of cardiovascular disease (CVD). The coexistence of sleep apnea syndrome (OSA) and metabolic risk factors of CVD is worth explaining. The aim of the study was to compare the serum adipocytokines in subjects with and without OSA, who had all elevated body mass index (BMI).

METHODS

Overweight (BMI: 25.0-29.9 kg/m2) and obese (BMI: 30.0-39.9 kg/m2) OSA-suspected Caucasian males, aged 30-63, with no acute disease or chronic disorder underwent polysomnographic evaluation to select OSA-positive (AHI > or = 5) and OSA-negative (AHI <5) subjects. Four subgroups were created of 18 persons each: Over(weight)-OSA-Neg, Over-OSA-Pos, Obese-OSA-Neg, Obese-OSA-Pos. In all subjects, plasma carbohydrate and lipid metabolism parameters, and serum uric acid, resistin and leptin concentrations were determined.

RESULTS

A decreased resistin level was observed in Over-OSA-Pos vs. Over-OSA-Neg subjects (P=0.037) as well as in Obese-OSA-Pos vs. Obese-OSA-Neg (P=0.045). No differences in leptin concentrations were observed. A positive correlation between leptin and BMI was in both overweight subgroups and a negative one between resistin and fasting glucose was in both obese subgroups.

CONCLUSIONS

OSA may decrease the serum resistin level in subjects with excess body mass and also may contribute to glucose metabolism, but has no influence on the leptin level.

Endothelium-derived markers and antioxidant status in the blood of obstructive sleep apnea males

Objective

The relationship between obstructive sleep apnea (OSA) and cardiovascular disease is intensively discussed. Endothelial leukocyte adhesion molecule (E-selectin) is one of factors facilitating leukocyte migration to the subendothelial layer which could be considered proatherogenic. The aim of the study was to determine E-selectin levels and total plasma antioxidant status (TAS) in the blood of different stage OSA patients.

Methods

Non-smoking, OSA-suspected males, aged 30-63, were selected for the study. An EMBLA polysomnographic system was used to establish the severity of apneic episodes. The results of apnea/hypopnea index (AHI) allowed dividing patients into the following groups: OSA-0 with AHI 0-4.9 (n = 14), OSA-1 with AHI 5-15 (n = 14), OSA-2 with AHI 16-30 (n = 13), OSA-3 with AHI ≥ 30 (n = 13). Complete blood count (CBC), glycemia during oral glucose tolerance test, fasting plasma lipid profile, uric acid, and high sensitivity C-reactive protein (hsCRP) were estimated among routine parameters. We determined plasma concentrations of E-selectin and total antioxidant status.

Results

We found progressively decreasing concentrations of TAS (P = 0.03) and increased concentrations of E-selectin (P = 0.0001) from OSA-0 to OSA-3 subjects. No correlation between E-selectin and metabolic parameters was noted.

Conclusion

In the studied OSA groups, E-selectin appeared an independent proatherogenic factor.

Comorbidities as an element of multidimensional prognostic assessment of patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation, some significant extrapulmonary effects, and important comorbidities. The BODE index, a multidimensional scale, has been proposed to better identify severity of the disease and to predict survival. The goal of the study was to evaluate the prevalence of concomitant diseases in patients with COPD and to assess correlations between comorbidities and the BODE index. Eighty patients with COPD were enrolled. They were at least 40 years old and had more than a 10-year history of smoking. The most frequent comorbidities were: systemic hypertension, edema of lower limbs, movement disorders, varices of lower limbs. Subjects with higher scores in BODE index had significantly greater prevalence of arrhythmias and episodes of pneumonia. Evident correlation was observed between low FEV(1) and episodes of pneumonia. We also found that patients with higher BODE scores had more exacerbations of COPD. Comorbidities are very common in COPD. Results indicate a close connection between the BODE index and some comorbidities, which suggests that these conditions may aggravate the COPD course and increase risk of mortality.

Tobacco smoking behavior among high school students in Poland

The aim of the study was to examine Polish students' smoking behavior. A group of 671 students completed a questionnaire about smoking. 53.1% of them tried smoking at least once. The most common age at an attempt to smoke was 18 years. Males tried smoking earlier than females. 23.1% were active smokers during the study. The age of 18 was the most common time when smoking became regular. Males smoked more frequently than females. There were significant differences between the kind of school and the frequency of smoking. Students of smoking parents smoked more frequently than those of non-smoking ones. Most smokers (80%) were aware of detrimental effects of addict and declared a will to quit smoking. We conclude that a substantial percentage of Polish students smoke. Anti-tobacco prevention must be started early, before the age of 18 and continued up to 21.

Influence of pleural macrophages on proliferative activity and apoptosis regulating proteins of malignant cells

Malignant tumors contain numerous macrophages as a major component of the leukocytic infiltrate. Only few studies have evaluated the interaction between products secreted by macrophages and tumor cells. Our objective was to study soluble factors produced by pleural macrophages. We sampled pleural effusions from patients with cancer and used human tumor cell lines as targets. Pleural macrophages were cultured and the supernatants were used as a conditioned medium for cultures of human cell lines A549, HT29, HCT116, SW620, MCF7, MDA-MB231, JURKAT, and HL60. We investigated apoptosis, proliferative activity, and expression of apoptosis regulating proteins Fas, Bcl2, Caspase-3, and survivin of malignant cells cultured in the conditioned medium. Our findings raise the possibility that macrophages from malignant pleural effusions can act as a factor inhibiting apoptosis of malignant cells.

Concentration of matrix metalloproteinase-9 in serum of patients with chronic obstructive pulmonary disease and a degree of airway obstruction and disease progression

Chronic obstructive pulmonary disease (COPD) is chronic inflammation leading to irreversible airway obstruction. Previous studies showed increased metalloproteinases (MMP) level, especially MMP-9, as a sign of local inflammation. Up-to-date, only a few studies estimated the MMP-9 serum concentration in COPD with respect to correlation with systemic inflammation. The aim of the present study was to estimate the MMP-9 serum concentration in COPD and to evaluate the correlation between MMP-9 and a degree of airway obstruction in COPD. Twenty three COPD patients and 23 healthy controls were enrolled. In both groups spirometry was performed. MMP-9 concentration in sera taken from both groups was studied using ELISA. We found that COPD patients had increased serum MMP-9 concentration compared with the control group (P=0.0005). In the COPD group, the MMP-9 levels were negatively correlated with FEV1 (P=0.01) and FEV1/FVC (P=0.0002). In conclusion, the results suggest that MMP-9 plays an important role in systemic inflammation in COPD. Higher MMP-9 serum concentration is connected with higher airway obstruction and disease progression.

The impact of the sleep apnea syndrome on oxidant-antioxidant balance in the blood of overweight and obese patients

The aim of the study was to assess the markers of oxidant-antioxidant status in excess body mass index (BMI) persons with and without the obstructive sleep apnea syndrome (OSAS). In overweight (BMI-1: 25.0-29.9 kg/m(2)) control and OSAS and obese (BMI-2: 30.0-34.9 kg/m(2)) control and OSAS subjects with no acute or chronic disorder the following markers were determined: concentration of plasma total antioxidant status, TAS, (Randox); activity of erythrocyte Cu, Zn-superoxide dysmutase, SOD, (Randox); plasma concentration of thiobarbituric acid reacting substances, TBARS, (Yagi method). BMI-1-OSA presented decreased SOD, compared with the BMI-1-C group (P=0.006). BMI-2-OSA showed both SOD (P=0.002) and TAS (P=0.047) decreased, and elevated TBARS (P=0.03) compared with the BMI-2-C group. There was a positive correlation between TAS & SOD and a negative one between TAS & TBARS in the BMI-1-C group. In BMI-2-C, a negative correlation between TAS & TBARS was observed. We conclude that OSAS decreases the blood antioxidant status in high BMI persons and may change the relationship between oxidative stress markers.

Oxidative stress markers in the blood of persons with different stages of obstructive sleep apnea syndrome

The aim of the study was to determine some biochemical factors reflecting oxidant-antioxidant balance in the blood of patients being in different stages of the obstructive sleep apnea syndrome (OSAS). The patients, suspected of OSAS, were submitted to biochemical and somnographic examinations. APolyMesam device was used to establish the severity of apnea episodes. The control group was composed of subjects without OSAS. The following parameters were determined: concentration of plasma total antioxidant status, TAS; activity of erythrocyte Cu, Zn-superoxide dysmutase, SOD; plasma lipid peroxidation products, TBARS. The OSAS patients had lower levels of SOD and TAS, and increased level of TBARS. We conclude that oxidative stress markers increase in the blood of OSAS patients to a variable degree, depending on the severity of the syndrome and, therefore, may be suitable for a clinical follow-up of such patients.

Relationship between nutritional status and pulmonary function in adult cystic fibrosis patients

Cystic fibrosis (CF) is a multisystem autosomal recessive disorder caused by the mutation of a single gene that encodes for the CF transmembrane regulator protein. Clinically, CF is characterized by chronic pulmonary infection, pancreatic insufficiency, and excessive losses of sweat electrolytes. Along with lung function, nutritional status appears one of the most important prognostic indicators in CF patients. In this study we examined the relationship between nutritional status and pulmonary function in adult CF patients. A group of 39 CF patients (mean age 23.9 +/-3.7 years) was studied. The mean value of body mass index (BMI) was 19.5 +/-2.9kg/m(2) (12.8-24.9kg/m(2)). The patients were grouped according to the presence or absence of malnutrition. Malnutrition was established in 11 patients (28.2%), 5 patients suffered from severe malnutrition. 28 patients (71.8%) had a normal nutritional status, but according to ESPEN guidelines, 9 of those patients were at risk of malnutrition. Statistical analysis revealed a significant difference between malnourished and not malnourished patients with respect to FEV(1)% and FVC%. Moreover, the patients with malnutrition were significantly more frequently colonized by P. aeruginosa and fungi and less so by MSSA.

Lung cancer in the elderly--increasing epidemiological problem of 21st century

Lung cancer is the second most common malignant neoplasm after prostate and breast cancers. It is the most frequent cause of death related to neoplasms. The elderly people over 65, are the most numerous population suffering from lung cancer. Risk of incidence and death increases with aging process. In majority of patients, diagnose is established in highly advanced neoplastic process. More than 80% of all types of lung cancers make non-small cell lung cancer (NSCLC) and less than 20%--small cell lung cancer (SCLC). The choice of the managment must be individually considered and should be based on the stage of cancer clinical advance, clinical and functional status, concomitant diseases, nutritional status, cognitive functions. The patients age is not a contradiction for the introducement of the treatment. Surgical treatment is a method by choice at the early stages of NSCLC. Radical radiotherapy should be introduced in the elderly disqualified from the operation. Single-agent chemotherapy seems to be benficial for the elderly with advanced NSCLC in good general condition, mainly due to less toxicity and satisfactory the survival rate. In the cases of SCLC polychemotherapy with prophylactic brain radiation is the first-line managment. Unfortunately, the effectivity of the therapy is occupied by its toxicity. Still frequent occurrence and late diagnosis of lung cancer, high mortality, low efficiency of chemo- and radiotherapy causes the necessity of newer research for more effective screening methods, more effective and safer lung cancer treatment schemes for the elderly.

Challenges in care of adult CF patients--the specialist cystic fibrosis team

Cystic fibrosis (CF) is the most common life-limiting, autosomal, recessive genetic disorder. The gene which is responsible for the symptoms of this disease is located on the long arm of chromosome 7 and encodes the protein called Cystic Fibrosis Transmembrane Conductance Regulator (CFTR), an apical chloride channel in epithelial cells. CF is a "multi-system" disease. It affects many parts of the body and it has a varied clinical expression. All patients with CF should have access to specialist services and the treatment must be comprehensive and multidisciplinary. The multidisciplinary team approach is important when trying to optimize care given to the patient and their family. The cystic fibrosis team may include personnel from the following specialist areas: medical, nursing, physiotherapy, dietetics, psychological, social/supportive. Close coordination is vital. Ideally, 'all members of the team' should have had CF care-related training. The specialist team approach ensures that such specialized multidisciplinary expertise is applied in all aspects of care, better knowledge of individual families, continuity, knowledge of treatment advances and the ability to apply these in daily management. Doubtlessly CF team ensures families a specific point of contact and they know who to talk to. In 1997 The Department of Pulmonology Diseases in Poznań started running a programme for CF adults at our University--the second CF adult centre in Poland. Members of our CF team have experience in the management of adults who have cystic fibrosis. Its members include physicians, nurses, a physiotherpist, a dietitian, a social worker and a psychologist. We must to build the team approach in CF care and use effectively talents of multiprofessional team members as fully as possible to deliver better services to patients.

[Multifocal colonization and hydrolytic activity of Candida strains isolated from lung cancer patients]

The aim was looking for correlation between hydrolytic activity and multifocal Candida invasions in 33 lung cancer patients (LC) before treatment. Materials used in this study were pharyngeal and rectal swab, sputum, bronchial secretion and urine. Isolation and identification of fungi were performed using ID C 32 test and the hydrolytic activity using API ZYM test.

RESULTS

1/ there were only Candida strains, especially C. albicans (78,8 %) isolated 2/ Candida in more than one sample were present in 74%, in three or four in 27,7% of LC. 3/ Candida strains produced 17 among 19 investigated enzymes 4/ there were statistically significant correlations between the activity of some hydrolytic enzymes and number of Candida foci observed.

CONCLUSIONS

1/ the results confirmed the influence of Candida hydrolytic activity on the course of infection. 2/ hydrolytic enzymes activity is one of important Candida pathogenicity factors.

Correlation between DNA content, expression of Ki-67 antigen of tumor cells and immunophenotype of lymphocytes from malignant pleural effusions

Malignant cells isolated from 26 malignant pleural effusions, collected from patients bearing metastatic carcinoma, were examined using flow cytometry. Expression of Ki-67 antigen, DNA ploidy, S phase fraction, DNA index of tumor cells and the percentage of aneuploid cell populations were determined. Lymphoid cells from the same malignant effusions and from 10 nonmalignant ones were examined using a panel of monoclonal antibodies (mAb) versus several CD antigens. While the percentages of T cells (CD3+, CD4+, CD8+) and B cells (CD19+) did not differ significantly in malignant versus nonmalignant effusions, those of CD56+ lymphocytes were found to be significantly depressed in malignant diploid and malignant aneuploid effusions as compared to benign ones. Expression of IL-2 receptors on lymphocytes, demonstrated by anti-CD25 mAb, was significantly higher in malignant diploid and malignant aneuploid effusions as compared with nonmalignant ones. An increase in the percentage of Ki-67-positive malignant cells was significantly correlated with the decrease of NK cells. S phase fraction, DNA index and the percentage of aneuploid populations did not correlate with the picture of lymphoid cells from pleural effusion. On the other hand, the percentage of Ki-67-positive tumor cells in pleural effusions was inversely proportional to the patients' survival time, although it was not statistically significant. Our data suggest that the poor prognosis of cancer characterized by the presence of an aneuploid cell population of malignant cells and the high percentage of proliferating cells in pleural effusions can be linked to the depression of NK cells.

Lung cancer risk in nonsmokers and GSTM1 and GSTT1 genetic polymorphism

Glutathione S-transferase (GST) polymorphism may contribute to the individual variability in detoxifying lung carcinogens. This effect might be particularly relevant at low-level exposure to environmental carcinogens, such as in nonsmokers exposed to environmental tobacco smoke (ETS). We conducted a case-control study among 122 nonsmoking lung cancer cases and 121 nonsmoking controls from eight countries. Information on environmental exposures was obtained through a personal interview. The presence of GSTM1 and GSTT1 genes was determined using multiplex PCR. GSTM1-positive samples were then analyzed for *1A and *1B polymorphism using an allele-specific amplification-PCR method. GSTM1*2 (null) individuals had an odds ratio (OR) of lung cancer of 1.5 [95% confidence interval (CI), 0.9-2.7]; the risk associated with this genotype was higher for cases with squamous and small cell carcinomas (OR, 2.3; 95% CI, 0.9-6.1) than for cases with adenocarcinomas. It was also elevated in individuals with long-term exposure to indoor wood combustion (OR, 3.1; 95% CI, 0.9-9.9), in subjects who mainly lived in a rural setting (OR, 3.6; 95% CI, 1.0-13), and in cases exposed to occupational carcinogens (OR, 10.7; 96% CI, 0.4-260) but not in subjects exposed to ETS. GSTT1*2 subjects did not show a risk of lung cancer. Our study suggests that the effect of GSTM1 polymorphism in nonsmokers is similar to that found in smokers. It does not seem to interact with ETS exposure, although we cannot exclude that it does in association with exposure to other specific environmental carcinogens.

Exposure to environmental tobacco smoke and risk of adenocarcinoma of the lung

We conducted a case-control study of adenocarcinoma of the lung and exposure to environmental tobacco smoke (ETS) in 7 countries. We interviewed 70 cases of adenocarcinoma of the lung and 178 population or hospital controls. All subjects had smoked fewer than 400 cigarettes in their lifetimes. Ever exposure to ETS from the parents during childhood was associated with a decreased risk [odds ratio (OR) 0.6, 95% confidence interval (CI) 0.3-1.2], and there was a suggestion of a decreasing trend in risk with increasing duration of exposure. Ever exposure to ETS from the spouse was not associated with an increased risk (OR 1.0, 95% CI 0.5-1.8), while the OR of ever exposure to ETS at the workplace was 1.5 (95% CI 0.8-3.0). For both exposure sources, an increased risk was observed among the highly exposed, and the OR among those with the highest duration of exposure to ETS from the spouse or at the workplace was 1.8 (95% CI 0.5-6.2). A similar risk was estimated for current exposure to ETS from either source. Our results confirm previous reports of a weak effect of adult ETS exposure on risk of adenocarcinoma of the lung. Bias and confounding cannot be excluded as explanations for the apparent decrease in risk from childhood exposure.

Exposure to environmental tobacco smoke and risk of adenocarcinoma of the lung

We conducted a case-control study of adenocarcinoma of the lung and exposure to environmental tobacco smoke (ETS) in 7 countries. We interviewed 70 cases of adenocarcinoma of the lung and 178 population or hospital controls. All subjects had smoked fewer than 400 cigarettes in their lifetimes. Ever exposure to ETS from the parents during childhood was associated with a decreased risk [odds ratio (OR) 0.6, 95% confidence interval (CI) 0.3-1.2], and there was a suggestion of a decreasing trend in risk with increasing duration of exposure. Ever exposure to ETS from the spouse was not associated with an increased risk (OR 1.0, 95% CI 0.5-1.8), while the OR of ever exposure to ETS at the workplace was 1.5 (95% CI 0.8-3.0). For both exposure sources, an increased risk was observed among the highly exposed, and the OR among those with the highest duration of exposure to ETS from the spouse or at the workplace was 1.8 (95% CI 0.5-6.2). A similar risk was estimated for current exposure to ETS from either source. Our results confirm previous reports of a weak effect of adult ETS exposure on risk of adenocarcinoma of the lung. Bias and confounding cannot be excluded as explanations for the apparent decrease in risk from childhood exposure.

[In vitro susceptibility to antifungal agents of Candida strains isolated from patients with various diseases of the respiratory tract]

The aim of the study was the estimation of in vitro susceptibility to antifungal agents of yeast isolated from sputum of 70 respiratory diseases patients using the disc-diffusion method-antimycogram. The following agents were tested: amphotericin B, 5-fluorocytosine, nystatin, ketoconazole, fluconazole. Only Candida strains were isolated from sputum, 82% of them were Candida albicans. We noted differences in susceptibility to antimycotics of Candida strains. The best antimycotic in vitro was 5-fluorocytosine. 54% of isolated Candida strains were resistant to 1 or more antimycotics.