Extension of the soil monitoring network via tea bag initiatives: A 3000 km latitudinal gradient in European Russia

The increasing popularity and recognition of citizen science approaches to monitor soil health have promoted the idea to assess soil microbial decomposition based on a standard litter sample - tea bags. Although tea bag initiatives are expanding across the world, the global datasets remain biased in regard to investigating regions and biomes. This study aimed to expand the tea bag initiative to European Russia, which remains a "white spot" on the tea bag index map. We also added urban soils into the analysis, which were underestimated previously. We compared the standard and local tea brands to explore possible adaptations of the standard approach to regions with limited access to standard tea brands. The established monitoring network included natural and urban sites in six vegetation zones along a 3000 km latitudinal gradient. There was a very close linear relationship (R2 = 0.94-0.98) in the mass loss of alternative and standard tea litter. The mass loss of green tea in soil along the latitudinal gradient showed an increasing trend from north to south. Variations in the microbial decomposition of green tea were mainly explained by the latitudinal gradient, with low soil temperature identified as key factors hampering decomposition. Mass loss of the more recalcitrant rooibos tea was mainly determined via land use, with decomposition rates on average 1.3 times higher in urban soils. This pattern was in line with higher soil temperatures and pH in urban sites compared to natural counterparts. The findings of our study could prove valuable in extending the tea bag network of soil decomposition assessment into broader territories, including urban areas. Additionally, they could facilitate the involvement of citizen science and complete the database for C cycle modeling depending on climatic conditions.

Are postoperative pain and patient satisfaction influenced by the number of ports in VATS for malignant pleural effusion treatment?

Objectives: The aim of this research is by using sociological methods of scientific research for tracking the pain and satisfaction indicators to prove that decreasing the number of ports in the VATS (Video-assisted thoracic surgery) for Malignant Pleural Effusion reduces postoperative pain and improves patient's satisfaction.Methods: Our study included 117 VATS procedures performed in the period from 01 January 2013 to 31 September 2016. The sociological method used to measure the pain indicator was an interview. The severity of postoperative pain was determined and reported according to a ten-point pain visual analogue scale (VAS). The degree of satisfaction was determined and reported according to a six-point and ten-point grading systems on the basis of a research interview procedure.Results: In the single-port method, the verbal pain scale for all the days covered by the research study statistically showed significantly lower values (P ˂ 0.0001) in comparison with the conventional method (P ˂ 0.0001). With regard to the patient's satisfaction, determined on the basis of the six-point system, the results were as follows: conventional VATS approach - average 3.1 with a standard deviation of 1.1 and ranging from 0 to 5; single-port VATS approach - average 4.3 with a standard deviation of 1.0 and within the range from 0 to 6. Conventional VATS approach - 6.8 - neutral. Single-port VATS approach - 8.1 - prevailing satisfaction.Conclusions: Based on our study and the studies of other authors, it can be concluded that postoperative pain and satisfaction after VATS in patients with MPE (Malignant pleural effusion) are influenced by the number of ports and the one-port technique shows better results than the conventional three-port method.The research study was registered and approved by the Clinical Research and Ethics Committee at the 'Prof. Dr. Stoyan Kirkovich' AD University Multi-Profile Hospital for Active Treatment Hospital, Stara Zagora. According to Protocol No. 11, Ref. No. 12471/30.10.2015 approved are the methods used by the sociological research study which uses predefined indicators to track patients who have undergone conventional VATS and single-port VATS. Indicators: postoperative pain and satisfaction.

Adaptive dynamics of cuticular hydrocarbons in Drosophila

Cuticular hydrocarbons (CHCs) are hydrophobic compounds deposited on the arthropod cuticle that are of functional significance with respect to stress tolerance, social interactions and mating dynamics. We characterized CHC profiles in natural populations of Drosophila melanogaster at five levels: across a latitudinal transect in the eastern United States, as a function of developmental temperature during culture, across seasonal time in replicate years, and as a function of rapid evolution in experimental mesocosms in the field. Furthermore, we also characterized spatial and temporal changes in allele frequencies for SNPs in genes that are associated with the production and chemical profile of CHCs. Our data demonstrate a striking degree of parallelism for clinal and seasonal variation in CHCs in this taxon; CHC profiles also demonstrate significant plasticity in response to rearing temperature, and the observed patterns of plasticity parallel the spatiotemporal patterns observed in nature. We find that these congruent shifts in CHC profiles across time and space are also mirrored by predictable shifts in allele frequencies at SNPs associated with CHC chain length. Finally, we observed rapid and predictable evolution of CHC profiles in experimental mesocosms in the field. Together, these data strongly suggest that CHC profiles respond rapidly and adaptively to environmental parameters that covary with latitude and season, and that this response reflects the process of local adaptation in natural populations of D. melanogaster.

Brownian Carnot engine

The Carnot cycle imposes a fundamental upper limit to the efficiency of a macroscopic motor operating between two thermal baths1. However, this bound needs to be reinterpreted at microscopic scales, where molecular bio-motors2 and some artificial micro-engines3-5 operate. As described by stochastic thermodynamics6,7, energy transfers in microscopic systems are random and thermal fluctuations induce transient decreases of entropy, allowing for possible violations of the Carnot limit8. Here we report an experimental realization of a Carnot engine with a single optically trapped Brownian particle as the working substance. We present an exhaustive study of the energetics of the engine and analyse the fluctuations of the finite-time efficiency, showing that the Carnot bound can be surpassed for a small number of non-equilibrium cycles. As its macroscopic counterpart, the energetics of our Carnot device exhibits basic properties that one would expect to observe in any microscopic energy transducer operating with baths at different temperatures9-11. Our results characterize the sources of irreversibility in the engine and the statistical properties of the efficiency-an insight that could inspire new strategies in the design of efficient nano-motors.

Adipokine pathways are altered in hippocampus of an experimental mouse model of Alzheimer's disease

A growing body of evidence suggests that β-amyloid peptides (Aβ) are unlikely to be the only factor involved in Alzheimer's disease (AD) aetiology. In fact, a strong correlation has been established between AD patients and patients with type 2 diabetes and/or cholesterol metabolism alterations. In addition, a link between adipose tissue metabolism, leptin signalling in particular, and AD has also been demonstrated. In the present study we analyzed the expression of molecules related to metabolism, with the main focus on leptin and prolactin signalling pathways in an APPswe/PS1dE9 (APP/PS1) transgenic mice model, at 3 and 6 months of age, compared to wild-type controls. We have chosen to study 3 months-old APP/PS1 animals at an age when neither the cognitive deficits nor significant Aβ plaques in the brain are present, and to compare them to the 6 months-old mice, which exhibit elevated levels of Aβ in the hippocampus and memory loss. A significant reduction in both mRNA and protein levels of the prolactin receptor (PRL-R) was detected in the hippocampi of 3 months old APP/PS1 mice, with a decrease in the levels of the leptin receptor (OB-R) first becoming evident at 6 months of age. We proceeded to study the expression of the intracellular signalling molecules downstream of these receptors, including stat (1-5), sos1, kras and socs (1-3). Our data suggest a downregulation in some of these molecules such as stat-5b and socs (1-3), in 3 months-old APP/PS1 brains. Likewise, at the same age, we detected a significant reduction in mRNA levels of lrp1 and cyp46a1, both of which are involved in cholesterol homeostasis. Taken together, these results demonstrate a significative impairment in adipokine receptors signalling and cholesterol regulation pathways in the hippocampus of APP/PS1 mice at an early age, prior to the Aβ plaque formation.

Radial integrals <r(k)>4f and nephelauxetic effect of Nd3+ in crystals

The radial expectation values <r(k)>4f,k=2, 4, 6, for oxygen- or halogen- coordinated Nd(3+) ions in 25 crystals have been obtained from experimental Slater parameter shifts ΔFk=Fk (free ion) - Fk (crystal) by means of the dielectric screening model. The <r(k)>4f values found by this new approach are compatible with those computed by relativistic 4f wave functions. The nephelauxetic ratios βk in respect to the free ion Nd IV have been also determined and related to covalency and bonding parameters.

Radiotherapy in the multimodality management of esophageal cancer

Squamous cell carcinoma and adenocarcinoma of the esophagus represent more than 90% of all cases of esophageal carcinoma. Although the incidence of squamous cell carcinoma has decreased, a continues increase in the incidence of adenocarcinoma has been observed, due to the increasing rate of obesity and gastroesophageal reflux disease. Treatment of carcinoma of the esophagus is complex and include surgery, chemotherapy and radiotherapy. The authors investigate the role of radiotherapy in the modern multimodality treatment of esophageal carcinomain order to derive recommendations for its implementation. The results of clinical trials and meta-analysis dealing with the radiotherapy application alone or as chemoradiation in preoperative, postoperative or definitive settings are summarized. When summarizing the data from the clinical trials and the meta-analyzes in esophageal carcinoma radiotherapy recommendations are drawn up. As a single modality radiotherapy is recommended only in palliative setting. Current data indicates that the neoadjuvant chemoradiation followed by the surgery is accepted as a standard treatment achieving 3-year overall survival rateraging between 30% and 60%. No improvement in local control or survival is observed when total irradiation dose is increased over 50.4Gy. Neoadjuvant or definitive chemoradiation became a standard treatmentin locally advanced tumors of the esophagus. Preoperative chemoradiation has proven contribution to improving treatment results when compared to surgery alone in both squamous cell and adenocarcinoma of esophagus. There is also a trend towards improved survival when neoadjuvant chemoradiation is applied compared to neoadjuvant chemotherapy alone. Data in favor of definitive radiotherapy as radical treatment are limited and its use is recommended only in case of palliation.

IS THERE A ROOM IN BULGARIA FOR RADIOTHERAPY OF GASTRIC CANCER?

Gastric cancer is the fourth most common cancer worldwide with one million new casesyearly and the second most frequent cause of cancer death. Although surgery is the leading treatment modality of gastric cancer the survival remains low (5- year survival is reported to be 25% in Europe and 60% in the Eastern world). The risk of locoregional recurrence grows with the increase of the tumor stage. In order to improve locoregional control a number of clinical studies in the last four decades have examined different strategies of adjuvant therapy, including chemotherapy, radiotherapy, chemoradiation with ambiguous results. Various regimens of radiotherapy alone, applied preand postoperatively or in combination with chemotherapy in pre- and postoperative settings have been studied. With the present article, the authors present the world experience of radiotherapy application in gastric carcinoma, supporting its introduction in to Bulgarian clinical practice. The study results concerning this topic have been discussed. SWOG/Intergroup 0116 study showed that postoperative chemoradiation leads to increased 5-year overall survival compared with surgery alone. A recent metaanalysis on randomized trials in operable gastric cancer, found that adjuvant radiotherapy leads to 20 % improvement in disease free survival and overall survival and found no subgroup of patients who do not benefit from adjuvant radiotherapy. The available data from the published studies and metaanalysis completely supports the introduction of chemoradiation for gastric cancer and in Bulgarian radiotherapy practice with the opportunity of gaining own experience.

Stress protein Hsp27 expression predicts the outcome in operated small cell lung carcinoma and large cell neuroendocrine carcinoma patients

PURPOSE

Heat shock protein (Hsp)27 is overexpressed in a range of human cancers and is implicated in tumor cell proliferation, differentiation, invasion, metastasis, and survival. The aim of the present study was to determine the prognostic significance of Hsp27 expression in small cell lung carcinoma (SCLC) and large cell neuroendocrine carcinoma (LCNEC).

METHODS

Surgically resected SCLCs (N=51) and LCNECs (N=15) were studied. The Hsp27 expression was detected immunohistochemically.

RESULTS

Hsp27 positive immunoreaction in the cytoplasm was observed in 45 (88%) SCLCs and 14 (93%) LCNECs. A combination of cytoplasmic with nuclear Hsp27 expression was observed in 28 (62%) SCLCs and 14 (100%) LCNECs. There was a correlation between Hsp27 cytoplasmic overexpression and Hsp27 nuclear expression with patient survival confirmed by Cox multivariate analysis.

CONCLUSION

We conclude that the higher Hsp27 cytoplasmic expression and nuclear expression may represent favorable prognostic factors in SCLC and LCNEC.

Management of upper cervical spine injuries: a review

Upper cervical spine injuries are commonly associated with trauma and require significant forces to produce. When these injuries occur they can have devastating functional consequences. The distinctive anatomy of the upper cervical spine leads injuries to occur in predictable patterns. Injuries can occur to the unique osseus structures or ligamentous connections. Common injuries include occipital condylar fractures, atlanto-occipital dislocation, fractures of the ring of C1, ligamentous injuries involving the ring of C1, and the three types of fractures of C2, pars fractures, odontoid fractures and C2 body fractures. We present these common injuries found in the occipital-atlantoaxial complex and their management based on the current and historical literature.

[Surgical treatment for intralobar pulmonary sequestration in 50-years old woman with aberrant artery from a. gastrica sin]

A case of 50-years old female, operated on for intralobar sequestration with two 2 anomalous arteries in lig. pulmonale inf., one arising from thoracic aorta and the other--from truncus coeliacus of abdominal aorta. The diagnosis was confirmed by CT scan with i.v. and a left lower lobectomy was carried out with exellent long-term result.

[Surgical treatment of pulmonary sequestration--20 years experience]

AIM

To study our experience in the diagnostics and treatment of pulmonary sequestration and to evaluate the long-term postoperative results.

MATERIAL AND METHODS

Between Jan 1989 and Jan 2009. 8 patients (3 men, 5 women, mean age of 23.9 years) were operated on for lung sequestration. Sequestration was intralobar in 6 cases and extralobar in 2 cases. The abnormality was discovered by chance in 2 patients. The most frequent clinical manifestation was those of recurrent bronchopneumonia. Chest X-rays showed an apparently benign, posterobasal image in 75% of the cases. Arteriography was performed in 2 patients and revealed an abnormal systemic artery. Computerized tomography imaging with i.v. contrast confirmed the diagnosis in 6 patients. The intralobar type of sequestration was treated by lobectomy, and the extralobar type by sequestrectomy.

RESULTS

The operative mortality and the morbidity rates were nil. The mean in-hospital stay was 7.75 days. The long-term postoperative results (follow-up from 5 to 20 years) are considered excellent.

CONCLUSION

The surgery is a method of choice in the treatment of pulmonary sequestration. with low rate of postoperative complications and excellent long-term results.

[Pleural tent after upper lobectomy--randomized study of it's efficacy and duration of the effect]

The aim of our study is to evaluate the safety, efficacy and also the maximum duration of effect of the pleural tent in reducing the incidence of air leak after upper lobectomy.

METHODS

Sixty patients who underwent upper lobectomy were prospectively randomized into two groups: 30 patients had creation of pleural tent (group 1) and 30 did not (group 2). The preoperative, operative, and postoperative characteristics of both groups were compared. Then multivariate analyses were used to identify factors predictive of prolonged air leaks and their duration. The reduction of incidences of air leak in the two groups was subsequently compared during successive postoperative periods.

RESULTS

Demographic and clinical profiles of both groups were not statistically different. The tented patients had statistically significant reduction of mean duration of air leak in days (4.9 +/- 1.79 vs 8.2 +/- 4.2), the number of days of a chest tube duration (7.3 +/- 1.14 vs 12.46 +/- 3.6), the length of postoperative in-hospital stay in days (9.4 +/- 1.86 vs 13.6 +/- 2.49), and the hospital stay cost per patient (leva, 3840 +/- 298 vs 5160 +/- 3890). Logistic regression analyses showed that no having creation a pleural tent procedure was the most significant predictive factor of the occurrence and duration of prolonged air leaks. A greater reduction in the duration of air leaks was observed before postoperative day 4 in group 1, and logistic regression analysis showed that having a pleural tent procedure was the most significant predictive factor of air leaks that persisted for less than 4 days.

CONCLUSIONS

Pleural tent creation after upper lobectomy is a simple and safe procedure that reduces the duration of air leaks and the hospital stay costs. The benefit from that procedure is achieved before postoperative day 4.

[Surgical treatment of pulmonary metastases--surgical methods, early and long-term results]

AIM

To retrospectively evaluate the postoperative results after surgery for lung metastases from extrapulmonary origin.

METHODS

A total of 45 patients were operated on for lung metastases between Jan 1996 and Dec 2006. They were 22 (48.9%) male and 23 (51.1%) female with a mean age of 51.6 years. Unilateral operation was carried out in 34 (75.6%) of the patients and another 11 (24.4%) patients were operated on for bilateral metastases. In 8 of them a one-stage operation was performed via median sternotomy (6) and bilateral successive thoracotomies (2). Two-stage strategy was applied in 3 patients. Metastasectomy via sternotomy as a surgical procedure was performed in all cases with bilateral lesions. In one case with one-stage successive thoracotomies a lobectomy and metastasectomy were used. In the group of unilateral operation the following procedures were carried out: metastasectomy in 23 (51%), lobectomy in 7 (15.6%), extended lobectomy in 2 (4.4%), sleeve lobectomy in 1 (2.2%) and polysegmental resection in 1 (2.2%). VATS was applied in 6 (13.3%) patients.

RESULTS

No 30-day postoperative mortality was faced. There were 3 (6.7%) minor postoperative complications. The mean number of resected metastases was 2.3 per patient. The primary tumor sites were as follow: colorectal carcinoma--15 (33.3%); renal carcinoma--5 (12.1%); breast carcinoma--6 (13.3%); soft tissue fibrosarcoma--6 (13.3%); osteosarcoma--4 (8.9%); melanoma--1 (2.2%); gastric carcinoma--1 (2.2%), thyreoid gland carcinoma--1 (2.2%); suprarenal carcinoma--1 (2.2%) and carcinoma of salivary gland type--1 (2.2%). Mediastinal lymph nodes dissection was carried out in all patients and in 5 (12.1%) was found a metastatic mediastinal lymph nodes involvement. Adequate control of primary site tumor was achieved in all patients. Until the end of the study 01.01.2008, 19 (42.2%) of the patients are alive. The median survival was 38 months with 95% Confidence Interval (33-43). The gender (p=0.194), metastases diameter (p=0.211), mediastinal lymphnode involvement (p=0.102), initial clinical symptoms (p=0.233) and the primary site stage (p=0.091) can not be considered as a prognostic factors. The prognosis was significantly influenced by histology (p=0.0275), but because of small number of cases in the groups result should be interpreted with caution. The disease free interval (p=0.0348) and metastases number > 3 (p=0.0456) are considered prognostic factors.

CONCLUSION

Surgery is an integral part of multimodality treatment of lung metastases with low postoperative complication rate and good long-term results. Respectability, "disease free interval" and number of metastases are considered to be the main prognostic factors.

[The role of resection surgical techniques in complex treatment of multi-resistant pulmonary tuberculosis]

A total of 16 patients with pulmonary resections for MDR-TB are included in a retrospective study for a period of 7 years. They are 9 (63.4%) male and 7 (36.3%) female with an average age of 32.6 years. Unilateral cavitary lesions are visualized in all patients. Bilateral changes are found in 9 (55.5%) patients, but the contralateral lesions are predominantly nodules and fibrosis. Multi-drug resistance was observed to an average of 4.4 anti-TB medicines. The mean duration of the preoperative re-treatment regimens is 4.9 months. Despite the preoperative anti-TB treatment, 8 (50%) of our patients are positive at the time of surgery. The following operations are carried out: lobectomy (68.75%), lobectomy with S6 (6.25%) and pneumonectomy (25%). No intraoperative and 30-day postoperative deaths are observed in our cohort. Postoperative complications are found in 4 (25%) of the cases. The mean postoperative in-hospital stay is 10.2 days. The postoperative anti-TB regimens are administered for at least 18 months, but in most of the patients their duration is 24 months. Postoperative follow-up is possible in all patients for the mean period of 34 months. Relapse of the disease is found in 3 (18.75%) preoperatively positive patients. Late mortality is observed in 1 (6.2%) patient 9 months after pneumonectomy due to relapse and empyema development. Eight (50%) of the patients are under follow-up program without medication. The rest 5 (31.25%) patients are negative but still on anti-TB regimens. In conclusion, we feel that pulmonary resections are of a paramount importance as an adjunctive method in the complex treatment of MDR-TB with good postoperative results.

[Results of the operative treatment of primary pulmonary sarcomas]

OBJECTIVE

To study and evaluate clinic, diagnostics and operative treatment of patients with primary pulmonary sarcomas (PPS).

MATERIAL AND METHODS

During 24 years period, a total of 49 patients underwent surgery for PPS. There were 29 male and 20 female with a mean age of 52.6 years. Main presenting complaints were shortness of breath, cough, chest pain, weight loss and haemoptysis. Correct preoperative diagnosis was obtained in 12 (24.48%) of the patients by bronchoscopy or percutaneous core biopsy. Carcinoma was diagnosed in 14 (28.6%) of them. Almost half of the cases were operated on without histological confirmation for suspected malignancy. The histological diagnoses were fibrosarcoma (16), fibroleiomyosarcoma (10), leiomyosarcoma (6), rhabdomyosarcoma (7), hemangiopericytoma (3), epitheloid hemangioendothelioma (3), undifferentiated sarcoma (2), malignant schwannoma (1) and liposarcoma (2). Only 2 of the tumors were scored in grade 1. The rest were classified in higher grades of malignancy. The following operations were carried out: lobectomy--30 (59.2%), including 2 sleeve lobectomies; pneumonectomy--10 (20.4%), polysegmental resections--3 (6.2%) and atypical resection--1 (2%). The resections were extended to the thoracic wall, diaphragm or pericardium in 4 patients. Endoscopic laser resection was applied in 1 (2%) case. Exploratory thoracotomy was performed on 3 (6.1%) patients. There were 2 (4.1%) stage I A; 26 (53.1%) stage I B; 11 (22.4) stage II B; 5 stage III A; 4 stage III B and 1 stage IV.

RESULTS

No postoperative death occurred. Postoperative empyema was observed in 2 cases (4.1%) and 1 patient (2%) was reoperated on for local recurrence 18 months after surgery. Adjuvant therapy was administered to 20 of the patients. Follow-up (range, 6 to 160 months) was available for 41 patients. The actuarial 5-year postoperative survival was 51.8% with mean survival of 40.8 months.

CONCLUSION

The correct preoperative diagnosis of PPS still presents a challenge. There are no specific clinical, imaging and other signs for this tumor evaluation. Surgery with systematic lymphnode dissection is a treatment of choice with an acceptable 5-year survival rate. Only the complete resection and the low stages of the tumor significantly influence survival.

[Spontaneous pneumomediastinum: clinic, diagnostics and treatment]

Spontaneous pneumomediastinum (SPM) is an uncommon, benign, self-limited disorder that usually occurs in young adults without any apparent precipitating factor or disease. The purpose of this study was to review our experience in dealing with this entity and detail a reasonable course of assessment and management. A retrospective case series of 4 patients with SPM were diagnosed and treated in a Thoraci Surgery Department at Saint Sofia Pulmonary Hospital between 2000 and 2006. The patiets' group included 3 male and 1 female with a mean age of 17.5 years (between 15 and 21). Acute onset chest pain was the predominant symptom at presentation. All of the patients developed clinically evident subcutaneous emphysema. Chest radiography and computerized tomography (CT) were diagnostic in all cases. Esophagogram and flexible bronchoscopy were used in all cases as well. All 4 patients were admitted to the hospital. Their mean hospital stay was 1.5 (between 1 and 2) days. All patients were conservatively treated. In a follow-up of 1-6 years no complications or recurrences were observed. In conclusion, SPM follows alveolar rupture in the pulmonary interstitium. It has a wide range of clinical features necessitating a high index of suspicion. Chest X-ray and CT scan should be always performed. Hospitalization and aggressive approach should be limited. SPM responds well to conservative treatment and follows a benign natural course.

[112 years of hydatid surgery in Bulgaria (1895-2007)]

Hydatid surgery in Bulgaria dates back of a hundred years. Most of famous Bulgarian surgeons have worked about problem of all locations of the Echonococcus granulosus in the human organism. Their scientific achievements are covered in more of two hundred theses, publications, dissertations. The hydatid disease always was in the schedule of every scientific forums - congresses, conferences, etc. A Bulgarian scientific council has been established with a great experience and very good postoperative results. It's many innovations in diagnostics and surgical treatment, accepted all over the world. Renovations of work in this field are develop. Prophylactic measures for this severe and common disease have been undertaken.

[Single-stage bilateral video-assisted thoracic surgery (VATS) in treatment of patients with primary spontaneous pneumothorax]

From January 2003 to April 2006, a total of 6 patients (mean age of 16.7 years) underwent single-stage bilateral VATS for primary spontaneous pneumothorax (PSP). All 6 patients had at least one episode of pneumothorax, requiring tube thoracostomy. Two patients had 2 previous ipsilateral episodes and 2 patients were with one episode in both sides each. One patient, operated on by VATS in another department, was with recurrence in the previously treated side. Chest CT revealed preoperatively bilateral apical bullae in 5 (83.3%) patients. Video-assisted thoracic suturing of apical bullae by Endo-Stitch was carried out in 8 pleural cavities, while in the last 2 pleural cavities apical bullae were resected using an Endo-GIA. Pleural abrasion was performed in 1 patient and the rest 5 patients had apical pleurectomy. Autologous fibrine glue was additionally applied in 3 cases for covering of suturing or resectional lines. No intraoperative complications or mortality were faced. The mean operative time was 87 minutes. No postoperative complications were observed. Mean duration of pleural drainage was 3.5 days. Postoperative hospital stay was 4.7 days. The mean follow-up was 10.3 months. One patient (the case without bullous pulmonary changes and with pleural abrasion) experienced left ipsilateral recurrence 19 months after the operation. He was reoperated on by VATS and apical pleurectomy was carried out. All patients restored their full working capacity within 1 month after the operation. They are doing well, no recurrence has been observed. In conclusion, we believe that single-stage bilateral operation by VATS is a safe procedure with excellent early and long-term results in patients with simultaneous bilateral PSP and in carefully selected young patients with ipsilateral PSP.

[Lung volume reduction surgery in treatment of diffusion pulmonary emphisema in case of chronic obstructive pulmonary disease]

Lung volume reduction surgery (LVRS) has become a palliative surgical method for selected patients with advanced pulmonary emphysema and disabilitating dyspnea The beneficial effects have been documented by numerous case series and by several randomized controlled trials. In well-selected patients the perioperative mortality does not exceed more than 5% in experienced centers and the expected improvement in FEV1 is a range of 30-60% at 3 to 6 months. Thereafter the lung function steadily declines, but the effect lasts for up to 4 to 6 years. Different approaches and surgical techniques are carried out, and most of the authors recommend bilateral lung volume reduction by video-assisted thoracic surgery. This therapeutic option was used alternatively in patients who were suitable candidates for lung transplantation, and several groups could demonstrate that transplantation could be postponed by 2 to 4 years after bilateral LVRS. The procedure itself does not jeopardize the chances for subsequent successful transplantation.

[Anatomical pulmonary resections via median sternotomy]

During a 10-year period a total of 5 anatomical pulmonary resections (2 lobectomies, 2 pneumonectomies with mediastinal tumor extirpation and 1 polysegmental resection-S1-3) were carried out in 4 patients via median sternotomy. They were operated on for bilateral complicated pulmonary hydatidosis (2), mediastinal teratocarcinoma with right lung invasion and mediastinal Hodgkin's disease after chemotherapy failure. The mean operative time was 161 minutes, and the mean in-hospital stay was 12.75 days. The postoperative period was complicated in 1 patient by pulmonary edema, successfully treated by medication. Teratocarcinoma patient died on the 73th postoperative day with disease progression. The long-term postoperative results in the rest 3 cases (follow-up between 5 and 8 years) are considered very good. In conclusion, median sternotomy is acceptable approach for unilateral or bilateral pulmonary resections in carefully selected patients.

Reduction of postprandial hyperglycemia in patients with type 2 diabetes reduces NF-kappaB activation in PBMCs

AIMS/HYPOTHESIS

Short-lasting hyperglycemia results in activation of the transcription factor NF-kappaB in peripheral blood mononuclear cells. We therefore studied whether the postprandial increase in glucose is sufficient to induce mononuclear NF-kappaB activation and whether blunting postprandial hyperglycemia with the alpha-glucosidase inhibitor acarbose reduces NF-kappaB activation.

METHODS

20 patients with type 2 diabetes were included in a double-blind randomized trial receiving 100 mg acarbose or placebo three times a day over a period of eight weeks. Peripheral blood mononuclear cells were isolated before and 120 minutes after a standardized breakfast. NF-kappaB binding activity was estimated by electrophoretic mobility shift assay and NF-kappaB-p65; translocation was determined by Western blot.

RESULTS

Eight weeks of treatment with acarbose significantly reduced postprandial hyperglycemia (p = 0.004 when compared to placebo), postprandial mononuclear NF-kappaB-binding activity (p = 0.045) and nuclear translocation of NF-kappaB-p65 (p = 0.02).

CONCLUSION

Reduction of postprandial glucose peak levels by acarbose reduces postprandial mononuclear NF-kappaB activation.

[Surgical treatment of chronical pulmonary abscesses--contemporary treatment]

Between Jan 1991 and Dec 2000 a total of 67 patients were operated on for chronic primary pulmonary abscesses. They were 57 men and 10 women with mean age of 46.2 (range, 12 to 72) years. The indications for surgery was mainly "delayed closure" following medical therapy and percutaneous tube drainage (3), as well as a massive hemoptysis in 4 cases. CT scanning and brochoscopy were performed in all patients. The majority of them had multiple isolates (51/67) of both aerobic and anaerobic (predominantly Bacteroides sp., Fusobacterium sp., and Peptococci) organisms. The following operations were carried out: lobectomy (52) including 8 decortications, bilobectomy (5), pneumonectomy (4) including two pleuro pneumonectomy, polysegmentectomy (4) and segmental resection (2). The 30-day hospital mortality rate was 1.49% (1 patient died following rethoracotomy for bronchial stump fistula with empyema and polyorganic insufficiency). Major postoperative complications were 6 (8.9%) and included 3 pleural empyema (additional drainage), two rethoracotomy for intrapleural bleeding and one residual pleural cavity, treated by thoracoplasty. Minor postoperative complications (atelectasis, wound infection and prolonged air-leakage) were observed in 9 patients (13.4%). The long-term results (following-up ranged from 6 to 112 weeks) are considered very good. In conclusion, surgery is indicated for patients with significant hemoptysis, suspected malignancy and those with "late healing" abscesses with acceptable postoperative results, although the rate of major postoperative complications remains relatively high.

[Surgical treatment of chronic pleural empyema--seven years' experience]

During a 7 years period a total of 112 patients with chronic pleural empyema were operated on. There were 92 male and 20 female with mean age of 48.4 years. The mean duration of empyema clinical manifestation up to the operation was 59 days. Pleurectomy and decortication were carried out in 99 patients and in the other 5 cases they were associated with pulmonary resection. Additional thoracoplasty was necessary in only 7 patients. Rethoracotomy for hemostasis was performed in 5 (5.6%) patients. The overall postoperative mortality was 5.6%. The mean hospital stay after pleurectomy and decortication was 13 days and after the thoracoplasty it was 19 days. The follow-up period was 6 months for 84 (75%) and 12 months for 70 (62%) of the patients. No disease relapse was observed. Pulmonary function was improved after 3 to 6 months in the majority (89%) of the patients. Fully recovered working capacity was found in 44% of the patients.

[Diagnosis and surgical treatment of pulmonary sequestration]

Between Jan. 1988 and Jan. 2003 4 patients (3 male, 1 female, mean age of 20 years) were operated on for lung sequestration. Sequestration was intralobar in 3 cases and extralobar in 1 case. The abnormality was discovered by chance in 1 patient. The most frequent clinical manifestation was those of recurrent bronchopneumonia. X-ray films of the chest showed an apparently benign, posterobasal image in 80% of the cases. Arteriography was performed in 1 patient and revealed an abnormal systemic artery. Computerized tomography imaging with i.v. contrast confirmed the diagnosis in 3 patients. The intralobar type of sequestration was treated by lobectomy and polysegmental resection--S7-12, and the extralobar type--by sequestrectomy. The operative mortality and the morbidity rate were nil. The mean stay in hospital was 10 days. The long-term postoperative results are considered excellent.

[Indications for the surgical treatment in bronchiectasis and postoperative results]

During Jan. 1990 and Dec. 2002 a total of 14 patients with bronchiectasis were operated on. They were 5 female and 9 male with mean age of 35.7 years. In two of them (14.3%) the disease was with bilateral localization. Patients were typically presented with cough and purulent sputum production 12(85.7%), recurrent pulmonary infections 8(57.1%), halitosis 6(42.9%) and hemoptysis 4(28.6%). The mean duration of clinical manifestations was 8.4 years. The indications for surgery were failure of medical treatment in 10(71.4%) patients, hemoptysis in 2(14.3%) and lung abscesus, as a complication in 2(14.3%) patients. The operative methods included 9(64.3%) lobectomies, 1(7.1%) pleuropneumonectomy, 1(7.1%) pneumonectomy, 1(7.1%) bilobectomy with broncho-esophageal fistula resection, 1(7.1%) middle lobectomy with polysegmental resection S7-10 and 1(7.1%) polysegmental resection S7-10. No 30-day postoperative death was faced. Major complications, followed by rethoracotomy, were found in 2(14.3%) of the cases. The postoperative results were excellent in 8(57.1%) of the patient, very good in 5(35.75) of them and in only 1 patient there was no clinical improvement. In conclusion, surgery for bronchiectasis is followed by acceptable postoperative complications and better long-term result after radical operation.

[Video-assisted thoracoscopic surgery (VATS) for treatment of pleural empyema]

During 1996-2003 a total of 359 patients were treated for empyema. Forty eight of them (with parapneumonic empyema) were prospectively randomized into 2 groups of 24 patients who underwent early decortication either by thoracotomy or VATS. Comparing to thoracotomy group, VATS group had a significantly shorter chest tube duration (5.8+/-1.1 vs 9+/-1.3 days; p=0.03) and postoperative in-hospital stay with parapneumonic empyema (8.7+/-0.9 vs 12.8+/-1.1 days; p=0.009). VATS has been found to be particularly useful for treating the fibrinopurulent phase of empyema, in which multiple loculations could be easily disrupted to allow adequate drainage of a "cleaned" pleural space. On the other hand, although VATS is highly effective, it is not indicated in every patient and it's indiscriminate use may lead to none required operative interventions.