A Case Study of Vitamin D Supplementation Therapy and Acute Respiratory Tract Infection

BACKGROUND

Low serum concentrations of 25-hydroxyvitamin D correlate with higher susceptibility to acute respiratory tract infections (ARTIs). The case study presented here aims at sheding light on the correlation between vitamin D levels, the vitamin D supplement dose, and the incidence of ARTIs.

CASE REPORT

A 23-year-old female patient with a vitamin D insufficiency was able to successfully increase her vitamin D levels from 45.60 nmol/l to 85.91 nmol/l (reference ranges 75-200 nmol/l) through the use of supplements. However, it was surprising to observe a decrease in vitamin D levels even though the patient continued taking supplements. Further examination indicated that the patient was experiencing common symptoms of an acute respiratory tract infection (ARTI). This case highlights the intricate connection between ARTIs and vitamin D intake.

CONCLUSION

This case study clearly demonstrates the intricate connection between vitamin D levels, supplement treatment, and ARTIs. The observed decrease in vitamin D levels during the course of supplementation, while the patient was suffering from an ARTI, suggests that respiratory infections may affect vitamin D metabolism.

OPG, OPN, EGF and VEGF Levels at Individual Breslow Score Stages in Malignant Melanoma

BACKGROUND/AIM

Melanoma represents one of the most aggressive forms of cancer. With the rapid increases in the incidence of melanoma in the United States, Australia and Europe over the last decades, melanoma has been considered an epidemic cancer in these areas. The aim of our study was to evaluate the utility of osteoprotegerin (OPG), osteopontin (OPN), epidermal growth factor (EGF) and vascular endothelial growth factor VEGF for the diagnosis and prognosis of melanoma.

PATIENTS AND METHODS

Overall, 322 individuals were assessed: 183 melanoma patients and 139 healthy individuals. Melanoma patients were divided into four subgroups according to the Breslow score. OPN, OPG, EGF, and VEGF were determined in each plasma sample.

RESULTS

The serum levels of the following biomarkers were statistically significantly higher in the melanoma group compared to the control group: OPG and, OPN (p<0.0001), EGF (p=0.0379). In the first stage, OPG (p=0.0236) and OPN (p=0.0327) showed a statistically significant increase. Concerning positive and negative sentinel node metastases a statistically significant change was observed in: OPN (p<0.0001), EGF (p=0.0114), VEGF (p=0.0114).

CONCLUSION

OPG and OPN are promising biomarkers of early-stage melanoma. EGF and VEGF appear to be prognostic biomarkers.

Stability of total prostate-specific antigen and free prostate-specific antigen after 10 years’ storage

Introduction:

PSA is a serine protease composed of 240 amino acids in a single polypeptide chain and is a routine parameter in prostate cancer diagnostics. The aim of our study was to test the long-term stability of tPSA and fPSA after 10 years’ storage at −80°C.

Materials and methods:

We analyzed two aliquots from 55 serum samples. The first was assayed in routine testing at the time of establishing the diagnosis. The second was thawed for further testing after approximately 10 years’ storage at −80°C. The mean of storage time was 10.41 years (min–max: 9.35–11.40 years). We compared the results of tPSA and fPSA. We calculated the fPSA/tPSA ratio and compared the results of clinical evaluation. Serum tPSA and fPSA levels were assayed using chemiluminescent kits Access Hybritech PSA and free PSA. All measurements were performed using the instrument UniCel® DxI 800.

Results:

tPSA decreased 3.59% on average with a correlation r=0.9213, and fPSA increased at an average of 2.41% with a correlation r=0.9338. The fPSA/tPSA ratio increased 0.80% on average with a correlation r=0.9174. On clinical evaluation, five samples had fallen to a less malignant category and three samples had risen to a higher malignant category compared with the original results.

Conclusion:

The stability of tPSA and fPSA levels in serum is sufficient after 10 years’ storage at −80°C. Calculation of the fPSA/tPSA ratio is not recommended due to the change in the category of malignancy of 15% of the samples.

A comparison of electrochemically pre-treated and spark-platinized carbon fiber microelectrode. Measurement of 8-oxo-7,8-dihydro-2'-deoxyguanosine in human urine and plasma

A novel method of carbon fiber microelectrode activation using spark discharge was demonstrated and compared to conventional electrochemical pretreatment by potential cycling. The spark discharge was performed at 800 V between the microelectrode connected to positive pole of the power supply and platinum counter electrode. Spark discharge led both to trimming of the fiber tip into conical shape and to the modification of carbon fiber microelectrode with platinum, as proven by scanning electron microscopy and electron dispersive X-ray spectroscopy. After the characterization of electrochemical properties using ferricyanide voltammetry, the activated electrodes were used for electrochemical analysis of 8-oxo-7,8-dihydro-2'-deoxyguanosine, an oxidative stress marker. Subnanomolar detection limits (0.55 nmol L(-1)) in high-performance liquid chromatography were achieved for spark platinized electrodes incorporated into the flow detection cell.

Searching for New Biomarkers and the Use of Multivariate Analysis in Gastric Cancer Diagnostics

AIM

The first aim of this study was to search for new biomarkers to be used in gastric cancer diagnostics. The second aim was to verify the findings presented in literature on a sample of the local population and investigate the risk of gastric cancer in that population using a multivariant statistical analysis.

PATIENTS AND METHODS

We assessed a group of 36 patients with gastric cancer and 69 healthy individuals. We determined carcinoembryonic antigen, cancer antigen 19-9, cancer antigen 72-4, matrix metalloproteinases (-1, -2, -7, -8 and -9), osteoprotegerin, osteopontin, prothrombin induced by vitamin K absence-II, pepsinogen I, pepsinogen II, gastrin and Helicobacter pylori for each sample.

RESULTS

The multivariate stepwise logistic regression identified the following biomarkers as the best gastric cancer predictors: CEA, CA72-4, pepsinogen I, Helicobacter pylori presence and MMP7.

CONCLUSION

CEA and CA72-4 remain the best markers for gastric cancer diagnostics. We suggest a mathematical model for the assessment of risk of gastric cancer.

The Role of TPS and TPA in the Diagnostics of Distant Metastases

AIM

The aim of the study was to assess the degree to which tissue polypeptide antigen (TPA) and tissue polypeptide-specific antigen (TPS), as well as carcinoembryonic antigen (CEA), can assist in the detection of distant metastases.

PATIENTS AND METHODS

We assessed 157 patients with colorectal and breast cancer divided into two groups. The first was a group of patients with cancer at stages 1, 2 and 3; the second was a group of patients with cancer at stage 4 with metastasis.

RESULTS

We found significantly higher levels of all biomarkers in the metastatic group compared to the group with cancer at stages 1-3 (p<0.0001). The calculated area under the receiver operating characteristic (ROC) curve was 0.9929 for TPS, 0.9337 for TPA and 0.7234 for CEA. The cut-off was calculated for each biomarker at 95% specificity, TPS cut-off=255 IU/l (sensitivity 95%), TPA cut-off=200 IU/l (sensitivity 70%) and CEA cut-off=18 μg/l (sensitivity 37%).

CONCLUSION

We suggest combining CEA with TPS or TPA in the detection of distant metastases or using only cytokeratins. This approach can significantly increase the quality of detection of the metastatic process.

Portal vein embolisation with application of haematopoietic stem cells in patients with primarily or non-resectable colorectal liver metastases

BACKGROUND

Insufficient future liver remnant volume (FLRV) is the main cause of low resectability of liver metastases from colorectal cancer (CLMs). One option for enhancing FLVR growth is the use of portal vein embolisation (PVE) with the application of autologous haematopoietic stem cells (HSCs).

PATIENTS AND METHODS

PVE with the application of HSCs was used in 11 patients (group 1) with primarily non-resectable CLMs due to insufficient FLRV without signs of extrahepatic metastases. The control group (group 2) consisted of 14 patients in whom only PVE was performed. We evaluated the product quality, FLRV growth, CLM volume, median survival and progression-free survival (PFS).

RESULTS

Product quality was achieved in all collections. In all group-I patients, sufficient FLRV growth occurred within three weeks. In the first and second weeks, FLRV increased optimally in most patients (p<0.006). In 13 out of the 14 group-2 patients, optimum FLVR growth was observed within three weeks following PVE (p<0.002). More rapid FLVR growth was observed in group 1 patients (p<0.01). CLM volume was significantly increased in both the group-2 (p<0.0005) and group-1 (p<0.008) patients at the time of liver resection. There was no significant difference in the growth of the CLM volume between the groups (p<0.18). The median survival was 7.3 and 6.8 months for group 1 and 2 patients, respectively, and the two-year PFS was 28% and 22% (p<0.18), respectively.

CONCLUSION

PVE with HSC application is a promising method for effectively stimulating FLRV growth in patients with primarily non-resectable CLMs.

Surgical treatment of colorectal cancer pulmonary metastases: 12-year results

The objective of the present study was to retrospectively analyze a cohort of patients who underwent surgery for colorectal cancer pulmonary metastases during a 12-year period.

PATIENTS AND METHODS

The sample included 75 patients who were monitored in terms of overall survival (OS) and disease-free interval (DFI) in relation to patient's age, preoperative values of biomarkers, type of surgery, number and size of metastases, occurrence of complications and length of hospitalisation.

RESULTS

A total of 95 surgical interventions were performed and 133 metastases were removed. Out of these, 28% of patients were free of any signs of relapse or disease progression for 5 years after metastasectomy. Those with two or more metastases are 2.3-times more at risk of disease progression. Tissue polypeptide specific antigen (TPS) values above the 140 IU/l cut-off point increase the risk of progression 3.9-times. The five-year survival rate among the group was 45%. Patients with 2 or more metastases are 2.7-times more at risk of death. TPS values above the 140 IU/l cut-off increase the risk of death 5.5 times, and carbohydrate antigen CA19-9 values above the 28 IU/ml cut-off point increase the risk of death by 3.2 times.

CONCLUSION

The number of metastases and the preoperative TPS values are decisive prognostic factors influencing both OS and DFI.

Surgical therapy of pulmonary metastases - 10-year results

INTRODUCTION

The surgical therapy of selected secondary pulmonary tumors, including both solitary and multiple or bilateral tumours, is currently a generally accepted therapeutic procedure demonstrably extending the long term survival of these patients.

PURPOSE

The purpose of the present study is a ten-year retrospective analysis of a group of patients who underwent surgery due to pulmonary metastases of various primary tumors.

METHODS

In 2000-2009, 87 patients (of which 44 were male with a median age of 64 years) with secondary pulmonary tumors underwent surgery at the departments of the authors of this study. Solitary metastases were found in 60 patients, multiple metastases in the remaining patients, while 13 patients had bilateral metastases. The median disease-free period from surgery of the primary tumor was 31 months.

RESULTS

In total, 74 unilateral and 13 bilateral surgeries were performed in one or two periods. The most common type of surgery included anatomical pulmonary resections (32 procedures), wedge resections (29 procedures) and laser excisions (24 procedures). In total, the radical resection was performed in 156 metastases. Post-operative morbidity was 17.2 % with zero mortality. A proportion of 50.6 % of operated patients survived after resection of metastases with median survival of 39 months. The overall three-year and five-year survivals in the group were 57 % and 38 %, respectively. A proportion of 35.6 % of patients live after resection of metastases without disease progression, and the median is 15 months.

CONCLUSION

The achieved results confirm the positive role of pulmonary metastasectomy in the therapy of disseminated cancer disease (Tab. 1, Fig. 5, Ref. 34).

Radiofrequency ablation of non-resectable lung tumors

BACKGROUND

Radiofrequency thermal ablation (RFA) is a minimally invasive, image guided technique for destroying tumour cells without damage to adjacent healthy tissue. It is used for partial or complete ablation of non resectable lung cancers and cancers of metastases to lung, providing an effective, relatively safe option for patients ineligible for surgery. We describe our experience with it.

METHODS

In 2005 and 2006, we performed radiofrequency ablation of 7 lung lesions in 6 patients. RFA was done percutaneously under image guided CT scan in 5 patients and in one patient during thoracotomy when we found a radically unresectable tumor necessitating debulking. CT lung screening was performed after 6 months and PET/CT was done within 12 months.

RESULTS

In the course of the screening, we diagnosed regression in 2 patients, a stationary state in 2 cases and local tumor progression in 2 patients, using computed tomography within 6 months after RFA. Using PET/CT within 12 months, we diagnosed non-ablation and liver metastases (there were none before) in one of the two patients with a stationary state diagnosed by means of CT before and recurrence of primary tumor in another patient. In one case of diagnosed regression, we diagnosed tumor progression. The patients survived an average of 30 months (range 9 to 60 months).

CONCLUSION

RFA of lung tumors is an easy method with little patient discomfort. It can be performed percutaneously using guided CT under general anaesthesia. RFA of lung tumors possibly alone or in combination with oncology treatment can prolong patient life.

[Surgical treatment of pulmonary carcinoids - ten-year results]

INTRODUCTION

Carcinoids are malignant neuro-endocrine tumours occurring in the bronchopulmonary location in about 25 %, and accounting for approximately 2 % of all pulmonary tumours.

MATERIAL AND METHODS

Our retrospective analysis included 27  patients, 14  men and 13  women, mean age 58.4  years, treated from 2000 to 2009 for carcinoids in bronchopulmonary locations. The tumour manifested clinically in 52 % of the cases, the most common symptom being cough; one tumour manifested as carcinoid syndrome. All patients underwent fibrobronchoscopy that was positive in 20  cases (74.1 %). Pre-surgery histological diagnoses were made in 13  patients (48.1 %). Chest CT scans were carried out in 26  patients, and the investigation failed to detect the expected pathological process in 2  of the patients. Octreoscans were carried out in 12  patients, and were successful in identifying a primary neuroendocrine tumour in 75 %.

RESULTS

All patients in the sample underwent rad-ical surgical therapy; the most common surgical procedure was lobectomy (70.4 %). Perioperative morbidity and mortality were zero. Typical carcinoids were found in 20  cases while 7  cases were atypical carcinoids, 20  tumours were located centrally. 74 % of the tumours were consistent with stage  I A disease. Mean follow-up period was 47 (range: 6-134)  months. Local recurrences were observed in 2  patients (7.4 %), but the tumour disseminated in 4  patients (14.8 %). Two patients (7.4 %) died during the follow-up period. Overall five-year survival in the sample was 92.3 %, 90.9 % in the typical carcinoid group and 100 % for atypical carcinoids. We found a statistically significant association between disease-free interval and histological type of the tumour; the risk of progression was 8  times higher in -patients with atypical carcinoids compared to patients with typical carcinoids (Log-Rank-Test: p-value = 0.0049).

CONCLUSION

Radical surgical treatment of bronchopulmonary carcinoids is the optimum therapeutic approach that results in the best results both regarding perioperative morbidity and mortality and regarding long-term survival of the patients.

The surgical anatomy of the nervus laryngeus recurrens

In this study, the authors remind the readers the problem traditionally discussed in the thyroid gland surgery--protection of the nervus laryngeus recurrens (NLR) from iatrogenic damage. The aim of this study is to point out some anatomical details on the course of the recurrent nerve (Ref 4).

Nephrogenic fibrosing dermopathy: a case study

Nephrogenic fibrosing dermopathy (NFD) is a rare disease which has only recently been described histopathologically. In the literature only about 100 cases of this disease have been described. NFD occurs most frequently in patients with renal insufficiency or after kidney transplantation. We present a case study of a patient who showed manifestations of NFD in the abdomen after a second transplantation of a cadaver kidney. The diagnosis was determined by an experienced histopathologist after excision of the focus. The authors discuss the etiology and genesis, which is not yet known, diagnosis of this disease and its treatment.

Cell volume measured by total internal reflection microfluorimetry: application to water and solute transport in cells transfected with water channel homologs

Total internal reflection (TIR) microfluorimetry was established as a method to measure continuously the volume of adherent cells and applied to measure membrane permeabilities in cells transfected with water channel homologs. Cytosol was labeled with the membrane-impermeant fluorophore calcein. Fluorescence was excited by the TIR evanescent field in a thin section of cytosol (approximately 150 nm) adjacent to the cell-substrate interface. Because cytosolic fluorophore number per cell remains constant, the TIR fluorescence signal should be inversely related to cell volume. For small volume changes in Sf-9 and LLC-PK1 cells, relative TIR fluorescence was nearly equal to inverse relative cell volume; deviations from the ideal were modeled theoretically. To measure plasma membrane osmotic water permeability, Pf, the time course of osmotically induced cell volume change was inferred from the TIR fluorescence signal. LLC-PK1 cells expressing the CHIP28 water channel had an HgCl2-sensitive, threefold increase in Pf compared to nontransfected cells (Pf = 0.0043 cm/s at 10 degrees C). Solute permeability was measured from the TIR fluorescence time course in response to solute gradients. Glycerol permeability in Sf-9 cells expressing the water channel homolog GLIP was (1.3 +/- 0.2) x 10(-5) cm/s (22 degrees C), greater than that of (0.36 +/- 0.04) x 10(-5) cm/s (n = 4, p < 0.05) for control cells, indicating functional expression of GLIP. Water and urea permeabilities were similar in GLIP-expressing and control cells. The TIR method should be applicable to the study of water and solute permeabilities and cell volume regulation in cells of arbitrary shape and size.

The in vitro and in vivo biotransformation of N-deacetyl-N-formylcolchicine

The major pathway of metabolic transformation of N-deacetyl-N-formylcolchicine is the oxidative cytochrome P450 dependent O-demethylation of substituents in the aromatic ring A and tropolone ring C. It was found that O-demethylation (both, in vitro and in vivo) takes place predominantly in the aromatic ring, especially at position 2.