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Advanced non-small cell lung cancer (NSCLC) is still a therapeutic challenge as the 5-year survival is under 30%. The optimal treatment regimen is still under debate.Neo adjuvant (NA) treatment given pre-pneumonectomy does not increase surgical complexity or peri-OP mortality while it has a potential to increase long term survival.We have conducted a retrospective study of 169 patients who underwent a pneumonectomy for NSCLC between January 2005 to December 2015 and focused on stage IIIa patients; a cohort of 51 patients, 30 which received neo adjuvant chemo-radiation (NA group) prior to pneumonectomy and 21 patients who had undergone pneumonectomy followed by adjuvant treatment (Adjuvant group). Surgical complexity and short- and long-term survival were evaluated. Surgical complexity was assessed by surrogates as surgery duration, hospitalization length and interdepartmental transfer.While no statistically significant differences were found in surgery duration, hospitalization length, morbidity in the 1st year post-OP and the peri-OP mortality; The long term beneficiary effect among the neo adjuvant patients was clear; while 30% of the NA patients were alive 8 years post-OP, there were no survivors in the adjuvant group 5.5 years post-OP.We conclude that while NA treatment has no effect on operation complexity, peri-OP mortality or post-OP morbidity; its impact on long term survival is protuberant, therefore, we believe that NA treatment should be considered as the treatment of choice in advanced NSCLC in need for pneumonectomy.

Background: Progastrin-releasing peptide (ProGRP) is a potential marker for small-cell lung cancer (SCLC) in serum; however, it may be more stable in plasma. We investigated a new plasma assay (ProGRPp) and its usefulness in diagnosing and monitoring SCLC. Methods: The marker concentrations were determined on the ARCHITECT i system. Results: The assay could distinguish SCLC from non-small-cell lung cancer (NSCLC: area under the curve 0.931, 95% CI 0.893–0.969; cross-validated accuracy 0.813; sensitivity 84.0%, specificity 96.3% at 140 pg ml−1 cutoff). The probability of SCLC when ProGRPp was >140 pg ml−1 was 91.8%, after adjusting for age, gender, and renal dysfunction. The NSCLC patients with ProGRPp >140 pg ml−1 were at high risk (odds ratio=37.0, P

Lung cancer is the leading cause of cancer death. Radiation therapy plays a key role in its treatment. Ionizing radiation induces cell death through chromosomal aberrations, which trigger mitotic catastrophe and apoptosis. However, many lung cancer patients show resistance to radiation. Dichloroacetate (DCA) is a small molecule that can promote mitochondrial activation by increasing the influx of pyruvate. Here, we tested whether DCA may increase the sensitivity of non-small cell lung cancer (NSCLC) cells to radiation through this mechanism.Two representative NSCLC cell lines (A549 and H1299) were tested for their sensitivity to radiation with and without pre-exposure to DCA. The treatment efficacy was evaluated using a clonogenic survival assay. An extracellular flux analyzer was used to assess the effect of DCA on cellular oxygen consumption as a surrogate marker for mitochondrial activity.We found that DCA increases the oxygen consumption rate in both A549 and H1299 cells by 60% (p = 0.0037) and 20% (p = 0.0039), respectively. Pre-exposure to DCA one hour before radiation increased the cytotoxic death rate 4-fold in A549 cells (55 to 13%, p = 0.004) and 2-fold in H1299 cells (35 to 17%, p = 0.28) respectively, compared to radiation alone.Mitochondrial induction by DCA may serve as a radio-sensitizer in non-small cell lung cancer.

Background: Volatile organic compounds (VOCs) are potential biomarkers for cancer detection in breath, but it is unclear if they reflect specific mutations. To test this, we have compared human bronchial epithelial cell (HBEC) cell lines carrying the KRASV12 mutation, knockdown of TP53 or both with parental HBEC cells. Methods: VOC from headspace above cultured cells were collected by passive sampling and analysed by thermal desorption gas chromatography mass spectrometry (TD-GC–MS) or sensor array with discriminant factor analysis (DFA). Results: In TD-GC–MS analysis, individual compounds had limited ability to discriminate between cell lines, but by applying DFA analysis combinations of 20 VOCs successfully discriminated between all cell types (accuracies 80–100%, with leave-one-out cross validation). Sensor array detection DFA demonstrated the ability to discriminate samples based on their cell type for all comparisons with accuracies varying between 77% and 93%. Conclusions: Our results demonstrate that minimal genetic changes in bronchial airway cells lead to detectable differences in levels of specific VOCs identified by TD-GC–MS or of patterns of VOCs identified by sensor array output. From the clinical aspect, these results suggest the possibility of breath analysis for detection of minimal genetic changes for earlier diagnosis or for genetic typing of lung cancers.

Little is known concerning the relationship of disease activity and sleep disturbances in inflammatory bowel disease (IBD) and specifically in patients with Crohn’s disease. This study examined the prevalence of poor sleep quality in patients with active and inactive Crohn’s disease compared with healthy controls. Participants included 108 patients with Crohn’s disease attending the IBD clinic of a tertiary medical center in 2009–2010 and 36 healthy volunteers. All prospectively completed a demographic questionnaire and the Pittsburgh sleep quality index (PSQI). Patients with Crohn’s disease completed the Crohn’s disease activity index (CDAI) and were divided into two groups accordingly: inactive disease (CDAI ≤150) and active disease (CDAI >150). Data on disease duration, medications, complications, and treatment were collected from the medical files. Seventy-one patients had inactive Crohn’s disease and 37 had active disease. All three groups were similar in mean age, sex distribution, and body mass index. Mean duration of Crohn’s disease was 10.22 ± 8.6 years; 40 patients (37 %) had ileal disease, 16 (15 %) colonic disease, and 56 (50 %) ileo-colonic disease. Patients with active disease had a significantly higher mean ± SD global score on the PSQI (8.6 ± 2.4; indicating poorer sleep quality) than patients with inactive disease (4.6 ± 1.9) or control subjects (5.1 ± 1.7) (p

The aim of this study was to assess the costs of screening healthcare workers (HCWs) for tuberculosis (TB) using the novel interferon-gamma release assay QuantiFERON((R))-TB Gold In-tube (QFT) versus the tuberculin skin test (TST). We used a prospective observational study with a cost-comparison analysis. The study was conducted at a regional center for ambulatory TB treatment. The study included 100 Israeli HCWs who were referred for routine TB screening. The participants were tested with both TST and QFT. For the TST, induration of 10 mm or more was considered a positive test. For the QFT, a threshold of 0.35 IU/ml interferon-gamma above background levels was a positive test. We developed a computerized model of the present TST-only screening method versus the QFT either alone (instead of the TST) or as a confirmatory test for a positive TST. Of the 100 subjects, 34 had a positive TST result and 17 had a positive QFT result. There was poor agreement between the TST and the QFT (kappa = 0.19). Assuming adherence to treatment of 50%, costs were minimized by using the QFT to confirm a positive TST (euro4155). The QFT-only model was cheaper than the TST-only model (euro7280 vs.euro8217, respectively). The QFT-only method required the fewest clinic visits (121) compared to the TST (344). Adherence to treatment in the QFT-positive group was 47% compared with 12% for the TST-positive group. Screening HCWs with the QFT test compared to the TST resulted in fewer possible cases being identified, lower costs, and increased adherence to treatment. Costs were minimized by using the QFT to confirm a positive TST. A QFT-based screening program for HCWs is feasible and should be evaluated systematically.

This retrospective study sought to systematically identify clinical and radiological features differentiating Mycobacterium kansasii from Mycobacterium tuberculosis infection. The sample included matched patients with a culture-positive diagnosis of M. tuberculosis infection (n = 121) or M. kansasii infection (n = 62) derived from the databases of two tuberculosis centers. Data on patient background and clinical features were collected, and chest radiographs were analyzed. Sixty percent of the M. kansasii group were native Israelis compared to 15% of the M. tuberculosis group (p = 0.0001). M. tuberculosis infection was associated with a higher rate of human immunodeficiency virus (HIV) infection (p = 0.03) and M. kansasii infection with a higher rate of lung disease (p = 0.0001). M. tuberculosis infection was characterized by a higher likelihood of bilateral disease (p = 0.005), pleural effusions, and lymphadenopathy (p = 0.006 and p = 0.001, respectively). There were ten deaths, all in the M. tuberculosis group. On multivariate logistic regression, the presence of chronic obstructive pulmonary disease and associated lung disease were significant predictors of M. kansasii infection. The findings show that there are group differences between the clinical features of the two infections. In the setting of pulmonary mycobacterial infection, the presence of coinfection with HIV, bilateral disease, pleural effusion, and lymphadenopathy make M. kansasii infection very unlikely.

Some studies have demonstrated that in infective endocar-ditis (IE) older age is associated with a higher mortality rate[1, 2], higher frequency of mitral-valve involvement [3],renal failure, and cerebral embolism [4]. In the studypresented here, we aimed to analyze the clinical features ofIE and to delineate short- and long-term outcome of IE inchildren, young adults and elderly patients. Charts of allpatients definitively diagnosed with IE from January 1987through December 1996 were identified (n=228) andgrouped according to age: group I included patients aged1–15 years; group II, patients aged 16–40 years; group III,patients aged 41–60 years; and group IV, patients aged≥61 years. For each patient, data on demographics, clinicalfeatures, and outcome were collected. Statistical analyseswere performed using ANOVA, chi-square, and Coxregression for multivariable analysis of survival (SPSSCorporation, Chicago, IL, USA).None of the 228 patients analyzed had a history ofintravenous drug abuse. There were 13 patients in group I,25 in group II, 57 in group III, and 133 in group IV. Nosignificant differences in clinical symptoms, rate of surgicalintervention, and length of hospitalization were foundamong the groups (Table 1). As expected, congenital heartanomalies were common (62%) in group I, while native-valve involvement (rheumatic and degenerative heartdisease) was more frequent in the other groups (40% ingroup II and 47% in groups III and IV; p=0.001).Prosthetic-valve IE occurred more commonly in groups IIand III (36 and 32%, respectively) than in groups I (8%)and IV (16%) (p