Association of increased postoperative opioid administration with non-small-cell lung cancer recurrence: a retrospective analysis

BACKGROUND

Evidence suggests that opioid-sparing anaesthetic techniques might be associated with increased cancer-free postoperative survival. This could be related to suppression of natural killer cells by opioid analgesics in the perioperative period. This retrospective analysis tested the hypothesis that greater opioid use in the postoperative period is associated with a higher incidence of recurrences after surgery for lung cancer.

METHODS

The medical records of 99 consecutive patients who underwent video-assisted thoracoscopic surgery with lobectomy for Stage I or IIa biopsy-proven non-small-cell lung cancer (NSCLC) were reviewed. Perioperative information including patient characteristics, laboratory data, and surgical, anaesthetic, nursing, and pharmacy reports were collected. Doses of opioids administered intra-operatively and for the first 96 h after operation were converted into equianalgesic doses of oral morphine using a standard conversion table. Data were then compared with the National Cancer Registry's incidence of disease-free survival for 5 yr.

RESULTS

A total of 99 patients with similar characteristics were included in the final analysis, 73 of whom were NSCLC recurrence-free at 5 yr and 26 had NSCLC recurrence within 5 yr. Total opioid dose during the 96 h postoperative period was 124 (101) mg of morphine equivalents in the cancer-free group and 232 mg (355) mg in the recurrence group (P=0.02).

CONCLUSIONS

This retrospective analysis suggests an association between increased doses of opioids during the initial 96 h postoperative period with a higher recurrence rate of NSCLC within 5 yr.

Effect of ochratoxin A and ochratoxin C on the monocyte and lymphocyte function

The effect of practically relevant mycotoxin concentrations on functions of immune cells was studied in in vitro experiments. Porcine mononuclear cells were exposed to a crudeAspergillus-ochraceus toxin containing OTA, a HPLC fraction identical with OTC derived from the crude toxin (RE2), as well as pure OTA and OTC in a concentration range from 0.46 to 3000 ng/ml. The influence of mycotoxin exposure on metabolic activity, mitogen induced proliferation, expression of the activation marker CD25 and the cell cycle of lymphocytes and on the formation of free oxygen radicals as well as the production of the cytokines IL-6 and TNF-α by monocytes was determined. Exposure to high concentrations of all mycotoxin preparations lead to non-specific suppression of the immune cell functions, which was related to cytotoxic effects. Low concentrations caused ambivalent reactions, especially on monocyte function. In general, the HPLC fraction RE2 had an up to 100-fold stronger effect than pure OTA. Ochratoxin-induced suppression of lymphocyte proliferation was not abrogated by phenylalanine or aspartame. The results indicate that immunomodulation can be caused by very low mycotoxin concentrations which are not related to clinical symptoms or loss of performance.

Charge-doping-driven evolution of magnetism and non-Fermi-liquid behavior in the filled skutterudite CePt4Ge(12-x)Sb(x)

The filled skutterudite compound CePt(4)Ge(12) is situated close to the border between the intermediate valence of Ce and heavy-fermion behavior. Substitution of Ge by Sb drives the system into a strongly correlated and, ultimately, upon further increasing the Sb concentration, an antiferromagnetically ordered state. Our experiments evidence a delicate interplay of emerging Kondo physics and the formation of a local 4f moment. An extended non-Fermi-liquid region, which can be understood in the framework of a Kondo-disorder model, is observed. Band-structure calculations support the conclusion that the physical properties are governed by the interplay of electron supply via Sb substitution and the concomitant volume effects.

Ca(2)Y(2)Cu(5)O(10): the first frustrated quasi-1D ferromagnet close to criticality

Ca(2)Y(2)Cu(5)O(10) is built up from edge-shared CuO(4) plaquettes forming spin chains. From inelastic neutron scattering data we extract an in-chain nearest-neighbor exchange J(1)≈-170  K and the frustrating next-neighbor J(2)≈32  K interactions, both significantly larger than previous estimates. The ratio α=|J(2)/J(1)|=0.19±0.01 places the system close to the critical point α(c)=0.25 of the J(1)-J(2) chain but in the 1D ferromagnetic regime. We establish that the vicinity to criticality only marginally affects the dispersion and coherence of the spin-wave-like magnetic excitations but instead results in a dramatic T dependence of high-energy Zhang-Rice singlet excitation intensities.

Physical properties and valence state of cerium in the filled skutterudite CePt₄Ge₁₂

Electronic, magnetic, and transport properties of the filled platinum-germanium skutterudite CePt₄Ge₁₂ are investigated. High resolution x-ray absorption spectroscopy measurements at the cerium L(III) edge demonstrate that CePt₄Ge₁₂ in this compound has a temperature-independent valence close to three. However, magnetic susceptibility, thermopower, Hall effect, and electronic specific heat reveal a broad maximum at Tmax D 65-80 K, suggesting the presence of valence fluctuations. The Sommerfeld coefficient γ = 105 mJ mol⁻¹ K⁻², deduced from specific heat, indicates moderately enhanced band masses for CePt₄Ge₁₂. We discuss these findings and conclude that CePt₄Ge₁₂ represents a system at the border between intermediate valence (IV) and Kondo lattice behavior. In addition, the lattice specific heat and the thermal conductivity are discussed with respect to the vibrational dynamics of Ce in the [Pt₄Ge₁₂] framework.

Multistep approach to microscopic models for frustrated quantum magnets: the case of the natural mineral azurite

The natural mineral azurite Cu(3)(CO(3))(2)(OH)(2) is a frustrated magnet displaying unusual and controversially discussed magnetic behavior. Motivated by the lack of a unified description for this system, we perform a theoretical study based on density functional theory as well as state-of-the-art numerical many-body calculations. We propose an effective generalized spin-1/2 diamond chain model which provides a consistent description of experiments: low-temperature magnetization, inelastic neutron scattering, nuclear magnetic resonance measurements, magnetic susceptibility as well as new specific heat measurements. With this study we demonstrate that the balanced combination of first principles with powerful many-body methods successfully describes the behavior of this frustrated material.

Superfluid density and energy gap function of superconducting PrPt4Ge12

The filled skutterudite superconductor PrPt4Ge12 was studied in muon-spin rotation (muSR), specific heat, and electrical resistivity experiments. The continuous increase of the superfluid density with decreasing temperature and the dependence of the magnetic penetration depth lambda on the magnetic field obtained by means of muSR, as well as the observation of a T3 dependence of the electronic specific heat indicate the presence of pointlike nodes in the superconducting energy gap. The gap and the specific heat are found to be well described by two models with point nodes, similar to results obtained for the unconventional heavy fermion skutterudite superconductor PrOs4Sb12.

High-pressure crystal chemistry of binary intermetallic compounds

Effects of high pressure on intermetallic compounds are reviewed with regards to structural stability and phase transitions. Changes of bonding properties and electronic structure are examplified by means of the elemental metals caesium and titanium, the latter forming an internal intermetallic compound at high pressures. After a short systematic overview regarding pressure effects, structural transformations in selected classes of intermetallic compounds like Zintl phases and AlB2-type arrangements precedes sections concerning high-pressure synthesis of Laves phases and intermetallic clathrates.