Baseline inflammation indexes and neutrophil-to-LDH ratio for prediction of the first mobilization failure without plerixafor-based regimens in multiple myeloma and lymphoma patients: A single-center retrospective study

BACKGROUND

Many factors were identified for mobilization failure (MF) in autologous hematopoietic stem-cell transplantation. To our knowledge, this is the first study to investigate the efficacy of baseline inflammation indexes and neutrophil-to-lactate dehydrogenase (LDH) ratio to predict MF in multiple myeloma (MM) and lymphoma.

METHODS

A total of 240 patients with lymphoma or MM hospitalized between January 2014 and June 2022 for the first stem cell mobilization were included in this retrospective single-center study. We evaluated the impact of baseline demographic, clinical, and laboratory data (before granulocyte colony-stimulating factor and chemotherapy implementation), including neutrophil, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), neutrophil-to-C-reactive protein, and neutrophil-to-LDH ratios on MF.

RESULTS

A total of 240 patients were divided into successful (214 patients, 89.16%) and poor mobilizers (26 patients, 10.84%). Poor mobilizers had lower neutrophil, NLR, SII, and neutrophil-to-LDH ratios (P values were .001, .022, .001, and .001, respectively). Among these markers, only the neutrophil-to-LDH ratio was statistically low in both poor mobilizer MM and lymphoma patients. Receiving operator characteristic curve analysis was performed to evaluate neutrophil, SII, and neutrophil-to-LDH ratios for MF. Neutrophil-to-LDH ratio had the highest specificity (93.93%, for ≤9.904 cut-off) compared to the other two variables. Multivariate logistic regression analysis showed that neutrophil-to-LDH ratio ≤ 9.904 (cut-off) (odds ratio: 7.116, P = .001), neutrophil counts ≤3300/mm3 (cut-off) (odds ratio: 3.248, P = .021), and lymphoma diagnosis (odds ratio: 2.674, P = .039) were independent risks for MF.

CONCLUSION

The neutrophil-to-LDH ratio could be a novel marker in lymphoma and MM patients to predict the first MF. New studies should be conducted for the optimization of this index.

The role of interventional pulmonology for the postoperative bronchopleural fistula

Background

: Postoperative bronchopleural fistula (BPF) remains a serious complication due to its high morbidity and mortality. Although various endoscopic techniques have been defined for the closure of BPF previously, no standard algorithm yet exists.

Aims

To study the effectiveness and safety of various endoscopic procedures in an interventional pulmonology unit.

Materials and Methods

The medical data of 15 postoperative BPF patients, who were undergone endoscopic intervention were retrospectively investigated.

Results

The mean size of the fistulas determined by bronchoscopic evaluation was 7.93 ± 3.26 mm (range 3-15 mm). Applied procedures were as follows: stent implantation (n: 8, 53.3%), stent implantation and polidocanol application (n: 4, 26.7%), only Argon Plasma Coagulation (APC) application (n: 2,13.3%), polidocanol application (n: 1,6.7%). Complete fistula closure was achieved in three of the 15 patients (20%). The procedures were partly successful in five (33.3%) patients and failed to be successful in seven (46.6%) patients. Survival rates in regard to procedural success were determined and a statistically significant difference was found in five-year survival rates (P = 0.027, P < 0.05).

Conclusion

Our results demonstrated that bronchoscopic procedures can be safely and effectively performed in patients who were not eligible for surgery for various reasons.

Synthesis of Na2Ti3O7 nanorods by a V-assisted route and investigation of their battery performance

We report the V-assisted synthesis of Na₂Ti₃O₇ nanorods via a conventional solid state reaction technique.

Altered isotope charge distribution of acetylcholine neurotransmitter and Myasthenia Gravis

Acetylcholine (ACh) is a central neurotransmitter that is used for signal transmission among neurons. For signal transmission in neurons, a neurotransmitter must bind to its receptor in order to produce an action potential. It is known that in Myasthenia Gravis (MG) cases, autoantibodies could block this binding. In the future, the treatment of MG could be achieved via modulation of molecular interaction between ACh and acetylcholine receptor (AChR). This study suggests that if an atom on a ligand (i.e. a neurotransmitter) is replaced with its isotope, it may cause charge redistribution such as that the binding between ligand and its receptor may be improved. Hence suggesting that with replacement of atoms with their isotopes in any biologically important ligand could alter its affinity towards its corresponding receptor, which would have a wide array of applications in medicine.

Enhancement of battery performance of LiMn2O4: correlations between electrochemical and magnetic properties

We report the results of a systematic investigation of structural, electrical transport, magnetic, and electrochemical properties of LiB_xMn_2−xO₄ (where x = 0.0–1), synthesized via a one-step solid state reaction technique.

Early tracheal stenosis causing extubation failure and prolonged ventilator dependency

Postintubation stenosis is the most frequent cause of benign tracheal stenosis and may cause reintubation and delay in weaning of intensive care unit patients. This case study describes typical patients with tracheal stenosis and the management of these patients. Five patients requiring reintubation and mechanical ventilation due to early intubation-related stenosis are discussed. Stridor developed in three cases after extubation. In these cases, bronchoscopy revealed tracheal stenosis. Dilatation and silicone stent placement were performed using rigid bronchoscopy. The other two patients were on ventilators when they were admitted to the intensive care unit and their stenoses were also treated by rigid bronchoscopy. Hypercapnia and hypoxia resolved after intervention in three cases. Of the remaining two patients, one had the tracheostomy closed and in the other patient ventilation was stopped but the tracheostomy was maintained. Tracheal stenosis developing in the subglottic region after extubation, especially after exposure to cuff pressure, may lead to reintubation. A tracheostomy may hinder the diagnosis of progressive stenosis and may lead to unnecessary maintenance of ventilator treatment. Early intubation-related tracheal stenosis should therefore be considered in cases of weaning or extubation failure and prompt appropriate investigation and treatment.

Results of tetanus vaccination in sarcoidosis

BACKGROUND AND OBJECTIVE

Cellular immunity abnormalities are associated with sarcoidosis. Normal cellular immunity is required for adequate humoral immunity; therefore, a decreased humoral immune response is possible in patients with sarcoidosis. We evaluated humoral immunity by vaccinating patients with sarcoidosis against tetanus.

PATIENTS AND METHOD

We screened 60 patients with sarcoidosis (42 females, average age 39 +/- 11 years) and 40 healthy subjects as a control (23 females, average age 38 +/- 9 years). Of the 51 sarcoidosis patients and 33 controls that did not have sufficient tetanus antibody titers, 48 patients and 31 controls agreed to be vaccinated and were included in the vaccination program. Blood serum samples were collected from the subjects before and after vaccination and evaluated for tetanus toxoid IgG antibodies with an enzyme-linked immunosorbent assay (ELISA).

RESULTS

As a result of the vaccination, 24 of the sarcoidosis patients (50%) and 7 of the controls (23%) had insufficient antibody responses (p = 0.019). No relationship was found in sarcoidosis patients between the rate of having sufficient antibody levels and disease duration, activation state, and radiographic staging of the disease. Conversely, mean lymphocyte numbers were significantly lower in patients with insufficient tetanus antibody levels (p = 0.013).

CONCLUSION

Tetanus vaccinations in sarcoidosis patients are less effective than in healthy controls, suggesting that patients with sarcoidosis have a hyporesponsive humoral immune system.

Diode laser in the endoscopic treatment of obstructive airway disease: two years experience in Istanbul

AIM

Laser therapy is a well-known technique which has been safely used for almost thirty years to treat endobronchial obstruction. Nd : YAG and Nd : YAP lasers are commonly used lasers, whose safety and efficacy have been investigated in several large series. Diode laser is a new laser system which has been mainly used in urology, endovascular surgery, ENT, and dermatology. In recent years it has been effectively used in endobronchial treatments.

MATERIAL AND METHOD

In this study, 61 patients who underwent endobronchial treatment with a diode laser in the Interventional Pneumology Unit of our hospital were retrospectively evaluated. Fifty-one patients were male. Mean age was 54.72 ± 13.81 years, and a total of 90 laser applications were given. In 39 cases, palliation of a malign obstruction was achieved while cure was achieved in 19 cases with benign obstruction. No major complication other than minor hemorrhage in 4 cases and temporary hypoxia in 2 cases was observed.

CONCLUSION

Diode laser can be used as an effective and safe modality for endobronchial treatment.

Vascular endothelial growth factor gene polymorphisms in Turkish patients with sarcoidosis

Polymorphism at +813 locus of vascular endothelial growth factor (VEGF) gene is considered to decrease predisposition to sarcoidosis. Our study aimed to investigate the roles of this polymorphism in the development and extent of sarcoidosis. We examined polymorphisms of the VEGF gene in 90 cases with histopathological diagnosis of sarcoidosis and in 110 healthy subjects. VEGF +813 gene polymorphisms were determined using a polymerase chain reaction-based method after DNA isolation. A significant increase in the frequency of the T allele was found in healthy subjects (odds ratio 0.55; 95% confidence interval 0.32-0.97, P<0.05). Our results suggest that increase in rarer T allele at + 813 locus of VEGF gene may diminish susceptibility to sarcoidosis in Turkish population.

The impact of gender, family and type of school on smoking in adolescents in Eyup, Istanbul, Turkey

OBJECTIVE

The aim of this study was to determine the influence of smoking habits and education of family, parents, the type of school and gender on smoking in adolescents.

METHODS

This cross-sectional study was performed on 1062 students from eight high schools in Eyup, Istanbul.

RESULTS

Twenty-five per cent of students were current smokers (30.1% of boys [n = 551], 20.9% girls [n= 511] 95% CI [26%, 34%] and [17%, 24%] respectively, (p < 0.05). Smoking rate was highest in vocational high schools and lowest in super high schools (33% [n = 406, 95% CI (29%, 38%)] and 11% [n = 127, 95% CI (6%, 17%)] respectively, p < 0.05). Smoking rate was higher in mothers (31.6% [n = 174, 95% CI (25%, 39%)] vs 15.5% [n = 336, 95% CI(12%, 19%)] and siblings (27.7% [n = 141, 95% CI (20%, 35%)] vs 18% [n = 350, 95% CI (14%, 22%)] of the female students who smoke than of those who did not smoke (p < 0.05). The rate of smoking in the siblings of 'smoker' boys was higher than that of 'non-smoker' boys (44.6% [n = 130, 95% CI (36%, 53%)] and 26.1% [n = 402, 95% CI (22%, 30%)] respectively; p < 0.05). The education level of 28%, [n = 82, 95% CI (19%, 39%)] of the mothers of 'smoker' girls, and of 19.6% [n = 429, 95% CI (16%, 23%)] of 'non-smoker' girls was high school and above (p < 0.05). The rate of high school and above education was higher in parents of male students who smoke than that in nonsmokers [45.1% and 27.9%, 95% CI (33%, 55%)] and (24%, 32%), respectively, p < 0.05. Number of smokers saying "Yes" in support of controlling smoking was less than non-smokers (p < 0.05).

CONCLUSION

Smoking rate was higher in boys, in vocational high schools and seems to be influenced by smoking habits and higher educational levels of their family members. This influence differs according to gender. Anti-tobacco messages should target family, friends and schools of adolescents.

Postoperative radiotherapy results in soft tissue sarcomas

19513

Background: Postoperative radiotherapy results with higher local rates than surgery alone. In this trial we have evaluated and studied factors that affects local recurrence rates. Methods: A retrospective clinical study of 125 eligible patients with soft tissue sarcoma diagnosis from SB Okmeydani Educational Hospital-Oncology Department treated between 1998–2002 years was performed. Tumor size, surgery margin histopathologic grade and type were evaluated. At subgroup analysis local recurrense rates were studied in groups with or without postoperative radiotherapy. Results: In 125 patients, 70 were tumor free, 45 were tumor positive or with suspicious margin after the surgery. Subgroup of 25 patients which have tumor size smaller than 5 cm and negative margin had no radiotherapy and had no local recurrens. In an other group of 45 patients which have tumor size larger than 5 cm and tumor negative after excision 18 patients did not have any postoperative radiotherapy and 4 of them (% 22) had local failure. The rest of the 27 patients of this group who had postoperatif radiotherapy had 2 (% 7) local failure. Among 55 patients with positive or suspicious margins; 18 had no postoperative radiotherapy and there were 6 (% 33) local recurrens while the 37 patients with radiotherapy had 7 (% 18) local recurrens rates. Conclusions: In operable soft tissue sarcomas tumor size, hystopathological grade, postoperatif surgery margins are the most important factors which affects local recurrens rates.

[Table: see text]

No significant financial relationships to disclose.

An analysis and epidemiologic study on new cancer patients admitted to our department between 1999–2003

20108

Background: Cancer is one of the most important health problems existing 10.1 millions of new patients and 6.2 millions dead in 2000. 15 millions of new patients will be supposed to be seen in 2020. Method: In this study; between 1999–2003, 41,564 new patients diagnosed as cancer admitted to our center were analyzed. International Classification Disease of Oncology (ICD-O) was used to classify the patients. Basal cell carcinoma and epidermoid carcinoma of the skin were not included. Rest of 41116 patients were reviewed according to their age, sex, diagnosis and coming region. Results: 55.6% of the patients were male. Top five location of the disease can be listed as follows: respiratory system (25.6%), gastrointestinal system (19.2%), breast (15.1%), genitourinary system (11.3%) and lymphoma (4.7%). Analysis according to gender is illustrated in Table . Most cases have come from Marmara Region. While peak incidence was detected between 60–69 years of age in males, it was 50–59 years of age in females. Least comings were seen below 20 years of ages in both sexes. Conclusions: Admission to our department increases gradually while it was 7,020 patients in 1999, it reached to 10,035 person in 2003. General population and population insured by Social Insurance Institution are mostly living in Marmara Region (48.16% of the population are insured by this institution and 41.72% of them reside in Marmara Region). Our department was unique active center in Social Insurance Institution’s order at that time. According to SEER (U.S. Surveillance Epidemiology and EndResults) data in United States (US); although prostate cancer is mostly seen cancer (15%) and lung cancer is recorded in just 13% of cases it is the leading data in our study (22.4%) and prostate cancer is only seen 3.8% of cases. This difference can be explained by effective screening programs in US and prostatic cancer patients mostly prefer to apply the Urology Department in our country. Smoking and environmental conditions may be the reason of high incidence in lung cancer.

[Table: see text]

No significant financial relationships to disclose.

Primary tracheal schwannoma: a case report

We present a rare case of primary tracheal schwannoma in a 49-year-old man who had experienced obstructive airway symptoms for 4 years. Computed Tomography (CT) showed an intratracheal polipoid mass lesion originating from the left lateral wall. Fibre-optic bronchoscopy revealed the diagnosis of an intratracheal poylpoid mass obstructing 70% of the lumen. After diagnosing a benign lesion by punch biopsies with bronchoscopy, thoracotomy was performed and the tumour was totally excised. Histopathological examination revealed a benign neurogenic tumour of schwann cell origin.

50 endobronchial tuberculosis cases based on bronchoscopic diagnosis

Endobronchial tuberculosis (ETB) is most often a complication of primary pulmonary tuberculosis in children, although it may also occur in adults. Bronchoscopically, mass lesion (polypoid and ulcerous granuloma), submucosal infiltration and fibrostenosis may usually be seen. 50 ETB cases were diagnosed by bronchial biopsy, bronchial fine needle aspiration and washing. Bronchoscopically, mass lesions were found in 31 cases (62%), 21 (42%) of which were ulcerous granulomas and 10 (20%) polypoid mass, while 11 (22%) cases were of submucosal infiltrative appearance, 16 (32%) fibrostenosis and 5 (10%) hyperaemia and oedema. The diagnosis could be made in 42 cases with bronchial biopsy, whereas only in 8 cases with bronchial fine needle aspiration. Statistically, therefore, the bronchial biopsy was found to be significantly more advantageous as compared to the other diagnostic methods for the diagnosis of ETB (p < 0.0001).

Malignant Leydig cell tumour of the testis: a case report and review of the literature

A rare case of malignant Leydig cell tumour of the testis is presented. There was no standard therapy regimen. Leydig cell carcinoma is relatively refractory to radiotherapy and chemotherapy. So a retroperitoneal node dissection should be performed before or after chemotherapy for staging and also for therapeutic reasons.