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Tobacco smoking is the main etiological factor of lung cancer (LC), which can also cause metabolome disruption. This study aimed to investigate whether the observed metabolic shift in LC patients was also associated with their smoking status. Untargeted metabolomics profiling was applied for the initial screening of changes in serum metabolic profile between LC and chronic obstructive pulmonary disease (COPD) patients, selected as a non-cancer group. Differences in metabolite profiles between current and former smokers were also tested. Then, targeted metabolomics methods were applied to verify and validate the proposed LC biomarkers. For untargeted metabolomics, a single extraction-dual separation workflow was applied. The samples were analyzed using a liquid chromatograph-high resolution quadrupole time-of-flight mass spectrometer. Next, the selected metabolites were quantified using liquid chromatography-triple-quadrupole mass spectrometry. The acquired data confirmed that patients' stratification based on smoking status impacted the discriminating ability of the identified LC marker candidates. Analyzing a validation set of samples enabled us to determine if the putative LC markers were truly robust. It demonstrated significant differences in the case of four metabolites: allantoin, glutamic acid, succinic acid, and sphingosine-1-phosphate. Our research showed that studying the influence of strong environmental factors, such as tobacco smoking, should be considered in cancer marker research since it reduces the risk of false positives and improves understanding of the metabolite shifts in cancer patients., (© 2024. The Author(s).)

Purpose: This report presents the long-term results of the hip joint reconstruction in patients with spastic hip disease through open reduction, proximal femur varus derotation osteotomy, and Dega transiliac osteotomy., Methods: We analyzed retrospectively patients diagnosed with a spastic form of bilateral cerebral palsy with painful hip subluxation or dislocation. All patients underwent the same surgical procedure. The minimum follow-up time was 15 years. The study group comprised 15 patients (22 hips), classified with the Gross Motor Function Classification System as levels IV and V. The hip joint range of motion and anteroposterior X-ray examination at the final follow-up visit were compared with pre-operative data. The pain level was evaluated using the Visual Analogue Scale (VAS), and the femoral head shape was assessed using the Rutz classification. The patients' caregivers answered questions regarding pain during sitting, personal hygiene activities, and at rest. The caregivers' satisfaction with the treatment was also assessed with the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire., Results: We observed a significant reduction of the hip joint pain and improvement in both radiological hip stability parameters and range of motion at the final follow-up visit. Based on the Rutz classification, one hip remained type B, while the other joints became type A. Reduced pain was reported in all three positions, with the most pronounced improvement during sitting and personal hygiene activities. Interestingly, patients with unilateral hip reconstruction were more prone to pain after reconstruction than those operated bilaterally., Conclusion: Primary reconstruction of the painful hip joint neurogenic dislocation results in a stable joint reduction, pain decrease, and improved quality of life in patients with cerebral palsy., Level of Evidence: IV case series., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Competing Interests: The authors report no conflict of interest.

Background: The optimal sequence and combination of surgery, chemotherapy and radiotherapy in patients with N2 non-small cell lung cancer (NSCLC) remain undefined. The aim of our study was to compare two treatment options for N2 NSCLC-induction therapy with subsequent surgery versus upfront surgery with adjuvant treatment., Methods: We retrospectively reviewed 405 patients with N2 disease in two centers, between January 2010 and December 2016. They were divided into two groups: the Induction Group, composed of patients who received neoadjuvant chemotherapy, and the Upfront surgery Group, composed of patients who underwent surgery as first-line therapy. Propensity score-matched (PSM) analysis was performed, and 52 patients were included in each group. Primary endpoints were: recurrence, overall survival (OS) and disease-free survival (DFS)., Results: After the PSM, no differences were observed in general characteristics, perioperative results, rates and severity of complications, and histopathology results. Seventeen patients (32.7%) of the induction group and 21 (40.4%) of the upfront surgery group had mediastinal lymph nodal involvement with skipping (p = 0.415). Recurrence rate was not different between the two groups (57.7% vs 50.0%, p = 0.478). No differences were observed in terms of OS (40.98 ± 35.78 vs 37.0 ± 40.69 months, p = 0.246) and DFS (29.67 ± 36.01 vs 27.96 ± 40.08 months, p = 0.697). The multivariable analysis identified the pT stage and skipping lymph node metastasis as independent predictive factors for OS., Conclusions: Upfront surgery followed by adjuvant therapy does not appear inferior in terms of recurrence, OS and DFS, compared to induction chemotherapy with subsequent surgery., (© 2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

The standard of care for patients with early-stage non-small cell lung cancer (NSCLC) is anatomical lung resection with lymphadenectomy. This multicenter, retrospective, cohort study aimed to identify predictors of 5-year survival in patients after thoracoscopic lobectomy for stage IA NSCLC. The study included 1249 patients who underwent thoracoscopic lobectomy for stage IA NSCLC between 17 April 2007, and December 28, 2016. The 5-year survival rate equaled 77.7%. In the multivariate analysis, higher age (OR, 1.025, 95% CI: 1.002 to 1.048; p = 0.032), male sex (OR, 1.410, 95% CI: 1.109 to 1.793; p = 0.005), chronic obstructive pulmonary disease (OR, 1.346, 95% CI: 1.005 to 1.803; p = 0.046), prolonged postoperative air leak (OR, 2.060, 95% CI: 1.424 to 2.980; p < 0.001) and higher pathological stage (OR, 1.271, 95% CI: 1.048 to 1.541; p = 0.015) were related to the increased risk of death within 5 years after surgery. Lobe-specific mediastinal lymph node dissection (OR, 0.725, 95% CI: 0.548 to 0.959; p = 0.024) was related to the decreased risk of death within 5 years after surgery. These findings provide valuable insights for clinical practice and may contribute to improving the quality of treatment of early-stage NSCLC.

Purpose: A great number of patients that suffer from lateral epicondylitis, commonly called tennis elbow (TE), are not successfully treated, meaning, not getting adequate therapeutic effects and the main origin of the pain not being handled appropriately. The hypothesis of the present study is that the inefficiency of the treatment of the chronic TE may often be due to underdiagnosis of posterior interosseous nerve (PIN) entrapment or and plica syndrome, as the authors believe that those pathologies can often occur simultaneously., Methods: A prospective cross sectional study was conducted. A total of 31 patients met the required criteria., Results: Thirteen (40.7%) of the patients had more than one source of the lateral elbow pain. Five patients (15.6%) had all three examined pathologies. Six patients (18.8%) had TE and PIN syndrome. Two patients (6.3%) had TE and plica syndrome., Conclusion: The present study demonstrated concomitant potential sources of lateral elbow pain in patients diagnosed with chronic TE. Our analysis shows how important it is to systematically diagnose patients that present with lateral elbow pain. The clinical characteristics of the three most common causes of chronic lateral elbow pain, meaning, TE, PIN compression, and plicae syndrome were also analyzed. Having adequate knowledge about the clinical aspects of these pathologies can help with a more effective differentiation of the etiology of chronic lateral elbow pain, and with that, a more efficient and cost-effective treatment plan., (© 2023. The Author(s).)

Background: High-energy devices allow better vessel sealing compared with monopolar electrocautery and could improve the outcomes of surgical operations. The objective of the study was to compare tissue dissection by the LigaSure™ device with that by monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy., Methods: This pragmatic, parallel group, prospective randomized controlled trial was funded by the Medtronic External Research Program (ISR-2016-10,756) and registered at www., Clinicaltrials: gov (NCT03125798). The study included patients aged 18 years or older, who had undergone thoracoscopic lobectomy with lymphadenectomy at the Department of Thoracic Surgery of Poznan University of Medical Sciences between May 3, 2018, and November 4, 2021. Using simple randomization, the patients were assigned to undergo tissue dissection with either the LigaSure device (study group) or monopolar electrocautery (control group). Participants and care givers, except operating surgeons, were blinded to group assignment. The primary outcome was postoperative chest drainage volume. Secondary outcomes were change of the esophageal temperature during subcarinal lymphadenectomy and C-reactive protein level 72 h after surgery., Results: Study outcomes were analyzed in 107 patients in each group. We found no differences between the study and control groups in terms of chest drainage volume (550 vs. 600 mL, respectively; p = 0.315), changes in esophageal temperature (- 0.1 °C vs. - 0.1 °C, respectively; p = 0.784), and C-reactive protein levels (72.8 vs. 70.8 mg/L, respectively; p = 0.503). The mean numbers of lymph nodes removed were 12.9 (SD: 3.1; 95% CI, 12.4 to 13.5) in the study group and 11.6 (SD: 3.2; 95% CI, 11.0 to 12.2) in the control group (p < 0.001)., Conclusions: The use of the LigaSure device did not allow to decrease the chest drainage volume, local thermal spread, and systemic inflammatory response. The number of lymph nodes removed was higher in patients operated with the LigaSure device, which indicated better quality of lymphadenectomy., (© 2023. The Author(s).)

The outcomes of non-small cell lung cancer surgery are influenced by the quality of lymphadenectomy. This study aimed to evaluate the impact of different energy devices on lymphadenectomy quality and identify additional influencing factors. This secondary analysis of the prospective randomized trial data (clinicaltrials.gov: NCT03125798) compared patients who underwent thoracoscopic lobectomy with the LigaSure device (study group, n = 96) and monopolar device (control group, n = 94). The primary endpoint was the lobe-specific mediastinal lymphadenectomy. Lobe-specific mediastinal lymphadenectomy criteria were met in 60.4% and 38.3% of patients in the study and control groups, respectively ( p = 0.002). In addition, in the study group, the median number of mediastinal lymph node stations removed was higher (4 vs. 3, p = 0.017), and complete resection was more often achieved (91.7% vs. 80.9%, p = 0.030). Logistic regression analysis indicated that lymphadenectomy quality was positively associated with the use of the LigaSure device (OR, 2.729; 95% CI, 1.446 to 5.152; p = 0.002) and female sex (OR, 2.012; 95% CI, 1.058 to 3.829; p = 0.033), but negatively associated with a higher Charlson Comorbidity Index (OR, 0.781; 95% CI, 0.620 to 0.986; p = 0.037), left lower lobectomy (OR, 0.263; 95% CI, 0.096 to 0.726; p = 0.010) and middle lobectomy (OR, 0.136; 95% CI, 0.031 to 0.606, p = 0.009). This study found that using the LigaSure device can improve the quality of lymphadenectomy in lung cancer patients and also identified other factors that affect the quality of lymphadenectomy. These findings contribute to improving lung cancer surgical treatment outcomes and provide valuable insights for clinical practice.

Our investigation aimed to assess the reliability of the femoral head shape classification system devised by Rutz et al . and observe its application in patients with cerebral palsy (CP) at different skeletal maturity levels. Four independent observers assessed anteroposterior radiographs of the hips of 60 patients with hip dysplasia associated with non-ambulatory CP (Gross Motor Function Classification System levels IV and V) and recorded the femoral head shape radiological grading system as described by Rutz et al . Radiographs were obtained from 20 patients in each of three age groups: under 8 years, between 8 and 12 years and above 12 years old, respectively. Inter-observer reliability was assessed by comparing the measurements of four different observers. To determine the intra-observer reliability, radiographs were reassessed after a 4-week interval. Accuracy was checked by comparing these measurements with the assessment of expert consensus. Validity was checked indirectly by observing the relationship between the Rutz grade and the migration percentage. The Rutz classification system's evaluation of femoral head shape showed moderate to substantial intra- and inter-observer reliability (mean κ  = 0.64 for intraobserver and mean κ  = 0.5 for interobserver). Specialist assessors had slightly higher intra-observer reliability than trainee assessors. The grade of femoral head shape was significantly associated with increasing migration percentage. Rutz's classification was shown to be reliable. Once the clinical utility of this classification can be established, it has the potential for broad application for prognostication and surgical decision-making and as an essential radiographic variable in studies involving the outcomes of hip displacement in CP. Level of evidence: III., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Coronavirus disease 2019 (COVID-19) can irreversibly damage the lungs and could possibly increase the risk of surgical treatment of lung cancer. The study aimed to assess the relationship between preoperative COVID-19 and complications and early outcomes of lung cancer surgery., Methods: This single-center cohort study included 444 patients who underwent lobectomy or segmentectomy for primary lung cancer from January 1, 2019 to December 31, 2021. The exclusion criteria were pneumonectomy, extended resection, and wedge resection. The groups of patients with (n = 72) and without (n = 372) the history of COVID-19 prior to surgery were compared. The groups were similar in terms of distribution of baseline, surgical and histopathological characteristics. The primary endpoint was the incidence of postoperative complications. Secondary endpoints were outcomes at discharge and at 90 days., Results: The incidence of postoperative complications did not differ between the groups of patients with and without COVID-19 history (30.6% vs 29.3%, p = 0.831). Outcomes at discharge and at 90 days after surgery did not differ between the groups. Among the patients with and without prior COVID-19, 97.2 and 99.5% were alive at discharge (p = 0.125), and 97.2% and 98.1% ninety days after surgery (p = 0.644), respectively. Patients with COVID-19 history more often required re-drainage (6.9% v 2.2%, p = 0.044) and reoperation (5.6 v 1.3%, p = 0.042)., Conclusions: COVID-19 history is not related to the general incidence of complications, outcomes at discharge from the hospital, and at 90-days after surgery., (© 2022. The Author(s).)

Introduction: Primary spontaneous pneumothorax (PSP) is a relatively common disease. Different studies have been published but lung resection, when no emphysema-like changes (ELC) are detected, is unclear. The aim of our study is to retrospectively investigate the role of lung resection of the apex of the lung in patients with no ELC., Methods: This is a retrospective multicenter study of 516 patients who underwent surgical treatment of PSP with no ELC between January 2007 and December 2017. Patients were divided into two groups: pleurodesis alone group, only mechanical pleurodesis performed (53 patients), and apical resection group, apical resection of the lung and mechanical pleurodesis performed (463 patients). The following were the primary end points considered: recurrence rate and perioperative complications; the following were the secondary end points considered: length of stay, chest tube removal, residual pleural space, prolonged air leak, and reoperation rate., Results: No differences were found in the baseline and operative characteristics of the two groups. Both primary end points were statistically different: recurrence rate (15.1% versus 6.5%, P = 0.023) and perioperative complications (18.9% versus 7.3%, P = 0.004). Among secondary end points length of stay (6.94 versus 5.55, P = 0.033) and prolonged air leak (15.1% versus 4.3%, P = 0.001) were statistically different. On multivariate analysis, lung resection emerged as a protective factor for recurrence (hazard ratio 0.182, P < 0.001)., Conclusions: In our experience, apical lung resection in patients without ELC may reduce recurrence rate and perioperative complications when compared with pleurodesis alone., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Pneumonectomy is a high-risk radical resection procedure, with bronchopleural fistula (BPF) being its most challenging and severe complication. This study aimed to assess the surgical risk factors and the impact of the bronchial stump closure technique on the incidence of the BPF., Methods: This is a single-center, cross-sectional study of the medical records of 455 post-pneumonectomy patients operated due to non-small cell lung cancer (NSCLC) in 2006-2017. We analyzed the following variables and their influence on the occurrence of the BPF: operation side, surgical techniques (i.e., manual suture or the stapler), stump buttressing, the extension of pneumonectomy, comorbidities, and postoperative complications., Results: BPF occurred in 7.47% of post-pneumonectomy patients. BPF was more prevalent in right-sided pneumonectomy versus left-sided (10.98% vs. 5.32%; P=0.026). The use of a stapler or manual suture was not associated with the incidence of the BPF (7.96% vs. 7.09%, P=0.72). There were no significant differences in the occurrence of BPF among bronchial stump buttressing with the parietal pleura (P=0.80), intercostal muscle flap (IMF) (P=0.46), and pericardial fat pad (P=0.88). When comparing data from 2006-2012 with those from 2013-2017, we found a steady decrease in the number of performed stump reinforcements, but this was not associated with a higher risk of BPF., Conclusions: The method used for stump closure, additional tissue buttressing of the bronchial stump and year of the surgery had no significant impact on the occurrence of BPF. Only right-sided pneumonectomy was associated with higher BPF occurrence., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-240/coif). The authors have no conflicts of interest to declare., (2022 Journal of Thoracic Disease. All rights reserved.)

Nowadays, Nature-Based Solutions (NBSs) are developing as innovative multifunctional tools to maximize urban ecosystem services such as storm water preservation, reduction of runoff and flood protection, groundwater pollution prevention, biodiversity enhancement, and microclimate control. Gdańsk is one of the first Polish cities to widely introduce rain gardens (one example of an NBS) in different areas such as parks, city center, main crossroads, and car parks. They involve different technical innovations individually tailored to local architecture, including historic buildings and spaces. Gdańskie Wody, which is responsible for storm water management in the city, adopted a pioneering strategy and started the construction of the first rain garden in 2018. Currently, there are a dozen rain gardens in the city, and this organisation's policy stipulates the construction of NBSs in new housing estates without building rainwater drainage. Various types of rain gardens can be created depending on location characteristics such as geo-hydrology, as well as local conditions and needs. Furthermore, each of them might be equipped with specific technical solutions to improve the rain garden's function - for example, an oil separator or setter can be included to absorb the initial, most polluted runoff. During winter, the large amount of sodium chloride usually used to grit the roads may pose the greatest threat to biodiversity and plants. These installations have been included in a large rain garden in Gdańsk, located in the central reservation of the main streets in the city center. This work presents various technical considerations and their impact on ecosystem functions, and the urban circularity challenges provided by rain gardens operating in different technologies and surroundings. The precipitation quantity and the following infiltration rate were estimated by installing pressure transducers. Furthermore, mitigation of the urban heat island was analysed based on remote sensing images., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: The video-assisted thoracic surgery (VATS) approach is widely used for pulmonary lobectomy, but its application for pneumonectomy is much less common and outcomes are ambiguous., Aim: To evaluate the feasibility and outcomes of VATS pneumonectomy., Material and Methods: This retrospective study included 19 patients with the mean age of 62.6 ±5.5 years who were qualified for VATS pneumonectomy between September 1, 2010, and January 31, 2020. Indications and technical aspects were analyzed. Moreover, short- and long-term outcomes were assessed., Results: There were no intraoperative deaths. Conversion to thoracotomy was necessary in 2 (10.5%) patients, because of bleeding in 1 patient and technical reasons in another. One patient died during the in-hospital period due to multi-organ failure as a result of bronchopleural fistula. Five other subjects developed postoperative complications, most often atrial fibrillation (n = 3). One patient was readmitted for empyema of the postpneumonectomy space without bronchopleural fistula. Histopathological examination revealed that the resection was complete (R0) in all cases and the most common type of cancer was squamous cell carcinoma (79%). Seven patients died during the follow-up: 1 because of surgical complications, 4 as a result of cancer progression, and 2 for non-cancer related reasons. Median survival was 47 months. One- and five-year probability of survival estimated by means of the Kaplan-Meier method was 0.88 ±0.07 and 0.43 ±0.15, respectively., Conclusions: VATS pneumonectomy can be performed safely, without increased risk of intraoperative and postoperative complications. It enables a complete lung cancer resection and is likely to provide good short- and long-term outcomes., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2021 Fundacja Videochirurgii.)

Halloysite, a nanoclay characterized by a unique, tubular structure, with oppositely charged interior and exterior, suitable, nanometric-range size, high biocompatibility, and low cost, is recently gaining more and more interest as an important and versatile component of various biomaterials and delivery systems of biomedical relevance. One of the most recent, significant, and intensely studied fields in which halloysite nanotubes (HNTs) found diverse applications is cancer therapy. Even though this particular direction is mentioned in several more general reviews, it has never so far been discussed in detail. In our review, we offer an extended survey of the literature on that particular aspect of the biomedical application of HNTs. While historical perspective is also given, our paper is focused on the most recent developments in this field, including controlled delivery and release of anticancer agents and nucleic acids by HNT-based systems, targeting cancer cells using HNT as a carrier, and the capture and analysis of circulating tumor cells (CTCs) with nanostructured or magnetic HNT surfaces. The overview of the most up-to-date knowledge on the HNT interactions with cancer cells is also given.

Objectives: Conversion of thoracoscopic lobectomy for lung cancer to thoracotomy can adversely affect short-term outcomes, but the impact on long-term outcomes is unknown. This study aimed to identify the risk factors for conversion and to determine the influence of conversion on the outcomes of lung cancer treatment., Methods: This retrospective study included 1002 consecutive patients with lung cancer who underwent thoracoscopic lobectomy between 7 June 1999 and 17 July 2018. The groups of patients with and without conversion were compared in terms of possible risk factors and the short- and long-term outcomes. The survival of patients was analysed by the Kaplan-Meier method., Results: Conversion was done in 105 patients (10.5%). On multivariable logistic regression analysis, the independent risk factors for conversion were pleural adhesions (P < 0.001) and mediastinal lymph node metastases (P < 0.001). Compared with the non-conversion group, the conversion group had longer chest drainage time (4 vs 3 days, P < 0.001) and hospital stay (8 vs 6 days, P < 0.001); more frequent complications (38.1% vs 27.1%, P = 0.018), including red blood cell transfusion (10.5% vs 2%, P < 0.001) and supraventricular arrhythmia (13.3% vs 7.5%, P = 0.037); and lower 5-year survival rate in patients with stage I lung cancer (70% vs 87%, P = 0.014). Conversion did not increase in-hospital mortality., Conclusions: Pleural adhesions and lymph node metastases increased the probability of conversion to thoracotomy. Conversion adversely affected the short-term outcomes of thoracoscopic lobectomy. Long-term outcomes of treatment of non-small-cell lung cancer could be worse in patients after conversion, but definitive conclusions cannot be made in this regard because of the absence of control of selection bias., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Introduction: One of the most significant challenges nowadays is to educate and predict the predispositions of young surgeons taking into consideration that every ability has its own learning curve., Aim: To determine the influence of selected factors and examine the shape and the length of the learning curve in performing simple tasks on an endoscopic simulator., Material and Methods: Twenty students took part in 4 training sessions with a one-week break between sessions. They were training 12 min and performed three tasks at every session on the endoscopic simulator. To identify whether selected factors influence the time of completing tasks, the participants were asked to fill in questionnaires. All participants also completed the Minnesota Manual Dexterity Test (MMDT) to assess hand-eye coordination., Results: Our research reveals that regardless of activities performed in free time, the shape of the learning curve was logarithmic. Improvement after the fourth session ranged from 50% to 75%. Performing specific activities in the free time did not influence the results achieved on the simulator. No statistically significant correlation between MMDT results and the time to accomplish each task was found., Conclusions: This study has shown that the length of the learning curve of performing simple tasks is quite short and the shape is logarithmic. It suggests that more complex exercises should be included in the training programme., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2020 Fundacja Videochirurgii.)

The ability of early lung cancer diagnosis is an unmet need in clinical practice. Lung cancer metabolomic analyses conducted so far have demonstrated several abnormalities in cancer lipid profile providing a rationale for further study of blood lipidome of the patients. In the present research, we performed a targeted lipidome screening to select molecules that show promise for early lung cancer detection. The study was conducted on serum samples collected from newly diagnosed, stage I non-small cell lung cancer (NSCLC) patients and non-cancer controls. A high-throughput mass spectrometry-based platform with confirmed interlaboratory reproducibility was used. The analyzed profile consisted of acylcarnitines, sphingomyelins, phosphatidylcholines and lysophosphatidylcholines. Among the assayed lipid species, the significant differences between NSCLC and non-cancer subjects were observed in the group of phosphatidylcholines (PC) and lysophosphatidylcholines (lysoPC), especially in the levels of lysoPC a C26:0; lysoPC a C26:1; PC aa C42:4; and PC aa C34:4. The metabolites mentioned above were used to create a multivariate classification model, which reliability was proved by permutation tests as well as external validation. Our study indicated choline-containing phospholipids as potential lung cancer markers. Further investigations of phospholipidome are crucial to better describe the shifts in metabolite composition occurring in lung cancer patients.

Aim: The aim of the study was to evaluate the impact of smoking cessation and its timing in the preoperative period on postoperative morbidity in patients undergoing surgery for non-small cell lung cancer (NSCLC)., Material and Methods: Two hundred and eighty-six patients surgically treated for NSCLC were prospectively analyzed in terms of duration and intensity of smoking, time period from smoking cessation to surgery, and postoperative morbidity. The patients were divided into five groups: I - current smokers and past smokers who quit smoking less than 2 weeks before surgery ( n = 67), II - past smokers who quit 2 weeks to 3 months ( n = 106), III - past smokers who quit 3 months to 1 year ( n = 30), IV - past smokers who quit more than 1 year ( n = 71), V - never smokers ( n = 12)., Results: In the analyzed group 95.8% were smokers or past smokers. Postoperative complications occurred in 40.2% of patients including pulmonary (21.3%) and cardiac morbidity (17.8%). The pulmonary and circulatory morbidity rates were the lowest in group V but the differences were not significant. Similarly, there were no significant differences between groups with and without pulmonary or circulatory complications regarding: number of daily smoked cigarettes, smoking duration and the moment of cessation. The analysis of segmental regression showed the smallest percentage of complications in patients who quit smoking between the 8 th and the 10 th week before the operation., Conclusions: Among patients surgically treated for NSCLC, duration of smoking and number of smoked cigarettes has no significant influence on frequency and type of postoperative complications. The best moment to quit smoking is the period between the 8 th and the 10 th week preceding surgery., Competing Interests: The authors report mo conflict of interest.

Introduction: Despite the constant decrease of performed pneumonectomies (PN) in recent years, it is still necessary for 15-20% of patients with non-small cell lung cancer (NSCLC) to undergo total lung resection due to the local progression of the disease., Aim: To assess the frequency and type of postoperative complications, quality of life, and the early and long-term results after PN performed due to NSCLC., Material and Methods: In the total group of 1160 patients, operated on in 2008-2011 due to NSCLC, 192 of them underwent PN (16.6%). The quality of life was analysed using EORTC-QLQ-C30 questionnaire., Results: Perioperative mortality after PN was 4%. Five-year survival reached 45%. The factors that significantly affected the 5-year survival in multivariate analysis were: pTNM stage, pN stage, intrapericardial resection, and additional extrapulmonary structures resection. The mean Global Quality of Life was 50.8. The Symptom Scale ranged from 7 to 54.3, the Functional Scale from 58.2 to 76.3 and the rate for NSCLC symptoms ranged from 2.2 to 48.1., Conclusions: Pneumonectomies in patients with NSCLC is associated with higher risk of postoperative complications but it does not significantly increase the perioperative mortality. Long-term results in this group of patients are encouraging. According to the questionnaire, the quality of life is favourable. Low intensity of typical NSCLC symptoms was observed. The appropriate qualification for right-sided PN and exclusion of metastasis in N2 nodes are crucial., Competing Interests: The authors report no conflict of interest.

In the last few years the idea of circular economy has become essential. Thus, designing methods of nutrients removal should be based on using materials that make it possible to recover those nutrients. Recently, methods applied in wastewater treatment plants cannot provide optimal results; moreover, the application of commercial coagulants like ferric chloride and polyaluminum chloride can cause difficulties in potential recovery of phosphorus from sludge. Sorption materials, both natural and modified, are appearing as successful for wastewater treatment, especially for treatment wetland effluent. To pursue circular economy principles, the capacity of waste materials needs to be tested with regard to nutrients removal. If in addition a possibility to recover them appears, it will be possible to close the circuit. The aim of the investigation, according to HELCOM and EU Water Framework Directive recommendations, was to explore the possibility of ensuring good and stable quality of effluent by the application of natural materials for phosphorous removal with possible minimum energy and material consumption. The objective was to determine the sorption capacity of two selected materials (waste material and chemically modified material) in steady conditions. The research focused also on the time of mixing, a period of sedimentation of absorbent materials, and the influence of used materials on the basic parameters of the solution: pH, temperature, total suspended solids, conductivity, turbidity, and color. M1 was a waste material after thermal treatment of carbonate-siliceous rock in temperature above 700 °C (Rockfos®). Material M2 was lanthanum-modified bentonite, a material of anthropogenic origin. Both selected materials have shown a high ability to reduce phosphates concentration in synthetic wastewater. Sorption capacity of materials M1 and M2 were 45.6 mg/g and 5.6 mg/g, respectively., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Examining the effects of acute stress across multiple modalities (behavioral, physiological, and endocrinological) can increase our understanding of the interplay among stress systems, and may improve the efficacy of stress detection. A multimodal approach also allows for verification of the biological stress response, which can vary between individuals due to myriad internal and external factors, thus allowing for reliable interpretation of behavioral markers of stress. Here, controlling for variables known to affect the magnitude of the stress response, we utilized the Trier Social Stress Test (TSST) to elicit an acute stress response in 80 healthy adult men and women. The TSST involves an interview-style oral presentation and critical social evaluation, and is highly effective in inducing psychosocial stress. Participants completed the study in individual 2 h sessions, during which we collected voice, polygraph and salivary hormone measures in baseline, stress, and relaxation phases. Our results show sizeable systematic increases in voice pitch (mean, minimum and variation in fundamental frequency, F0), hormone levels (cortisol) and decreases in skin temperature and hand movement during psychosocial stress, with striking similarities between men and women. However, cortisol and skin temperature only weakly predicted changes in voice pitch during stress, in either women or men, respectively. Thus, while our results provide compelling evidence that psychosocial stress manifests itself behaviorally by increasing voice pitch and its variability alongside simultaneous activation of physiological and endocrinological stress systems, our results also highlight a relatively weak degree of intra-individual 'response coherence' across these stress systems, with dissociations among different stress measures related most strongly to sex., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Chronic spontaneous urticaria (CSU) is one of the commonest diseases in allergological and dermatological practice. It constitutes an interdisciplinary problem, and its pathogenesis is not always easily determined. It has been suggested that metabolic syndrome and hyperlipidaemia are more frequent in patients with CSU, but the influence of overweight and obesity on the development of CSU has not been thoroughly investigated., Aim: To assess the association between body parameters and the development of CSU., Methods: The study enrolled 85 patients with CSU, who were divided into three subgroups: patients whose only symptoms were weals, patients whose only symptom was angio-oedema, and patients with urticaria and accompanying angio-oedema. Mean weight, height, body mass index (BMI), body surface area, disease duration and age of disease onset were recorded RESULTS: There was a statistically significant association between CSU and heavier weight, higher BMI, greater affected body surface area and older age at disease onset. Subjects with higher BMI values had a tendency towards longer disease duration. There were no statistically significant differences between the three subgroups., Conclusions: Our results suggest that CSU, especially if of long duration, may be associated with overweight and obesity, while increased body mass can result in later onset of urticaria symptoms. Further analyses to confirm the presented results and possible association between obesity and CSU occurrence are needed., (© 2018 British Association of Dermatologists.)

Introduction: Patients over 75 years of age, who, in addition, often have already exceeded the average life expectancy, in the Polish population on average 77.4 years, are the subject of discussion concerning the most appropriate choice of treatment., Aim: To analyse the long-term results in elderly patients over 75 years of age with lung cancer who underwent curative pulmonary resection., Material and Methods: 166 patients aged from 75 to 85 (mean: 77.4 ±2.3) operated on for non-small cell lung cancer (NSCLC) were included in this study. There were 128 (77%) men and 38 (23%) women., Results: Lobectomy, including bilobectomy, was performed in 122 (74%) patients, pneumonectomy in 8 (5%) patients, and wedge resections or segmentectomy in the remaining 36 patients. Squamous or adenocarcinoma was diagnosed in 46% and 42% of cases respectively. Clinical stage I A was diagnosed in 36 (22%) patients, I B in 51 (31%), IIA in 30 (18%), IIB in 19 (11%) and IIIA in 30 (18%) of our cases. The early 30-day postoperative mortality was 5% whilst postoperative morbidity occurred in 47% of cases. The five-year survival rate was 30%. In statistical analysis, the TNM classification ( p = 0.0490), the number of postoperative complications ( p = 0.0001) and obstructive atelectasis requiring repeat bronchofibroscopic aspirations ( p = 0.0137) in the early postoperative period most negatively influenced the long-term survival in the whole study group., Conclusions: Surgical resections for lung cancer in patients over 75 years of age are characterised by a relatively good long-term prognosis. Careful and strictly detailed preoperative selection, particularly of patients with pulmonary comorbidities and the earliest possible diagnosis of a lung tumour, can reduce the occurrence of these postoperative complications in elderly patients, which negatively influence long-term results.

Introduction: Over the years, pulmonary carcinoids have been treated as locally malignant tumors because of the favorable prognosis. It is currently known that the clinical course of the disease is mainly dependent on the carcinoid subtype., Aim: To analyze the early and long-term surgical treatment outcomes for typical and atypical carcinoids., Material and Methods: A total of 90 patients were treated surgically for pulmonary carcinoid tumors in the years 2007-2015. Typical carcinoids were diagnosed in 69 (77%) cases, while atypical carcinoids - in 21 (23%); 67 patients underwent lobectomy, 3 - sleeve lobectomy, 9 - bilobectomy, 2 - pneumonectomy, 1 - segmentectomy, and 8 - wedge resection., Results: None of the patients died in the postoperative period. Complications occurred in 14.4% of patients. The most common complications included: arrhythmias (5.6%), prolonged air leak (3.3%), and residual pneumothorax (3.3%). Among the 21 patients with atypical carcinoids, N1 metastasis was found in 1 (4.8%) patient, while N2 - in 5 (23.8%) patients. In the group of 69 patients with typical carcinoids, N1 metastasis was revealed in 7 (10.1%) patients and N2 metastases - in 2 (2.9%) patients. The probability of 5-year survival in patients with typical and atypical carcinoids was 96% and 83%, respectively. During the follow-up period 7 (7.8%) patients, including 6 with atypical carcinoids, experienced local recurrence; distant metastasis occurred in 8 (8.9%) cases, including 6 with atypical carcinoids., Conclusions: Although radical surgical treatment provides excellent long-term outcomes, it should be noted that patients with pulmonary carcinoids (especially with the atypical subtype) may experience local recurrence and distant metastases even many years after surgery.

The publication of the human genome sequence provided direction in the search for novel diagnostic and therapeutic methods for the treatment of human diseases. The aim of the present study was to investigate the hypothesis that the expression profile of genes involved in the regulation of angiogenesis may be a marker in endometrial cancer that facilitates the diagnosis and prognosis of patients, as well as the identification of novel therapeutic targets. The current study included 36 patients with grade (G) 1 to 3 endometrial cancer, and a control group of patients consisting of females that qualified for the removal of the uterus. Out of these, 28 samples (control, 3; G1, 7; G2, 12; and G3, 6) were selected for microarray analysis. Molecular analysis of the endometrial samples involved the extraction of total RNA, purification of the obtained extracts and subsequent analysis of the gene expression profiles using an oligonucleotide microarray technique (GeneChip® Human Genome U133A plates). The results indicated that the mRNA expression profile of genes involved in the regulation of angiogenesis varies depending on the degree of histological differentiation of endometrial adenocarcinoma. Similar results were obtained from descriptive statistics characterizing the expression profile of 691 mRNAs associated with the regulation of angiogenesis in the groups of patients with endometrial adenocarcinoma. In addition, the results of the present study indicated that neuropilin2 (NRP2) may serve an important role in the activity of endothelial cells, and may affect vascular endothelial growth factor, and potentially plexins and integrins via regulation of their functions. An understanding of how these proteins interact remains to be determined; however, elucidating these interactions may provide an explanation for the mechanisms underlying angiogenesis. In conclusion, the results of the present study suggest that NRP2 may be a valuable target for investigation in future pharmacological studies involving angiogenesis in endometrial cancer.