Institution-Level Evolution of Lung Cancer Resection Quality With Implementation of a Lymph Node Specimen Collection Kit

IntroductionLung cancer surgery with a lymph node kit improves patient-level outcomes, but institution-level impact is unproven.MethodsUsing an institutional stepped-wedge implementation study design, we compared lung cancer resection quality between institutions in preimplementation and postimplementation phases of kit deployment and, within implementing institutions, resections without versus with the kit. Benchmarks included rates of nonexamination of lymph nodes, nonexamination of mediastinal lymph nodes, and attainment of American College of Surgeons Operative Standard 5.8. We report institution-level adjusted ORs (aORs) for attaining quality benchmarks.ResultsFrom 2009 to 2020, three preimplementing hospitals had 953 resections; 11 implementing hospitals had 4013 resections, 58% without and 42% with the kit. Quality was better in implementing institutions and with kit cases. Compared with preimplementing institutions, the aOR for nonexamination of lymph nodes was 0.62 (0.49–0.8, p = 0.002), nonexamination of mediastinal lymph nodes was 0.56 (0.47–0.68, p < 0.0001), and attainment of Operative Standard 5.8 was 7.3 (5.6–9.4, p < 0.0001); aORs for kit cases were 0.01 (0.001–0.06), 0.08 (0.06–0.11), and 11.6 (9.9–13.7), respectively (p < 0.0001 for all). Surgical quality was persistently poor in preimplementing institutions but sequentially improved in implementing institutions in parallel with kit adoption. In implementing institutions, resections with the kit had a uniformly high level of quality, whereas nonkit cases had a low level of quality, approximating that of preimplementing institutions. Within implementing institutions, 5-year overall survival was 61% versus 51% after surgery with versus without the kit (p < 0.001).ConclusionsSurgery with a lymph node specimen collection kit improved institution-level quality of curative-intent lung cancer resection.     

In vitro anti-Helicobacter pylori activity of aqueous extract from Persian Oak testa

Objective: Growing problem of antibiotic resistance in Helicobacter pylori, as a common cause of chronic gastritis and even stomach cancer, demands searching for novel candidates of herbal sources. This study is aimed at assessing the antimicrobial activity of aqueous extract obtained from Quercus brantii var. persica seed coat(Testa) on H. pylori isolated from gastric biopsy specimens.Methods: Such specimens were collected from 100 patients presenting with endoscopic gastroduodenal findings. Testa extracts were prepared from Persian Oak forests in the province of Kohgiluyeh and BoyerAhmad, IRAN. H. pylori isolates were obtained by a series of standard bacteriology tests and cell culture,then were confirmed by PCR. The activity of testa extracts towards 25 H. pylori isolates was assessed by well diffusion method, microdilution assay, and a disk diffusion assay in vitro. Results were analyzed statistically by one-way ANOVA analysis.Results: Aqueous extract of testa demonstrated an antimicrobial activity with zone diameters of inhibition ranged from 0 mm to 40 mm. Its inhibitory activity increased simultaneously with increasing extract concentration. The lowest MIC and MBC were both recorded as 2 μg/m L. Anti-H. pylori activity of testa extract was approximately close to tetracycline and metronidazole and less than amoxicillin. A potent extract of testa possessed significant inhibitory activity(P 0.05).Conclusion: Testa extract is suggested as a natural therapeutic source against the gastric H. pylori infection. However, evaluating the in vivo activity of this extract is necessary too.     

Anti-HER2 therapy: how to use Herceptin®in clinical practice

The recombinant, humanized monoclonal antibody Herceptin^®is administered as an initial 4 mg/kg i.v. infusion over 90 min, followed by weekly 2 mg/kg i.v. infusions over 30 min. In pivotal clinical trials Herceptin^®, both as a single agent and in combination with chemotherapy, was found to produce a significant survival benefit in HER2-positive metastatic breast cancer patients. Importantly, Herceptin^®was well tolerated and was not associated with a poor side-effect profile, producing mainly mild to moderate side-effects. These were generally associated with the initial infusion. The incidence of adverse events was low with Herceptin^®therapy and severe vomiting and alopecia, typical of many chemotherapy treatment regimens, were not experienced by patients in the trials. Cardiac dysfunction was the most significant Herceptin^®-related adverse event but could, in most cases, be managed using standard therapy. The favourable adverse event profile seen with Herceptin^®is reflected in the quality of life (QoL) data. The health-related QoL of patients receiving Herceptin^®therapy alone or in combination with chemotherapy was found to be maintained. Previous studies have noted a deterioration of health-related QoL in patients treated with chemotherapy only. Thus, as well as providing significant survival benefit, Herceptin^®therapy improves patient well being.     

A very high level of crossreactivity is an essential feature of the T-cell receptor

It is commonly accepted that a high level of antigen specificity is a feature of T-cell activation. However, here, Don Mason argues that a comprehensive response to foreign antigens requires that T cells are widely crossreactive, such that one cell reacts productively with approximately 10⁶ different MHC-associated minimal peptide epitopes.     

Vacuolating cytotoxin purified fromHelicobacter pyloricauses mitochondrial damage in human gastric cells

We investigated the effects of vacuolating cytotoxin (VacA) prepared fromHelicobacter pylorion the metabolism of gastric epithelial cells, AZ-521. VacA caused the ATP levels to decrease in a time-dependent manner; by approximately 20% in 6 h, 35% in 12 h and 50% in 24 h, at a concentration of 120 nM. This decrease was also dependent on the concentration of VacA. To evaluate the impairment of mitochondria by VacA, mitochondrial membrane potential was estimated by flow cytometric analysis using 3, 3′-dihexyloxacarbocyanine iodide as a substrate. VacA decreased membrane potential with the relative fluorescence intensity of AZ-521 cells in 6 h from 52±3 to 24±1. Treatment of the cells with bafilomycin A1, a specific inhibitor of vacuolar ATPase proton pump, showed no apparent effect on these changes in the levels of ATP and the mitochondrial membrane potential. Secondly, we estimated the effect of VacA on oxygen consumption. VacA inhibited oxygen consumption in AZ-521 cells: the levels of PO₂in the medium of control cells decreased by 73% in 3 h and 37% in 6 h, whereas those in VacA-treated cells were 84% in 3 h and 59% in 6 h. Flow cytometric analysis showed the number of cells in the G₀/G₁phase was increased by VacA. Taken together, VacA induced an inactivation of energy metabolism followed by mitochondrial damage, leading to impairment of the cell cycle in gastric epithelial cells.     

Surgical management of cerebral arteriovenous malformations with intraoperative digital subtraction angiography

Complete excision of cerebral arteriovenous malformations (AVMs) is requisite to improving the outcome of patients with AVMs. Five patients with a small or medium cerebral AVM underwent surgery with an intraoperative digital subtraction angiography (DSA) unit. There were no residual AVMs and no complications in the examination of intraoperative DSA. The findings of postoperative angiography were consistent with those of intraoperative DSA. Intraoperative DSA provided the benefits of not only identification of a feeding artery, but also recognition of the complete excision during surgery.