Statistical evaluation of the lymphocyte proliferation assay with non-stimulated cultures

A micromethod for the lymphoproliferative assay has been evaluated statistically with non-stimulated human lymphocyte combinations. Different variance components were estimated by means of a hierarchical analysis of variance. Instead of using an arbitrary value for a significant difference between stimulated and non-stimulated cultures, the value can be calculated on the basis of the components of variance in the experimental design. The method disclosed systematic differences between the values of control cultures depending on the lymphocyte combinations and groups of persons examined, which underlines that every experiment should always contain non-stimulated cultures. Further, cell-cell cooperation and differences in spontaneous DNA synthesis within individual lymphocyte populations could be demonstrated.     

Lung Transplantation in Hungary From Cardiac Surgeons' Perspective

Thoracic organ transplantation made a fresh start in Hungary with the first double lung transplant in December 2015. This major leap in Hungarian transplantation was preceded by almost 10 years of preparation, new infrastructure development, and structural changes not only at the organizational level but in human resources as well. In the following years, until recently, altogether 47 lung transplants were performed on 24 men and 23 women. The underlying pathologies were as follows: chronic obstructive pulmonary disease, 25; cystic fibrosis, 11; idiopathic pulmonary fibrosis, 7; as well as other diseases, including bronchiectasis, eosinophilic granuloma, lymphangioleiomyomatosis, and primary pulmonary hypertension in 4 cases. The youngest recipient was 13 and the oldest was 65 years old. Overall survival rates at 30 days and at 1 year were 96% and 82%, respectively. No patients were lost in the cystic fibrosis and other diseases group, whereas the 1-year survival rates of the chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis groups were 73% and 71%, respectively. The results show the robustness and viability of the program, although there is still opportunity for further improvement. In this short paper, we summarize the fields of possible further cooperation of thoracic and cardiac teams as well as future challenges facing the new Hungarian lung transplant program.     

Avoidance of avascular necrosis of the femoral head, following fractures of the femoral neck, by early reduction and internal fixation

Clinical, experimental and post-mortem studies suggest that avascular necrosis of the femoral head following fractures of the neck of the femur, is due to compression, torsion, stretching or rupture of the blood vessels by displacement of the fragments. If this is true then urgent reduction and internal fixation are important in the prevention of this complication. This study shows that those cases which were submitted to early reduction and internal fixation had a reduced incidence in severity of avascular necrosis compared with those in whom operation was delayed. Therefore it is proposed that fractures of the femoral neck should be treated by early reduction and internal fixation.     

Studies on the embryotoxic effects of ortho-, meta- and para-xylene

CFY rats were exposed to inhalation of ortho-, meta-, or para-xylene at 150, 1500, or 3000 mg/m³ concentration for 24 h/day from day 7 to day 14 of pregnancy. Additional groups of 3 rats were exposed to o-xylene at 150, 1500, or 3000 mg/m³ concentrations for 2 h only on the 18th day of pregnancy. In this latter group of rats exposed to o-xylene 18th day of pregnancy, the o-xylene concentration in the blood of the rats was proportional to that in the atmosphere. The solvent crossed the placenta; it was present in the fetal blood and amniotic fluid. All the 3 xylene isomers inhaled at the highest concentration brought about toxic effects in the mother animals. All the 3 isomers brought about the retardation of fetal development: a decrease in the weight of the fetuses, an increase in the incidence of the symptoms of skeletal retardation, a decrease in the activity of different enzymes, succinic dehydrogenase, alkaline- and acid phosphatase and glucose 6-phosphatase, characteristic features of the functional maturity of the nephron. Retardation of the fetuses was dose-dependent, but also dependent on the chemical structure of the particular isomer; their effectiveness was para-, ortho- and meta-xylene in the decreasing order of potency. None of the isomers proved to be teratogenic. Meta- and para-xylene inhalation at the highest concentration increased the incidence of extra ribs. Preimplantation fetal loss was increased by meta- and para-xylene, meta-xylene at the highest concentration interfered with the process of implantation, while para-xylene exposure resulted in an increased postimplantation loss of the fetuses. Ortho-xylene inhalation was without effect on the incidence of the extra ribs, either on implantation, or on the pre- and postimplantation fetal losses.     

Lung Transplant Patients on Kilimanjaro

BackgroundAfter its initial difficulties were overcome, lung transplantation became an accepted and effective treatment for end-stage lung disease. Patients can take part in almost all kinds of sports after lung transplantation, including high-altitude mountaineering, which is an extreme sport even for healthy individuals. Several articles have been published about high-altitude tolerance of transplanted patients. However, this was the first high-altitude expedition that included only lung transplant patients.MethodsThe Vienna lung transplantation team organized an expedition in 2017 to conquer the peak of Mount Kilimanjaro, which consisted of 10 lung transplanted patients and 24 accompanying medical personnel. The participants were tested before and several times during the hike to evaluate their general and cardiopulmonary status, the severity of altitude sickness, and radio-morphologic changes. The results of the lung transplanted patients were compared to the results of their healthy companions.ResultsThe group started at 2360 meters and reached the 5895-meter-high summit of Mount Kilimanjaro after 6 days on June 18, 2017. Eight transplant patients and 24 escorting medical personnel reached the peak. This means that the success rate was 94%, which is significantly higher than the reported 85% for this route. The 2 transplant patients who did not make the summit turned back on the first and second day because they lacked the necessary fitness for the trip. We did not see a significant difference in the results regarding cardiopulmonary status or the severity of altitude sickness, although we observed mildly higher blood pressure and altitude sickness score results in the lung transplant group.ConclusionBased on our experiences, we can state that a stable patient after lung transplantation who attains the necessary physical fitness can achieve similar or even better physical results than an average healthy individual.     

PD-L1 Expression of Lung Cancer Cells,Unlike Infiltrating Immune Cells,Is Stable and Unaffected by Therapy During Brain Metastasis

BackgroundApproximately 50% of brain metastases originate from non–small-cell lung cancer. The median survival of patients with brain metastases is 1 month without treatment. Novel immunotherapeutic strategies, such as those targeting the programmed death ligand 1 (PD-L1)/programmed cell death 1 (PD-1) axis, are promising in patients with advanced systemic disease but are often preferentially administered to patients with tumors showing PD-L1 positivity.Patients and MethodsSurgically resected paired primary lung adenocarcinoma and brain metastasis samples of 61 patients were analyzed. We compared the paired samples regarding the amount of peritumoral and stromal mononuclear infiltration, PD-L1 expression of tumor and immune cells, and PD-1 expression of immune cells. We investigated the effect of radiotherapy, chemotherapy, and steroid therapy on PD-L1 expression in brain metastases.ResultsThere was significant positive correlation regarding the PD-L1 expression of tumor cells between the paired primary lung adenocarcinoma and brain metastatic samples with the use of different cutoff levels (1%, 5%, 50%). We found no impact of chemotherapy or steroid therapy on the changes of PD-L1 expression of tumor cells between the 2 sites. There is no or only limited concordance of the proportion of PD-1– or PD-L1–positive tumor-associated immune cells between the paired tumor samples, which suggests that brain metastases develop their own immune environment.ConclusionWe observed a strong correlation of PD-L1 positive tumor cells between primary lung adenocarcinoma cases and their corresponding brain metastases, which is not significantly influenced by chemotherapy or steroid therapy.