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Fernandez-Marcelo T.,Complutense University of Madrid | Fernandez-Marcelo T.,Sanitary Research Institute of San Carlos Hospital IdISSC Madrid | Gomez A.,Service of Thoracic Surgery | Gomez A.,Sanitary Research Institute of San Carlos Hospital IdISSC Madrid | And 16 more authors.
Journal of Experimental and Clinical Cancer Research | Year: 2015

Abstract Background: Considering previous data and the need to incorporate new biomarkers for the prognosis of solid tumours into the clinic, our aim in this work consists of evaluating the potential clinical use of telomeres and telomerase in non-small cell lung cancer (NSCLC). Methods: Telomere status was established by determination of telomere length using the Terminal Restriction Fragment length method, and telomerase activity by the Telomeric Repeat Amplification Protocol in 142 NSCLCs and their corresponding control samples, obtained from patients submitted to surgery. Group-oriented curves for disease-free survival were calculated according to the Kaplan-Meier method considering telomere length, T/N ratio (telomere length in tumour to control tissue) and telomerase activity. Results: Overall, tumours had significantly shorter telomeres compared with telomeres in control tissues (P = 0.027). More than 80 % of NSCLCs displayed telomerase activity. Regarding prognosis studies, patients whose tumours showed a mean telomere length (MTL) <7.29 Kb or T/N ratio <0.97 showed a significantly poor clinical evolution (P = 0.034 and P = 0.040, respectively). As result of a Cox multivariate analysis including pathologic state and lymph node dissemination, the MTL and T/N ratio emerged as independent significant prognostic factors. Conclusions: Telomerase activity was identified as a marker of poor prognosis. The novel finding of this study is the independent prognosis role of a specific telomere status in NSCLC patients. According to our results, telomere function may emerge as a useful molecular tool that allow to select groups of NSCLC patients with different clinical evolution, in order to establish personalized therapy protocols. © 2015 Fernández-Marcelo et al. Source

Varela G.,University of Salamanca | Brunelli A.,Service of Thoracic Surgery | Jimenez M.F.,University of Salamanca | Di Nunzio L.,Service of Thoracic Surgery | And 3 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2010

Background and objective: To our knowledge, no reports have been published describing the effect of suction on pleural pressures after different types of lobectomy. Improving knowledge of pleural physiology in the postoperative period could lead to better postoperative care. The aim of this investigation is to evaluate the effect of postoperative suction on inspiratory, expiratory and differential pleural pressures after upper or lower lobectomy. Methods: Records of intrapleural pressures from 24 lobectomy patients (operated on in two different institutions) were selected for study. All patients had normal preoperative pulmonary function tests (forced expiratory volume in 1 s (FEV1) >80% and forced vital capacity (FVC)/FEV1 >70%), and neither postoperative air leak nor any other postoperative complication. We selected six cases of each type of lobectomy (right upper lobectomy (RUL), right lower lobectomy (RLL), left upper lobectomy (LUL) and left lower lobectomy (LLL)). In three cases of each group, no suction was indicated, while in the other three cases, chest tubes were placed under 15 cmH2O suction, according to the standard local perioperative care protocol in each participating centre. Inspiratory and expiratory pleural pressures were measured at 2-min intervals by an electronic device using a DigiVent® (Millicore A.B., Sweden) suction chamber. Recording started 5-10 h after closing the chest, and included 5 consecutive hours during the first postoperative night, with the patients at rest in 30-45° sitting position. There was no evidence of pneumothorax during the recording time. The influence of lobectomy site (upper or lower) and suction on inspiratory, expiratory and differential pressures were evaluated by Student's t-tests. Results: In the group of cases under no suction, upper lobectomy patients had larger differential pressures (22.6 in upper vs 11.5 cmH2O in lower lobectomy cases, p < 0.001), differential pressure decreased in patients under suction (9.1 in upper vs 11.1 cmH2O in lower lobectomy cases, p < 0.001) and the effect was mainly due to a less negative inspiratory pressure. Conclusion: Pleural suction leads to a large decrease of differential pleural pressure after upper pulmonary lobectomy. The influence of this finding on postoperative work of breathing in the early postoperative period remains to be investigated. © 2009 European Association for Cardio-Thoracic Surgery. Source

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