Extended Resections for Thymic Malignancies

Abstract:Almost all series reporting on the results of resection in thymic tumors indicate that the performance of a complete resection is probably the most important prognostic factor. This issue is not a factor in Masaoka stage I and II tumors that are almost always easily completely resected and have an excellent prognosis. Masaoka stage III tumors that invade the pericardium, lungs, or great vessels have relatively higher incomplete resection rates, significantly higher recurrence rates, and thus a worse prognosis. There are several small reports on the efficacy of resection of the great veins when involved by a thymic malignancy with low morbidity and meaningful long-term survival. Superior vena cava reconstruction is commonly performed by a polytetrafluroethylene, venous, or pericardial graft. These cases can usually be identified preoperatively and, thus, considered for induction therapy. Because these types of cases are almost always of marginal respectability in terms of obtaining a true en bloc resection, there is an increasing enthusiasm for offering induction therapy in an effort to enhance resectability. Preliminary results suggest increased R0 resection rates and improved survival with induction therapy for locally advanced tumors. The optimal induction treatment is unknown. The ultimate extended surgery for advanced thymic tumors is an extrapleural pneumonectomy performed for extensive pleural disease (Masaoka stage IVA). These rarely performed operations are done for IVA disease found at initial presentation and for recurrent disease as a salvage procedure. Again these advanced patients are probably best managed by induction chemotherapy followed by resection

An expanded phylogeny of the Entodiniomorphida (Ciliophora : Litostomatea)

The Entodiniomorphida are a diverse and morphologically complex group of ciliates which are symbiotic within the digestive tracts of herbivorous mammals. Previous phylogenies of the group have exclusively considered members of one family, the Ophryoscolecidae, which are symbiotic within ruminants. We sought to improve understanding of evolution within the entodiniomorphs by expanding the range of ciliates examined to include the Cycloposthiidae and Macropodimidae (symbionts of equids and macropodids respectively). The entire SSU-rRNA gene was sequenced for 3 species, Cycloposthium edentatum, Macropodinium ennuensis and M. yalanbense, and aligned against 14 litostome species and 2 postciliodesmatophoran outgroup species. Cycloposthium was consistently grouped as the sister-taxon to the Ophryoscolecidae although support for this relationship was low. This suggests that there is more evolutionary distance between the Cycloposthiidae and Ophryoscolecidae than previously inferred from studies of gross morphology, cell ontogeny or ultrastructure. In contrast, Macropodinium did not group with any of the entodiniomorphs, instead forming the sister group to the entire Trichostomatia (Entodiniomorphida + Vestibuliferida). This early diverging position for the macropodiniids is concordant with their morphology and ontogeny which failed to group the family with any of the entodiniomorph suborders. The currently accepted classification of the Trichostomatia is thus deficient and in need of review

Postpneumonectomy syndrome: Surgical management and long-term results

ObjectivePostpneumonectomy syndrome is a rare syndrome of dynamic airway obstruction caused by extreme rotation and shift of the mediastinum after pneumonectomy, resulting in symptomatic central airway compression. We have treated this syndrome by mediastinal repositioning and placement of saline-filled prostheses into the pneumonectomy space. There is a paucity of outcome data for patients treated surgically, with only a single series of 11 patients previously reported. We analyzed our recent experience with treatment of this syndrome and report on the short and long-term outcomes and quality of life assessment of the largest series ever reported of patients treated by mediastinal repositioning.MethodsRecords were reviewed of all patients who underwent mediastinal repositioning for postpneumonectomy syndrome between January of 1992 and June of 2006. Long-term health-related quality of life was assessed by administration of the Saint George's Respiratory Questionnaire.ResultsThere were 18 patients (15 women and 3 men) with a median age of 44 years (range 14–67 years). Thirteen patients had undergone right pneumonectomy, and 5 patients had undergone left pneumonectomy. None of the patients in whom postpneumonectomy syndrome developed after left pneumonectomy had a right-sided aortic arch. Five patients had undergone pneumonectomy in childhood (age < 13 years). The median interval between pneumonectomy and mediastinal repositioning was 7.5 years (range 1.1–54.8 years). The median follow-up was 32 months (range 4–143 months). The operative mortality was 5.6% (1/18). Complications occurred in 5 patients (27.8%): pneumonia in 3 patients and acute respiratory distress syndrome in 2 patients. The median hospitalization was 6 days (range 3–155 days). Some 77% (10/13) of patients reported significant improvement in their breathing and overall state of health after surgery; 15.4% of patients (2/13) were somewhat better, and 7.7% of patients (1/13) had no improvement. No patients' condition was worse after surgery. All patients who reported improvement in their symptoms after surgery remained symptomatically improved at the time of the quality of life assessment. Some 92.3% (12/13) were not at all or only slightly limited in their social activities because of breathing problems, and 84.6% (11/13) were not at all or only slightly limited in their ability to work as a result of their physical health.ConclusionRepositioning of the mediastinum with placement of prostheses for postpneumonectomy syndrome can be performed with low mortality and morbidity. Surgical repositioning provides immediate and lasting symptomatic relief to patients in whom postpneumonectomy syndrome develops

Parents’ participation in child protection practice: toward respect and inclusion

In this article, we focus on parents' opportunities for, and experiences of, participation in child protection decision making in Queensland, Australia. Drawing on a qualitative analysis of 10 interviews with parents who have children 0-8 years of age and who have been subject to child protection investigation, we examine parents' perceptions of the process. Parents reported a range of difficulties in interactions with practitioners, Including family-related and systemic factors; the most common grievances Involved poor communication practices and negative worker attitudes, which created further disengagement. Conversely, interactions involving a willingness to listen, support, and provide for goal-focused plans were seen as faCilitating positive outcomes. Taking into account the case complexity and Interrelationships between workers' and clients' atfltudes and behaViours, we discuss strategies for promoflng parents' participation

A Functional Naturalism

I provide two arguments against value-free naturalism. Both are based on considerations concerning biological teleology. Value-free naturalism is the thesis that both (1) everything is, at least in principle, under the purview of the sciences and (2) all scientific facts are purely non-evaluative. First, I advance a counterexample to any analysis on which natural selection is necessary to biological teleology. This should concern the value-free naturalist, since most value-free analyses of biological teleology appeal to natural selection. My counterexample is unique in that it is likely to actually occur. It concerns the creation of synthetic life. Recent developments in synthetic biology suggest scientists will eventually be able to develop synthetic life. Such life, however, would not have any of its traits naturally selected for. Second, I develop a simple argument that biological teleology is a scientific but value-laden notion. Consequently, value-free naturalism is false. I end with some concluding remarks on the implications for naturalism, the thesis that (1). Naturalism may be salvaged only if we reject (2). (2) is a dogma that unnecessarily constrains our conception of the sciences. Only a naturalism that recognizes value-laden notions as scientifically respectable can be true. Such a naturalism is a functional naturalism

Rossiter-McLaughlin Effect Measurements for WASP-16, WASP-25 and WASP-31

We present new measurements of the Rossiter-McLaughlin (RM) effect for three WASP planetary systems, WASP-16, WASP-25 and WASP-31, from a combined analysis of their complete sets of photometric and spectroscopic data. We find a low amplitude RM effect for WASP-16 (Teff = 5700 \pm 150K), suggesting that the star is a slow rotator and thus of an advanced age, and obtain a projected alignment angle of lambda = -4.2 degrees +11.0 -13.9. For WASP-25 (Teff = 5750\pm100K) we detect a projected spin-orbit angle of lambda = 14.6 degrees \pm6.7. WASP-31 (Teff = 6300\pm100K) is found to be well-aligned, with a projected spin-orbit angle of lambda = 2.8degrees \pm3.1. A circular orbit is consistent with the data for all three systems, in agreement with their respective discovery papers. We consider the results for these systems in the context of the ensemble of RM measurements made to date. We find that whilst WASP-16 fits the hypothesis of Winn et al. (2010) that 'cool' stars (Teff < 6250K) are preferentially aligned, WASP-31 has little impact on the proposed trend. We bring the total distribution of the true spin-orbit alignment angle, psi, up to date, noting that recent results have improved the agreement with the theory of Fabrycky & Tremaine (2007) at mid-range angles. We also suggest a new test for judging misalignment using the Bayesian Information Criterion, according to which WASP-25 b's orbit should be considered to be aligned.Comment: 20 pages, 14 tables, 10 figures. Accepted to MNRA

Anastomotic complications after tracheal resection: Prognostic factors and management

ObjectiveWe sought to identify risk factors for anastomotic complications after tracheal resection and to describe the management of these patients.MethodsThis was a single-institution, retrospective review of 901 patients who underwent tracheal resection.ResultsThe indications for tracheal resection were postintubation tracheal stenosis in 589 patients, tumor in 208, idiopathic laryngotracheal stenosis in 83, and tracheoesophageal fistula in 21. Anastomotic complications occurred in 81 patients (9%). Eleven patients (1%) died after operation, 6 of anastomotic complications and 5 of other causes (odds ratio 13.0, P = .0001 for risk of death after anastomotic complication). At the end of treatment, 853 patients (95%) had a good result, whereas 37 patients (4%) had an airway maintained by tracheostomy or T-tube. The treatments of patients with an anastomotic complication were as follows: multiple dilations (n = 2), temporary tracheostomy (n = 7), temporary T-tube (n = 16), permanent tracheostomy (n = 14), permanent T-tube (n = 20), and reoperation (n = 16). Stepwise multivariable analysis revealed the following predictors of anastomotic complications: reoperation (odds ratio 3.03, 95% confidence interval 1.69-5.43, P = .002), diabetes (odds ratio 3.32, 95% confidence interval 1.76-6.26, P = .002), lengthy (≥4 cm) resections (odds ratio 2.01, 95% confidence interval 1.21-3.35, P = .007), laryngotracheal resection (odds ratio 1.80, 95% confidence interval 1.07-3.01, P = .03), age 17 years or younger (odds ratio 2.26, 95% confidence interval 1.09-4.68, P = .03), and need for tracheostomy before operation (odds ratio 1.79, 95% confidence interval 1.03-3.14, P = .04).ConclusionsTracheal resection is usually successful and has a low mortality. Anastomotic complications are uncommon, and important risk factors are reoperation, diabetes, lengthy resections, laryngotracheal resections, young age (pediatric patients), and the need for tracheostomy before operation

WASP-50b: a hot Jupiter transiting a moderately active solar-type star

We report the discovery by the WASP transit survey of a giant planet in a close orbit (0.0295+-0.0009 AU) around a moderately bright (V=11.6, K=10) G9 dwarf (0.89+-0.08 M_sun, 0.84+-0.03 R_sun) in the Southern constellation Eridanus. Thanks to high-precision follow-up photometry and spectroscopy obtained by the telescopes TRAPPIST and Euler, the mass and size of this planet, WASP-50b, are well constrained to 1.47+-0.09 M_jup and 1.15+-0.05 R_jup, respectively. The transit ephemeris is 2455558.6120 (+-0.0002) + N x 1.955096 (+-0.000005) HJD_UTC. The size of the planet is consistent with basic models of irradiated giant planets. The chromospheric activity (log R'_HK = -4.67) and rotational period (P_rot = 16.3+-0.5 days) of the host star suggest an age of 0.8+-0.4 Gy that is discrepant with a stellar-evolution estimate based on the measured stellar parameters (rho_star = 1.48+-0.10 rho_sun, Teff = 5400+-100 K, [Fe/H]= -0.12+-0.08) which favours an age of 7+-3.5 Gy. This discrepancy could be explained by the tidal and magnetic influence of the planet on the star, in good agreement with the observations that stars hosting hot Jupiters tend to show faster rotation and magnetic activity (Pont 2009; Hartman 2010). We measure a stellar inclination of 84 (-31,+6) deg, disfavouring a high stellar obliquity. Thanks to its large irradiation and the relatively small size of its host star, WASP-50b is a good target for occultation spectrophotometry, making it able to constrain the relationship between hot Jupiters' atmospheric thermal profiles and the chromospheric activity of their host stars proposed by Knutson et al. (2010).Comment: 9 pages, 8 figures. Accepted for publication in Astronomy & Astrophysic

Thiazole-induced rigidification in substituted dithieno-tetrathiafulvalene : the effect of planarisation on charge transport properties

Two novel tetrathiafulvalene (TTF) containing compounds 1 and 2 have been synthesised via a four-fold Stille coupling between a tetrabromo-dithienoTTF 5 and stannylated thiophene 6 or thiazole 4. The optical and electrochemical properties of compounds 1 and 2 have been measured by UV-vis spectroscopy and cyclic voltammetry and the results compared with density functional theory (DFT) calculations to confirm the observed properties. Organic field effect transistor (OFET) devices fabricated from 1 and 2 demonstrated that the substitution of thiophene units for thiazoles was found to increase the observed charge transport, which is attributed to induced planarity through S-N interactions of adjacent thiazole nitrogen atoms and TTF sulfur atoms and better packing in the bulk