Impact of routine videothoracoscopy as the first step of the planned resectiona for lung cancer. Experience of 1306 cases

We have analyzed our experience of 1306 patients with NSCLC, submitted from November 1991 to December 2007 to routine videothoracoscopy exploration, as the first step of the planned procedure, in order to evaluate its validity in obtaining precise assessment of tumor extension, verifying thoracoscopic resectability and in decreasing the rate of unnecessary thoracotomies. Thoracoscopy revealed inoperability in 58 patients (4.4%) mostly due to pleural dissemination (2.4%) or mediastinal infiltration (1.7%). Of the remaining 1248 (95.6%), 449 (34.4%) had thoracoscopic resection (230 lobectomies, 6 pneumonectomies, 230 wedge resections), 767 (58.7%) underwent open resection (592 lobectomies, 175 pneumonectomies), and 32 (2.4%) had an exploratory thoracotomy (ET). Among the 32 ETs, thoracoscopy had suspected unresectability in 7 (0.5%), had been incompletely carried out in 4 early cases (0.3%) and had been unfeasible in 21 (1.6%). In our previous series from 1980 to 1991 the E.T. rate had been 11.6%. In the present series, after the introduction of routine thoracoscopy, the E.T. rate is 2.4% and the global rate of patients correctly staged, by thoracoscopy is 73.3%, significantly better than by CT. Video exploration resulted highly reliable in excluding conditions of unresectability with a negative predictive value (NPV) of 0.97. We conclude that preliminary thoracoscopy is useful in obtaining correct staging, reliably evaluates resectability of the lesion and helps in decreasing unnecessary thoracotomies

Routine surgical videothoracoscopy as the first step of the planned resection for lung cancer

Objectives Notwithstanding preoperative staging, a number of procedures still end in an exploratory thoracotomy as a result of unexpected findings. The aim of this work is to evaluate the validity of routine videothoracoscopy, performed as the first step of every planned resection for non–small cell lung cancer, to assess tumor resectability and feasibility of the resection through thoracoscopy. Methods and Results From November 1991 to December 2007, in our department, 1306 patients with non–small cell lung cancer, judged operable at conventional staging, underwent videothoracoscopy before the operation. Thoracoscopy revealed inoperability in 58 (4.4%) patients, mostly owing to pleural dissemination (2.5%) or mediastinal infiltration (1.7%). In the remaining 1248 (95.6%), thoracoscopy did not reveal inoperability. Of these, 449 (34.4%) underwent thoracoscopic resection. The other 799 (61.2%) underwent thoracotomy: 767 underwent resection, but 32 (2.5%) had an exploratory thoracotomy. Thoracoscopy had suggested unresectability in 7 (0.5%) patients, had been incompletely carried out in 4 (0.3%), and was unfeasible in 21 (1.6%) owing to insurmountable technical reasons. In our previous series from 1980 to 1991 the exploratory thoracotomy rate had been 11.6%. In the present series, after the introduction of routine thoracoscopy in the staging process, the exploratory thoracotomy rate was 2.5%. Thoracoscopy was reliable in excluding unresectability (negative predictive value 0.97). The global percentage of correct staging was significantly better (P < .0001) by thoracoscopy (73.3%) than by computed tomography (48.7%). Considering T descriptor, video-assisted thoracic surgery correctly matched with final pathologic staging in 96.2% of patients. Conclusions Routine preliminary videothoracoscopy ensured assessment of tumor resectability and feasibility of the resection through thoracoscopy and limited unnecessary thoracotomies

Applications of Terra MODIS data for Iraq marshland monitoring

Since the 1970s, the Iraq Marshlands have been damaged significantly, but recently (May 2003-March 2004), more than 20% of the original marshland area has been re-flooded.The goal of the work is to observe the evolution of the marshes in terms of extension and to evaluate the success of wetland restoration on the base of multispectral and multitemporal MODIS images collected in 2007-2008.MODIS (MODerate resolution Imaging Spectroradiometer) has a viewing swath width of 2,330 km and views the entire surface of the Earth every one to two days. Its detectors measure 36 spectral bands between 0.405 and 14.385 μm, and it acquires data at three spatial resolutions -- 250m, 500m, and 1,000m.These data with their low spatial resolution but high time frequency are suitable for regional-scale time-series studies.The satellite data have been corrected for atmospheric effects using an IDL (Interactive Data Language) procedure based on MODTRAN and 6S radiative transfer codes. These radiative transfer codes require, in input, atmospheric vertical profiles, aerosol optical thickness(AOT) and columnar water vapour content (WV). Vertical profiles are obtained from the nearest meteorological station or by climatological data set. AOT and WV are retrieved either from the MODIS MODATML2 atmospheric product, or from the AERONET (Aerosol robotic network).Then different classifications (Pixel- and Object-Oriented) have been tested, compared and discussed to evaluate the best approach to apply on regional-scale time-series studie

Standard test methods for rating of solar reflectance of built-up surfaces and potential use of satellite remote sensors

More and more attention is being paid to the solar reflectance of built-up surfaces due to its influence on the summer heating of buildings and urban areas and the consequent effects on energy needs for air conditioning, as well as on the peak load of the electric grid. Several standard test methods are available for measuring solar reflectance in the laboratory or in the field, based on different devices and approaches. A convergence of some methods has been achieved by rating programs in the U.S. and, more recently, in Europe and other areas. However, laboratory or field measurements are impractical for characterizing a large number of urban surfaces—whether it is for identifying critical issues, developing policies, or verifying compliance with building requirements. In this regard, satellite remote sensors have recently become available, through which it is possible to estimate the reflectance of roof and pavement surfaces thanks to a spatial resolution that is suitable for identifying and characterizing individual built-up surfaces. In the present paper, the most-used standard test methods for rating of solar reflectance are reviewed. Subsequently, some publicly accessible satellite sensors are examined, through which comparable measurements could be obtained

PCOS from Lifestyle to the Use of Inositol and Insulin Sensitizers

PCOS patients are typically characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries, and these aspects are frequent in a high percentage of women during the reproductive life. PCOS frequently show overweight and/or obesity and are characterized by a higher production of androgens and reduced sensitivity to insulin. In fact it is of great importance to note that more than 40–45% of all PCOS patients show overweight up to obesity and that these patients have a modest up to an exaggerated hyperinsulinism in response to the standard oral glucose tolerance test (OGTT). What is relevant to point out is that such reduced insulin sensitivity can be observed also in 10–15% of the normal weight PCOS, thus confirming that hyperinsulinism can show up not only in relation to obesity or to excess of fat tissue but also as an intrinsic abnormal ability to control glucose metabolism. Recent data clearly demonstrated that reduced insulin sensitivity can be gained with a specific attention to lifestyle, including not only a diet but also certain degree of physical activity. However, a specific effect on hyperinsulinemia can be achieved using glucose sensitizer drugs, such as metformin, so that to reduce the negative modulation exerted by hyperinsulinemia on the reproductive axis as well as on neuroendocrine control of reproduction with relevant effects also on adrenal function and neurosteroid production. The evolution of therapeutical approach to PCOS proposed in recent years the use of inositol in two of the isomers at present available, that is myo-inositol (MYO) and D-chiro-inositol (DCI). These two compounds are tightly linked one to the other since MYO is transformed by an epimerase in DCI, having each tissue its own conversion rate, likely due to the specific needs for the two different molecules. In general both these compounds work as specific modulators of the intracellular second messenger activated by the insulin linkage with its own membrane receptor. Recent data demonstrated also that integrative administration of MYO in lean PCOS ameliorated insulin response to OGTT and that both MYO and DCI reduced insulin response to OGTT in overweight or obese PCOS. Both isomers have been demonstrated to improve also ovarian function and LH response to GnRH stimulation, typically abnormal in PCOS patients. Though impossible to state what of the two isomers play the main role, it appears clear that the metabolic impairment(s) are great part of the casual factor(s) of the abnormal reproductive function in PCOS

SPOT5 imagery for soil salinity assessment in Iraq

Soil salinization is a form of topsoil degradation due to the formation of soluble salts at deleterious levels. This phenomenon can seriously compromise vegetation health and agricultural productivity, and represents a worldwide environmental problem. Remote sensing is a very useful tool for soil salinization monitoring and assessment. In this work we show some results of a study aimed to define a methodology for soil salinity assessment in Iraq based on SPOT 5 imagery. This methodology allows the identification of salinized soils primarily on bare soils. Subsequently some soil salinity assessment can be done on vegetated soils. On bare soil the identification of salt is based on spectral analysis, using the Minimum Noise Fraction transformation and several indexes found in literature. In case of densely vegetated soils the methodology for the discrimination of salinized soils has been integrated with the results obtained from the classification of vegetation coverage. © (2012) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only

Identification of SUHI in Urban Areas by Remote Sensing Data and Mitigation Hypothesis through Solar Reflective Materials

The urban heat island (UHI) is an increasingly widespread phenomenon of concern to the wellbeing and the health of populations living in urban environments. The SUHI (Surface UHI) is directly related to UHI and influences its extension and intensity. Satellite images in the thermal infrared spectral region can be used to identify and study the SUHI. In this work, Landsat 8 TIR images were acquired to study the SUHI of a medium-sized municipality of the Po valley in the northern part of Italy. An additional Worldview 3 satellite image was used to classify the study area and retrieve the surface albedo of building roofs. Using the Local Climate Zone approach, existing roof materials were virtually replaced by solar reflective materials, and the mitigation potential of the SUHI and the UHI was quantified. This virtual scenario shows a decrease in the overheating of building roofs with respect to the ambient temperature of up to 33% compared to the current situation in the industrial areas. Focusing on UHI intensity, the air temperature decrease could be up to 0.5◦C

Videothoracoscopic approach to stage I non-small cell lung cancer

SCOPO: A oltre vent\u2019anni dalla loro introduzione, le lobectomie videotoracoscopiche non sono ancora estensivamente eseguite. Scopo del presente studio \ue8 valutare la validit\ue0 dello staging e del trattamento videotoracoscopico analizzando un\u2019esperienza ventennale di 286 lobectomie videotoracoscopiche per cancro polmonare non a piccole cellule al primo stadio clinico TNM. MATERIALI METODI: Dall\u2019Ottobre 1991 al dicembre 2013, 1549 pazienti con tumore polmonare non a piccole cellule, candidati alla resezione chirurgica sulla base dello staging convenzionale sono stati sottoposti a videotoracoscopia come primo tempo dell\u2019intervento pianificato per escludere cause occulte d\u2019 inoperabilit\ue0 e verificare la resecabilit\ue0 e la sua fattibilit\ue0 in tecnica videoendoscopica. La lobectomia videotoracoscopica \ue8 stata volutamente limitata a pazienti in stadio clinico I. Pazienti con tumori pi\uf9 avanzati sono stati sottoposti a resezione toracotomica anche qualora tecnicamente resecabili toracoscopicamente. I dati di sopravvivenza, inseriti in un data base dedicato, sono stati analizzati col metodo di Kaplan- Meier e log-rank test. RISULTATI: Nei 1549 pazienti la videotoracoscopia rivel\uf2 cause occulte d\u2019 inoperabilit\ue0 in 62 (4%), per la maggior parte dovute a carcinosi (33 pz. 2,1%) infiltrazione mediastinica (22 pz. 1,4%),o infiltrazione dell\u2019arteria in scissura in pazienti non tolleranti una pneumonectomia (7pz. 0,4%). 534 (34,5%) pazienti furono sottoposti a resezione videotoracoscopica (286 lobectomie, 7 pneumonectomie, 241 wedge resections), 919 (59,3%) ebbero una resezione toracotomica (649 lobectomie, 158 pneumonectomie, 35 trachealsleeve pneumonectomies, 77 wedge resections), 34 (2,2%) ebbero una toracotomia esplorativa (TE) nonostante la videotoracoscopia preliminare. Tra le 286 videolobectomie la mortalit\ue0 operatoria \ue8 stata nulla, ma 2 pazienti decedettero entro i 60 giorni postoperatori per una polmonite controlaterale in un caso e per rottura del cuore dopo IMA in un altro. Non sono state osservate recidive locali. Nel follow-up prolungato al 2013, 41 (14,3%) pazienti morirono di progressione di malattia neoplastica, 6 (2%) ebbero un cancro polmonare metacrono, 25 (8.7%) morirono per cause non correlate al tumore, 7 (2,4) morirono per altri tumori e 28 (9.8%) per cause non conosciute. Il tasso di sopravvivenza globale a lungo termine dopo lobectomia videotoracoscopica per i pazienti allo Stadio I \ue8 stato dell\u201983,8% a tre anni e del 64,3% a 5 anni. La sopravvivenza a 5 anni \ue8 stata significativamente migliore (p=0.004) per i pazienti T1N0 (70%) che T2N0 (55%) e per i pazienti di et\ue0 inferiore ai 55 anni (86,4% p=0.0001) o con lesioni < di 2cm (80,8% p=0.03). COMMENTI E CONCLUSIONI: La toracoscopia preliminare di routine ebbe un tasso di accuratezza del 72.4%, si dimostr\uf2 estremamente affidabile nell\u2019escludere cause di non resecabilit\ue0 (NPV 0.95) e consent\uec di diminuire il tasso di TE al 2,1%. Considerando le toracotomie esplorative evitate e le resezioni videoendoscopiche effettuate, la videotoracoscopia consent\uec globalmente di evitare 596 (38,5%) toracotomie non necessarie. Nella nostra esperienza, la lobectomia videotoracoscopica si \ue8 dimostrata una tecnica sicura con un basso tasso di complicanze intraoperatorie. Lo studio retrospettivo della nostra esperienza, esteso su un lungo lasso di tempo e condotto su una casistica monocentrica e standardizzata ha dimostrato tassi di sopravvivenza a lungo termine comparabili a quelli delle convenzionali lobectomie toracotomiche. Sulla base dei nostri dati e di quelli dell\u2019 esperienza internazionale la lobectomia videotoracoscopica rappresenta oggi una valida opzione per il trattamento del cancro polmonare al primo stadio.AIM: Aim of this study is to evaluate the validity of videothoracoscopic staging and treatment in a twenty-year-long series of 286 VATS lobectomies for Clinical Stage I NSCLC. MATERIAL OF STUDY: We retrospectively reviewed 1549 candidates to resection after conventional staging from November 1991 to December 2013, and routinely submitted to videothoracoscopy immediately before the procedure. Patients deemed operable at videoexploration were resected by thoracoscopy or thoracotomy. Out of 534 VATS resections 286 thoracoscopic lobectomies for clinical stage I cancers were performed with strict indications and standardized technique; more advanced tumours were converted even when thoracoscopically resectable. Impact of preliminary videothoracoscopy and and longterm Kaplan-Meier survival was analyzed. RESULTS AND DISCUSSION: Out of 1549 patients, videothoracoscopy disclosed inoperability in 62 (4 %), mostly for pleural carcinosis (33pts.-2.1%) or mediastinal infiltration (22pts-1.4%). 534 (34.5%) patients had videothoracoscopic resection (286 lobectomies, 7 pneumonectomies, 241 wedge resections), 919 (59.3%) had thoracotomy resection, 34 (2.2%) had an exploratory thoracotomy (ET). Thoracoscopy had an accuracy rate of 72.4%, was reliable in excluding unresectability (NPV 0.95), and decreased the rate of ETs to 2.1%, ,sparing 596 (38.5%) thoracotomies. There was no intraoperative mortality or recurrence. Stage I patients had 83.8% 3-yr survival and 64.3% 5-yr survival. Five-year survival was significantly better (p=0.004) for T1N0 patients (70%) than T2N0 (55%) and for patients younger than 55 (86.4%) or with lesion < 2 cm (80.8%). CONCLUSIONS: Preliminary videothoracoscopy reliably assesses tumor resectability and feasibility of thoracoscopic resection, limiting unnecessary thoracotomies. Videolobectomies are safe and survival is comparable to open lobectomy. KEY WORDS: Lobectomy, Lung cancer, Minimally invasive surgery, Thoracoscopy, VATS