Thoracoscopic versus open lobectomy debate: the pro argument

Introduction: Controversy persists about the role of VATS lobectomy for patients with lung cancer. This is particularly true in Europe, where VATS (video assisted thoracic surgery) lobectomy is performed for lung cancer less often than in the USA or Japan. This article reviews existing data comparing the results of VATS vs. open lobectomy for the treatment of lung cancer in order to provide a scientific basis for a rational assessment of this issue

Small median tumor diameter at cure threshold (<20 mm) among aggressive non-small cell lung cancers in male smokers predicts both chest X-ray and CT screening outcomes in a novel simulation framework

The effectiveness of population-wide lung cancer screening strategies depends on the underlying natural course of lung cancer. We evaluate the expected stage distribution in the Mayo CT screening study under an existing simulation model of non-small cell lung cancer (NSCLC) progression calibrated to the Mayo lung project (MLP). Within a likelihood framework, we evaluate whether the probability of 5-year NSCLC survival conditional on tumor diameter at detection depends significantly on screening detection modality, namely chest X-ray and computed tomography. We describe a novel simulation framework in which tumor progression depends on cellular proliferation and mutation within a stem cell compartment of the tumor. We fit this model to randomized trial data from the MLP and produce estimates of the median radiologic size at the cure threshold. We examine the goodness of model fit with respect to radiologic tumor size and 5-year NSCLC survival among incident cancers in both the MLP and Mayo CT studies. An existing model of NSCLC progression under-predicts the number of advanced-stage incident NSCLCs among males in the Mayo CT study (p-value = 0.004). The probability of 5-year NSCLC survival conditional on tumor diameter depends significantly on detection modality (p-value = 0.0312). In our new model, selected solution sets having a median tumor diameter of 16.2ﾖ22.1 mm at cure threshold among aggressive NSCLCs predict both MLP and Mayo CT outcomes. We conclude that the median lung tumor diameter at cure threshold among aggressive NSCLCs in male smokers may be small (<20 mm)

ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer

The European Society of Thoracic Surgeons (ESTS) organized a workshop dealing with lymph node staging in non-small cell lung cancer. The objective of this workshop was to develop guidelines for definitions and the surgical procedures of intraoperative lymph node staging, and the pathologic evaluation of resected lymph nodes in patients with non-small cell lung cancer (NSCLC). Relevant peer-reviewed publications on the subjects, the experience of the participants, and the opinion of the ESTS members contributing on line, were used to reach a consensus. Systematic nodal dissection is recommended in all cases to ensure complete resection. Lobe-specific systematic nodal dissection is acceptable for peripheral squamous T1 tumors, if hilar and interlobar nodes are negative on frozen section studies; it implies removal of, at least, three hilar and interlobar nodes and three mediastinal nodes from three stations in which the subcarinal is always included. Selected lymph node biopsies and sampling are justified to prove nodal involvement when resection is not possible. Pathologic evaluation includes all lymph nodes resected separately and those remaining in the lung specimen. Sections are done at the site of gross abnormalities. If macroscopic inspection does not detect any abnormal site, 2-mm slices of the nodes in the longitudinal plane are recommended. Routine search for micrometastases or isolated tumor cells in hematoxylin-eosin negative nodes would be desirable. Randomized controlled trials to evaluate adjuvant therapies for patients with these conditions are recommended. The adherence to these guidelines will standardize the intraoperative lymph node staging and pathologic evaluation, and improve pathologic staging, which will help decide on the best adjuvant therap

From parliamentary pay to party funding: the acceptability of informal institutions in advanced democracies

While direct state funding of political parties has been a prominent theme in cross-national research over the last decade, we still know little about party strategies to access state resources that are not explicitly earmarked for partisan usage. This paper looks at one widespread but often overlooked informal party practice: the ‘taxing’ of MP salaries, i.e., the regular transfer of fixed salary shares to party coffers. Building on notions of informal institutions developed in work on new democracies, our theoretical approach specifies factors that shape the acceptability of this legally non-enforceable intra-organisational practice. It is tested through a selection model applied to a unique data set covering 124 parties across 19 advanced democracies. Controlling for a range of party- and institutional-level variables, we find that the presence of a taxing rule and the collection of demanding tax shares are more common in leftist parties (high internal acceptability) and in systems in which the penetration of state institutions by political parties is intense (high external acceptability)

South African choral music (Amakwaya) : song, contest and the formation of identity.

Thesis (Ph.D.-Music)-University of Natal, 2002.Amakwaya refers to the tradition and performance practice of choirs in South Africa that emerged from the mission-schools in the nineteenth century and is manifest today in the annual competitions held by various Teachers' Associations or company-sponsored events like the National Choir Festival. This choral practice, combining Western music styles with African tradition, bears the marks - both social and aesthetic - of colonial and missionary influences, and is closely linked to the emerging black middle class, their process of negotiating identity, and their later quest for a national culture. Many aspects of contemporary amakwaya performance practice, it is argued, including the recent interest of many members of the amakwaya community in opera, can be understood through an analysis of the social dimensions of these choirs. Particular attention is given to the role played by competitions and the sectionalised repertoire. The criticisms made in this regard flow from an understanding of the social meaning and aesthetic thrust of the tradition, from the author's practical involvement with the choirs, and from extensive discussions with choristers and conductors. The first part of the thesis is concerned with identifying the role played by European values such as those of education and progress, in the self-understanding of the emerging missioneducated black South African elite in the second half of the nineteenth century. An initial tendency towards uncritical imitation and attempts at assimilation ended in the experience of rejection by the settler community and isolation. It was followed, in the last quarter of the nineteenth century, by a complex negotiation between traditional and modern values. With political, social and economic mobility restricted in white South Africa, the black middle class turned towards artistic expression such as choral singing in order to define and express a distinctively African concept of civilisation. In this process, amakwaya performance developed into a powerful means whereby class identity and consciousness could be constructed and communicated. The second part looks into the framework of amakwaya, and at the mission schools and colleges they attended and the competitions they organise. As a result of the practice of hymn singing, participation in a choir soon became an important part of the leisure time activities of the early mission converts. This formative phase of amakwaya is illustrated in a case study of one of the most influential schools in Natal, Adams College, near Amanzimtoti, where the first black South African School of Music was established. In order to promote the values important to the missionaries as well as their converts - discipline, progress, and success - competitions were encouraged at the mission stations. These became models for the competitions which today are the main feature of amakwaya practice. The voices of various members of the community are used to present a critical evaluation of the positive and negative aspects of present-day competitions. The last part of the thesis concentrates on amakwaya repertoire, particularly as it is represented at important choral competitions such as the National Choir Festival. This part also attempts to facilitate an understanding of the genesis, structure and aesthetic of the sectionalised repertoire, which consists of neo-traditional songs, Western compositions, and choral works composed by mission-educated musicians. Strict adherence to the sectionalised repertoire is a unique feature of amakwaya performance practice to the present day

Von der Kieferabformung zum virtuellen Modell: Eine Pilotstudie zur Genauigkeit industrieller CT-gestützter Messungen von Abformmaterialien

1. Background and Aims With computed tomography scans impressions can be saved and edited as virtual data. Aim of the study was to evaluate influence parameters of different impression materials and trays and their relevance related to accuracy and dimensional stability. 2. Material and Methods Two alginate impressions (Zhermack Hydrogum® 5, Kaniedenta Tetrachrom) and a polyether impression (3M Espe Impregum™) were each combined with two acrylic trays (3M Espe Position Tray™, Profimed Opti-Tray) and CT-scanned directly after impression at the Fraunhofer Institute Development Center X-ray Technology EZRT in Fürth. Each impression was digitized ten times at the same day, three times after two days and twice after six days. Thus a determination of dimensional stability was enabled. As reference for determining precision of the impression materials an acrylic model was digitized with a high-resolution μCT-scanner. For graphic and statistical analysis VGStudio Max® was used. 3. Results Both alginate impressions were less stable in dimension than the polyether impression material. The alginate impression Zhermack Hydrogum® 5 resulted in more deviation (151 μm) after six days than the Kaniedenta Tetrachrom impression. The polyetherscans showed a mean deviation of 73 μm. Precision of both alginates were similarly exact. (Arithmetic mean: Hydrogum® 5 0.129 mm ± 0.021 mm, Tetrachrom 0.137 mm ± 0.002 mm). The kind of tray had a limited influence on the results of alginate impressions, while precision of Impregum™ depended on the chosen tray combination. 4. Practical Conclusion Precision of alginate impressions is sufficient for clinical use in orthodontics and showed after correct storage even after two days acceptable results. Hydrogum® 5 impressions proved to be slightly more precise compared to the reference, but less dimension stable than the Tetrachrom impressions. The impression tray 3M Espe Position Tray™ seemed to be more practicable due to better retention effect compared to Opti-Tray of Profimed.1. Hintergrund und Ziele Mittels computertomographischer Aufnahmen können Abformungen als virtuelle Datensätze gespeichert und bearbeitet werden. Ziel der Studie (unterstützt vom Wissenschaftsfond der DGKFO), war die Evaluation der Einflussparameter bei unterschiedlichen Abformmaterialien und Abformlöffeln und deren Relevanz im Bezug auf Genauigkeit und Dimensionsstabilität. 2. Methoden Zwei Alginatabformungen (Zhermack Hydrogum® 5, Kaniedenta Tetrachrom) und eine Polyetherabformung (3M Espe Impregum™) in Kombination mit je zwei Kunststofflöffeln (3M Espe Position Tray™, Profimed Opti-Tray) wurden direkt nach Abdrucknahme am Fraunhofer Entwicklungszentrum Röntgentechnik EZRT in Fürth, mittels CT-Scan digitalisiert. Jeder Abdruck wurde noch am selben Tag zehnmal digitalisiert, nach zwei Tagen folgten drei und nach sechs Tagen zwei weitere Aufnahmen. Dadurch war eine Bestimmung der Dimensionsstabilität der unterschiedlichen Materialien möglich. Als Referenz für die Genauigkeitsermittlung der Abformmaterialien wurde ein Kunststoffmodell mit einer hochauflösenden μCT-Forschungsanlage digitalisiert. Für die graphische und statistische Analyse wurde VGStudio Max® verwendet. 3. Ergebnisse und Beobachtungen Die beiden Alginatabformungen waren weniger dimensionsstabil als das Polyether-Abformmaterial. Die Alginatabformung Zhermack Hydrogum® 5 ergab nach sechs Tagen eine größere Abweichung (151 μm) als die Kaniedenta Tetrachrom-Abformung. Die Polyetheraufnahmen zeigten eine mittlere Abweichung von 73 μm. Die Genauigkeit der beiden Alginate war ähnlich exakt (Mittelwerte: Hydrogum® 5 0,129 mm ± 0,021 mm, Tetrachrom 0,137 mm ± 0,002 mm). Die Art des Löffels beeinflusste das Ergebnis der Alginatabformungen nur bedingt, während die Genauigkeit der Impregum™ Abformungen von der gewählten Löffelkombination abhing. 4. Praktische Schlussfolgerungen Die Genauigkeit der Alginatabformungen ist in der Kieferorthopädie klinisch ausreichend und weist bei korrekter Lagerung auch nach zwei Tagen noch akzeptable Ergebnisse auf. Hydrogum 5-Abformungen erwiesen sich minimal präziser gegenüber der Referenz, aber geringer dimensionsstabil als die Tetrachrom-Abformungen. Der Abformlöffel 3M Espe Position Tray™ erschien aufgrund besserer Retentionswirkung gegenüber dem Opti-Tray von Profimed als praktikabler

Anachronic Renaissance

Book Review of Anachronic Renaissance, by Alexander Nagel and Christopher S. Wood. ISBN 9780853319894. Reviewed by Kimberly Detterbeck

Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database

OBJECTIVES A retrospective database was developed by the European Society of Thoracic Surgeons, collecting patients submitted to surgery for thymic tumours to analyse clinico-pathological prognostic predictors. METHODS A total of 2151 incident cases from 35 institutions were collected from 1990 to 2010. Clinical-pathological characteristics were analysed, including age, gender, associated myasthenia gravis stage (Masaoka), World Health Organization histology, type of thymic tumour [thymoma, thymic carcinoma (TC), neuroendocrine thymic tumour (NETT)], type of resection (complete/incomplete), tumour size, adjuvant therapy and recurrence. Primary outcome was overall survival (OS); secondary outcomes were the proportion of incomplete resections, disease-free survival and the cumulative incidence of recurrence (CIR). RESULTS A total of 2030 patients were analysed for OS (1798 thymomas, 191 TCs and 41 NETTs). Ten-year OS was 0.73 (95% confidence interval 0.69-0.75). Complete resection (R0) was achieved in 88% of the patients. Ten-year CIR was 0.12 (0.10-0.15). Predictors of shorter OS were increased age (P < 0-001), stage [III vs I HR 2.66, 1.80-3.92; IV vs I hazard ratio (HR) 4.41, 2.67-7.26], TC (HR 2.39, 1.68-3.40) and NETT (HR 2.59, 1.35-4.99) vs thymomas and incomplete resection (HR 1.74, 1.18-2.57). Risk of recurrence increased with tumour size (P = 0.003), stage (III vs I HR 5.67, 2.80-11.45; IV vs I HR 13.08, 5.70-30.03) and NETT (HR 7.18, 3.48-14.82). Analysis using a propensity score indicates that the administration of adjuvant therapy was beneficial in increasing OS (HR 0.69, 0.49-0.97) in R0 resections. CONCLUSIONS Masaoka stages III-IV, incomplete resection and non-thymoma histology showed a significant impact in increasing recurrence and in worsening survival. The administration of adjuvant therapy after complete resection is associated with improved surviva

Autocracy-Sustaining Versus Democratic Federalism:Explaining the Divergent Trajectories of Territorial Politics in Russia and Western Europe

This article provides a comparative assessment of territorial politics in Russia and Western Europe. The consolidation or deepening of regional autonomy in Western Europe contrasts with the transformation of Russia from a segmented and highly centrifugal state into a centralized authoritarian state in the course of just two decades. The consolidation of territorial politics in Western Europe is linked to the presence of endogenous safeguards that are built into their territorial constitutional designs and most importantly to the dynamics that emanate from multi-level party competition in the context of a liberal and multi-level democracy. In contrast, in Russia, neither endogenous safeguards nor multi-level party democracy play an important role in explaining the dynamics of Russian federalism, but who controls key state resources instead. We argue that under Putin power dependencies between the Russian center and the regions are strongest where regional democracy is at its weakest, thus producing ‘autocracy-sustaining’ instead of a democratic federation. By studying the relationship between federalism and democracy in cases where both concepts are mutually reinforcing (as in Western Europe) with the critical case of Russia where they are not, we question the widely held view that democracy is a necessary pre-condition for federalism.Peer reviewe

Tales of the unexpected: the selection of British party leaders since 1963

Jeremy Corbyn’s election as Leader of the Labour Party in 2015 stunned observers and practitioners of British politics alike. In this article, we first outline a theoretical framework that purports to explain why political parties operating in parliamentary systems choose the leaders they do. We then examine 32 leadership successions involving five major British parties since 1963, and note that many of these were unexpected, in that they were triggered by unforeseen circumstances, such as the sudden death or resignation of the incumbent. Examining each party in turn, we briefly explain why the winners won and identify at least eight cases (a quarter of our sample) where a candidate widely expected to prevail at the outset was ultimately defeated by a ‘dark horse’, ‘second favourite’ or even ‘rank outsider’. Of these, Corbyn’s election in 2015 was the most unexpected and, consistent with the findings of studies of party leadership conventions in other parliamentary systems, namely Canada and Spain, suggests that ideological and policy concerns are sometimes more important than considerations of party unity and electability, especially when a leadership contest is dominated by party activists