Pulmonary Rehabilitation in lung cancer

Non-small-cell lung cancer (NSCLC) represents a very severe disease, being its incidence increasingly reported and, nowadays, successfully treatable only when surgery is deemed to be feasible. Furthermore, the disease and the clinical effects related to the complementary therapies (radio and/or chemotherapy) may strongly affect, frequently with dramatic clinical side effects, the patient’s ability to endure physical exercise. In such context, the PR(PR), which has already been proved to be useful and effective in other diseases such as COPD, could play a pivotal role. The aim of this review article is, therefore, to analyze the pertinent data recently reported in English literature in order to highlight the role of rehabilitation as complementary therapy in the management of patients with NSCLC. The evidence currently available suggests that, when surgery is indicated, PR is a safe and feasible option, both during pre-operative and post-operative timing.The safety and feasibility of rehabilitation are proven even in inoperable patients, although to date, little evidence has been reported on its role in the overall management of such complex diseases

Vascular phenotypes in primary non-small cell lung carcinomas and matched brain metastases

BACKGROUND: Anti-angiogenic therapy with bevacizumab (an anti-vascular endothelial growth factor (VEGF) antibody) predominantly targets immature blood vessels. Bevacizumab has shown a survival benefit in non-small cell lung carcinoma (NSCLC) and has recently been demonstrated to be safe in patients with brain metastases. However, it is not known whether bevacizumab is effective against brain metastases or whether metastases are representative of their primary in terms of VEGF expression, hypoxia, proliferation and vascular phenotype. The aim of this study was to evaluate these factors in a series of matched primary NSCLCs and brain metastases. METHODS AND RESULTS: Immunohistochemistry showed strong correlation of carbonic anhydrase 9 expression (a marker of hypoxia) in primary and secondary cancers (P=0.0002). However, the proliferation index, VEGF expression, microvessel density and the proportion of mature vessels were discordant between primary and secondary cancers. The mean proportion of mature vessels was 63.2% higher in the brain metastases than the primary tumours (P=0.004). Moreover, the vascular pattern of the primary tumour was not representative of the metastasis. CONCLUSIONS: Brain metastases have a significantly higher proportion of mature vasculature, suggesting that they may be refractory to anti-VEGF therapy. These findings may have implications for clinical trials and biomarker studies evaluating anti-angiogenic agents in brain metastases

Intrathoracic solitary fibrous tumor - an international multicenter study on clinical outcome and novel circulating biomarkers

Intrathoracic solitary fibrous tumor (SFT) is a rare disease. Radical resection is the standard of care. However, estimating prognosis and planning follow-up and treatment strategies remains challenging. Data were retrospectively collected by five international centers to explore outcome and biomarkers for predicting event-free-survival (EFS). 125 histological proven SFT patients (74 female; 59.2%; 104 benign; 83.2%) were analyzed. The one-, three-, five- and ten-year EFS after curative-intent surgery was 98%, 90%, 77% and 67%, respectively. Patients age (>/=59 vs. 10 cm vs. 5 vs. < 5 HR 3.91, CI 1.40-10.89, p = 0.009) were prognostic after univariate analyses. After multivariate analyses tumor-dignity and fibrinogen remained as independent prognosticators. Besides validating the role of age, tumor-dignity, tumor-size, stage and resection margins, we identified for the first time inflammatory markers as prognosticators in SFT

Effect of blood glucose level on standardized uptake value (SUV) in F-18- FDG PET-scan : a systematic review and meta-analysis of 20,807 individual SUV measurements

Objectives To evaluate the effect of pre-scan blood glucose levels (BGL) on standardized uptake value (SUV) in F-18-FDG-PET scan. Methods A literature review was performed in the MEDLINE, Embase, and Cochrane library databases. Multivariate regression analysis was performed on individual datum to investigate the correlation of BGL with SUVmax and SUVmean adjusting for sex, age, body mass index (BMI), diabetes mellitus diagnosis, F-18-FDG injected dose, and time interval. The ANOVA test was done to evaluate differences in SUVmax or SUVmean among five different BGL groups (200 mg/dl). Results Individual data for a total of 20,807 SUVmax and SUVmean measurements from 29 studies with 8380 patients was included in the analysis. Increased BGL is significantly correlated with decreased SUVmax and SUVmean in brain (p <0.001, p <0.001,) and muscle (p <0.001, p <0.001) and increased SUVmax and SUVmean in liver (p = 0.001, p = 0004) and blood pool (p=0.008, p200 mg/dl had significantly lower SUVmax. Conclusion If BGL is lower than 200mg/dl no interventions are needed for lowering BGL, unless the liver is the organ of interest. Future studies are needed to evaluate sensitivity and specificity of FDG-PET scan in diagnosis of malignant lesions in hyperglycemia.Peer reviewe

Cross-oncopanel study reveals high sensitivity and accuracy with overall analytical performance depending on genomic regions

BackgroundTargeted sequencing using oncopanels requires comprehensive assessments of accuracy and detection sensitivity to ensure analytical validity. By employing reference materials characterized by the U.S. Food and Drug Administration-led SEquence Quality Control project phase2 (SEQC2) effort, we perform a cross-platform multi-lab evaluation of eight Pan-Cancer panels to assess best practices for oncopanel sequencing.ResultsAll panels demonstrate high sensitivity across targeted high-confidence coding regions and variant types for the variants previously verified to have variant allele frequency (VAF) in the 5-20% range. Sensitivity is reduced by utilizing VAF thresholds due to inherent variability in VAF measurements. Enforcing a VAF threshold for reporting has a positive impact on reducing false positive calls. Importantly, the false positive rate is found to be significantly higher outside the high-confidence coding regions, resulting in lower reproducibility. Thus, region restriction and VAF thresholds lead to low relative technical variability in estimating promising biomarkers and tumor mutational burden.ConclusionThis comprehensive study provides actionable guidelines for oncopanel sequencing and clear evidence that supports a simplified approach to assess the analytical performance of oncopanels. It will facilitate the rapid implementation, validation, and quality control of oncopanels in clinical use.Peer reviewe

Model driver screening and evaluation program final technical report. Volume 2, Maryland pilot older driver study.

This research project studied the feasibility as well as the scientific validity and utility of performing functional capacity screening with older drivers. A Model Program was described encompassing procedures to detect functionally impaired drivers who pose an elevated risk to themselves and others; to support remediation of functional limitations if possible; to provide mobility counseling to inform and connect individuals with local alternative transportation options; and to educate the public and professionals about the link between functional decline and driving safety-all within a larger context of helping to preserve and extend the mobility of older persons. Early in this project, a questionnaire was developed and distributed to Driver License Administrators in the U.S. and Canada to broadly determine cost and time parameters, while identifying legal, ethical, or policy implications that could influence implementation of Model Program activities. Subsequently, a battery of functional tests was developed and pilot tested in Motor Vehicle Administration sites, and in the community. A database of scores on functional ability measures, driving habits information, and crash and violation history was created for over 2,500 drivers in three samples drawn from license renewal, medical referral, and residential community populations. Cost estimates for functional capacity screening and related Model Program activities were developed for research and production settings. A 477-page Safe Mobility for Older People Notebook (DOT HS 808 853) was developed to support program initiatives promoting the safe mobility of older persons across all States and Provinces, including an Annotated Research Compendium of Driver Assessment Techniques for Age-Related Functional Impairments. A set of guidelines for motor vehicle administrators was also produced to update the 1992 publication by NHTSA and AAMVA of the same title.This research project studied the feasibility as well as the scientific validity and utility of performing functional capacity screening with older drivers. A Model Program was described encompassing procedures to detect functionally impaired drivers who pose an elevated risk to themselves and others; to support remediation of functional limitations if possible; to provide mobility counseling to inform and connect individuals with local alternative transportation options; and to educate the public and professionals about the link between functional decline and driving safety-all within a larger context of helping to preserve and extend the mobility of older persons. Early in this project, a questionnaire was developed and distributed to Driver License Administrators in the U.S. and Canada to broadly determine cost and time parameters, while identifying legal, ethical, or policy implications that could influence implementation of Model Program activities. Subsequently, a battery of functional tests was developed and pilot tested in Motor Vehicle Administration sites, and in the community. A database of scores on functional ability measures, driving habits information, and crash and violation history was created for over 2,500 drivers in three samples drawn from license renewal, medical referral, and residential community populations. Cost estimates for functional capacity screening and related Model Program activities were developed for research and production settings. A 477-page Safe Mobility for Older People Notebook (DOT HS 808 853) was developed to support program initiatives promoting the safe mobility of older persons across all States and Provinces, including an Annotated Research Compendium of Driver Assessment Techniques for Age-Related Functional Impairments. A set of guidelines for motor vehicle administrators was also produced to update the 1992 publication by NHTSA and AAMVA of the same title.National Highway Traffic Safety Administration, Office of Research and Traffic Records, Washington, D.C.Mode of access: Internet.Author corporate affiliation: Scientex Corporation, Alexandria, Va.Author corporate affiliation: TransAnalytics, LLC, Kulpsville, Pa.Includes bibliographical references (p. 79-80)Final technical report Oct. 1996-Mar. 2003Subject code: EECSubject code: WPHDSubject code: WWCSubject code: WWBSubject code: RCGCDSubject code: WEDSubject code: WPHSubject code: YE

Synthesis of human factors research on older drivers and highway safety. Volume I: older driver research synthesis.

The overall goals in this project were to perform literature reviews and syntheses, using meta-analytic techniques, where appropriate, for a broad and comprehensive body of research findings on older driver needs and (diminished) capabilities, and a more focused body of work concerning human factors and highway safety, to support the development of specific research products. The research products completed through these activities included: (1) an applications-oriented Older Driver Highway Design Handbook intended to supplement standard design manuals for practitioners; (2) an Older Driver Research Synthesis, oriented toward human factors professionals and researchers; (3) a Human Factors and Highway Safety Synthesis capturing major findings and trends in studies of driver use of (and difficulties with) a wide range of highway elements; (4) future research program recommendations that are focused on specified applications and are consistent with the needs identified through other work in this project; and (5) the shell of a relational data base (RIDHER) structured to encompass the information elements in these research syntheses.The overall goals in this project were to perform literature reviews and syntheses, using meta-analytic techniques, where appropriate, for a broad and comprehensive body of research findings on older driver needs and (diminished) capabilities, and a more focused body of work concerning human factors and highway safety, to support the development of specific research products. The research products completed through these activities included: (1) an applications-oriented Older Driver Highway Design Handbook intended to supplement standard design manuals for practitioners; (2) an Older Driver Research Synthesis, oriented toward human factors professionals and researchers; (3) a Human Factors and Highway Safety Synthesis capturing major findings and trends in studies of driver use of (and difficulties with) a wide range of highway elements; (4) future research program recommendations that are focused on specified applications and are consistent with the needs identified through other work in this project; and (5) the shell of a relational data base (RIDHER) structured to encompass the information elements in these research syntheses.Federal Highway Administration, Office of Safety and Traffic Operations Research and Development, McLean, Va.Mode of access: Internet.Author corporate affiliation: Scientex Corporation, Transportation Safety Division, Kulpsville, Pa.Final report. Sept. 1993-Oct. 1997Subject code: EECSubject code: WOHSubject code: SFBSubject code: WPSubject code: