Attitudes and access to lung volume reduction surgery for COPD: a survey by the British Thoracic Society.

OBJECTIVE: Lung volume reduction surgery for emphysema leads to improved survival in appropriately selected individuals, and it is therefore recommended in national and international guidelines for this group of patients. Despite this, fewer than 100 patients undergo the procedure each year in the UK. Our objective was to establish whether this reflects concerns about morbidity and mortality or difficulties in the referral pathway. DESIGN AND SETTING: We conducted a survey of members of the British Thoracic Society by email to investigate this in the second half of 2013. The survey included questions about access to investigations, the indications for lung volume reduction surgery (LVRS), whether a multidisciplinary meeting discussed eligibility of patients for LVRS and what the morbidity and mortality associated with the procedure was. RESULTS: There were 65 responses, 82% from respiratory physicians. Roughly half of the respondents were either unsure about the risks of death or prolonged (>30 days) hospital stay involved or significantly over-estimated them. In total, 70% did not have a specific multidisciplinary team to discuss the management of patients with advanced chronic obstructive pulmonary disease (COPD). There was no consensus as to which patients with COPD should undergo a CT scan to evaluate them for possible surgery. CONCLUSIONS: Patients with COPD require a systematic and multidisciplinary approach to assessment for LVRS and these survey data suggest that work is needed to deliver this evidence-based therapy in a consistent and comprehensive way across the UK

Techniques of assessing small airways dysfunction

The small airways are defined as those less than 2 mm in diameter. They are a major site of pathology in many lung diseases, not least chronic obstructive pulmonary disease (COPD) and asthma. The small airways are frequently involved early in the course of these diseases, with significant pathology demonstrable often before the onset of symptoms or changes in spirometry and imaging. Despite their importance, they have proven relatively difficult to study. This is in part due to their relative inaccessibility to biopsy and their small size which makes their imaging difficult. Traditional lung function tests may only become abnormal once there is a significant burden of disease within them. This has led to the term ‘the quiet zone’ of the lung. In recent years, more specialised tests have been developed which may detect these changes earlier, perhaps offering the possibility of earlier diagnosis and intervention. These tests are now moving from the realms of clinical research laboratories into routine clinical practice and are increasingly useful in the diagnosis and monitoring of respiratory diseases. This article gives an overview of small airways physiology and some of the routine and more advanced tests of airway function

A Field Survey of Respiration Rates in Leaves of Arctic Plants

In a survey of several plant species found at Churchill, Manitoba, in the transition zone between the low and subarctic regions, we measured leaf respiration in terms of total respiration and alternative pathway respiration rates. Leaves of arctic plants exhibit higher rates of total respiration and alternative (cyanide insensitive) respiration than temperate species. There is a negative correlation between plant height and alternative pathway activity. Shorter plants have higher rates of alternative pathway respiration. More alternative pathway activity may mean that there is less energy in the form of ATP available for growth. A shorter growth habit keeps these plants in the still air close to the ground. This prevents cooling, water loss and physical damage due to wind abrasion. Thus plants with high rates of alternative pathway respiration may be better adapted to the arctic environment. The alternative pathway respiration of Orchis rotundifolia was shown to be under the influence of the biological clock.Key words: Subarctic, plant respiration, alternative pathway, cyanide insensitivMots clés: subarctique, respiration des plantes, voie alterne, insensible au cyanur

FGFR2 amplification in colorectal adenocarcinoma

FGFR2 is recurrently amplified in 5% of gastric cancers and 1%–4% of breast cancers; however, this molecular alteration has never been reported in a primary colorectal cancer specimen. Preclinical studies indicate that several FGFR tyrosine-kinase inhibitors (TKIs), such as AZD4547, have in vitro activity against the FGFR2-amplified colorectal cell line, NCI-H716. The efficacy of these inhibitors is currently under investigation in clinical trials for breast and gastric cancer. Thus, better characterizing colorectal tumors for FGFR2 amplification could identify a subset of patients who may benefit from FGFR TKI therapies. Here, we describe a novel FGFR2 amplification identified by clinical next-generation sequencing in a primary colorectal cancer. Further characterization of the tumor by immunohistochemistry showed neuroendocrine differentiation, similar to the reported properties of the NCI-H716 cell line. These findings demonstrate that the spectrum of potentially clinically actionable mutations detected by targeted clinical sequencing panels is not limited to only single-nucleotide polymorphisms and insertions/deletions but also to copy-number alterations.</jats:p

Microdosimetry radiation analysis method and device

Apparatus and method for qualitatively and quantitatively analyzing a complex radiation field are provided. A microdosimetry device is provided having an array of microstructure parallel p-n junctions. Each junction defines a predetermined sensitive volume within which a voltage pulse is produced responsive to incident radiation. Circuitry in communication with the detector array generates digital pulse signals representative of the voltage pulses induced within the sensitive volumes responsive to incident radiation, and further provides a summation of the digital pulses occurring at particular energies. The summations of digital pulses are compared to known energies generated by known ionizing particles in comparable sensitive volumes to generate an dose equivalent estimate. Apparatus and method for calculating the total dose from an incident radiation field may also be included

Ariel - Volume 4 Number 5

Editors David A. Jacoby Eugenia Miller Tom Williams Associate Editors Paul Bialas Terry Burt Michael Leo Gail Tenikat Editor Emeritus and Business Manager Richard J. Bonnano Movie Editor Robert Breckenridge Staff Richard. Blutstein Mary F. Buechler Alice M. Johnson J.D. Kanofskv Rocky Webe

Passive solid state microdosimeter with electronic readout

Apparatus and method for qualitatively and quantitatively analyzing a complex radiation field are provided. A passive microdosimetry detector device records the energy deposition of incident radiation using an array of microstructure non-volatile memory devices. Each microstructure non-volatile memory device is capable of storing a predetermined initial charge without requiring a power source. A radiation particle incident to a microstructure non-volatile memory device is termed an event . Each such event may generate a charge within a sensitive volume defined by the microstructure non-volatile memory device. The charge generated within the sensitive volume alters the stored initial charge by an amount falling within a range corresponding to the energy deposited by certain particle types. Data corresponding to such charge alterations for a plurality of microstructure non-volatile memory devices within an array of such devices are presented to a qualitative analyzing device. The qualitative analyzing device converts the data to a spectral analysis of the incident radiation field by applying ICRP-recommended weighting factors to individual events or approximations thereof