Long-term disease-free survival of patients with radically resected thymomas: relevance of cell-cycle protein expression

BACKGROUND. Despite radical Surgical resection, thymomas often recur. The objective of the current retrospective Study was to investigate the prognostic relevance of the expression of cell-cycle proteins in these neoplasms to formulate a possible therapeutic Surveillance strategy for the prevention of recurrence. METHODS. The authors retrospectively reviewed the main clinicopathologic factors, including the World Health Organization (WHO) classification, of patients with thymoma who had undergone radical surgical resection. Specimens were studied using immunohistochemistry and the expression of cell-cycle proteins (i.e., p21, p27, and p53) was assessed. Univariate and multivariate analysis of predicting survival prognostic factors were performed. RESULTS. The authors analyzed 88 patients with thymoma who underwent radical surgical resection at the study institution. According to the Masaoka staging system, 41 patients had Stage I disease, 31 patients had Stage II disease, and 16 patients had Stage III disease. There were 24 tumor recurrences (27.3%), 4 of which were local, 16 of which were distant intrathoracic, and 4 of which were extrathoracic. The second radical resection provided a disease-free Survival rate that was similar to the first. Only Masaoka stage (P=0.001), WHO classification (P=0.001), high expression of p53 (P=0.03), and low expression of p21 (P=0.02) and p27 (P=0.001) were found to he correlated with a reduced disease-free survival. Low p27 expression was found to be the most significant predictive factor of a short disease-free Survival (P=0.001), especially when associated with low p21 expression and high p53 expression (P=0.0001). CONCLUSIONS. Long-term disease-free survival in thymoma patients treated with radical surgical resection Was found to be correlated with Masaoka stage, WHO classification, and expression of cell-cycle proteins, with the latter found to be the most significant predictive factor. Functional cooperation between cell-cycle proteins might constitute another level of regulation in tumor growth. More careful surveillance should be adopted whenever there is negative cell-cycle protein expression. (c) 2005 American Cancer Society

Feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules

BACKGROUND: General anesthesia with single-lung ventilation is considered mandatory for thoracoscopic pulmonary resection. We assessed in a randomized study the feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules. METHODS: Between March 2001 and February 2003, 60 patients were randomized into two 30-patients arms: a general anesthesia arm entailing double-lumen intubation and thoracic epidural anesthesia (control group); and an awake arm entailing sole thoracic epidural anesthesia at T4-T5 (awake group). Anesthesia time; operative time; global operating room time; patient satisfaction with the anesthesia and technical feasibility scored into 4 grades (from 1 = poor to 4 = excellent); visual analog pain score (VAS), nursing care (number of patient calls per day), 24 hours changes in arterial oxygenation (DeltaPaO2), and hospital stay were assessed. RESULTS: There was no mortality. There was no difference in technical feasibility between the groups although 2 patients in the awake group required conversion to thoracotomy due to severe adhesions. Other 2 patients in each group required conversion due to unexpected lung cancer requiring lobectomy. Comparisons of awake versus control group results showed that in the awake group, anesthesia satisfaction score was greater (4 vs 3, p = 0.04), whereas DeltaPaO2 (-3 mm Hg vs -6.5 mm Hg, p = 0.002); nursing care (2.5 calls per day vs 4 calls per day, p = 0.0001), and hospital stay (2 days vs 3 days, p = 0.02) were significantly reduced. CONCLUSIONS: In our study, awake thoracoscopic resection of solitary pulmonary nodules proved safely feasible. It resulted in better patient satisfaction, less nursing care and shorter in-hospital stay than procedures performed under general anesthesi

Effects of lung volume reduction surgery for emphysema on glycolipidic hormones

BACKGROUND: Pulmonary emphysema is associated with cachexia and disregulation of the hormones regulating the glycolipid metabolism, insulin resistance, and altered substrate utilization. This study aimed at identifying the effects of lung volume reduction surgery (LVRS) on glycolipidic hormones compared to respiratory rehabilitation (RR). METHODS: Thirty-three patients with moderate-to-severe emphysema who were undergoing video-assisted thoracoscopic LVRS were compared to 31 similar patients who refused the operation and followed a standardized RR program. All patients were evaluated before and 12 months after treatment for respiratory function, body composition, glycolipidic hormones, metabolic parameters, and insulin resistance, which was calculated using the homeostatic model assessment index for insulin resistance (HOMA-IR). These groups were compared to a matched healthy control population. RESULTS: Only after LVRS significant improvements were obtained in respiratory function (FEV1, +25.2%; p<0.0001; residual volume, -19.5%; p<0.0001), metabolic parameters (total cholesterol, +13.1%; p<0.01; high-density lipoprotein cholesterol, +11.2%; p<0.01; triglycerides, +18.4; p<0.001; nonesterified fatty acid, -19.7%; p<0.001), and body composition (fat-free mass [FFM], +6.5%; p<0.01; fat mass [FM], +11.9%; p<0.01). The leptin/FM ratio (-6.1%; p<0.01) and resistin/FM ratio (-5.6%; p<0.01) decreased, whereas the adiponectin/FM ratio (+6.9%; p<0.01) and ghrelin (+9.2%; p<0.01) increased, together with reductions in glycemia (-8.8%; p<0.01), insulin level (-20.4%; p<0.001), and HOMA-IR (-27.2%; p<0.0001). The decrement in residual volume was correlated with increment of FFM (rho=-0.49; p<0.02), FM (rho=-0.55; p<0.009), and ghrelin (rho=-0.52; p<0.01), and also with decreases in leptin corrected for FM (rho=0.50; p<0.02) and, marginally, HOMA-IR (rho=0.35; p=0.07). CONCLUSIONS: After LVRS, glycolipidic hormone levels and nutritional status significantly improved, along with insulin resistance reduction and more physiologic utilization of substrates. Correlations between residual volume and body composition as well as glycolipidic hormone levels suggest that postoperative recovery in respiratory dynamics may induce favorable clinical changes when compared to RR

Awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis: a safe outpatient procedure

OBJECTIVE: To verify the feasibility and compare the results of thoracoscopic sympathectomy under local anaesthesia (LA) and spontaneous breathing vs. general anaesthesia (GA) with one-lung ventilation. METHODS: Two groups of consecutive patients underwent one stage bilateral T2-T3 thoracoscopic sympathectomy under LA (n=15) and GA (n=30) by the same surgical team for treatment of primary palmar hyperhidrosis. The groups were homogeneous for relevant demographic, physiological and clinical data, including pulmonary function. In both groups, patient's satisfaction was evaluated 24h after surgery by a simple interview and scored into five grades (1=very poor to 5=excellent), while quality of life (QOL) was evaluated by SF-36 and Nottingham's Health Profile questionnaires before and 6 months after surgery. A cost comparison between groups concerning devices, drugs, global in operating room time, medical personnel and hospital stay was also carried out. RESULTS: No operative mortality was recorded. The overall in operating room time for the whole bilateral procedure under LA was 63.55+/-10.58 vs. 86.05+/-5.75 under GA (P<0.01) and temperature increased in all patients from a baseline of 25.42+/-0.56 up to 32.15+/-0.84 degrees C. All patients undergone LA were discharged the same day after a chest roentgenogram and a short stay in the outpatient clinic. Among them three patients (20%) experienced a minimal (<30%) pneumothorax that required no treatment, while five (33.3%) had a trunk compensatory sweating that spontaneously resolved on the long run. Patients undergoing GA were discharged after a mean stay of 1.38+/-0.6 days. Among these, eight (26.6%) had prolonged trunk compensatory sweating that did not persist longer than 3 months. At a follow-up of 7.16+/-2.97 months, QOL was significantly improved with no difference between groups. The overall rate of satisfaction was greater in the LA group (P<0.05). CONCLUSIONS: In our study, awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis could be safely and effectively performed as an outpatient procedure in patients refusing GA. Postoperative quality of life was equal to that in patients undergone the same procedure under GA, while patient satisfaction was better and cost were significantly reduced

Quality of life after tailored combined surgery for stage I non-small-cell lung cancer and severe emphysema

Background. We analyzed the early and long-term quality of life changes occurring in 16 patients undergoing tailored combined surgery for stage I non-small-cell lung cancer (NSCLC) and severe emphysema. Methods. Mean age was 65 +/- 5 years. All patients had severe emphysema with severely impaired respiratory function and quality of life. Tumor resection was performed with sole lung volume reduction (LVR) in 5 patients, separate wedge resection in 3 patients, segmentectomy in 2 patients, and lobectomy in 6 patients. A bilateral LVR was performed in 5 patients. Quality of life was assessed at baseline and every 6 months postoperatively by the Short-form 36 (SF-36) item questionnaire. Results. Mean follow-up was 44 +/- 21 months. All tumors were pathologic stage I. There was no hospital mortality nor major morbidity. Significant improvements occurred for up to 36 months in the general health (p = 0.02) domain and for up to 24 months in physical functioning (p = 0.02), role physical (p = 0.005), and general health (P = 0.01) SF-36 domains. Associated improvements regarded dyspnea index (-1.3 +/- 0.6) forced expiratory volume in one second (+0.28 +/- 0.2L), residual volume (-1.18 +/- 0.5L) and 6-minute-walking test distance (+86 +/- 67 m). Actuarial 5-year survival was similar to that of patients with no cancer undergoing LVRS during the same period (68% vs 82%, p = not significant). Conclusions. Our study suggests that selected patients with stage I NSCLC and severe emphysema may significantly benefit from tailored combined surgery in terms of long-term quality of life and survival. (Ann Thorac Surg 2003;76:1821-7

A BeppoSAX observation of the super-soft source CAL87

We report on a BeppoSAX Concentrator Spectrometer observation of the super-soft source (SSS) CAL87. The X-ray emission in SSS is believed to arise from nuclear burning of accreted material on the surface of a white dwarf (WD). An absorbed blackbody spectral model gives a chi^2_v of 1.18 and a temperature of 42 +/- ^13 _11 eV. However, the derived luminosity and radius are greater than the Eddington limit and radius of a WD. Including an O viii edge at 0.871 keV gives a significantly better fit (at > 95% confidence) and results in more realistic values of the source luminosity and radius. We also fit WD atmosphere models to the CAL87 spectrum. These also give reasonable bolometric luminosities and radii in the ranges 2.7-4.8 10^{36} erg/s and 8-20 10^7 cm, respectively. These results support the view that the X-ray emission from CAL87 results from nuclear burning in the atmosphere of a WD.Comment: 4 pages. Accepted for publication in A&A (Letters

An extreme, blueshifted iron line profile in the Narrow Line Seyfert 1 PG 1402+261; an edge-on accretion disk or highly ionized absorption?

We report on a short XMM-Newton observation of the radio-quiet Narrow Line Seyfert 1 PG 1402+261. The EPIC X-ray spectrum of PG 1402+261 shows a strong excess of counts between 6-9 keV in the rest frame. This feature can be modeled by an unusually strong (equivalent width 2 keV) and very broad (FWHM velocity of 110000 km/s) iron K-shell emission line. The line centroid energy at 7.3 keV appears blue-shifted with respect to the iron Kalpha emission band between 6.4-6.97 keV, while the blue-wing of the line extends to 9 keV in the quasar rest frame. The line profile can be fitted by reflection from the inner accretion disk, but an inclination angle of >60 deg is required to model the extreme blue-wing of the line. Furthermore the extreme strength of the line requires a geometry whereby the hard X-ray emission from PG 1402+261 above 2 keV is dominated by the pure-reflection component from the disk, while little or none of the direct hard power-law is observed. Alternatively the spectrum above 2 keV may instead be explained by an ionized absorber, if the column density is sufficiently high (N_H > 3 x 10^23 cm^-2) and if the matter is ionized enough to produce a deep (tau~1) iron K-shell absorption edge at 9 keV. This absorber could originate in a large column density, high velocity outflow, perhaps similar to those which appear to be observed in several other high accretion rate AGN. Further observations, especially at higher spectral resolution, are required to distinguish between the accretion disk reflection or outflow scenarios.Comment: Accepted for publication in ApJ (18 pages, 5 figures, 1 table

Autonomous 3D geometry reconstruction through robot-manipulated optical sensors

Many industrial sectors face increasing production demands and the need to reduce costs, without compromising the quality. The use of robotics and automation has grown significantly in recent years, but versatile robotic manipulators are still not commonly used in small factories. Beside of the investments required to enable efficient and profitable use of robot technology, the efforts needed to program robots are only economically viable in case of large lot sizes. Generating robot programs for specific manufacturing tasks still relies on programming trajectory waypoints by hand. The use of virtual simulation software and the availability of the specimen digital models can facilitate robot programming. Nevertheless, in many cases, the virtual models are not available or there are excessive differences between virtual and real setups, leading to inaccurate robot programs and time-consuming manual corrections. Previous works have demonstrated the use of robot-manipulated optical sensors to map the geometry of samples. However, the use of simple user-defined robot paths, which are not optimized for a specific part geometry, typically causes some areas of the samples to not be mapped with the required level of accuracy or to not be sampled at all by the optical sensor. This work presents an autonomous framework to enable adaptive surface mapping, without any previous knowledge of the part geometry being transferred to the system. The novelty of this work lies in enabling the capability of mapping a part surface at the required level of sampling density, whilst minimizing the number of necessary view poses. Its development has also led to an efficient method of point cloud down-sampling and merging. The article gives an overview of the related work in the field, a detailed description of the proposed framework and a proof of its functionality through both simulated and experimental evidences