Video-assisted thoracic surgery (VATS) as a safe alternative for the resection of pulmonary metastases: a retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>VATS has become a preferred method for benign surgical conditions, yet still remains controversial for malignancies. The purpose of this study was to review our results of pulmonary metastasectomies using both conventional open thoracotomy and VATS techniques.</p> <p>Methods</p> <p>This is a retrospective chart review of pulmonary metastasectomies performed from 1986 to 2006. The surgical approach used for the initial pulmonary metastasectomy was either open thoracotomy or VATS. Main outcomes were overall survival and recurrence free survival, evaluated using Kaplan Meier analysis. A non-inferiority margin was set at 0.2.</p> <p>Results</p> <p>A total of 280 surgical procedures were performed on 186 patients. From 171 eligible individuals, 135 patients were treated with thoracotomy (82 M, 53 F; median age 49 years), and 36 with VATS (18 M, 18 F; median age 58.5 years). Primary cancers were mainly: 81 sarcoma (47%), 26 colorectal adenocarcinoma (15%) and 22 renal cell carcinoma (13%). Median postoperative follow was 26.2 months. The conversion rate was 10.3% and there were no cases of pleural cavity seeding. The 5-year overall survival rates were 58.8% for thoracotomy and 69.6% for VATS, with median overall survival of 53.2 months and 30.1 months, respectively (p = 0.03). The estimated difference in 5-year overall survival was 10.8%. Second occurrences were noted in 59 thoracotomy and 10 VATS patients. The 5-year recurrence free survival rates were 51% in thoracotomy and 67% in VATS (p = 0.27), with median recurrence free survival of 24.8 months and 25.6 months, respectively.</p> <p>Conclusion</p> <p>In cases of pulmonary metastases, VATS is an acceptable alternative that is both safe and efficacious. Non-inferiority analysis of 5-year overall survival demonstrates that VATS is equivalent to thoracotomy. VATS patients also have a longer recurrence free survival. Based on our experience, it is permissible to use VATS resection in these circumstances: small tumor, fewer nodules, single lesion, age ≤ 53, unilateral, tumor size amenable to wedge resection, and non-recurrent disease.</p

Interannual variability of the outflow of Weddell Sea bottom water

The Weddell Sea Bottom Water (WSBW) export from 1999 to 2019 displays distinct seasonal and interannual variability. From 2014 into 2017 a marked salinity decrease was recorded, with the lowest salinity, 34.615, attained in early 2016. The reduced salinity is derived from the V‐shaped trough formed by a double front along the shelf break of the Weddell Gyre's western boundary, which is filled with a blend of surface water and modified Weddell Deep Water. We estimate that when the V‐shaped apex attains a depth of greater than ~700m, the thermobaric effect promotes its descent into the WSBW. We propose that this occurred during anomalously strong cyclonic wind stress curl over the Weddell Gyre from 2014 into 2017, which increased the intensity of the gyre and its western boundary current, deepening the V‐shape trough. The WSBW salinity increased to its prior to 2014 values as the wind stress relaxed in 2018

Cooling and ventilating the abyssal ocean

The abyssal ocean is filled with cold, dense waters that sink along the Antarctic continental slope and overflow sills that lie south of the Nordic Seas. Recent integrations of chlorofluorocarbon‐11 (CFC) measurements are similar in Antarctic Bottom Water (AABW) and in lower North Atlantic Deep Water (NADW), but Antarctic inputs are ≈ 2°C colder than their northern counterparts. This indicates comparable ventilation rates from both polar regions, and accounts for the Southern Ocean dominance over abyssal cooling. The decadal CFC‐based estimates of recent ventilation are consistent with other hydrographic observations and with longer‐term radiocarbon data, but not with hypotheses of a 20th‐century slowdown in the rate of AABW formation. Significant variability is not precluded by the available ocean measurements, however, and interannual to decadal changes are increasingly evident at high latitudes

The EBR-II X501 Minor Actinide Burning Experiment

The X501 experiment was conducted in EBR-II as part of the IFR (Integral Fast Reactor) program to demonstrate minor actinide burning through the use of a homogeneous recycle scheme. The X501 subassembly contained two metallic fuel elements loaded with relatively small quantities of americium and neptunium. Interest in the behavior of minor actinides (MA) during fuel irradiation has prompted further examination of existing X501 data, and generation of new data where needed in support of the U.S. waste transmutation effort. The X501 experiment is one of the few minor actinide-bearing fuel irradiation tests conducted worldwide and knowledge can be gained by understanding the changes in fuel behavior due to addition of MA’s. Of primary interest are the affect of the MA’s on fuel-cladding-chemical-interaction, and the redistribution behavior of americium. The quantity of helium gas release from the fuel and any effects of helium on fuel performance are also of interest. It must be stressed that information presented at this time is based on the limited PIE conducted in 1995-1996, and currently represents a set of observations rather than a complete understanding of fuel behavior

The EBR-II X501 Minor Actinide Burning Experiment

The X501 experiment was conducted in EBR II as part of the Integral Fast Reactor program to demonstrate minor actinide burning through the use of a homogeneous recycle scheme. The X501 subassembly contained two metallic fuel elements loaded with relatively small quantities of americium and neptunium. Interest in the behavior of minor actinides (MA) during fuel irradiation has prompted further examination of existing X501 data and generation of new data where needed in support of the U.S. waste transmutation effort. The X501 experiment is one of the few MA bearing fuel irradiation tests conducted worldwide, and knowledge can be gained by understanding the changes in fuel behavior due to addition of MAs. Of primary interest are the effect of the MAs on fuel cladding chemical interaction and the redistribution behavior of americium. The quantity of helium gas release from the fuel and any effects of helium on fuel performance are also of interest. It must be stressed that information presented at this time is based on the limited PIE conducted in 1995–1996 and, currently, represents a set of observations rather than a complete understanding of fuel behavior. This report provides a summary of the X501 fabrication, characterization, irradiation, and post irradiation examination

Arctic system on trajectory to new state

The Arctic system is moving toward a new state that falls outside the envelope of glacial-interglacial fluctuations that prevailed during recent Earth history. This future Arctic is likely to have dramatically less permanent ice than exists at present. At the present rate of change, a summer ice-free Arctic Ocean within a century is a real possibility, a state not witnessed for at least a million years. The change appears to be driven largely by feedback-enhanced global climate warming, and there seem to be few, if any processes or feedbacks within the Arctic system that are capable of altering the trajectory toward this “super interglacial” state

Mesoscale Atlantic water eddy off the Laptev Sea continental slope carries the signature of upstream interaction

A mesoscale eddy formed by the interaction of inflows of Atlantic water (AW) from Fram Strait and the Barents Sea into the Arctic Ocean was observed in February 2005 off the Laptev Sea continental slope by a mooring equipped with a McLane Moored Profiler. The eddy was composed of two distinct, vertically aligned cores with a combined thickness of about 650 m. The upper core of approximately ambient density was warmer (2.6°C), saltier (34.88 psu), and vertically stably stratified. The lower core was cooler (0.1°C), fresher (34.81 psu), neutrally stratified and ∼0.02 kg/m3 less dense than surrounding ambient water. The eddy, homogeneous out to a radius of at least 3.4 km, had a 14.5 km radius of maximum velocity, and an entire diameter of about 27 km. We hypothesize that the eddy was formed by the confluence of the Fram Strait and Barents Sea AW inflows into the Arctic Ocean that takes place north of the Kara Sea, about 1100 km upstream from the mooring location. The eddy's vertical structure is likely maintained by salt fingering and diffusive convection. The numerical simulation of one-dimensional thermal and salt diffusion equations reasonably reproduces the evolution of the eddy thermohaline patterns from the hypothesized source area to the mooring location, suggesting that the vertical processes of double-diffusive and shear instabilities may be more important than lateral processes for the evolution of the eddy. The eddy is able to carry its thermohaline anomaly several thousand kilometers downstream from its source location

Group interventions to improve health outcomes : a framework for their design and delivery

Peer reviewedPublisher PD

Storm-induced upwelling of high pCO2 waters onto the continental shelf of the western Arctic Ocean and implications for carbonate mineral saturation states

Author Posting. © American Geophysical Union, 2012. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Geophysical Research Letters 39 (2012): L07606, doi:10.1029/2012GL051574.The carbon system of the western Arctic Ocean is undergoing a rapid transition as sea ice extent and thickness decline. These processes are dynamically forcing the region, with unknown consequences for CO2 fluxes and carbonate mineral saturation states, particularly in the coastal regions where sensitive ecosystems are already under threat from multiple stressors. In October 2011, persistent wind-driven upwelling occurred in open water along the continental shelf of the Beaufort Sea in the western Arctic Ocean. During this time, cold (32.4) halocline water—supersaturated with respect to atmospheric CO2 (pCO2 > 550 μatm) and undersaturated in aragonite (Ωaragonite < 1.0) was transported onto the Beaufort shelf. A single 10-day event led to the outgassing of 0.18–0.54 Tg-C and caused aragonite undersaturations throughout the water column over the shelf. If we assume a conservative estimate of four such upwelling events each year, then the annual flux to the atmosphere would be 0.72–2.16 Tg-C, which is approximately the total annual sink of CO2 in the Beaufort Sea from primary production. Although a natural process, these upwelling events have likely been exacerbated in recent years by declining sea ice cover and changing atmospheric conditions in the region, and could have significant impacts on regional carbon budgets. As sea ice retreat continues and storms increase in frequency and intensity, further outgassing events and the expansion of waters that are undersaturated in carbonate minerals over the shelf are probable.Funding for this work was provided by the National Science Foundation (ARC1041102 – JTM, OPP0856244-RSP, and ARC1040694- LWJ), the National Oceanic and Atmospheric Administration (CIFAR11021- RHB) and the West Coast & Polar Regions Undersea Research Center (POFP00983 – CLM and JM).2012-10-1

Seasonal variation of upwelling in the Alaskan Beaufort Sea : impact of sea ice cover

Author Posting. © American Geophysical Union, 2012. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 117 (2012): C06022, doi:10.1029/2012JC007985.Data from a mooring array deployed from August 2002 to September 2004 are used to characterize differences in upwelling near the shelf break in the Alaskan Beaufort Sea due to varying sea ice conditions. The record is divided into three ice seasons: open water, partial ice, and full ice. The basic response is the same in each of the seasons. Roughly 8 h after the onset of easterly winds the shelf break jet reverses, followed approximately 10 h later by upwelling of saltier water which is cold near the shelf break (Pacific Winter Water) and warm at depth (Atlantic Water). The secondary circulation at the outer shelf is, to first order, consistent with a two-dimensional Ekman balance of offshore flow in the upper layer and onshore flow at depth. There are, however, important seasonal differences in the upwelling. Overall the response is strongest in the partial ice season and weakest in the full ice season. It is believed that these differences are dictated by the degree to which wind stress is transmitted through the pack-ice, as the strength of the wind-forcing was comparable over the three seasons. An EOF-based upwelling index is constructed using information about the primary flow, secondary flow, and hydrography. The ability to predict upwelling using the wind record alone is explored, which demonstrates that 90% of easterly wind events exceeding 9.5 m s−1 drive significant upwelling. During certain periods the ice cover on the shelf became landfast, which altered the upwelling and circulation patterns near the shelf break.The following grants provided support for this study: National Ocean Partnership Program project N00014-07-1-1040 and National Science Foundation projects OPP-0731928 and OPP-0713250.2012-12-2