79 research outputs found
Risk of recurrence in surgically resected stage I adenocarcinoma of the lung: histopathologic and immunohistochemical analysis
STUDY OBJECTIVES: Stage I adenocarcinoma of the lung is the most common type of lung cancer. A better understanding of the histopathology and molecular biology of lung cancer might improve the capability to predict the outcome for any individual patient. The purpose of this study was to evaluate several histopathologic and molecular markers in order to assess their prognostic value in stage I adenocarcinoma. METHODS: Fifty-five patients at the Seoul National University Bundang Hospital were enrolled in the study. Histopathologic factors and molecular markers were selected. RESULTS: Multivariate analysis demonstrated that necrosis, lymphatic vessel invasion, E-cadherin, p53, and Ki-67 emerged as independent prognostic factors of recurrence. When patients were grouped according to low or high risk according to the number of factors involved, the difference in disease-free survival between these groups was statistically significant. CONCLUSIONS: In resected stage I adenocarcinoma, necrosis, lymphatic vessel invasion, E-cadherin, and p53 have been identified as independent predictors of disease-free survival
B4-04: Detection of peripheral lung cancer in the bronchial washing specimen using MAGE A1-6 RT-PCR
Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy
Background
Video-assisted thoracic surgery sleeve resection with bronchial anastomosis or bronchoplasty is a technically demanding procedure. Three-dimensional endoscopic surgery has been reported to be helpful in decreasing operation time and improving spatial perception with less surgical errors, but there have been rare reports about relatively difficult thoracoscopic procedures utilizing 3D thoracoscope. We performed this study to evaluate early clinical outcomes of thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope.
Methods
Data from a total of 36 patients who underwent thoracoscopic sleeve lobectomy or bronchoplasty at our institution from December 2015 to October 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 10 mm, 30° three-dimensional thoracoscope. Twenty-three patients (81%) were male, and mean age was 65.9â±â9.4 years. Fourteen patients (38.9%) underwent sleeve resection with bronchial anastomosis, 22 (61.1%) underwent wedge or simple bronchoplasty, and one patient received concomitant PA procedure. Bronchial anastomosis sites were not covered with viable tissue flaps.
Results
There was no (0%) suture needle injury from spatial misperception during bronchoplasty or sleeve anastomosis. There was no (0%) operative mortality. The pathologic report revealed squamous cell carcinoma (63.9%), adenocarcinoma (19.4%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (2.8%). One (2.8%) late mortality was due to systemic recurrence of sarcomatoid carcinoma. There was no (0.0%) anastomotic failure. The mean number of dissected lymph nodes were 27.4â±â13.2, and mean operation time was 216.8â±â60.0 min. Median postoperative 24-h drain amount was 315 mL. Median chest tube days and hospital days were 4 and 6, respectively. Two patients (5.6%) had complications greater than Clavien-Dindo grade IIâone case of ARDS, and the other case of a delayed bronchopleural fistula.
Conclusions
Thoracoscopic sleeve resection and bronchoplasty utilizing HD 3D thoracoscope is a safe and effective procedure with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed
Epidermal Growth Factor Receptor Mutation and Pathologic-Radiologic Correlation Between Multiple Lung Nodules with Ground-Glass Opacity Differentiates Multicentric Origin from Intrapulmonary Spread
IntroductionNo standard guidelines detailing recommendations for the selection and treatment for multiple lung nodules with ground-glass opacity (GGO) have been established. For treatment decision, we analyzed epidermal growth factor receptor (EGFR)/K-ras somatic aberrations and pathologic-radiologic correlation in multiple lung nodules presented as GGO to differentiate multifocal lesions from intrapulmonary spread.MethodsTwenty-four patients with multiple lung nodules presented as GGO were identified to investigate somatic mutations of EGFR (exon 18â21) and K-ras (codons 2, 13, and 61). This series included 18 atypical adenomatous hyperplasias (AAH), 15 bronchioloalveolar carcinomas (BAC), and 23 adenocarcinomas (ADC) obtained from 24 patients.ResultsHigh frequency of discordant EGFR mutations (17 of 24, 70.8%) could discriminate tumor clonality (18 of 24, 75%) of multiple lung neoplastic nodules presented as GGO. EGFR mutations were common in AAH (38.9%), BAC (46.7%), and ADC (39.1%). In case 4, AAH and BAC had different mutational changes, and in case 10, the BAC lesion contains EGFR mutation that is not in the invasive ADC. In case 17, the BAC had more mutational changes than the carcinoma. The pure GGO appearance in the radiologic examination corresponded preinvasive pathologic change.ConclusionsThis study showed that synchronous BAC and/or ADC can have different EGFR or K-ras mutational profiles suggesting these lesions arise as independent events rather than intrapulmonary spread or systemic metastasis. This has significant implication in staging and treatment. These findings might be a clue to establish guidelines of the multiple neoplastic lung nodules with GGO
Additional mechanical pleurodesis after thoracoscopic wedge resection and covering procedure for primary spontaneous pneumothorax
BACKGROUND: Additional mechanical pleurodesis for the treatment of primary spontaneous pneumothorax (PSP) is believed to reduce the recurrence of PSP, and a covering procedure with absorbable mesh also shows comparable results. This study was conducted to determine whether additional mechanical pleurodesis would be effective in reducing recurrence after thoracoscopic wedge resection and covering procedure. MATERIALS AND METHODS: Between May 2003 and August 2005, 99 patients underwent thoracoscopic bullectomy with staple line covering with absorbable cellulose mesh and fibrin glue followed by an additional mechanical pleurodesis. These patients were compared with 98 patients who underwent thoracoscopic bullectomy with staple line coverage alone. RESULTS: The additional mechanical pleurodesis group had findings comparable to those of the coverage group for duration of postoperative chest drainage, length of hospital stay, and complication rate. After median follow-up of 29.2 months, postoperative recurrence occurred in four patients (4.0%). CONCLUSIONS: Additional mechanical pleurodesis after covering procedure is also effective in decreasing postoperative recurrence of PSP
Epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangements in lung cancer with nodular ground-glass opacity
VÄr uppsats handlar om formativ bedömning och vad det innebÀr att arbeta sÄ i undervisningen. Vi tolkar att rÄdande lÀroplaner beskriver ett uppdrag som ligger i linje med ett formativt arbetssÀtt. Syftet var att ta reda pÄ om lÀrare i samhÀllskunskap som arbetar pÄ gymnasiet arbetar formativt och hur de gör det. Ett annat vanligt namn för formativ bedömning Àr bedömning för lÀrande (BFL). Genom kvalitativa intervjuer har vi frÄgat gymnasielÀrare i samhÀllskunskap hur de arbetar med bedömning, om de arbetar formativt och om det finns nÄgon samsyn pÄ deras respektive gymnasieskolor kring bedömning. Vi ville ocksÄ veta vad formativt arbete innebÀr. Bedömning för lÀrande fokuserar pÄ lÀrandet och hur eleven kan utvecklas och nÄ framgÄng i lÀrandet. Genom att konkretisera mÄl, syfte och kunskapskvaliteter sÄ att eleven förstÄr dessa kan eleven fÄ syn pÄ sitt eget lÀrande. NÀr eleven ges makt över sitt eget lÀrande leder det till ökad motivation. I formativ bedömning arbetar lÀraren bland annat med feedback och kamrat- och sjÀlvvÀrdering. VÄrt resultat visar att lÀrarna vi intervjuat i stor utstrÀckning arbetar summativt med formativa inslag i varierande grad, förutom en av lÀrarna som arbetar pÄ en gymnasieskola i BorÄs som arbetar enligt bedömning för lÀrande. Studien visar att det rÄder brist pÄ samsyn kring bedömning pÄ gymnasie-skolorna, förutom pÄ skolan i BorÄs dÀr det finns tid avsatt för möten och samtal kring formativ bedömning. Litteraturen visar pÄ de positiva effekterna av bedömning för lÀrande vilket ocksÄ styrks av intervjun med lÀraren i BorÄs
A Functional Polymorphism on Chromosome 15q25 Associated with Survival of Early Stage NonâSmall-Cell Lung Cancer
Introduction:The 15q25 region has been associated with lung-cancer risk and might also be associated with the prognosis of lung cancer. This study was conducted to determine the impact of a functional polymorphism in the CHRNA3 gene on chromosome 15q25 in the survival of patients with early-stage nonâsmall-cell lung cancer (NSCLC).Methods:Five hundred and eighty-three consecutive patients with surgically resected NSCLC were enrolled. The rs6495309C > T polymorphism in the promoter of the CHRNA3 gene was investigated. The association between genotype and overall survival (OS) and disease-free survival (DFS) was analyzed.Results:Patients with the rs6495309 CT or TT genotype had a significantly better OS and DFS than the rs6495309 CC genotype (adjusted hazard ratio for OS = 0.56, 95% confidence interval = 0.41â0.75, p = 0.0001; and adjusted hazard ratio for DFS = 0.61, 95% confidence interval = 0.48â0.79, p = 0.0001). An association between the rs6495309C > T polymorphism and survival outcome was demonstrated in smokers and never-smokers, and in squamous-cell carcinomas and adenocarcinomas.Conclusion:The CHRNA3 rs6495309C > T polymorphism may affect survival in patients with early-stage NSCLC. Analysis of the rs6495309C > T polymorphism can help identify patients at high risk of a poor disease outcome
Comparison of extended reality and conventional methods of basic life support training: protocol for a multinational, pragmatic, noninferiority, randomised clinical trial (XR BLS trial)
Abstract
Background
Conventional cardiopulmonary resuscitation (CPR) training for the general public involves the use of a manikin and a training video, which has limitations related to a lack of realism and immersion. To overcome these limitations, virtual reality and extended reality technologies are being used in the field of medical education. The aim of this study is to explore the efficacy and safety of extended reality (XR)-based basic life support (BLS) training.
Methods
This study is a prospective, multinational, multicentre, randomised controlled study. Four institutions in 4 countries will participate in the study. A total of 154 participants will be randomly assigned to either the XR group or the conventional group stratified by institution and sex (1:1 ratio). Each participant who is allocated to either group will be sent to a separate room to receive training with an XR BLS module or conventional CPR training video. All participants will perform a test on a CPR manikin after the training. The primary outcome will be mean compression depth. The secondary outcome will be overall BLS performance, including compression rate, correct hand position, compression, and full release and hands-off time.
Discussion
Using virtual reality (VR) to establish a virtual educational environment can give trainees a sense of realism. In the XR environment, which combines the virtual world with the real world, trainees can more effectively learn various skills. This trial will provide evidence of the usefulness of XR in CPR education.
Trial registration
ClinicalTrials.gov
NCT04736888. Registered on 29 January 202
Postoperative air leak grading is useful to predict prolonged air leak after pulmonary lobectomy
Prognostic Implications of Postoperative Infectious Complications in Non-Small Cell Lung Cancer
Background: Few studies have evaluated the long-term impact of postoperative infectious complications in patients
with non-small cell lung cancer (NSCLC). We aimed to determine the impact of infectious complications
on long-term outcomes after surgical resection for NSCLC. Methods: We performed a retrospective study of
1,380 eligible patients who underwent pulmonary resection for NSCLC from 2003 to 2012. Complications
were divided into infectious complications and non-infectious complications. Kaplan-Meier survival analysis
was used to compare unadjusted 5-year cancer-specific survival (CSS) rates and recurrence-free survival
(RFS) rates. Cox regression was used to determine the impact of infectious complications on 5-year CSS and
RFS. Results: The rate of total complications and infectious complications was 24.3% and 4.3%, respectively.
In the node-negative subgroup, the 5-year CSS and RFS rates were 75.9% and 57.1% in patients who had
infectious complications, compared to 87.9% and 78.4% in patients who had no complications. Infectious
complications were a negative prognostic factor for 5-year RFS (hazard ratio, 1.92; 95% confidence interval,
1.00â3.69; p=0.049). In the node-positive subgroup, the 5-year CSS rate and RFS were 44.6% and 48.4% in
patients who had infectious complications, compared to 70.5% and 48.4% for patients who had no
complications. Conclusion: Postoperative infectious complications had a negative impact on CSS and RFS in
node-negative NSCLC. Our findings may help improve risk assessment for tumor recurrence after pulmonary
resection for node-negative NSCLC
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