Background The prevention of recurrence after a first episode of primary spontaneous pneumothorax (PSP) remains a debated issue. The likelihood of recurrence based on the presence of blebs and bullae ...detected on high-resolution computed tomography (HRCT) imaging is controversial. Methods We evaluated patients conservatively treated for PSP who underwent chest HRCT scan in a single-institution retrospective longitudinal study. Absolute risk values and positive and negative predictive values of recurrence based on HRCT findings were the primary end points. Results We analyzed 176 patients. Ipsilateral and contralateral recurrence developed in 44.8% and 12% of patients, respectively. The risk of recurrence was significantly related to the presence of blebs or bullae, or both, at HRCT. The risk of ipsilateral recurrence for patients with or without blebs and bullae was 68.1% and 6,1%, respectively (positive predictive value, 68.1%; negative predictive value, 93,9%). The risk of contralateral pneumothorax for patients with or without blebs and bullae was 19% and 0%, respectively (positive predictive value, 19%; negative predictive value, 100%). The risk of ipsilateral recurrence was directly related to the dystrophic severity score: recurrence risk increased by up to 75% in patients with bilateral multiple lesions. Multivariate analysis showed that a positive HRCT was significantly related to ipsilateral recurrence. Conclusions The presence of blebs and bullae at HRCT after a first episode of PSP is significantly related to the development of an ipsilateral recurrence or a contralateral episode of pneumothorax. Further studies are needed to validate the dystrophic severity score in the selection of patients for early surgical referral.
The extractivism of bromeliads in Paraná for ornamental purposes has been occurring since the 70's, due to the easy access in the forests, the high demand of consumers, and the small number of ...producers in the region. Among the species of this group stands out Nidularium innocentii Lem. as the second most extracted species with commercial purpose. The reversal of this situation may be associated with the implantation of agronomic crops, but there are few and sparse studies on the germination of this species. Thus, in this context a study was carried out in order to evaluate seed germination and survival on different substrates. Six alternative types of substrates that were easily accessible to the rural producer were tested: peat, coconut husk fiber, plantmax®, earthworm humus, humid pine bark and sieved agricultural soil. The experiment was carried out in a completely randomized design, with four replicates and 25 seeds per experimental unit, at room temperature, in a greenhouse, with sprinkler irrigation for a period of 90 days. Nidularium inocentii showed germination on average at 7 days and maximum germination point was reached at 15.2 days, with an average of 65.8% of germination. Among the substrates tested, coconut husk fiber, peat and humid pine bark obtained the best results on seedling survival after seed germination. The study confirms the feasibility of sexual reproduction of the species for agronomic crops using low cost and locally abundant substrates.
Objective: Patients with non-small cell lung cancer (NSCLC) with metastases to ipsilateral mediastinal lymph nodes (N2) are an heterogeneous group of patients as regard to prognosis and treatment. ...Indication and timing of surgery remain controversial. The present study investigates the prognostic factors, in order to identify homogenous subgroups of patients. Methods: Histologically proven N2-NSCLC patients, who underwent a complete surgical resection were retrospectively reviewed. Clinical and pathological features were reported and analyzed, and survival study was performed. Results: One hundred eighty-three patients were analyzed. Overall 1.3 and 5 years survival rates were, respectively, 70, 35 and 20%, with a median survival time of 24 months. Univariate analysis showed a significant better prognosis for: incidental N2 respect to clinical N2 (5-years 35.4 vs 17.4%); single level lymph node involvement respect to multiple levels (5-years 23.8 vs 14.7%); metastases to superior mediastinal or aortic nodes respect to lower mediastinal nodes (5-years 32 and 24.3 vs 16.3%); right upper lobe tumors with superior mediastinal nodes and left upper lobe tumors with aortic nodes respect to lower lobes tumors with lower mediastinal nodes (5-years 31.8 and 26.9 vs 15.7%). Skip metastases had not a significant survival advantage respect to continuous lymphatic spread. N2 clinical status, the number of levels involved and the two specific patterns of lymphatic spread resulted significant prognostic factors at multivariate analysis. Conclusions: Clinical N2 status, number of lymph nodes levels involved and specific patterns of lymphatic spread identify homogenous subgroups of patients that can be proposed for different therapeutic strategies.
Non Small Cell Lung Cancer (NSCLC) is the major cause of cancer related-death. Many patients receive diagnosis at advanced stage leading to a poor prognosis. At present, no satisfactory screening ...tests are available in clinical practice and the discovery and validation of new biomarkers is mandatory. Surface Enhanced Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (SELDI-ToF-MS) is a recent high-throughput technique used to detect new tumour markers. In this study we performed SELDI-ToF-MS analysis on serum samples treated with the ProteoMiner™ kit, a combinatorial library of hexapeptide ligands coupled to beads, to reduce the wide dynamic range of protein concentration in the sample. Serum from 44 NSCLC patients and 19 healthy controls were analyzed with IMAC30-Cu and H50 ProteinChip Arrays.
Comparing SELDI-ToF-MS protein profiles of NSCLC patients and healthy controls, 28 protein peaks were found significantly different (p < 0.05), and were used as predictors to build decision classification trees. This statistical analysis selected 10 protein peaks in the low-mass range (2-24 kDa) and 6 in the high-mass range (40-80 kDa). The classification models for the low-mass range had a sensitivity and specificity of 70.45% (31/44) and 68.42% (13/19) for IMAC30-Cu, and 72.73% (32/44) and 73.68% (14/19) for H50 ProteinChip Arrays.
These preliminary results suggest that SELDI-ToF-MS protein profiling of serum samples pretreated with ProteoMiner™ can improve the discovery of protein peaks differentially expressed between NSCLC patients and healthy subjects, useful to build classification algorithms with high sensitivity and specificity. However, identification of the significantly different protein peaks needs further study in order to provide a better understanding of the biological nature of these potential biomarkers and their role in the underlying disease process.
Spontaneous pneumothorax represents a rare and potentially severe complication of Wegener’s granulomatosis. A 31-year-old man with Wegener’s granulomatosis on immunosuppressive therapy was admitted ...for a right massive spontaneous pneumothorax. After chest drainage he presented with a prolonged air leak that required a surgical treatment. Histologic findings did not reveal any necrotizing granulomatous vasculitis, but only subpleural fibrous tissue. We hypothesize that pneumothorax could be related to the subpleural fibrous retraction induced by immunosuppressive therapy.
The aim of this study was to investigate the effectiveness, safety and appropriate mode of administration of intrapleural talc for pleurodesis, in the treatment of malignant pleural effusion (MPE).
...Prospective not randomized trial was conducted to compare thoracoscopic talc poudrage (TP) with tube thoracostomy and talc slurry (TS) for the local control of malignant pleural effusion. Both procedures were previously standardized; 6g of talc was administered for each procedure. Only the patients with lung re-expansion after drainage entered the study. Patients at high risk for general anaesthesia, poor general conditions and short life-expectancy received talc slurry through a chest tube, at the bedside. All the other patients underwent videothoracoscopic talc poudrage, with a pneumatic atomizer, under general anaesthesia. Morbidity, 30-day freedom from recurrence and long-term results were assessed and the two groups were compared.
One hundred and nine patients entered the study (72 TP, 37 TS). Sixty-three patients in the TP group (87.5%) and 27 in the TS group (73%) had an immediate successful pleurodesis (p = 0.049); 53 patients (88.3%) and 16 patients (69.6%) had a successful pleurodesis 90 days after the procedure; 59 patients (81.9%) and 23 patients (62.2%), respectively, had a life-long pleural symphysis (p = 0.023). Adverse effects were generally mild: chest pain (36.1% in TP patients, 48.6% in TS patients) and fever (38.8% and 35.1%, respectively) were the more common but the difference was not significant between the two groups. We observed neither acute respiratory failure nor mortality due to the procedure.
Our study confirms that intrapleural talc carries good results in the treatment of malignant pleural effusion. TP was significantly more effective than TS; both methods were safe but TS had a higher incidence of thoracic pain during the procedure. Talc pleurodesis should be offered to every patient with MPE, apart from terminally ill ones, provided that a satisfying lung re-expansion has been achieved. TP should be performed whenever possible; otherwise, a slurry bedside procedure will be worthwhile, even in patients with low performance status (PS), though poorer results have to be expected. A careful selection is essential to define the proper technique.
The general objective of this paper is to explore the role thatpublic employment policies play in the performance of the local labor market and in achieving higher and better working conditions. In ...this sense, two ideas guide the investigation: On the one hand, the importance of recovering alternative theoretical approaches that provide new elements to interpret the labor market that structures and behaves in a complex way and, on the other, the consideration that socio-economic phenomena can not be understood outside the geographic space or used territory. To analyze interventions on the labor market in Río Cuarto, interviews were conducted with three key informants who were responsible for the areas of employment in the different political-administrative levels of government (national, provincial and municipal) during the period 2012-2015. Political management experiences shed light on how policy addresses labor market problems based on the previous diagnosis of their performance, the problems that are identified and defined as priorities and the causes to which they are attributed as well as the consideration of the way in which the policy is done, their conditioning and coordination of objectives and interventions with other levels of government.
El objetivo general del presente trabajo es explorar el rol que las políticas públicas de empleo tienen en el desempeño del mercado de trabajo local y en la consecución de mayores y mejores condiciones laborales. En este sentido, dos ideas fuerzas orientan la investigación: por un lado, la importancia de recuperar enfoques teóricos alternativos que aporten nuevos elementos para interpretar el mercado de trabajo que se estructura y se comporta de manera compleja y, por otro, la consideración de que los fenómenos socio-económicos no pueden ser comprendidos fuera del espacio geográfico o territorio usado. Para analizar las intervenciones sobre el mercado de trabajo de Río Cuarto se realizaron entrevistas a tres informantes clave que se desempeñaron como responsables de las áreas de empleo en los distintos niveles político-administrativos de gobierno (nacional, provincial y municipal) durante el período 2012-2015. Las experiencias de gestión política arrojan luz sobre el modo en que se abordan los problemas del mercado de trabajo a partir del diagnóstico previo de su desempeño, de los problemas que se identifican y definen como prioritarios y de las causas a las que se atribuyen así como de la consideración del modo en que se hace la política, sus condicionamientos y la coordinación de objetivos e intervenciones con otros niveles de gobierno.
Resumen
El objetivo general del presente trabajo es explorar el rol que las políticas públicas de empleo tienen en el desempeño del mercado de trabajo local y en la consecución de mayores y mejores ...condiciones laborales. En este sentido, dos ideas fuerzas orientan la investigación: por un lado, la importancia de recuperar enfoques teóricos alternativos que aporten nuevos elementos para interpretar el mercado de trabajo que se estructura y se comporta de manera compleja y, por otro, la consideración de que los fenómenos socio-económicos no pueden ser comprendidos fuera del espacio geográfico o territorio usado. Para analizar las intervenciones sobre el mercado de trabajo de Río Cuarto se realizaron entrevistas a tres informantes clave que se desempeñaron como responsables de las áreas de empleo en los distintos niveles político-administrativos de gobierno (nacional, provincial y municipal) durante el período 2012-2015. Las experiencias de gestión política arrojan luz sobre el modo en que se abordan los problemas del mercado de trabajo a partir del diagnóstico previo de su desempeño, de los problemas que se identifican y definen como prioritarios y de las causas a las que se atribuyen así como de la consideración del modo en que se hace la política, sus condicionamientos y la coordinación de objetivos e intervenciones con otros niveles de gobierno.
Resumo
O objetivo geral do estudo é explorar o papel que as políticas públicas desmpenham no mercado de trabalho local e na criação de mais quantidade de emprego e na obtenção de melhores condições de trabalho. Nesse sentido, duas ideias orientam a investigação: por um lado, a importância de recuperar abordagens teóricas alternativas que contribuem com novos elementos para interpretar o mercado de trabalho que está estruturado e que se comporta forma complexa, e, por outro, a consideração de que os fenômenos socioeconômicos não podem ser compreendidos fora do espaço geográfico ou território. Para analisar as intervenções no mercado de trabalho de Rio Cuarto, foram realizadas entrevistas com três informantes-chave que foram responsáveis pelas áreas de emprego nos diferentes níveis político-administrativos de governo (nacional, provincial e municipal) durante o período 2012-2015. As experiências de gestão política lançam luz sobre como a política aborda os problemas do mercado de trabalho a partir do diagnóstico prévio dos problemas que são identificados e definidos como prioridade e das causas que lhe são atribuídos, bem como a consideração de como a política é feita, as suas condições e coordenação de objetivos e intervenções com outros níveis de governo.
Abstract
The general objective of this paper is to explore the role thatpublic employment policies play in the performance of the local labor market and in achieving higher and better working conditions. In this sense, two ideas guide the investigation: On the one hand, the importance of recovering alternative theoretical approaches that provide new elements to interpret the labor market that structures and behaves in a complex way and, on the other, the consideration that socio-economic phenomena can not be understood outside the geographic space or used territory. To analyze interventions on the labor market in Río Cuarto, interviews were conducted with three key informants who were responsible for the areas of employment in the different political-administrative levels of government (national, provincial and municipal) during the period 2012-2015. Political management experiences shed light on how policy addresses labor market problems based on the previous diagnosis of their performance, the problems that are identified and defined as priorities and the causes to which they are attributed as well as the consideration of the way in which the policy is done, their conditioning and coordination of objectives and interventions with other levels of government.
•Surgical fixation of flail chest is indicated in very selected patients.•Several different materials and techniques are available for surgical fixation.•A traditional technique involving Judet and ...Sanchez-Loret plates is little used now.•Judet and Sanchez-Loret plates can be still useful in cases of thin and fragile bone.
Flail chest is now usually treated by conservative methods and surgical fixation remains indicated in selected cases. Different techniques can be used for fixation. The aim of this paper is to present a case in which Judet and Sanchez-Loret plates were employed and to discuss the usefulness of this traditional technique.
A 79-year-old woman was admitted for left thoracic trauma with severe antero-lateral flail chest. She was affected by COPD with chronic respiratory failure, ischemic heart disease, autoimmune thrombocytopenia treated on chronic steroid therapy and severe osteoporosis. CT-scan detected multiple rib fractures, left hemothorax and lung contusions. An initial conservative treatment of flail chest involved compressive bandage and then internal pneumatic stabilization in ICU, but it failed. The patient underwent successful surgical treatment of the flail chest by fixation of the anterior fractures from the second to the eight rib. Judet and Sanchez-Lloret plates were used. A bilateral pneumonia developed during the rehabilitation period and the patient died two months after operation.
Judet and Sanchez-Lloret plates represent a traditional technique for fixation of flail chest. This technique is less and less used and progressively replaced by newer materials, especially titanium plates with screws or intramedullary struts. Our patient had multiple comorbidities and a very fragile bones that advised against use of screws or intramedullary struts.
Judet and Sanchez-Lloret plates can be still considered a useful tool for the fixation of flail chest in cases of thin and fragile bones.
Aim of this study is to identify the factors that may influence the lymphadenectomy during VATS anatomical lung resection with particular interest on operator experience.
Clinical and pathological ...data from the prospective VATS Italian nationwide registry were reviewed and analysed. Patients with incomplete data regarding tumor and surgical characteristics, GGO, or with distant metastases were excluded. Patients clinical data, tumor characteristics, operation information and surgeon experience were collected and compared to resected lymph nodes number (#RN), resected N2 nodes number (#N2RN) and resected N2 stations number. A multivariable model was built using logistic regression analysis. Surgeon experience was categorized considering the number of VATS major anatomical resection and years after residency.
The final analysis was conducted on 3727 patients. The median #RN and #N2RN were 11 (1–51) and 5 (0–41). Regarding the analysed outcomes, #N2RN > 6 resulted in 1812 (48.8%)cases, #RN > 10 in 2124 (57.0%)cases and more than 3 N2 stations were harvested in 1447 (38.8%)patients.
First operator experience with number of VATS lobectomies>50 (p < 0.001), operator seniority after residency5-10years (p < 0.001), cTNM II/III(p = 0.017), lobectomy/bilobectomy vs segmentectomy (p < 0.001), and upper/middle lobe tumor location (p < 0.005)resulted significantly associated to #N2RN > 6 at the multivariable analysis. First operator experience with number of VATS lobectomies>50 (p < 0.001), operator seniority after residency5-10years (p < 0.001) and lobectomy/bilobectomy (p < 0.001) resulted significantly associated to #RN > 10 at the multivariable analysis.
Our study showed that lymphadenectomy during VATS lobectomy is influenced by tumor factors such as cTstage and tumor location but also by operator experience, with a higher number of resected lymph nodes in surgeons with a high number of VATS procedures and years after residency compared to surgeons with less experience.
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