Surgical treatment of lung cancer: Predicting postoperative morbidity in the elderly population Rueth, Natasha M., MD, MS; Parsons, Helen M., MPH; Habermann, Elizabeth B., PhD, MPH ...
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
06/2012, Volume:
143, Issue:
6
Journal Article
Peer reviewed
Open access
Objectives Surgical resection is standard treatment for early-stage non–small cell lung cancer; however, perception of postoperative risk may influence the decision to proceed for elderly patients. ...With population data, we analyzed postoperative complications and morbidity predictors for older patients undergoing lobectomy for stage I non–small cell lung cancer. Methods The Surveillance Epidemiology and End-Results–Medicare linked database (2000–2005) identified patients (ages 66–80 years) undergoing lobectomy for stage I non–small cell lung cancer. We comprehensively evaluated in-hospital postoperative complications (pulmonary, cardiac, infectious, noncardiopulmonary) with International Classification of Diseases, Ninth Revision , diagnosis codes. Logistic regression models were constructed to identify patient, tumor, and treatment characteristics associated with complications. Results In all, 4171 patients were included, 2329 of whom had 4097 in-hospital postoperative complications (55.8%). Pulmonary complications were most common (n = 1598; 38.3%) followed by cardiac (n = 1020; 24.5%). Complications were significantly associated with age at least 75 years, male sex, higher comorbidity index, larger tumors, and treatment at nonteaching hospitals ( P < .05). Patients with complications had a longer median stay (8 days) than patients without (6 days; P < .001). The 30-day mortality was 4.2%. Conclusions Population-based analysis demonstrated that perioperative complications after lobectomy for stage I non–small cell lung cancer in older patients exceeded 50% and were associated with specific patient, tumor, and treatment characteristics. Better understanding of the impact of these risk factors may facilitate surgical decision making and encourage implementation of more effective perioperative care guidelines for older surgical patients.
Background
Postoperative complications after resection of oesophagogastric carcinoma can result in considerable early morbidity and mortality. However, the long‐term effects on survival are less ...clear.
Methods
All patients undergoing intentionally curative resection for oesophageal or gastric cancer between 2006 and 2016 were selected from an institutional database. Patients were categorized by complication severity according to the Clavien–Dindo classification (grades 0–V). Complications were defined according to an international consensus statement. The effect of leak and severe non‐leak‐related complications on overall survival, recurrence and disease‐free survival was assessed using Kaplan–Meier analyses to evaluate differences between groups. All factors significantly associated with survival in univariable analysis were entered into a Cox multivariable regression model with stepwise
elimination.
Results
Some 1100 patients were included, with a median age of 69 (range 28–92) years; 48·1 per cent had stage III disease and cancer recurred in 428 patients (38·9 per cent). Complications of grade III or higher occurred in 244 patients (22·2 per cent). The most common complications were pulmonary (29·9 per cent), with a 13·0 per cent incidence of pneumonia. Rates of atrial dysrhythmia and anastomotic leak were 10·0 and 9·6 per cent respectively. Patients with a grade III–IV leak did not have significantly reduced overall survival compared with those who had grade 0–I complications. However, patients with grade III–IV non‐leak‐related complications had reduced median overall survival (19·7 versus 42·7 months; P < 0·001) and disease‐free survival (18·4 versus 36·4 months; P < 0·001). Cox regression analysis identified age, tumour stage, resection margin and grade III–IV non‐leak‐related complications as independent predictors of poor overall and disease‐free survival.
Conclusion
Beyond the acute postoperative period, anastomotic leak does not adversely affect survival, however, other severe postoperative complications do reduce long‐term overall and disease‐free survival.
Long‐term follow‐up of patients undergoing oesophagogastric cancer resection showed that it is severe non‐leak‐related complications, rather than anastomotic leaks, that significantly reduce overall and disease‐free survival.
Bad news
During the inflammatory response that drives atherogenesis, macrophages accumulate progressively in the expanding arterial wall. The observation that circulating monocytes give rise to lesional ...macrophages has reinforced the concept that monocyte infiltration dictates macrophage buildup. Recent work has indicated, however, that macrophage accumulation does not depend on monocyte recruitment in some inflammatory contexts. We therefore revisited the mechanism underlying macrophage accumulation in atherosclerosis. In murine atherosclerotic lesions, we found that macrophages turn over rapidly, after 4 weeks. Replenishment of macrophages in these experimental atheromata depends predominantly on local macrophage proliferation rather than monocyte influx. The microenvironment orchestrates macrophage proliferation through the involvement of scavenger receptor A (SR-A). Our study reveals macrophage proliferation as a key event in atherosclerosis and identifies macrophage self-renewal as a therapeutic target for cardiovascular disease.
ABSTRACT
The white dwarf binary pathways survey is dedicated to studying the origin and evolution of binaries containing a white dwarf and an intermediate-mass secondary star of the spectral type A, ...F, G, or K (WD + AFGK). Here, we present CPD-65 264, a new post-common envelope binary with an orbital period of 1.37 d that contains a massive white dwarf ($0.86\pm 0.06\, \mathrm{M}_{\odot }$) and an intermediate-mass ($1.00\pm 0.05\, \mathrm{M}_{\odot }$) main-sequence secondary star. We characterized the secondary star and measured the orbital period using high-resolution optical spectroscopy. The white dwarf parameters are determined from HST spectroscopy. In addition, TESS observations revealed that up to 19 per cent of the surface of the secondary is covered with starspots. Small period changes found in the light curve indicate that the secondary is the second example of a G-type secondary star in a post-common envelope binary with latitudinal differential rotation. Given the relatively large mass of the white dwarf and the short orbital period, future mass transfer will be dynamically and thermally stable and the system will evolve into a cataclysmic variable. The formation of the system can be understood assuming common envelope evolution without contributions from energy sources besides orbital energy. CPD-65 264 is the seventh post-common envelope binaries with intermediate-mass secondaries that can be understood assuming a small efficiency in the common envelope energy equation, in agreement with findings for post-common envelope binaries with M-dwarf or substellar companions.
Pregnancy and childbirth are among the strongest risk factors for depression but the neurocognitive mechanisms underlying this enhanced risk are unknown. This study investigated emotional and ...non-emotional cognition in 57 pregnant women with or without an affective disorder during their third trimester, and the association between cognitive biases and subsequent postpartum depression (PPD). Of the pregnant women, 22 had a diagnosis of unipolar disorder (UD) and seven of bipolar disorder (BD) in full or partial remission, while 28 had no history of affective disorder. We included a control group of 29 healthy non-pregnant women. First, participants were interviewed, completed non-emotional and emotional cognitive tests and lastly filled out questionnaires. The participants were assessed two times after birth: at a home visit shortly after birth, and with a telephone interview to assess PPD in the first six months after birth. Healthy pregnant women rated infant cries less negatively than non-pregnant women, possibly reflecting preparation for motherhood. Pregnant women with UD exhibited a negative bias in ratings of infant cries, whereas pregnant women with BD showed a positive bias in ratings of infant happy faces and recognition of adult facial expressions. Across all pregnant women, more negative ratings of infant cries were associated with enhanced risk of PPD. Negatively biased perception of infant cries during pregnancy may thus signal vulnerability toward PPD.
Abstract
Establishing a large sample of post-common-envelope binaries (PCEBs) that consist of a white dwarf plus an intermediate mass companion star of spectral type AFGK, offers the potential to ...provide new constraints on theoretical models of white dwarf binary formation and evolution. Here, we present a detailed analysis of two new systems, TYC 110-755-1 and TYC 3858-1215-1. Based on radial velocity measurements, we find the orbital periods of the two systems to be ∼0.85 and ∼1.64 d, respectively. In addition, HST spectroscopy of TYC 110-755-1 allowed us to measure the mass of the white dwarf in this system (0.78 M⊙). We furthermore analysed TESS high-time-resolution photometry and find both secondary stars to be magnetically extremely active. Differences in the photometric and spectroscopic periods of TYC 110-755-1 indicate that the secondary in this system is differentially rotating. Finally, studying the past and future evolution of both systems, we conclude that the common envelope efficiency is likely similar in close white dwarf plus AFGK binaries and PCEBs with M-dwarf companions and find a wide range of possible evolutionary histories for both systems. While TYC 3858-1215-1 will run into dynamically unstable mass transfer that will cause the two stars to merge and evolve into a single white dwarf, TYC 110-755-1 is a progenitor of a cataclysmic variable system with an evolved donor star.
ABSTRACT
Constraints from surveys of post-common envelope binaries (PCEBs) consisting of a white dwarf plus an M-dwarf companion have led to significant progress in our understanding of the formation ...of close white dwarf binary stars with low-mass companions. The white dwarf binary pathways project aims at extending these previous surveys to larger secondary masses, i.e. secondary stars of spectral-type AFGK. Here, we present the discovery and observational characterization of three PCEBs with G-type secondary stars and orbital periods between 1.2 and 2.5 d. Using our own tools as well as MESA, we estimate the evolutionary history of the binary stars and predict their future. We find a large range of possible evolutionary histories for all three systems and identify no indications for differences in common envelope evolution compared to PCEBs with lower mass secondary stars. Despite their similarities in orbital period and secondary spectral type, we estimate that the future of the three systems is very different: TYC 4962-1205-1 is a progenitor of a cataclysmic variable system with an evolved donor star, TYC 4700-815-1 will run into dynamically unstable mass transfer that will cause the two stars to merge, and TYC 1380-957-1 may appear as supersoft source before becoming a rather typical cataclysmic variable star.
ABSTRACT
Virtually all binaries consisting of a white dwarf with a non-degenerate companion can be classified as either close post-interaction systems (with orbital periods of a few days or less), or ...wide systems (with periods longer than decades), in which both components have effectively evolved as single stars. Binaries with periods between these two extremes can help constrain common envelope efficiency, or highlight alternative pathways towards the creation of compact binaries. To date such binaries have remained mostly elusive. Here we present three white dwarfs in binaries with evolved subgiant stars with orbital periods of 41, 52, and 461 d. Using Hubble Space Telescope spectroscopy we find that all three systems contain low mass white dwarfs (≤0.4 M⊙). One system, TYC 8394−1331−1, is the inner binary of a hierarchical triple, where the white dwarf plus subgiant binary is orbited by a more distant companion star. These binaries were likely formed from a phase of stable but non-conservative mass transfer, as opposed to common envelope evolution. All three systems will undergo a common envelope phase in the future, but the two shorter period systems are expected to merge during this event, while the longest period system is likely to survive and create a close binary with two low mass white dwarfs.
Exercise-induced bronchoconstriction update—2016 Weiler, John M., MD; Brannan, John D., PhD; Randolph, Christopher C., MD ...
Journal of allergy and clinical immunology,
11/2016, Volume:
138, Issue:
5
Journal Article
Peer reviewed
The first practice parameter on exercise-induced bronchoconstriction (EIB) was published in 2010. This updated practice parameter was prepared 5 years later. In the ensuing years, there has been ...increased understanding of the pathogenesis of EIB and improved diagnosis of this disorder by using objective testing. At the time of this publication, observations included the following: dry powder mannitol for inhalation as a bronchial provocation test is FDA approved however not currently available in the United States; if baseline pulmonary function test results are normal to near normal (before and after bronchodilator) in a person with suspected EIB, then further testing should be performed by using standardized exercise challenge or eucapnic voluntary hyperpnea (EVH); and the efficacy of nonpharmaceutical interventions (omega-3 fatty acids) has been challenged. The workgroup preparing this practice parameter updated contemporary practice guidelines based on a current systematic literature review. The group obtained supplementary literature and consensus expert opinions when the published literature was insufficient. A search of the medical literature on PubMed was conducted, and search terms included pathogenesis, diagnosis, differential diagnosis, and therapy (both pharmaceutical and nonpharmaceutical) of exercise-induced bronchoconstriction or exercise-induced asthma (which is no longer a preferred term); asthma; and exercise and asthma. References assessed as relevant to the topic were evaluated to search for additional relevant references. Published clinical studies were appraised by category of evidence and used to document the strength of the recommendation. The parameter was then evaluated by Joint Task Force reviewers and then by reviewers assigned by the parent organizations, as well as the general membership. Based on this process, the parameter can be characterized as an evidence- and consensus-based document.
The presence of in-feed anti-sea lice drugs and their relationship with organic enrichment is poorly understood in sediment surrounding salmon farms. Using data from an aquaculture monitoring program ...(2018–2020), we describe this relationship at ten sites in four Canadian provinces. Three anti-sea lice pesticides (lufenuron, teflubenzuron, emamectin benzoate and metabolite desmethyl emamectin benzoate), and one antibiotic (oxytetracycline) were detected. Concentrations were often below limits of quantification. Values are also lower than those reported in other aquaculture salmon-producing countries. Highest concentrations, along with organic enrichment, were observed ~200 m of cages with lower concentrations detected up to 1.5 km away. Most samples had at least two drugs present: 75.2 % (British Columbia), 91.4 % (Newfoundland), and 54.8 % (New Brunswick/Nova Scotia) highlighting the potential for cumulative effects. Emamectin benzoate and oxytetracycline were detected four and three years respectively after last known treatments, demonstrating the need for research on overall persistence of compounds.
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•Sediment data collected through an aquaculture monitoring program were used.•Three anti-sea lice drugs and one antibiotic were detected at ten salmon sites.•The highest concentrations and organic enrichment were observed within 200 m of cages.•Most sediment samples had at least two drugs present.•There is a significant patchiness in drug presence and organic matter enrichment.
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