Background/Objectives: The surgical resection of pulmonary metastases is considered a therapeutic option in selected cases. In light of this, we present the results from a national multicenter ...prospective registry of lung metastasectomy. Methods: This retrospective analysis involves data collected prospectively and consecutively in a national multicentric Italian database, including patients who underwent lung metastasectomy. The primary endpoints were the analysis of morbidity and overall survival (OS), with secondary endpoints focusing on the analysis of potential risk factors affecting both morbidity and OS. Results: A total 470 lung procedures were performed (4 pneumonectomies, 46 lobectomies/bilobectomies, 13 segmentectomies and 407 wedge resections) on 461 patients (258 men and 203 women, mean age of 63.1 years). The majority of patients had metastases from colorectal cancer (45.8%). In most cases (63.6%), patients had only one lung metastasis. A minimally invasive approach was chosen in 143 cases (30.4%). The mean operative time was 118 min, with no reported deaths. Morbidity most frequently consisted of prolonged air leaking and bleeding, but no re-intervention was required. Statistical analysis revealed that morbidity was significantly affected by operative time and pulmonary comorbidities, while OS was significantly affected by disease-free interval (DFI) > 24 months (p = 0.005), epithelial histology (p = 0.001) and colorectal histology (p = 0.004) during univariate analysis. No significant correlation was found between OS and age, gender, surgical approach, surgical extent, surgical device, the number of resected metastases, lesion diameter, the site of lesions and nodal involvement. Multivariate analysis of OS confirmed that only epithelial histology and DFI were risk-factors, with p-values of 0.041 and 0.031, respectively. Conclusions: Lung metastasectomy appears to be a safe procedure, with acceptable morbidity, even with a minimally invasive approach. However, it remains a local treatment of a systemic disease. Therefore, careful attention should be paid to selecting patients who could truly benefit from surgical intervention.
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disorder which can be an incidental finding in imaging tests performed during the investigation of another condition, ...or is the final diagnosis in patients evaluated for chronic obstructive complaints. To explore the possible association between specific histopathology features and the mode of clinical presentation, we retrieved the clinical, functional, radiological, and pathological data of all 13 patients diagnosed with DIPNECH at our Institution over a 14-year period (2000–2014). As compared to patients with incidental disease (6/13, 46 %), patients with symptomatic disease were younger mean (SD): 57.7 vs. 68.7 years,
p
= 0.046, were more likely to have mosaic attenuation (100 vs. 0 %,
p
= 0.001) and small multiple nodules (100 vs. 17 %,
p
= 0.005) at CT, and showed a significantly higher number of foci of linear neuroendocrine proliferation median (IQR): 28 (13–37) vs. 6 (5–13),
p
= 0.018 and of tumorlets median (IQR): 10 (8–20) vs. 1 (1–1),
p
= 0.002 at histology. Incidental disease was found in association with pulmonary adenocarcinoma in five out of six patients (83.3 %). The results of our study provide preliminary evidence that symptomatic patients with DIPNECH represent a specific subset characterized by younger age and a higher burden of foci of neuroendocrine proliferation.
Data-driven methods open up unprecedented possibilities for maritime surveillance using automatic identification system (AIS) data. In this work, we explore deep learning strategies using historical ...AIS observations to address the problem of predicting future vessel trajectories with a prediction horizon of several hours. We propose novel sequence-to-sequence vessel trajectory prediction models based on encoder–decoder recurrent neural networks (RNNs) that are trained on historical trajectory data to predict future trajectory samples given previous observations. The proposed architecture combines long short-term memory RNNs for sequence modeling to encode the observed data and generate future predictions with different intermediate aggregation layers to capture space-time dependencies in sequential data. Experimental results on vessel trajectories from an AIS dataset made freely available by the Danish Maritime Authority (DMA) show the effectiveness of deep learning methods for trajectory prediction based on sequence-to-sequence neural networks, which achieve better performance than baseline approaches based on linear regression or on the multilayer perceptron architecture. The comparative evaluation of results shows: first, the superiority of attention pooling over static pooling for the specific application, and second, the remarkable performance improvement that can be obtained with labeled trajectories, i.e., when predictions are conditioned on a low-level context representation encoded from the sequence of past observations, as well as on additional inputs (e.g., port of departure or arrival) about the vessel's high-level intention, which may be available from AIS.
ABSTRACT
Background and objective: Transbronchial needle aspiration (TBNA) is useful for diagnosing peripheral pulmonary lesions (PPL). However, TBNA is largely underused and the variables that may ...be related to its diagnostic usefulness have not been specifically studied. The aim of the present study was to evaluate the performance characteristics and predictors of yield from TBNA of PPL, and to compare the performance characteristics of different bronchoscopic sampling methods.
Methods: Consecutive patients with PPL were prospectively enrolled, and during the same examination, TBNA, transbronchial lung biopsy (TBLB) and bronchial washing (BW) were performed.
Results: Two hundred and eighteen PPL in 218 patients were sampled. TBNA was more sensitive (65%) than either TBLB (45%, P < 0.001) or BW (22%, P < 0.001). TBNA was the only diagnostic procedure in 42/196 patients (21%) with malignant lesions, and was more likely to be the only diagnostic procedure for lesions lacking (23/85 patients, 27%) than for lesions with the bronchus sign (19/111 patients, 17%). In multivariate analysis, a lesion size >2 cm, malignancy and location in the middle lobe were independent predictors of a positive TBNA result.
Conclusions: TBNA is the single best contributor to the success of bronchoscopy in the diagnosis of PPLs, and should be routinely used especially in the presence of lesions lacking the bronchus sign. Lesion size of > 2 cm, location in the middle lobe, and malignant nature are strong predictors of a positive TBNA result.
In a large series of patients with peripheral pulmonary lesions, transbronchial needle aspiration was the single best method associated with successful diagnosis. Preference should be given to this method, especially for lesions lacking the bronchus sign on CT.
A Correction has been published | View Neurogenic tumors represent 10 to 34% of all mediastinal tumors and among them, neurofibroma originating from the vagus nerve are rare entities. We present a ...case of a neurofibroma with cystic degeneration originating from the left branch of the vagus nerve in a 27-year-old man without von Recklinghausen disease. A complete robotic resection of the mediastinal mass has been performed, with amputation of the vagus nerve enclosed in the mass. The postoperative course was uneventful and the patient was discharged in two days.
Background
The role of video-assisted thoracoscopic surgery for the treatment of non-small-cell lung cancer after neoadjuvant chemotherapy remains controversial. The aim of this study is to ...demonstrate the reliability of video-assisted lobectomy compared to the open approach by evaluating perioperative and long-term outcomes.
Methods
In this retrospective, multicentric study from January 2010 to December 2018, we included all patients with non-small-cell lung cancer who underwent lobectomy through the video-assisted or open approach after neoadjuvant chemotherapy. The perioperative outcomes, including data concerning the feasibility of the surgical procedure, the occurrence of any medical and surgical complications and long-term oncological evidence, were collected and compared between the two groups. To minimize selection bias, propensity score matching was performed.
Results
A total of 286 patients were enrolled: 193 underwent thoracotomy lobectomy, and 93 underwent VATS lobectomy. The statistical analysis showed that surgical time (
P
< 0.001), drainage time (
P
< 0.001), days of hospitalization (
P
< 0.001) and VAS at discharge (
P
= 0.042) were lower in the VATS group. The overall survival and disease-free survival were equivalent for the two techniques on long-term follow-up.
Conclusions
VATS lobectomy represents a valid therapeutic option in patients affected by non-small-cell lung cancer after neoadjuvant chemotherapy. The VATS approach in our experience seems to be superior in terms of the perioperative outcomes, while maintaining oncological efficacy.
Residual masses in patients with mediastinal lymphoma may be positron emission tomography (PET) positive during follow-up also in cases of complete response. The aim of this retrospective study is to ...verify the reliability of mediastinal PET-positive findings in suggesting disease relapse or progression during follow-up by histological verification. From January 2002 to March 2016, 96 patients with mediastinal lymphoma underwent PET follow-up after front-line treatment. A surgical biopsy was performed to confirm the suspected relapse (for a total of 113 procedures). A lymphoma relapse was diagnosed in 66/102 successful procedures (64.7%). Diagnosis at relapse was concordant with the initial diagnosis in all but 3 cases. Standardized uptake value was significantly higher among patients with relapse than among those who remained in remission (10 versus 5, p < .05). PET scan helps individuate patients with a high suspect of lymphoma relapse and may guide the surgeon to the most suitable target.
Point source estimation aims to detect and localize a concentrated diffusive source as well as to estimate its intensity and induced field from pointwise-in-time-and-space measurements of sensors ...spread over the area to be monitored. The space–time dynamics of the diffused field is modeled by an advection–diffusion–reaction partial differential equation (ADR PDE) and a finite element (FE) method is adopted in order to spatially discretize the ADR PDE model. Source identifiability, i.e. the ability to detect the source and uniquely identify its location and intensity, is analyzed in a system-theoretic framework by providing sufficient conditions in terms of rank tests on suitable polynomial matrices. Further, a novel finite element multiple model (FE-MM) filtering approach to source estimation is presented. The approach consists of running a bank of FE Kalman filters, each conditioned to the source being placed in a given element of the FE mesh, and then combining the estimates of such filters in order to produce estimates of the source location and intensity as well as of the diffusing field. The effectiveness of the proposed source estimation algorithm is demonstrated via simulation experiments in both cases of motionless source of unknown position and mobile source.
PDF
