Pulmonary function and patient complaints appear to improve up to 12 months after lobectomy but long-term prospective studies based on clinical data are scarce. Improvement in pulmonary function may ...depend on the area and extent of the resection and the time from the operation. This prospective study aimed to determine pulmonary function changes according to the resected lobe.
This prospective study included 59 patients requiring single lobectomy. Total volume and low-attenuation volume (LAV) for each lobe and the entire lungs were calculated based on helical computed tomography images. Vital capacity (VC), forced expiratory volume in one second (FEV
), percent FEV
(%FEV
), percent lung diffusion capacity for carbon monoxide (%DL
), %DL
divided by the alveolar volume (%DL
/V
), modified Medical Research Council (mMRC) grades, and COPD Assessment Test (CAT) scores were compared at 3, 6, and 12 months after surgery.
VC was higher at 12 months than at 3 months after right upper lobectomy (RUL) or right lower lobectomy (RLL). FEV
and %FEV
were higher at 12 months than at 6 months after left lower lobectomy (LLL). %DL
was higher at 12 months than at 3 months after RUL or left upper lobectomy (LUL). DL
/V
, mMRC grades, and CAT scores did not change significantly in the period from 3 to 12 months after any lobectomy procedure. Compared to the predicted postoperative values, the observed values of VC for RUL, RLL, and LUL; FEV
for RLL; %FEV
for RLL and LUL; %DL
for LUL; and %DL
/V
for all lobectomy procedures were higher at 12 months.
Improvements in pulmonary function and symptoms varied according to the resected lobe. Some of the observed pulmonary function values were higher than the predicted postoperative values. Pulmonary function changes may be related to the location, volume, and extent of emphysematous changes.
It is well known that the solution of an exterior acoustic problem governed by the Helmholtz equation is violated at the eigenfrequencies of the associated interior problem when the boundary element ...method (BEM) based on the conventional boundary integral equation (CBIE) is applied without any special treatment to solve it. To tackle this problem, the Burton-Miller formulation using a linear combination of the CBIE and its normal derivative (NDBIE) emerges as an effective and efficient formula which is proved to yield a unique solution for all frequencies if the imaginary part of the coupling constant of the two equations is nonzero. The most difficult part in implementing the Burton-Miller formulation is that the NDBIE is a hypersingular type, and it is often regularized by using the fundamental solution of the Laplace's equation. But various regularization procedures in the literature give rise to integrals which are still difficult and/or extremely time consuming to evaluate in general. However, when constant triangular elements are used to discretize the boundary, all the strongly-singular and hypersingular integrals can be evaluated in finite-part sense explicitly without any difficulty, and the numerical computation becomes more efficient than any other singularity-subtraction technique. Therefore, in this paper, these singular integrals are evaluated rigorously for triangular constant element as finite parts of the divergent integrals by canceling out the divergent terms which appears in the limiting process explicitly. The correctness of the formulation is also demonstrated through some numerical test examples.
Highlights • First report of successful desensitization against skin rash induced by alectinib. • The patient was able to resume alectinib treatment safely after desensitization. • Desensitization ...should be considered in patients with alectinib sensitivities.
BACKGROUNDPostoperative assessment of pulmonary function is important for estimating the risk of thoracic surgery and long-term disability following pulmonary resection, including predicted ...postoperative (ppo) forced expiratory volume (FEV) in one second (ppoFEV1) and percent predicted lung diffusion capacity for carbon monoxide (ppo%DLCO) estimation. The ppo values were compared using four different estimation methods between chronic obstructive pulmonary disease (COPD) and non-COPD patients and according to the resected lobe. METHODSThis prospective study included 59 eligible patients requiring single lobectomy and succeeded in performing pulmonary function tests at 3 and 12 months after lobectomy. The ppoFEV1 and ppo%DLCO were compared with poFEV1 and po%DLCO obtained at 3 and 12 months after lobectomy. The ppo values were estimated using the four usual methods: the 19-segment anatomical technique (S), perfusion scintigraphy (Q), quantitative CT (CT), and quantitative CT with low attenuation volume (CTLAV) subtraction. RESULTSFor non-COPD and COPD patients, the smallest mean difference between ppo and po values was observed by S for FEV1 and %DLCO. Based on the resected lobe, the smallest mean difference was observed by (I) Q for right upper lobectomy (RUL) excluding %DLCO at 12 months by S, (II) S for left upper lobectomy (LUL), (III) CT and CTLAV for right lower lobectomy (RLL), and (IV) CT and CTLAV for left lower lobectomy (LLL) at 12 months. The ppo values calculated by S for RUL (FEV1 at 3 and 12 months and %DLCO at 3 months) and by all four methods for LLL (FEV1 and %DLCO at 3 months) were smaller than the po values. CONCLUSIONSThe S method is adequate for calculating ppoFEV1 and ppo%DLCO when patients are classified as non-COPD and COPD. However, S sometimes overestimates the ppoFEV1 and ppo%DLCO when patients are classified according to the resected lobe. The CTLAV method may be the method of choice instead of S for calculating ppoFEV1 and ppo%DLCO in patients who undergo lung lobectomy despite the presence or absence of airflow limitation.
Pemetrexed monotherapy has come to be recognized as the standard of care for second-line therapy of non-squamous non-small cell lung cancer (NSCLC). Thymidylate synthase (TS) expression is recognized ...as a potential predictor of the response to pemetrexed-based chemotherapy in patients with advanced NSCLC. The purpose of this study was to identify useful predictors of the response to pemetrexed other than TS expression.
The records of non-squamous NSCLC patients without driver mutations who received pemetrexed monotherapy as a second or later line of chemotherapy at Kitasato University Hospital between March 2009 and October 2015 were retrospectively reviewed, and the treatment outcomes were evaluated.
In the 116 patients with non-squamous NSCLC, the overall response rate and progression-free survival (PFS) were 10.3% and 2.1 months, respectively. The disease control rate and PFS differed significantly among current smokers and never-smokers/former light smokers (44.9 vs. 65.8%, and 1.8 vs. 4.0 months, respectively). Furthermore, multivariate analysis identified Eastern Cooperative Oncology Group Performance Status and smoking status as independent predictors of the PFS.
The clinical data obtained in this study may provide a valuable basis for the use of smoking status as a predictor of pemetrexed monotherapy in wild-type NSCLC patients.
Postoperative assessment of pulmonary function is important for estimating the risk of thoracic surgery and long-term disability following pulmonary resection, including predicted postoperative (ppo) ...forced expiratory volume (FEV) in one second (ppoFEV
) and percent predicted lung diffusion capacity for carbon monoxide (ppo%DLCO) estimation. The ppo values were compared using four different estimation methods between chronic obstructive pulmonary disease (COPD) and non-COPD patients and according to the resected lobe.
This prospective study included 59 eligible patients requiring single lobectomy and succeeded in performing pulmonary function tests at 3 and 12 months after lobectomy. The ppoFEV
and ppo%DLCO were compared with poFEV
and po%DLCO obtained at 3 and 12 months after lobectomy. The ppo values were estimated using the four usual methods: the 19-segment anatomical technique (S), perfusion scintigraphy (Q), quantitative CT (CT), and quantitative CT with low attenuation volume (CT
) subtraction.
For non-COPD and COPD patients, the smallest mean difference between ppo and po values was observed by S for FEV
and %DLCO. Based on the resected lobe, the smallest mean difference was observed by (I) Q for right upper lobectomy (RUL) excluding %DLCO at 12 months by S, (II) S for left upper lobectomy (LUL), (III) CT and CT
for right lower lobectomy (RLL), and (IV) CT and CT
for left lower lobectomy (LLL) at 12 months. The ppo values calculated by S for RUL (FEV
at 3 and 12 months and %DLCO at 3 months) and by all four methods for LLL (FEV
and %DLCO at 3 months) were smaller than the po values.
The S method is adequate for calculating ppoFEV
and ppo%DLCO when patients are classified as non-COPD and COPD. However, S sometimes overestimates the ppoFEV
and ppo%DLCO when patients are classified according to the resected lobe. The CT
method may be the method of choice instead of S for calculating ppoFEV
and ppo%DLCO in patients who undergo lung lobectomy despite the presence or absence of airflow limitation.
Summary
Background
Previous study indicated that an optional anti-cancer drug for the treatment of small-cell lung cancer (SCLC) is amrubicin. However, no prospective studies have evaluated amrubicin ...in chemo-naive elderly or poor-risk patients with SCLC. Therefore, this study aimed to evaluate the efficacy of amrubicin as first-line chemotherapy for elderly or poor-risk patients with extensive-disease SCLC (ES-SCLC).
Methods
Patients with chemotherapy-naive ES-SCLC received multiple cycles of 40 mg/m
2
amrubicin for 3 consecutive days every 21 days. The primary endpoint was the overall response rate (ORR), and the secondary endpoints were progression-free survival (PFS), overall survival (OS), and safety.
Results
Between March 2011 and August 2015, 36 patients were enrolled in this study. Each patient received a median of four treatment cycles (range, 1–6 cycles). ORR was 52.8% 95% confidence interval (CI), 37–69%. The median PFS and OS periods were 5.0 months (95% CI, 3.4–6.6 months) and 9.4 months (95% CI, 5.2–13.6 months), respectively. Neutropenia was the most common grade 3 or 4 adverse event (69.4%), with febrile neutropenia developing in 13.9% of patients. No treatment-related death occurred. At the time of starting second-line chemotherapy, 19 of 22 patients (86%) had significantly improved or maintained their performance status (PS) relative to their PS at the time of starting amrubicin monotherapy as first-line chemotherapy (
P
= 0.027).
Conclusions
The results of the present study suggest that amrubicin could be considered as a viable treatment option for chemotherapy-naive elderly or poor-risk patients with ES-SCLC (Clinical trial registration number: UMIN000011055
www.clinicaltrials.gov
).
Superstrate-type Cu(In,Ga)Se sub(2) (CIGS) thin film solar cells were fabricated using Zn sub(1-x)Mg sub(x)O buffer layers. Due to the diffusion of Cd into CIGS during the growth of the CIGS layer, ...the conventional buffer material of CdS is not suitable. ZnO is a good candidate because of higher thermal tolerance but the conduction band offset (CBO) of ZnO/CIGS is not appropriate. In this study, the Zn sub(1-x)Mg sub(x)O buffer layers were used to fulfill both the requirements. The superstrate-type solar cells with a soda-lime glass/In sub(2)O sub(3):Sn/Zn sub(1-x)Mg sub(x)O/CIGS/Au structure were fabricated with different band gap energies of the Zn sub(1-x)Mg sub(x)O layer. The CIGS layers Ga/(In + Ga)~0.25 were deposited by co-evaporation method. The substrate temperature during the CIGS deposition of 450 degree C did not cause the intermixing of the Zn sub(1-x)Mg sub(x)O and CIGS layers. The conversion efficiency of the cell with Zn sub(1-x)Mg sub(x)O was higher than that with ZnO due to the improvement of open-circuit voltage and shunt resistance. The results well corresponded to the behavior of the adjustment of CBO, demonstrating that the usefulness of the Zn sub(1-x)Mg sub(x)O layer for the CBO control in the superstrate-type CIGS solar cells.
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