We present results from water-channel experiments on neutrally-stable turbulent flows over staggered arrays of cubical obstacles modelling idealised urban canopies. Attention is concentrated on the ...vertical profiles of the Eulerian (
T
E
) and Lagrangian (
T
L
) time scales of the turbulence above three canopies with different plan area fractions (
λ
P
= 0.1, 0.25 and 0.4). The results show that both the streamwise and vertical components of
T
L
increase approximately linearly with height above the obstacles, supporting Raupach’s linear law. The comparisons with the Lagrangian time scales over canyon-type canopies in the skimming flow and wake interference regimes show that the staggered configuration of cubical obstacles increases the streamwise
T
L
, while decreasing its vertical counterpart. A good agreement has also been found between the eddy viscosities (
K
T
) estimated by applying Taylor’s theory and the classical first order closure relating the momentum flux to the velocity gradient. The results show that
K
T
obeys Prandtl’s theory, particularly for
λ
P
= 0.25 and 0.4.
Background
Blood level of C-reactive protein (CRP) at diagnosis is a well-know prognostic bio-marker in different primary tumors, but its role has not been investigated in resectable lung metastases. ...The aim of our study is to assess the predictive value of baseline (CRP0) and 3rd postoperative day (CRP3) levels on long-term survival of patients undergoing lung metastasectomy.
Methods
A total of 846 consecutive patients underwent the first pulmonary resection for lung metastases between January 2003 and December 2015, including 611 (72%) single surgical procedures, 235 (28%) multiple metastasectomies, 501 (59%) epithelial primary tumors, 276 (33%) sarcomas, 66 (8%) melanomas, 286 (33.8%) with 0 risk factors (CRP0 ≤ 2 and CRP3 ≤ 84 mg/L) and 560 (66.2%) with ≥ 1 risk factor (CRP
0
> 2 and/or CRP
3
> 84 mg/L).
Results
Cumulative 5-year survival was 57% in patients with low CRP (0 risk factors) versus 43% in high CRP (≥ 1 risk factor,
p
< 0.0002), 62% versus 50% respectively for epithelial tumors (
p
< 0.0140), and 51% versus 34% for sarcomas (
p
< 0.0111). Multivariable Cox analysis confirmed a mortality hazard ratio of 2.5 at 1-year and 1.5 at 5-years in patients with high CRP.
Conclusions
Baseline and postoperative CRP levels predict survival of patients with resectable lung metastases. These data provide a rationale for prospective clinical trials testing the efficacy of anti-inflammatory or immune-modulating agents as “adjuvant” therapy after lung metastasectomy, in patients with elevated pre- and/or postoperative CRP levels.
Purpose
The prognostic impact of baseline C-reactive protein (CRP) in non-small-cell
lung cancer (NSCLC) is debated. To evaluate this issue, we performed a
systematic review and meta-analysis to ...explore the role of CRP value in
predicting early-stage NSCLC survival.
Methods
Ten articles on early-stage NSCLC were eligible and included in our study. We
performed a random-effects meta-analysis and assessed heterogeneity and
publication bias. We pooled hazard ratio (HR) estimates and their 95%
confidence intervals (CIs) on mortality for the comparison between the
study-specific highest category of CRP level versus the lowest one.
Results
In overall analysis, elevated pretreatment CRP values were significantly
associated with poor overall survival (HR 1.60, 95% CI 1.30-1.97,
p<0.001, I2 = 71.9%). Similar results were observed across
considered strata. However, higher mortality risk was reported in studies in
which CRP was combined with other factors (HR 1.96, 95% CI 1.58-2.45) and in
those using a cutoff value of 3 mg/L (HR 1.89, 95% CI 1.52-2.35).
Conclusions
Based on our analysis, baseline high CRP level is significantly associated
with poor prognosis in early-stage NSCLC. Further prospective controlled
studies are needed to confirm these data.
After complex thoracic exenterations, total diaphragmatic resection and reconstruction is challenging. We describe our novel technique for total diaphragmatic replacement with permeable nonabsorbable ...mesh after extended pneumonectomy.
Prognostic factors in patients with single mediastinal station (sN2) involvement continues to be a debated issue.
Data on 213 adenocarcinoma patients with sN2 involvement and who had undergone ...complete anatomical lung resection and lymphadenectomy, were retrospectively reviewed. Clinical and pathological characteristics together with adjuvant therapy (AD) and node (N) status classifications (number of resected nodes (#RN), number of metastatic nodes (#MN), and node ratio (#MN/#RN = NR) were analyzed.
Univariable analysis confirmed that age (0.009), #MN (0.009), NR (0.003), #N1 involved stations (
= 0.003), and skip metastases (
= 0.005) were related to overall survival (OS). Multivariable analysis confirmed, as independent prognostic factors, age <66 years and NR with a three-year OS (3YOS) of 78.7% in NR < 10% vs. 46.6% in NR > 10%. In skip metastases, NR (HR 2.734, 95% CI 1.417-5.277,
= 0.003) and pT stage (HR2.136, 95% CI 1.001-4.557,
= 0.050) were confirmed as independent prognostic factors. AD did not influence the OS of patients with singular positive lymph nodes (
= 0.41), while in patients with multiple lymph nodes and AD, a significantly better 3YOS was demonstrated, i.e., 49.1% vs. 30% (
= 0.004). In patients with N2 + N1 involvement, age (
= 0.002) and AD (
= 0.022) were favorable prognostic factors.
Adenocarcinoma patients with single N2 station involvement had a favorable outcome in the case of skip metastases and low NR. Adjuvant therapy improves survival with multiple nodal involvement, while its role in single node involvement should be clarified.
Despite ongoing efforts to improve therapy in malignant pleural mesothelioma, few patients undergoing extrapleural pneumonectomy experience long-term survival (LTS). This study aims to explore ...predictors of LTS after extrapleural pneumonectomy and to define a prognostic score.
From January 2000 to December 2010, we retrospectively reviewed clinicopathologic and oncological factors in a multicenter cohort of 468 malignant pleural mesothelioma patients undergoing extrapleural pneumonectomy. LTS was defined as survival longer than 3 years. Associations were evaluated using χ(2), Student's t, and Mann-Whitney U tests. Logistic regression, Cox regression hazard model, and bootstrap analysis were applied to identify outcome predictors. Survival curves were calculated by the Kaplan-Meier method. Receiver operating characteristic analyses were used to estimate optimal cutoff and area under the curve for accuracy of the model.
Overall, 107 patients (22.9%) survived at least 3 years. Median overall, cancer-specific, and disease-free survival times were 60 (95% confidence interval CI, 51 to 69), 63 (95% CI, 54 to 72), and 49 months (95% CI, 39 to 58), respectively. At multivariate analysis, age (odds ratio, 0.51; 95% CI, 0.31 to 0.82), epithelioid histology (odds ratio, 7.07; 95% CI, 1.56 to 31.93), no history of asbestos exposure (odds ratio, 3.13; 95% CI, 1.13 to 8.66), and the ratio between metastatic and resected lymph nodes less than 22% (odds ratio, 4.12; 95% CI, 1.68 to 10.12) were independent predictors of LTS. According to these factors, we created a scoring system for LTS that allowed us to correctly predict overall, cancer-specific, and disease-free survival in the total sample, obtaining two different groups with favorable or poor prognosis (area under the curve, 0.74; standard error, 0.04; p < 0.0001).
Our prognostic model facilitates the prediction of LTS after surgery for malignant pleural mesothelioma and can help to stratify the outcome and, eventually, tailor postoperative treatment.
Highlights • No standard therapies have been validated for Stage-III epithelial thymic tumors. • Surgical radicality and post-op outcomes are acceptable after multimodal treatment. • A rewarding ...survival may be expected after induction therapy followed by surgery. • WHO-Histology seems to be the most important prognostic factor.
An unusual case of persistent pneumothorax Kawamukai, Kenji; Leuzzi, Giovanni; Di Saverio, Salomone ...
The Annals of thoracic surgery,
07/2014, Letnik:
98, Številka:
1
Journal Article
Recenzirano
Odprti dostop
We herein report a case of a 45-year-old white male who referred to the emergency department for a right pneumothorax. A chest tube was emergently placed. Due to incomplete lung reexpansion, the ...patient underwent a right thoracoscopy disclosing the presence of several kinky vessels consistent of localized pleural angiomatosis, and a talc pleurodesis was performed. Computed tomographic scan and angiography confirmed an anomalous vascular connection between systemic and pulmonary circulation. Thus, a vascular percutaneous transcatheter embolization of the abnormal vessel was successfully executed and the patient was discharged without consequence.
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