Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This ...statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required.
This article introduces the special section on Religion, Spirituality, and Advertising. A person's belief in a religion or their spiritual identity can have a direct influence on the way they live ...and their attitudes and values. This can also impact an individual's perception toward an advertiser's message and images or advertising in general. While studies on the topic of religion and spirituality in the marketing literature are on the rise, there is still a substantive research gap on this topic, particularly on the theoretical and empirical developments pertaining to the influence of religion on various aspects of advertising topics. For this special section, the Call for Papers resulted in 37 submissions, which finally resulted in five articles that present a different focus on the topic and aim to encourage new discourse into the area of religion, spirituality, and advertising.
PurposeThis research investigates how consumers who are most active on Facebook during the day vs in the evening differ, differ in their ad consumption, and how advertising effects vary as a function ...of a key moderator: gender.Design/methodology/approachUsing a survey of 281 people, the research identifies Facebook users who are more intensely using mobile social media during the day versus in the evening, and measures five Facebook mobile advertising outcomes: brand and product recall, clicking on ads, acting on ads and purchases.FindingsThe results show that women who are using social media more intensely during the day are more likely to use Facebook to seek information, hence, Facebook mobile ads tend to be more effective for these users compared to those in the evening.Research limitations/implicationsThis contributes to the literature by analyzing how the time of day affects social media behavior in relation to mobile advertising effectiveness, and broadening the scope of mobile advertising effectiveness research from other than just clicks on ads to include measures like brand and product recall.Practical implicationsBy analyzing the effectiveness of mobile advertising on social media as a function of the time of day, advertisers can be more targeted in their media buys, and so better use their social media budgets, i.e. advertising is more effective for women who use social media (Facebook) more intensely during the day than for those who use social media more intensely in the evening as the former tend to seek more information than the latter.Social implicationsThis research extends media ecology theory by drawing on circadian rhythm research to provide a first demonstration of how the time of day relates to different uses of mobile social media, which in turn relate to social media mobile advertising consumption.Originality/valueWhile research on social media advertising has been steadily increasing, little has been explored on how users consume ads when they engage with social media at different periods along the day. This paper extends media ecology theory by investigating time of day, drawing on the circadian rhythm literature, and how it relates to social media usage.
Summary Background Malignant pleural mesothelioma incidence continues to rise, with few available evidence-based therapeutic options. Results of previous non-randomised studies suggested that ...video-assisted thoracoscopic partial pleurectomy (VAT-PP) might improve symptom control and survival. We aimed to compare efficacy in terms of overall survival, and cost, of VAT-PP and talc pleurodesis in patients with malignant pleural mesothelioma. Methods We undertook an open-label, parallel-group, randomised, controlled trial in patients aged 18 years or older with any subtype of confirmed or suspected mesothelioma with pleural effusion, recruited from 12 hospitals in the UK. Eligible patients were randomly assigned (1:1) to either VAT-PP or talc pleurodesis by computer-generated random numbers, stratified by European Organisation for Research and Treatment of Cancer risk category (high vs low). The primary outcome was overall survival at 1 year, analysed by intention to treat (all patients randomly assigned to a treatment group with a final diagnosis of mesothelioma). This trial is registered with ClinicalTrials.gov , number NCT00821860. Findings Between Oct 24, 2003, and Jan 24, 2012, we randomly assigned 196 patients, of whom 175 (88 assigned to talc pleurodesis, 87 assigned to VAT-PP) had confirmed mesothelioma. Overall survival at 1 year was 52% (95% CI 41–62) in the VAT-PP group and 57% (46–66) in the talc pleurodesis group (hazard ratio 1·04 95% CI 0·76–1·42; p=0·81). Surgical complications were significantly more common after VAT-PP than after talc pleurodesis, occurring in 24 (31%) of 78 patients who completed VAT-PP versus ten (14%) of 73 patients who completed talc pleurodesis (p=0·019), as were respiratory complications (19 24% vs 11 15%; p=0·22) and air-leak beyond 10 days (five 6% vs one 1%; p=0·21), although not significantly so. Median hospital stay was longer at 7 days (IQR 5–11) in patients who received VAT-PP compared with 3 days (2–5) for those who received talc pleurodesis (p<0·0001). Interpretation VAT-PP is not recommended to improve overall survival in patients with pleural effusion due to malignant pleural mesothelioma, and talc pleurodesis might be preferable considering the fewer complications and shorter hospital stay associated with this treatment. Funding BUPA Foundation.
By looking at specific motivations for social media use as general action or inaction goals, this research provides a cognitive account of their effects on perceptions of paid advertising on ...smartphones. Results across two studies show that specific motivations with an overarching action goal (i.e. seeking information, seeking excitement, and seeking emotional support) relate positively to perceptions of advertising entertainment, while those with an overarching inaction goal (i.e. seeking relaxation) relate negatively to perceptions of advertising entertainment. In addition, the motivation to seek information from social media relates positively to perceptions of advertising informativeness. Perceptions of both advertising informativeness and advertising entertainment relate negatively to perceptions of advertising intrusiveness, leading to indirect effects of specific motivations on intrusiveness. Direct effects of specific motivations on intrusiveness are minimal.
Abstract The ability to deliver large transgenes to a single genomic sequence with high efficiency would accelerate biomedical interventions. Current methods suffer from low insertion efficiency and ...most rely on undesired double-strand DNA breaks. Serine integrases catalyze the insertion of large DNA cargos at attachment (att) sites. By targeting att sites to the genome using technologies such as prime editing, integrases can target safe loci while avoiding double-strand breaks. We developed a method of phage-assisted continuous evolution we call IntePACE, that we used to rapidly perform hundreds of rounds of mutagenesis to systematically improve activity of PhiC31 and Bxb1 serine integrases. Novel hyperactive mutants were generated by combining synergistic mutations resulting in integration of a multi-gene cargo at rates as high as 80% of target chromosomes. Hyperactive integrases inserted a 15.7 kb therapeutic DNA cargo containing von Willebrand Factor. This technology could accelerate gene delivery therapeutics and our directed evolution strategy can easily be adapted to improve novel integrases from nature.
The 8
th
tumour, node and metastasis (TNM) revision of the staging classification for lung cancer has attempted to clarify the different properties of four distinct clinical presentations: ...synchronous multiple primary lung cancers; primary tumour with intrapulmonary metastases; pneumonic-type adenocarcinoma and multiple ground glass/lepidic lesions. The respective biological profiles determine different surgical strategies for each category. Accurate preoperative histological confirmation is required to identify synchronous primary tumours which should then be managed as two separate episodes within the confines of patient characteristics. Equally important is the confirmation of intrapulmonary metastasis which indicates a more conservative resection of the smaller lesion. In contrast, pneumonic-type adenocarcinoma may require larger parenchymal resection to achieve anatomical clearance but also symptom relief. Multiple subsolid lesions require a carefully planned strategy of parenchymal sparing and possible observation of less malignant abnormalities. In all the above situations careful clinical, radiological and pathological assessment is imperative to avoid one embarking on inappropriate invasive management. Either when the widespread nature of the disease renders extensive surgery futile or the relative benign or pre-malignant nature of the multiple lesions imply that the risks of surgery outweigh the prognostic benefits.
OBJECTIVES
For many years, extrapleural pneumonectomy (EPP) was the operation of choice for the radical management of pleural mesothelioma in the UK. However, doubts surrounding the efficacy of EPP, ...and the change in demographics of the affected population, have prompted a transition in our practice towards extended pleurectomy/decortication (EPD). The aim of this study was to determine the effects an intentional transition from EPP to EPD has had on patient outcome.
METHODS
Data from 362 patients undergoing radical surgery (229 EPD, 133 EPP) during 1999–2014 were included. Demographics and outcome were compared between the two groups; EPP versus EPD.
RESULTS
The median age of patients undergoing EPD was significantly higher than those undergoing EPP 57 years (range 14–70 years) vs 65 years (range 42–81 years), P < 0.001. There was a significantly higher proportion of patients with performance status ≥1 in the EPD group (46.3 vs 35.4%, P = 0.047). There was no difference in the median length of hospital stay between the two groups 14 days (range 1–133 days) vs 13 days (range 0–93 days), P = 0.409. There was also no difference between the groups in terms of in-hospital mortality (EPP 5.3% and EPD 6.6%, P = 0.389), 30-day mortality EPP 8 (6.0%) and EPD 8 (3.5%), P = 0.294 or 90-day mortality EPP 18 (13.5%) and EPD 21 (9.2%), P = 0.220. There was a significantly higher early reoperation rate in the EPP group (15.0 vs 6.2%, P = 0.008) but a significantly higher late reoperation rate in the EPD group (0.8 vs 5.3%, P = 0.037). There was no significant difference in overall survival or disease-free interval between the two groups (P = 0.899 and P = 0.399, respectively). However, overall survival was significantly greater in patients over the age of 65 undergoing EPD (12.5 vs 4.7 months, P = 0.001).
CONCLUSION
The transition from EPP to EPD in our standard practice has enabled us to operate on more elderly, frail patients with no significant increase in use of hospital resources, and without detriment to overall survival.
Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an incidence of 0.25-5%. It can also ...occur as extension of infection from adjacent structures such as the oesophagus, airways and lungs, or as descending necrotizing infection from the head and neck. In addition, there is a chronic form of 'chronic fibrosing mediastinitis' usually caused by granulomatous infections. In this expert consensus, the evidence for strategies for treatment and prevention of mediatinitis is reviewed in detail aiming at reducing the incidence and optimizing the management of this serious condition.
PDF
