Background Neuroendocrine (NE) differentiation is widely studied in non-small cell lung carcinoma... more Background Neuroendocrine (NE) differentiation is widely studied in non-small cell lung carcinomas (NSCLC) however, its significance remains unclear in basaloid squamous cell carcinomas (B-SqCC). This study aims to assess the extent of NE differentiation in B-SqCC and characterize the underlying molecular process. Methods This study evaluated resected B-SqCC, small cell lung cancer (SCLC) and poorly differentiated SqCC (PD-SqCC) from 2005 to 2020 at the Ottawa Hospital. Samples were subject to pathological review, immunohistochemistry (IHC) and survival analysis. Gene expression analysis was performed on B-SqCC samples exhibiting NE+ and NE- regions (paired samples) to identify differentially expressed genes (DEGs). These DEGs were subsequently validated in unpaired B-SqCC and TCGA samples. Results B-SqCC cases were more likely to exhibit nuclear molding, resetting and peripheral palisading than PD-SqCC. B-SqCC were also more likely to demonstrate NE differentiation compared to PD-S...
Neste relato de experimento determinamos os calores específicos do alumínio e do aço inox, mostra... more Neste relato de experimento determinamos os calores específicos do alumínio e do aço inox, mostrando também com pode ser viabilizado para sua aplicação nas escolas do ensino médio, traçando uma estratégia para sua aplicação possibilitando ao aluno construir seu próprio conhecimento, com o auxílio da tecnologia. Usamos o método de ensino através do qual a lógica da organização de uma sala de aula é de fato invertida por completo. Foram utilizados três ambientes educacionais em forma de Rotação na qual será, o laboratório de informática da escola, o laboratório de ciências e um ambiente virtual(Google classroom), lançando mão de software como fritizing, para desenhar os circuitos e Excel para tratamento dos dados coletados. Os resultados concorda com as literaturas publicadas.
Primary biphasic tumors of the lung are rare. Lung lesions with a biphasic pattern are far more c... more Primary biphasic tumors of the lung are rare. Lung lesions with a biphasic pattern are far more commonly primary or metastatic soft tissue tumors with entrapped native respiratory epithelium, giving the false impression of a biphasic tumor. We report a case of bilateral benign metastasizing leiomyomas in a 69-year-old female where the tumor cells diffusely entrapped native respiratory glands in a phyllodes-like pattern. The radiographic characteristics and histologic appearance were not immediately diagnostic and covered a wide differential. Reaching the final diagnosis required the use of immunohistochemical studies as well as correlation with the patient's history and radiographic findings. To the best of our knowledge, this is the first report of pulmonary benign metastasizing leiomyoma presenting in a phyllodes-like pattern. This case illustrates the importance of considering entrapment of native lung epithelium in the differential diagnosis of biphasic-appearing lung tumors.
Background: Systemic therapy prolongs overall survival (OS) in advanced nonsmall cell lung cancer... more Background: Systemic therapy prolongs overall survival (OS) in advanced nonsmall cell lung cancer (NSCLC), but diagnostic tests, staging and molecular profiling take time, and this can delay therapy initiation. OS approximates first-order kinetics. Methods: We used OS of chemo-naive NSCLC patients on a placebo/best supportive care trial arm to estimate % of patients dying while awaiting therapy. We digitized survival curves from eight studies, calculated OS half-life, then estimated the proportion surviving after different times of interest (t n) using the formula: X = exp − t n * 0.693∕t 1∕2 , where EXP signifies exponential, * indicates multiplication, 0.693 is the natural log of 2, and t 1/2 is the survival half-life in weeks. Results: Across trials, the OS half-life for placebo/best supportive care in previously untreated NSCLC was 19.5 weeks. Hence, based on calculations using the formula above, if therapy were delayed by 1, 2, 3, or 4 weeks then 4%, 7%, 10%, and 13% of all patients, respectively, would die while awaiting treatment. Others would become too sick to consider therapy even if still alive. Conclusions: This quantifies why rapid baseline testing and prompt therapy initiation are important in advanced NSCLC. It also illustrates why screening procedures for clinical trial inclusion must be faster. Otherwise, it is potentially hazardous for a patient to be considered for a trial due to risk of death or deterioration while awaiting eligibility assessment. It is also important to not delay initiation of systemic therapy for procedures that add relatively little value, such as radiotherapy for small, asymptomatic brain metastases.
INTRODUCTION AND OBJECTIVE:Urodynamic (UDN) training is very heterogeneous throughout the world. ... more INTRODUCTION AND OBJECTIVE:Urodynamic (UDN) training is very heterogeneous throughout the world. According to the International Continence Society (ICS), trainees should attend a theoretical course...
Background: Systemic therapy prolongs overall survival (OS) in advanced NSCLC. The best outcome r... more Background: Systemic therapy prolongs overall survival (OS) in advanced NSCLC. The best outcome requires the best therapy choice. To choose the best therapy requires baseline diagnostic tests, staging and molecular profiling, but patients are at risk of deteriorating and dying while awaiting testing prior to therapy initiation. OS follows first order kinetics. We used population kinetics assessments to estimate % of patients dying while awaiting therapy initiation. Method: For 1st line studies in advanced NSCLC that included a placebo or best supportive care (BSC) arm we digitized published OS curves, used GraphPad Prism 7 for exponential decay nonlinear regression analysis, calculated OS half-life (t1/2) and assessed data fit to 1 and 2 phase decay models. The proportion of patients “x” surviving after a time of interest tn was calculated by the Excel formula x =EXP(-tn*0.693/t1/2) where * indicates multiplication and 0.693 is the natural logarithm of 2. Results: We identified 7 tr...
Accurate diagnosis of interstitial lung disease (ILD) is crucial for management and prognosis but... more Accurate diagnosis of interstitial lung disease (ILD) is crucial for management and prognosis but can be challenging even for experienced clinicians. Expert multidisciplinary discussion (MDD) is considered the reference standard for ILD diagnosis; however, there remain concerns regarding lack of validation studies and relative limited information on the impact of MDD in real-life clinical practice. The goal of this study was to assess the effect of MDD in providing a specific ILD diagnosis, changing the diagnosis provided upon referral, and to determine how often and in which way MDD altered management. Material and Methods. Retrospective observational study in an ILD referral tertiary academic center. MDD diagnoses were categorized as specific, provisional, and unclassifiable ILD. Pre-MDD and MDD diagnoses were compared for change in diagnosis and concordance rates for specific diagnoses. Relevant change in management including initiation or change in pharmacological treatment, ref...
The field of business shows an increasing interest in exploring conversational agents to improve ... more The field of business shows an increasing interest in exploring conversational agents to improve service quality and market competitiveness. Furthermore, the advances in machine learning capabilities leverage the natural language processing towards natural and straightforward dialogue experiences for industries. However, in the best of our knowledge, no literature review outlines conversational agents in the business industry, primarily taking into account computational learning capabilities. This article presents a systematic literature review that encompasses these areas looking through the use of machine learning to improve the field of business. The review followed a guideline for systematic reviews to present the literature of the last decade, emphasizing business perspectives such as domains, goals, and challenges, and computational methods for self-learning, personalization, and response generation of conversational agents. As a result, the article provides the answers of three general, three focused, and two statistical questions to address the role of artificial intelligence in conversational agents applied to business domains. In this regard, the results show that no study combines self-learning, personalization, and generative-based responses for the same business solution. Additionally, the article describes the organization of the state-of-the-art, highlighting the correlation of business perspectives and machine learning methods. The contributions of this review focus on opportunities and future research directions towards human-like conversational agents for business.
Historically, a non-small-cell lung carcinoma diagnosis, without pathologic subclassification, pr... more Historically, a non-small-cell lung carcinoma diagnosis, without pathologic subclassification, provided sufficient information to guide therapy. Evidence now demonstrates that pathologic subtype classification is central in selecting optimal treatment. This review aimed to identify factors associated with a specific pathologic diagnosis. All nonoperative cases of non-small-cell lung carcinoma (NSCLC) referred to the medical oncology divisions of the Ottawa Hospital Cancer Centre (2008) and Princess Margaret Hospital, Toronto (2007-2010) were identified. The charts were reviewed for demographics, diagnostic methods, and final diagnosis. Logistic regression was performed to identify variables associated with a specific diagnosis. Of 739 patient records analyzed, 377 (51%) were men, 299 (40%) were aged over 70 years, and 510 (69%) had an Eastern Cooperative Oncology Group performance status of 0-2. Three hundred and eighty five (52%) of patients were diagnosed in a tertiary academic center. The lung primary was sampled in 503 (68%) of patients. Computed tomography-guided biopsy (n = 370, 50%) and bronchoscopy (n = 179, 24%) were the most common techniques. Four hundred and seventy seven (65%) of biopsies were cytologic specimens alone, and immunohistochemistry was performed in 337 (46%) of cases. The most common diagnoses were adenocarcinoma (n = 338, 46%), NSCLC not otherwise specified (n = 254, 34%), and squamous cell carcinoma (n = 115, 16%). Overall, 456 (62%) of patients received a specific pathologic diagnosis. Factors significantly associated with attaining a specific pathologic diagnosis were diagnosis outside an academic center (adjusted odds ratios [OR] 2.1 [95% CI, 1.41-3.14]; P = .0003), histologic laboratory samples (adjusted OR 1.58 [95% CI, 1.003-2.49]; P = .049), and immunohistochemical testing (adjusted OR 1.82 [95% CI, 1.25-2.70], P = .0021). A significant minority of patients with NSCLC do not receive a specific pathologic diagnosis. In an era of individualized medicine, this may potentially impact optimal clinical management.
Thymic epithelial neoplasms are rare, with little prospective research to guide management. Surge... more Thymic epithelial neoplasms are rare, with little prospective research to guide management. Surgery is the primary treatment modality for localized disease, but chemotherapy may be indicated in advanced disease. We performed a retrospective chart review of all cases over a 12-year period at our institution. With ethics approval, data collected included patient characteristics, histologic type (World Health Organization [WHO] criteria), staging (Masaoka system), paraneoplastic syndromes, treatment details, and outcomes. The primary analysis is descriptive. Thymic epithelial neoplasms were identified in 76 patients: 46% women with a median age 60 years (range, 25-89 years), 93% with Eastern Cooperative Oncology Group performance status of 0 to 1. Myasthenia gravis was present in 21%. The distribution by WHO histologic classification was A, 15%; AB, 30%; B1, 16%; B2, 13%; B3, 17%; C, 7%; neuroendocrine thymic tumor (NETT), 1%; and unclassified, 1%. Of 64 patients who underwent operation, 53 underwent R0 resection. Eleven surgical patients received chemotherapy (induction, n = 6; adjuvant, n = 4; both, n = 1) and 27 received radiotherapy (induction, n = 2; adjuvant, n = 25). Twelve patients were not considered for surgery, and 3 patients received no therapy at all. Chemotherapy was received at some point in the disease course in 14 patients. Common first-line regimens were platinum/etoposide (n = 8), carboplatin/paclitaxel (n = 3), and CAP (cyclophosphamide, doxorubicin [Adriamycin], cisplatin [n = 2]). The first-line response rate (Response Evaluation in Solid Tumors [RECIST]) was 55%. After a median follow-up of 45 months, 59 (78%) patients remain alive. Thymoma was associated with superior overall survival compared with thymic carcinoma (P < .0001). Although surgical resection is the mainstay of treatment for thymic epithelial neoplasms, it remains clear that these are chemosensitive diseases.
Despite recent advances in treatment modalities, the survival rate of patients with lung cancer h... more Despite recent advances in treatment modalities, the survival rate of patients with lung cancer has not significantly improved. Therefore, new avenues are being explored in the era of evolving personalized patient management by early detection. Cytology is now the mainstay to address the diagnostic needs of pulmonary malignancies. Cytology specimens deliver diagnostic results equivalent to tissue biopsies. Fine-needle aspirations are equally useful to perform diagnostic, predictive, and prognostic immunohistochemical markers and molecular analysis. This article reviews the main new technologies that produced this revolution. The new role of the cytopathologist in this time of interdisciplinary care is also discussed.
The present study investigated the ability of 5-oxo-EicosaTetraEnoic acid (5-oxo-ETE) for modulat... more The present study investigated the ability of 5-oxo-EicosaTetraEnoic acid (5-oxo-ETE) for modulating airway smooth muscle (ASM) tone in human bronchi. 5-Oxo-ETE induced a concentration-dependent relaxing effect on human bronchi pre-contracted with methacholine (MCh) and arachidonic acid (AA). This relaxing response was highly sensitive to Iberiotoxin (IbTx), a large conducting Ca(2+)-activated K(+) channel (BK(Ca)) inhibitor. Furthermore, microelectrode measurements revealed that 5-oxo-ETE (0.1-10 microM) hyperpolarizes the membrane potential of human bronchial ASM cells. These hyperpolarizing effects were also inhibited in the presence of 10nM IbTx. Lastly, 5-oxo-ETE was shown to directly activate reconstituted BK(Ca) channels derived from human airway smooth muscles. In summary, the 5-oxo-ETE eicosanoid activates a specific K(+) conductance, involved in membrane hyperpolarization, which in turn reduces Ca(2+) entry and facilitates relaxation of smooth muscle cells.
Pediatric Critical Care Medicine is proud to present translations of selected abstracts into Chin... more Pediatric Critical Care Medicine is proud to present translations of selected abstracts into Chinese, French, Italian, Japanese, Portuguese, and Spanish. We sincerely thank the following for their important work on these translations:
Serous and mucinous cystic neoplasms (SCNs/MCNs) are the most common true cystic neoplasms of the... more Serous and mucinous cystic neoplasms (SCNs/MCNs) are the most common true cystic neoplasms of the pancreas and occur more frequently in women. The aim of this study was to characterize the stroma of SCNs to compare its phenotype with that of MCNs. A total of 12 SCNs and 5 MCNs were analyzed immunohistochemically using the following antisera: progesterone receptor (PR), estrogen receptor (ER), inhibin, CD10, and vimentin. Normal pancreatic tissue (17 cases) and ductal adenocarcinomas of the pancreas (3 cases) were used as controls. Eight of 12 patients with SCNs and all 5 patients with MCNs were women. For SCNs, the stroma was sclerotic and paucicellular and showed focal moderate to strong reactivity for PR. Estrogen receptor, CD10, and inhibin were virtually negative. For MCNs, the stroma was more cellular and ovarianlike and showed a larger number of PR-positive cells with focal expression of ER and inhibin. Vimentin was expressed in all stromal cells in both groups. Both SCNs and MCNs contain PR-positive stromal cells. In view of the aforementioned clinical and immunophenotypical similarities, we suggest that in SCNs and MCNs, the stromal framework is similar in origin and/or differentiation.
Myopericytoma is a recently described hemangiopericytoma-like neoplasm with myoid differentiation... more Myopericytoma is a recently described hemangiopericytoma-like neoplasm with myoid differentiation. These tumors are typically located in the subcutaneous and soft tissues of the extremities. The authors report a rare pleural-based pulmonary myopericytoma in a 58-year-old woman. The lesion was grossly homogeneous and well circumscribed. Microscopically, it was composed of densely packed spindle cells organized as whorls and short interlacing fascicles with a concentric perivascular distribution. Immunohistochemical reactions were positive for vimentin, smooth muscle actin (SMA), muscle-specific actin, and Bcl-2 and negative for desmin, h-caldesmon, cytokeratin, and CD34. Atypically, increased mitotic activity was noted, but no other malignant features were identified. The differential diagnoses are discussed with specific emphasis on solitary fibrous tumor of the pleura, which is the most common benign pleural-based spindle cell neoplasm and may be a diagnostic pitfall with potential...
Primary adenocarcinoma of lung has replaced squamous cell carcinoma as the commonest histological... more Primary adenocarcinoma of lung has replaced squamous cell carcinoma as the commonest histological subtype of lung cancer and the incidence of primary lung adenocarcinoma appears to be rising. Although the main factors behind this 'epidemic-like' situation are largely undiscovered, filter cigarettes appear to significantly contribute to this shift in the histopathological spectrum. The new multidisciplinary classification of adenocarcinoma of lung was introduced to address advances in clinical, pathological, radiological and molecular sciences. The purpose of this essay is to discuss various classes of lung adenocarcinoma in the new classification with their classical imaging features on computed tomography and summarise the recent advances in the field of radiology and review radiology recommendations.
The combined positron emission tomography/computed tomography scan is ideal in the initial stagin... more The combined positron emission tomography/computed tomography scan is ideal in the initial staging of lymphomas and for evaluating the response to treatment. In posttreatment studies, the presence of a residual, metabolically active mass at the site of initially documented lymphoma is not expected to be anything other than residual active disease. We describe a case of intestinal non-Hodgkin's lymphoma that responded to chemotherapy but with a residual metabolically active mass at the site of initial disease. This mass was revealed to be a clinically silent closed intestinal perforation with abscess formation. Similar conditions should be kept in mind during the interpretation of posttreatment combined positron emission tomography/computed tomography scan and before exposing the patient to additional chemotherapy.
Background Neuroendocrine (NE) differentiation is widely studied in non-small cell lung carcinoma... more Background Neuroendocrine (NE) differentiation is widely studied in non-small cell lung carcinomas (NSCLC) however, its significance remains unclear in basaloid squamous cell carcinomas (B-SqCC). This study aims to assess the extent of NE differentiation in B-SqCC and characterize the underlying molecular process. Methods This study evaluated resected B-SqCC, small cell lung cancer (SCLC) and poorly differentiated SqCC (PD-SqCC) from 2005 to 2020 at the Ottawa Hospital. Samples were subject to pathological review, immunohistochemistry (IHC) and survival analysis. Gene expression analysis was performed on B-SqCC samples exhibiting NE+ and NE- regions (paired samples) to identify differentially expressed genes (DEGs). These DEGs were subsequently validated in unpaired B-SqCC and TCGA samples. Results B-SqCC cases were more likely to exhibit nuclear molding, resetting and peripheral palisading than PD-SqCC. B-SqCC were also more likely to demonstrate NE differentiation compared to PD-S...
Neste relato de experimento determinamos os calores específicos do alumínio e do aço inox, mostra... more Neste relato de experimento determinamos os calores específicos do alumínio e do aço inox, mostrando também com pode ser viabilizado para sua aplicação nas escolas do ensino médio, traçando uma estratégia para sua aplicação possibilitando ao aluno construir seu próprio conhecimento, com o auxílio da tecnologia. Usamos o método de ensino através do qual a lógica da organização de uma sala de aula é de fato invertida por completo. Foram utilizados três ambientes educacionais em forma de Rotação na qual será, o laboratório de informática da escola, o laboratório de ciências e um ambiente virtual(Google classroom), lançando mão de software como fritizing, para desenhar os circuitos e Excel para tratamento dos dados coletados. Os resultados concorda com as literaturas publicadas.
Primary biphasic tumors of the lung are rare. Lung lesions with a biphasic pattern are far more c... more Primary biphasic tumors of the lung are rare. Lung lesions with a biphasic pattern are far more commonly primary or metastatic soft tissue tumors with entrapped native respiratory epithelium, giving the false impression of a biphasic tumor. We report a case of bilateral benign metastasizing leiomyomas in a 69-year-old female where the tumor cells diffusely entrapped native respiratory glands in a phyllodes-like pattern. The radiographic characteristics and histologic appearance were not immediately diagnostic and covered a wide differential. Reaching the final diagnosis required the use of immunohistochemical studies as well as correlation with the patient's history and radiographic findings. To the best of our knowledge, this is the first report of pulmonary benign metastasizing leiomyoma presenting in a phyllodes-like pattern. This case illustrates the importance of considering entrapment of native lung epithelium in the differential diagnosis of biphasic-appearing lung tumors.
Background: Systemic therapy prolongs overall survival (OS) in advanced nonsmall cell lung cancer... more Background: Systemic therapy prolongs overall survival (OS) in advanced nonsmall cell lung cancer (NSCLC), but diagnostic tests, staging and molecular profiling take time, and this can delay therapy initiation. OS approximates first-order kinetics. Methods: We used OS of chemo-naive NSCLC patients on a placebo/best supportive care trial arm to estimate % of patients dying while awaiting therapy. We digitized survival curves from eight studies, calculated OS half-life, then estimated the proportion surviving after different times of interest (t n) using the formula: X = exp − t n * 0.693∕t 1∕2 , where EXP signifies exponential, * indicates multiplication, 0.693 is the natural log of 2, and t 1/2 is the survival half-life in weeks. Results: Across trials, the OS half-life for placebo/best supportive care in previously untreated NSCLC was 19.5 weeks. Hence, based on calculations using the formula above, if therapy were delayed by 1, 2, 3, or 4 weeks then 4%, 7%, 10%, and 13% of all patients, respectively, would die while awaiting treatment. Others would become too sick to consider therapy even if still alive. Conclusions: This quantifies why rapid baseline testing and prompt therapy initiation are important in advanced NSCLC. It also illustrates why screening procedures for clinical trial inclusion must be faster. Otherwise, it is potentially hazardous for a patient to be considered for a trial due to risk of death or deterioration while awaiting eligibility assessment. It is also important to not delay initiation of systemic therapy for procedures that add relatively little value, such as radiotherapy for small, asymptomatic brain metastases.
INTRODUCTION AND OBJECTIVE:Urodynamic (UDN) training is very heterogeneous throughout the world. ... more INTRODUCTION AND OBJECTIVE:Urodynamic (UDN) training is very heterogeneous throughout the world. According to the International Continence Society (ICS), trainees should attend a theoretical course...
Background: Systemic therapy prolongs overall survival (OS) in advanced NSCLC. The best outcome r... more Background: Systemic therapy prolongs overall survival (OS) in advanced NSCLC. The best outcome requires the best therapy choice. To choose the best therapy requires baseline diagnostic tests, staging and molecular profiling, but patients are at risk of deteriorating and dying while awaiting testing prior to therapy initiation. OS follows first order kinetics. We used population kinetics assessments to estimate % of patients dying while awaiting therapy initiation. Method: For 1st line studies in advanced NSCLC that included a placebo or best supportive care (BSC) arm we digitized published OS curves, used GraphPad Prism 7 for exponential decay nonlinear regression analysis, calculated OS half-life (t1/2) and assessed data fit to 1 and 2 phase decay models. The proportion of patients “x” surviving after a time of interest tn was calculated by the Excel formula x =EXP(-tn*0.693/t1/2) where * indicates multiplication and 0.693 is the natural logarithm of 2. Results: We identified 7 tr...
Accurate diagnosis of interstitial lung disease (ILD) is crucial for management and prognosis but... more Accurate diagnosis of interstitial lung disease (ILD) is crucial for management and prognosis but can be challenging even for experienced clinicians. Expert multidisciplinary discussion (MDD) is considered the reference standard for ILD diagnosis; however, there remain concerns regarding lack of validation studies and relative limited information on the impact of MDD in real-life clinical practice. The goal of this study was to assess the effect of MDD in providing a specific ILD diagnosis, changing the diagnosis provided upon referral, and to determine how often and in which way MDD altered management. Material and Methods. Retrospective observational study in an ILD referral tertiary academic center. MDD diagnoses were categorized as specific, provisional, and unclassifiable ILD. Pre-MDD and MDD diagnoses were compared for change in diagnosis and concordance rates for specific diagnoses. Relevant change in management including initiation or change in pharmacological treatment, ref...
The field of business shows an increasing interest in exploring conversational agents to improve ... more The field of business shows an increasing interest in exploring conversational agents to improve service quality and market competitiveness. Furthermore, the advances in machine learning capabilities leverage the natural language processing towards natural and straightforward dialogue experiences for industries. However, in the best of our knowledge, no literature review outlines conversational agents in the business industry, primarily taking into account computational learning capabilities. This article presents a systematic literature review that encompasses these areas looking through the use of machine learning to improve the field of business. The review followed a guideline for systematic reviews to present the literature of the last decade, emphasizing business perspectives such as domains, goals, and challenges, and computational methods for self-learning, personalization, and response generation of conversational agents. As a result, the article provides the answers of three general, three focused, and two statistical questions to address the role of artificial intelligence in conversational agents applied to business domains. In this regard, the results show that no study combines self-learning, personalization, and generative-based responses for the same business solution. Additionally, the article describes the organization of the state-of-the-art, highlighting the correlation of business perspectives and machine learning methods. The contributions of this review focus on opportunities and future research directions towards human-like conversational agents for business.
Historically, a non-small-cell lung carcinoma diagnosis, without pathologic subclassification, pr... more Historically, a non-small-cell lung carcinoma diagnosis, without pathologic subclassification, provided sufficient information to guide therapy. Evidence now demonstrates that pathologic subtype classification is central in selecting optimal treatment. This review aimed to identify factors associated with a specific pathologic diagnosis. All nonoperative cases of non-small-cell lung carcinoma (NSCLC) referred to the medical oncology divisions of the Ottawa Hospital Cancer Centre (2008) and Princess Margaret Hospital, Toronto (2007-2010) were identified. The charts were reviewed for demographics, diagnostic methods, and final diagnosis. Logistic regression was performed to identify variables associated with a specific diagnosis. Of 739 patient records analyzed, 377 (51%) were men, 299 (40%) were aged over 70 years, and 510 (69%) had an Eastern Cooperative Oncology Group performance status of 0-2. Three hundred and eighty five (52%) of patients were diagnosed in a tertiary academic center. The lung primary was sampled in 503 (68%) of patients. Computed tomography-guided biopsy (n = 370, 50%) and bronchoscopy (n = 179, 24%) were the most common techniques. Four hundred and seventy seven (65%) of biopsies were cytologic specimens alone, and immunohistochemistry was performed in 337 (46%) of cases. The most common diagnoses were adenocarcinoma (n = 338, 46%), NSCLC not otherwise specified (n = 254, 34%), and squamous cell carcinoma (n = 115, 16%). Overall, 456 (62%) of patients received a specific pathologic diagnosis. Factors significantly associated with attaining a specific pathologic diagnosis were diagnosis outside an academic center (adjusted odds ratios [OR] 2.1 [95% CI, 1.41-3.14]; P = .0003), histologic laboratory samples (adjusted OR 1.58 [95% CI, 1.003-2.49]; P = .049), and immunohistochemical testing (adjusted OR 1.82 [95% CI, 1.25-2.70], P = .0021). A significant minority of patients with NSCLC do not receive a specific pathologic diagnosis. In an era of individualized medicine, this may potentially impact optimal clinical management.
Thymic epithelial neoplasms are rare, with little prospective research to guide management. Surge... more Thymic epithelial neoplasms are rare, with little prospective research to guide management. Surgery is the primary treatment modality for localized disease, but chemotherapy may be indicated in advanced disease. We performed a retrospective chart review of all cases over a 12-year period at our institution. With ethics approval, data collected included patient characteristics, histologic type (World Health Organization [WHO] criteria), staging (Masaoka system), paraneoplastic syndromes, treatment details, and outcomes. The primary analysis is descriptive. Thymic epithelial neoplasms were identified in 76 patients: 46% women with a median age 60 years (range, 25-89 years), 93% with Eastern Cooperative Oncology Group performance status of 0 to 1. Myasthenia gravis was present in 21%. The distribution by WHO histologic classification was A, 15%; AB, 30%; B1, 16%; B2, 13%; B3, 17%; C, 7%; neuroendocrine thymic tumor (NETT), 1%; and unclassified, 1%. Of 64 patients who underwent operation, 53 underwent R0 resection. Eleven surgical patients received chemotherapy (induction, n = 6; adjuvant, n = 4; both, n = 1) and 27 received radiotherapy (induction, n = 2; adjuvant, n = 25). Twelve patients were not considered for surgery, and 3 patients received no therapy at all. Chemotherapy was received at some point in the disease course in 14 patients. Common first-line regimens were platinum/etoposide (n = 8), carboplatin/paclitaxel (n = 3), and CAP (cyclophosphamide, doxorubicin [Adriamycin], cisplatin [n = 2]). The first-line response rate (Response Evaluation in Solid Tumors [RECIST]) was 55%. After a median follow-up of 45 months, 59 (78%) patients remain alive. Thymoma was associated with superior overall survival compared with thymic carcinoma (P < .0001). Although surgical resection is the mainstay of treatment for thymic epithelial neoplasms, it remains clear that these are chemosensitive diseases.
Despite recent advances in treatment modalities, the survival rate of patients with lung cancer h... more Despite recent advances in treatment modalities, the survival rate of patients with lung cancer has not significantly improved. Therefore, new avenues are being explored in the era of evolving personalized patient management by early detection. Cytology is now the mainstay to address the diagnostic needs of pulmonary malignancies. Cytology specimens deliver diagnostic results equivalent to tissue biopsies. Fine-needle aspirations are equally useful to perform diagnostic, predictive, and prognostic immunohistochemical markers and molecular analysis. This article reviews the main new technologies that produced this revolution. The new role of the cytopathologist in this time of interdisciplinary care is also discussed.
The present study investigated the ability of 5-oxo-EicosaTetraEnoic acid (5-oxo-ETE) for modulat... more The present study investigated the ability of 5-oxo-EicosaTetraEnoic acid (5-oxo-ETE) for modulating airway smooth muscle (ASM) tone in human bronchi. 5-Oxo-ETE induced a concentration-dependent relaxing effect on human bronchi pre-contracted with methacholine (MCh) and arachidonic acid (AA). This relaxing response was highly sensitive to Iberiotoxin (IbTx), a large conducting Ca(2+)-activated K(+) channel (BK(Ca)) inhibitor. Furthermore, microelectrode measurements revealed that 5-oxo-ETE (0.1-10 microM) hyperpolarizes the membrane potential of human bronchial ASM cells. These hyperpolarizing effects were also inhibited in the presence of 10nM IbTx. Lastly, 5-oxo-ETE was shown to directly activate reconstituted BK(Ca) channels derived from human airway smooth muscles. In summary, the 5-oxo-ETE eicosanoid activates a specific K(+) conductance, involved in membrane hyperpolarization, which in turn reduces Ca(2+) entry and facilitates relaxation of smooth muscle cells.
Pediatric Critical Care Medicine is proud to present translations of selected abstracts into Chin... more Pediatric Critical Care Medicine is proud to present translations of selected abstracts into Chinese, French, Italian, Japanese, Portuguese, and Spanish. We sincerely thank the following for their important work on these translations:
Serous and mucinous cystic neoplasms (SCNs/MCNs) are the most common true cystic neoplasms of the... more Serous and mucinous cystic neoplasms (SCNs/MCNs) are the most common true cystic neoplasms of the pancreas and occur more frequently in women. The aim of this study was to characterize the stroma of SCNs to compare its phenotype with that of MCNs. A total of 12 SCNs and 5 MCNs were analyzed immunohistochemically using the following antisera: progesterone receptor (PR), estrogen receptor (ER), inhibin, CD10, and vimentin. Normal pancreatic tissue (17 cases) and ductal adenocarcinomas of the pancreas (3 cases) were used as controls. Eight of 12 patients with SCNs and all 5 patients with MCNs were women. For SCNs, the stroma was sclerotic and paucicellular and showed focal moderate to strong reactivity for PR. Estrogen receptor, CD10, and inhibin were virtually negative. For MCNs, the stroma was more cellular and ovarianlike and showed a larger number of PR-positive cells with focal expression of ER and inhibin. Vimentin was expressed in all stromal cells in both groups. Both SCNs and MCNs contain PR-positive stromal cells. In view of the aforementioned clinical and immunophenotypical similarities, we suggest that in SCNs and MCNs, the stromal framework is similar in origin and/or differentiation.
Myopericytoma is a recently described hemangiopericytoma-like neoplasm with myoid differentiation... more Myopericytoma is a recently described hemangiopericytoma-like neoplasm with myoid differentiation. These tumors are typically located in the subcutaneous and soft tissues of the extremities. The authors report a rare pleural-based pulmonary myopericytoma in a 58-year-old woman. The lesion was grossly homogeneous and well circumscribed. Microscopically, it was composed of densely packed spindle cells organized as whorls and short interlacing fascicles with a concentric perivascular distribution. Immunohistochemical reactions were positive for vimentin, smooth muscle actin (SMA), muscle-specific actin, and Bcl-2 and negative for desmin, h-caldesmon, cytokeratin, and CD34. Atypically, increased mitotic activity was noted, but no other malignant features were identified. The differential diagnoses are discussed with specific emphasis on solitary fibrous tumor of the pleura, which is the most common benign pleural-based spindle cell neoplasm and may be a diagnostic pitfall with potential...
Primary adenocarcinoma of lung has replaced squamous cell carcinoma as the commonest histological... more Primary adenocarcinoma of lung has replaced squamous cell carcinoma as the commonest histological subtype of lung cancer and the incidence of primary lung adenocarcinoma appears to be rising. Although the main factors behind this 'epidemic-like' situation are largely undiscovered, filter cigarettes appear to significantly contribute to this shift in the histopathological spectrum. The new multidisciplinary classification of adenocarcinoma of lung was introduced to address advances in clinical, pathological, radiological and molecular sciences. The purpose of this essay is to discuss various classes of lung adenocarcinoma in the new classification with their classical imaging features on computed tomography and summarise the recent advances in the field of radiology and review radiology recommendations.
The combined positron emission tomography/computed tomography scan is ideal in the initial stagin... more The combined positron emission tomography/computed tomography scan is ideal in the initial staging of lymphomas and for evaluating the response to treatment. In posttreatment studies, the presence of a residual, metabolically active mass at the site of initially documented lymphoma is not expected to be anything other than residual active disease. We describe a case of intestinal non-Hodgkin's lymphoma that responded to chemotherapy but with a residual metabolically active mass at the site of initial disease. This mass was revealed to be a clinically silent closed intestinal perforation with abscess formation. Similar conditions should be kept in mind during the interpretation of posttreatment combined positron emission tomography/computed tomography scan and before exposing the patient to additional chemotherapy.
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